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Sorensen JA, Milkovich PJ, Khorsandi F, Gorucu S, Weichelt BP, Scott E, Johnson A. Tractors, Trees, and Rollover Protective Structures: A Cause for Concern. J Agromedicine 2024; 29:162-167. [PMID: 38240313 DOI: 10.1080/1059924x.2024.2305322] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Injury and fatality events that are caused by tree work and tractor-related activities contribute to the already elevated rates of work-related injuries in the agriculture and logging sectors. This brief report highlights the circumstances surrounding these events, as well as a number of surveillance sources that identify the extent to which they contribute to the injury burden in these hazardous industries. These data sources include fatality investigations, agricultural injury news reports, consumer product injury data captured from emergency rooms and near-miss reporting data captured from individuals participating in the National Rollover Protective Structure Rebate Program (NRRP). Several recommendations for further research and interventional efforts are outlined, with particular consideration of the manner in which rollbars have been involved in falling object incidents.
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Affiliation(s)
- Julie A Sorensen
- Northeast Center for Occupational Health and Safety, Bassett Research Institute, Cooperstown, NY, USA
| | - Pamela J Milkovich
- Northeast Center for Occupational Health and Safety, Bassett Research Institute, Cooperstown, NY, USA
| | - Farzaneh Khorsandi
- Department of Biological and Agricultural Engineering, University of California, Davis, CA, USA
| | - Serap Gorucu
- Agricultural and Biological Engineering Department, University of Florida, Gainesville, FL, USA
| | - Bryan P Weichelt
- National Farm Medicine Center • National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS), Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Erika Scott
- Northeast Center for Occupational Health and Safety, Bassett Research Institute, Cooperstown, NY, USA
| | - Andrew Johnson
- Northeast Center for Occupational Health and Safety, Bassett Research Institute, Cooperstown, NY, USA
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Bergh EP, Mann LK, Won JH, Nobles A, Johnson A, Papanna R. Anchoring device to prevent membrane detachment and preterm premature rupture of membranes after fetal intervention. Ultrasound Obstet Gynecol 2024. [PMID: 38514967 DOI: 10.1002/uog.27646] [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] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Anchoring the fetal membrane to the uterine wall via a novel suture delivery system could reduce the risk of preterm premature rupture of membranes (PPROM) after fetoscopic surgery. This study assesses the feasibility of using a novel device designed for minimally invasive suturing to anchor fetal membranes to the uterine wall and to close surgical defects after fetoscopy. METHODS We tested the suturing device both ex vivo and in vivo. In the ex vivo studies, 12-French trocar defects were created with a fetoscope in five specimens of human uterine tissue with fetal membranes attached. Specimens were examined for integrity of the anchoring stitch. For in vivo studies, trocar defects were created in the two uterine horns of three pregnant ewes, each carrying twins at ~79-90 days gestation. One trocar defect in each ewe was repaired using the suture device, and the other was left unrepaired as a control. The repair sites were examined for membrane anchoring integrity when the defect was created and at delivery. RESULTS Fetal membranes were successfully anchored to the uterine myometrium using this device in all five trials performed ex vivo. The in vivo trials also revealed successful membrane anchoring compared with controls both at the time of device deployment and five-to-eight weeks after the procedure. CONCLUSIONS We successfully anchored amniotic membranes to the underlying myometrium via suturing device both ex vivo and in vivo. Further studies are needed to evaluate the efficacy of the device and to determine whether it can successfully anchor fetal membranes percutaneously in human subjects. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- E P Bergh
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - L K Mann
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J H Won
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - A Nobles
- HeartStitch, Inc., Fountain Valley, CA, USA
| | - A Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, McGovern Medical School at UTHealth Houston, The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Espinoza J, Agarwal N, Johnson A, Hernandez-Andrade E, Backley S, Papanna R, Bergh EP. Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence. Ultrasound Obstet Gynecol 2024. [PMID: 38437460 DOI: 10.1002/uog.27629] [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] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS). METHODS This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant. RESULTS Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016). CONCLUSIONS Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, Johnson A, McNaughton N, Rodak T, McCullough K, Soklaridis S. Power to the people? A co-produced critical review of service user involvement in mental health professions education. Adv Health Sci Educ Theory Pract 2024; 29:273-300. [PMID: 37247126 DOI: 10.1007/s10459-023-10240-z] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Meaningful service user involvement in health professions education requires integrating knowledge held by "lay" people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge "counts" and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.
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Affiliation(s)
- Csilla Kalocsai
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sacha Agrawal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lee de Bie
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- Independent service user educator researcher, Toronto, ON, Canada
| | - Suze Berkhout
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education at University Health Network and University of Toronto, Toronto, ON, Canada
- Michener Institute of Education at University Health Network, Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kim McCullough
- Department of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Krispin E, Javinani A, Odibo A, Carreras E, Emery SP, Sepulveda Gonzalez G, Habli M, Hecher K, Ishii K, Miller J, Papanna R, Johnson A, Khalil A, Kilby MD, Lewi L, Bennasar Sans M, Otaño L, Zaretsky MV, Sananes N, Turan OM, Slaghekke F, Stirnemann J, Van Mieghem T, Welsh AW, Yoav Y, Chmait R, Shamshirsaz AA. Consensus protocol for management of early and late twin-twin transfusion syndrome: Delphi study. Ultrasound Obstet Gynecol 2024; 63:371-377. [PMID: 37553800 DOI: 10.1002/uog.27446] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Fetoscopic laser photocoagulation (FLP) is a well-established treatment for twin-twin transfusion syndrome (TTTS) between 16 and 26 weeks' gestation. High-quality evidence and guidelines regarding the optimal clinical management of very early (prior to 16 weeks), early (between 16 and 18 weeks) and late (after 26 weeks) TTTS are lacking. The aim of this study was to construct a structured expert-based clinical consensus for the management of early and late TTTS. METHODS A Delphi procedure was conducted among an international panel of experts. Participants were chosen based on their clinical expertise, affiliation and relevant publications. A four-round Delphi survey was conducted using an online platform and responses were collected anonymously. In the first round, a core group of experts was asked to answer open-ended questions regarding the indications, timing and modes of treatment for early and late TTTS. In the second and third rounds, participants were asked to grade each statement on a Likert scale (1, completely disagree; 5, completely agree) and to add any suggestions or modifications. At the end of each round, the median score for each statement was calculated. Statements with a median grade of 5 without suggestions for change were accepted as the consensus. Statements with a median grade of 3 or less were excluded from the Delphi process. Statements with a median grade of 4 were modified according to suggestions and reconsidered in the next round. In the last round, participants were asked to agree or disagree with the statements, and those with more than 70% agreement without suggestions for change were considered the consensus. RESULTS A total of 122 experts met the inclusion criteria and were invited to participate, of whom 53 (43.4%) agreed to take part in the study. Of those, 75.5% completed all four rounds. A consensus on the optimal management of early and late TTTS was obtained. FLP can be offered as early as 15 weeks' gestation for selected cases, and can be considered up to 28 weeks. Between 16 and 18 weeks, management should be tailored according to Doppler findings. CONCLUSIONS A consensus-based treatment protocol for early and late TTTS was agreed upon by a panel of experts. This protocol should be modified at the discretion of the operator, according to their experience and the specific demands of each case. This should advance the quality of future studies, guide clinical practice and improve patient care. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Krispin
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Javinani
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - E Carreras
- Maternal-Fetal Medicine Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S P Emery
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - G Sepulveda Gonzalez
- Instituto de Salud Fetal (ISF), Hospital Regional Materno Infantil, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - M Habli
- Department of Pediatric Surgery, Fetal Care Center of Cincinnati, Good Samaritan Hospital, Cincinnati, OH, USA
| | - K Hecher
- Department of Obstetrics and Prenatal Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - K Ishii
- Maternal-Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - J Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | - R Papanna
- Fetal Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - A Johnson
- Fetal Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
| | - M D Kilby
- Fetal Medicine Center, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Illumina UK, Great Abbington, Cambridge, UK
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M Bennasar Sans
- BCNatal, Maternal-Fetal Medicine Center, Hospital Clínic i Hospital Sant Joan de Déu, Barcelona, Spain
| | - L Otaño
- Maternal-Fetal Medicine Unit, Obstetric Division, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - M V Zaretsky
- Colorado Fetal Care Center, Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
| | - N Sananes
- Obstetrics and Gynecology Department, Strasbourg University Hospital, Strasbourg, France
- Inserm 1121 'Biomaterials and Bioengineering', Strasbourg University, Strasbourg, France
| | - O M Turan
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Slaghekke
- Department of Obstetrics, Fetal Medicine Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - T Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - A W Welsh
- Maternal-Fetal Medicine, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Y Yoav
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Chmait
- Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A A Shamshirsaz
- Maternal Fetal Care Center (MFCC), Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Poyntz-Wright IP, Harrison XA, Johnson A, Zappala S, Tyler CR. Assessment of the impacts of GABA and AChE targeting pesticides on freshwater invertebrate family richness in English Rivers. Sci Total Environ 2024; 912:169079. [PMID: 38049000 DOI: 10.1016/j.scitotenv.2023.169079] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
Globally, riverine system biodiversity is threatened by a range of stressors, spanning pollution, sedimentation, alterations to water flow, and climate change. Pesticides have been associated with population level impacts on freshwater invertebrates for acute high-level exposures, but far less is known about the chronic impact of episodic exposure to specific classes of pesticides or their mixtures. Here we employed the use of the UK Environment Agency's monitoring datasets over 40 years (covering years 1980 to 2019) to assess the impacts of AChE (acetylcholinesterase) and GABA (gamma-aminobutyric acid) receptor targeting pesticides on invertebrate family richness at English river sites. Concentrations of AChE and GABA pesticides toxic to freshwater invertebrates occurred (measured) across 18 of the 66 river sites assessed. For one of the three river sites (all found in the Midlands region of England) where data recorded over the past 40 years were sufficient for robust modelling studies, both AChE and GABA pesticides associated with invertebrate family richness. Here, where AChE total pesticide concentrations were classified as high, 46 of 64 invertebrate families were absent, and where GABA total pesticide concentration were classified as high, 16 of 64 invertebrate families were absent. Using a combination of field evidence and laboratory toxicity thresholds for population relevant endpoints we identify families of invertebrates most at risk in the selected English rivers to AChE and GABA pesticides. We, furthermore, provide strong evidence that the absence of the invertebrate family Polycentropodidae (caddisfly) from one field site is due to exposure effects to AChE pesticides.
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Affiliation(s)
- Imogen P Poyntz-Wright
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
| | - Xavier A Harrison
- Centre for Ecology and Conservation, University of Exeter, Penryn TR10 9FE, UK
| | - Andrew Johnson
- Centre of Ecology and Hydrology, MacLean Building, Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK
| | - Susan Zappala
- JNCC, Quay House, 2 East Station Road, Fletton Quays, Peterborough PE2 8YY, UK
| | - Charles R Tyler
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
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Buchlak QD, Tang CHM, Seah JCY, Johnson A, Holt X, Bottrell GM, Wardman JB, Samarasinghe G, Dos Santos Pinheiro L, Xia H, Ahmad HK, Pham H, Chiang JI, Ektas N, Milne MR, Chiu CHY, Hachey B, Ryan MK, Johnston BP, Esmaili N, Bennett C, Goldschlager T, Hall J, Vo DT, Oakden-Rayner L, Leveque JC, Farrokhi F, Abramson RG, Jones CM, Edelstein S, Brotchie P. Effects of a comprehensive brain computed tomography deep learning model on radiologist detection accuracy. Eur Radiol 2024; 34:810-822. [PMID: 37606663 PMCID: PMC10853361 DOI: 10.1007/s00330-023-10074-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Non-contrast computed tomography of the brain (NCCTB) is commonly used to detect intracranial pathology but is subject to interpretation errors. Machine learning can augment clinical decision-making and improve NCCTB scan interpretation. This retrospective detection accuracy study assessed the performance of radiologists assisted by a deep learning model and compared the standalone performance of the model with that of unassisted radiologists. METHODS A deep learning model was trained on 212,484 NCCTB scans drawn from a private radiology group in Australia. Scans from inpatient, outpatient, and emergency settings were included. Scan inclusion criteria were age ≥ 18 years and series slice thickness ≤ 1.5 mm. Thirty-two radiologists reviewed 2848 scans with and without the assistance of the deep learning system and rated their confidence in the presence of each finding using a 7-point scale. Differences in AUC and Matthews correlation coefficient (MCC) were calculated using a ground-truth gold standard. RESULTS The model demonstrated an average area under the receiver operating characteristic curve (AUC) of 0.93 across 144 NCCTB findings and significantly improved radiologist interpretation performance. Assisted and unassisted radiologists demonstrated an average AUC of 0.79 and 0.73 across 22 grouped parent findings and 0.72 and 0.68 across 189 child findings, respectively. When assisted by the model, radiologist AUC was significantly improved for 91 findings (158 findings were non-inferior), and reading time was significantly reduced. CONCLUSIONS The assistance of a comprehensive deep learning model significantly improved radiologist detection accuracy across a wide range of clinical findings and demonstrated the potential to improve NCCTB interpretation. CLINICAL RELEVANCE STATEMENT This study evaluated a comprehensive CT brain deep learning model, which performed strongly, improved the performance of radiologists, and reduced interpretation time. The model may reduce errors, improve efficiency, facilitate triage, and better enable the delivery of timely patient care. KEY POINTS • This study demonstrated that the use of a comprehensive deep learning system assisted radiologists in the detection of a wide range of abnormalities on non-contrast brain computed tomography scans. • The deep learning model demonstrated an average area under the receiver operating characteristic curve of 0.93 across 144 findings and significantly improved radiologist interpretation performance. • The assistance of the comprehensive deep learning model significantly reduced the time required for radiologists to interpret computed tomography scans of the brain.
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Affiliation(s)
- Quinlan D Buchlak
- Annalise.ai, Sydney, NSW, Australia.
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia.
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia.
| | | | - Jarrel C Y Seah
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | - Hung Pham
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Jason I Chiang
- Annalise.ai, Sydney, NSW, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Nazanin Esmaili
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Bennett
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Jonathan Hall
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, St Vincent's Health Australia, Melbourne, VIC, Australia
- Department of Radiology, Austin Hospital, Melbourne, VIC, Australia
| | - Duc Tan Vo
- Department of Radiology, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, SA, Australia
| | | | - Farrokh Farrokhi
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA, USA
| | | | - Catherine M Jones
- Annalise.ai, Sydney, NSW, Australia
- I-MED Radiology Network, Brisbane, QLD, Australia
- School of Public and Preventive Health, Monash University, Clayton, VIC, Australia
- Department of Clinical Imaging Science, University of Sydney, Sydney, NSW, Australia
| | - Simon Edelstein
- Annalise.ai, Sydney, NSW, Australia
- I-MED Radiology Network, Brisbane, QLD, Australia
- Department of Radiology, Monash Health, Clayton, VIC, Australia
| | - Peter Brotchie
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, St Vincent's Health Australia, Melbourne, VIC, Australia
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Lo B, Teferi B, Wong HW, Abi-Jaoude A, Chopra J, Charow R, Zhang M, Shi J, Johnson A, Levinson A, Cleverley K, Henderson J, Voineskos A, Wiljer D. Enhancing the value of digital health tools for mental health help-seeking in Canadian transitional aged youth during the pandemic: Qualitative study. Int J Med Inform 2024; 182:105299. [PMID: 38061186 DOI: 10.1016/j.ijmedinf.2023.105299] [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: 06/06/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
While the COVID-19 pandemic has greatly exacerbated the mental health challenges of transition-aged youth (TAY) between 17 and 29 years old, it has also led to the rapid adoption of digital tools for mental health help-seeking and treatment. However, to date, there has been limited work focusing on how this shift has impacted perceptions, needs and challenges of this population in using digital tools. The current study aims to understand their perspectives on mental health help-seeking during the pandemic and emerging issues related to digital tools (e.g., digital health equity, inclusivity). A total of 16 TAY were invited from three post-secondary institutions in the Greater Toronto Area. A total of two streams of focus groups were held and participants were invited to share their perceptions, needs and experiences. Five main themes were identified: 1) Helpfulness of a centralized resource encompassing a variety of diverse mental health supports help-seeking; 2) The impact of the shift to online mental health support on the use of informal supports; 3) Digital tool affordability and availability; 4) Importance of inclusivity for digital tools; and 5) Need for additional support for mental health seeking and digital tool navigation. Future work should examine how these needs can be addressed through new and existing digital mental health help-seeking tools for TAY.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; Information Management Group, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario M6J 1H4, Canada.
| | - Bemnet Teferi
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Dalla Lana School of Public Health, 155 College St, Toronto, Ontario M5T 3M7, Canada.
| | - Howard W Wong
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Alexxa Abi-Jaoude
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Jasmine Chopra
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Rebecca Charow
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - Melody Zhang
- UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Andrea Levinson
- Health and Wellness, University of Toronto, 700 Bay Street, Toronto, ON M5G 1Z6, Canada; Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada.
| | - Kristin Cleverley
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7, Canada; Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario M6J 1H4, Canada.
| | - Jo Henderson
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario M6J 1H4, Canada.
| | - Aristotle Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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Artna E, Abi-Jaoudé A, Sockalingam S, Perry C, Johnson A, Wun C, Kozloff N, Henderson J, Levinson A, Buchman DZ. Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study. BMJ Open 2024; 14:e080707. [PMID: 38238177 PMCID: PMC10806589 DOI: 10.1136/bmjopen-2023-080707] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Transitional-aged youth (16-29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are not yet thoroughly characterised. OBJECTIVES This study aimed to answer the following research question: What are the beliefs and attitudes of youth with mental illness about COVID-19 vaccines, and how do these perspectives affect vaccine acceptance? The study aims to generate findings to inform the development of vaccine resources specific to youth with mental health concerns. METHODS A qualitative methodology with a youth engagement focus was used to conduct in-depth semistructured interviews with transitional-aged youth aged 16-29 years with one or more self-reported mental health diagnoses or concerns. Mental health concerns encompassed a wide range of symptoms and diagnoses, including mood disorders, anxiety disorders, neurodevelopmental disorders and personality disorders. Participants were recruited from seven main mental health clinical and support networks across Canada. Transcripts from 46 youth and 6 family member interviews were analysed using thematic analysis. RESULTS Two major themes were generated: (1) factors affecting trust in COVID-19 vaccines and (2) mental health influences and safety considerations in vaccine decision-making. Subthemes included trust in vaccines, trust in healthcare providers, trust in government and mistreatment towards racialised populations, and direct and indirect influences of mental health. CONCLUSIONS Our analysis suggests how lived experiences of mental illness affected vaccine decision-making and related factors that can be targeted to increase vaccine uptake. Our findings provide new insights into vaccine attitudes among youth with mental health concerns, which is highly relevant to ongoing vaccination efforts for new COVID-19 strains as well as other transmissible diseases and future pandemics. Next steps include cocreating youth-specific public health and clinical resources to encourage vaccination in this population.
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Affiliation(s)
- Erin Artna
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexxa Abi-Jaoudé
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire Perry
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Johnson
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charlotte Wun
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jo Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Levinson
- Health & Wellness Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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10
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Backley S, Bergh E, Garnett J, Li R, Maroufy V, Jain R, Fletcher S, Tsao K, Austin M, Johnson A, Papanna R. Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure. Ultrasound Obstet Gynecol 2024. [PMID: 38207160 DOI: 10.1002/uog.27579] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Laparotomy-assisted fetoscopic closure of spina bifida utilizing heated-humidified carbon dioxide gas has been associated with less maternal morbidity than open in-utero spina bifida closure. Fetal cardiovascular changes during these surgical interventions are not well defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR)<110 bpm over 10 minutes) and changes in umbilical artery Doppler parameters throughout open in-utero closure with those observed during laparotomy-assisted fetoscopic closure. METHODS We conducted a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and umbilical artery velocimetry were systematically obtained during preoperative assessment, every 5 minutes during the intraoperative period, and in the postoperative assessment. FHR, pulsatility indexes and end-diastolic flows were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocities were measured in the fetoscopic cohort. Each fetal heart rate recording time point was correlated to maternal parameters, including heart rate, systolic and diastolic blood pressures. RESULTS Fetal bradycardia occurred in 4/22 cases (18.2%) of open in-utero closure and in 21/46 cases (45.7%) of fetoscopic closure. FHR gradually decreased in both cohorts after general anesthesia and decreased further during surgery. FHR were significantly lower after two hours of surgery in the fetoscopic closure than in the open in-utero closure group. In addition, the FHR (BPM) change in the final stages of the fetal surgery from the baseline FHR was significantly lower in the fetoscopic cohort (-32.3 (-35.7, -29.1)) compared to the open cohort (-23.5 (-28.1, -18.8)) (p=0.002). Abnormal end-diastolic flow (defined as absent or reversed end-diastolic flow) in the umbilical artery Doppler velocity occurred in 3/22 (13.6%) of the open closure cohort and in 23/46 (50%) of the fetoscopic closure cohort (p=0.004). There were no differences in umbilical artery end-diastolic flow and pulsatility index between closure techniques during the various stages of assessment. CONCLUSIONS We observed a decrease in the FHR and abnormalities in umbilical artery Doppler parameters in both open in-utero and fetoscopic closure groups. Fetal bradycardia was more prominent during fetoscopic closure following heated-humidified carbon dioxide insufflation, but the FHR recovered after cessation of the heated-humidified carbon dioxide. Changes in FHR and umbilical artery Doppler parameters during in-utero spina bifida closure were observed to be transient, no cases required emergency delivery and no fetoscopic closure were converted to open closure. These observations should inform algorithms for perioperative management of fetal bradycardia associated with in-utero spina bifida closure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - E Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J Garnett
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - V Maroufy
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - R Jain
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Anesthesia, Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - S Fletcher
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - K Tsao
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Austin
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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11
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Rajit D, Johnson A, Callander E, Teede H, Enticott J. Learning health systems and evidence ecosystems: a perspective on the future of evidence-based medicine and evidence-based guideline development. Health Res Policy Syst 2024; 22:4. [PMID: 38178086 PMCID: PMC10768258 DOI: 10.1186/s12961-023-01095-2] [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: 05/09/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024] Open
Abstract
Despite forming the cornerstone of modern clinical practice for decades, implementation of evidence-based medicine at scale remains a crucial challenge for health systems. As a result, there has been a growing need for conceptual models to better contextualise and pragmatize the use of evidence-based medicine, particularly in tandem with patient-centred care. In this commentary, we highlight the emergence of the learning health system as one such model and analyse its potential role in pragmatizing both evidence-based medicine and patient-centred care. We apply the learning health system lens to contextualise the key activity of evidence-based guideline development and implementation, and highlight how current inefficiencies and bottlenecks in the evidence synthesis phase of evidence-based guideline development threaten downstream adherence. Lastly, we introduce the evidence ecosystem as a complementary model to learning health systems, and propose how innovative developments from the evidence ecosystem may be integrated with learning health systems to better enable health impact at speed and scale.
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Affiliation(s)
- D Rajit
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Melbourne, VIC, 3168, Australia
| | - A Johnson
- Monash Partners Academic Health Sciences Centre, Melbourne, VIC, Australia
| | - E Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Melbourne, VIC, 3168, Australia
- Monash Partners Academic Health Sciences Centre, Melbourne, VIC, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Melbourne, VIC, 3168, Australia
- Monash Partners Academic Health Sciences Centre, Melbourne, VIC, Australia
- Monash Health Endocrinology and Diabetes Departments, Melbourne, Australia
| | - J Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Melbourne, VIC, 3168, Australia.
- Monash Partners Academic Health Sciences Centre, Melbourne, VIC, Australia.
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12
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Minot SS, Mayer-Blackwell K, Fiore-Gartland A, Johnson A, Self S, Bhatti P, Yao L, Liu L, Sun X, Jinfa Y, Kublin J. Strain-level characterization of health-associated bacterial consortia that colonize the human gut during infancy. medRxiv 2023:2023.12.16.23300077. [PMID: 38168439 PMCID: PMC10760300 DOI: 10.1101/2023.12.16.23300077] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background The human gut microbiome develops rapidly during infancy, a key window of development coinciding with maturation of the adaptive immune system. However, little is known of the microbiome growth dynamics over the first few months of life and whether there are any generalizable patterns across human populations. We performed metagenomic sequencing on stool samples (n=94) from a cohort of infants (n=15) at monthly intervals in the first six months of life, augmenting our dataset with seven published studies for a total of 4,441 metagenomes from 1,162 infants. Results Strain-level de novo analysis was used to identify 592 of the most abundant organisms in the infant gut microbiome. Previously unrecognized consortia were identified which exhibited highly correlated abundances across samples and were composed of diverse species spanning multiple genera. Analysis of a cohort of infants with cystic fibrosis identified one such novel consortium of diverse Enterobacterales which was positively correlated with weight gain. While all studies showed an increased community stability during the first year of life, microbial dynamics varied widely in the first few months of life, both by study and by individual. Conclusion By augmenting published metagenomic datasets with data from a newly established cohort we were able to identify novel groups of organisms that are correlated with measures of robust human development. We hypothesize that the presence of these groups may impact human health in aggregate in ways that individual species may not in isolation.
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Affiliation(s)
| | | | - Andrew Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Andrew Johnson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Steven Self
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC, Canada
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, USA
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lena Yao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Lili Liu
- Key Laboratory of Occupational Disease Prevention and Treatment, Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, China
| | - Xin Sun
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi Jinfa
- Nanhai Maternity and Child Healthcare Hospital of Foshan, Foshan, China
| | - James Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA
- HIV Vaccine Trials Network, Fred Hutchinson Cancer Center, Seattle, USA
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13
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Poyntz-Wright IP, Harrison XA, Johnson A, Zappala S, Tyler CR. Pesticide pollution associations with riverine invertebrate communities in England. Sci Total Environ 2023; 903:166519. [PMID: 37640080 DOI: 10.1016/j.scitotenv.2023.166519] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Globally freshwater biodiversity has experienced major decline and chemical pollutants are believed to have played a significant role in this decline, but this has not been well quantified for most riverine invertebrate populations. Here we applied a biogeographically independent trait-based bioindicator, SPEARpesticides across sites across five regions (Northern, Midlands and Western, Anglian, Southeast, and Southwest) in England to investigate for associations specifically between pesticide use/pollution and riverine invertebrate communities over a 55-year period (1965-2019). Both spatially and temporally post-1990, the Anglian and Thames regions consistently showed the lowest SPEARpesticides scores, illustrating the presence of fewer pesticide sensitive species. The Anglian region had the highest pesticide use compared to all other regions from 1990 to 2018 and there were negative relationships between the level of pesticide/insecticide use and the regional SPEARpesticides score. Biochemical Oxygen Demand and ammonia, as measures of general water quality, were also negatively correlated with the SPEARpesticides scores across the regions, but these factors were not the driver for the lower SPEARpesticides scores seen in the Anglian region. Based on SPEARpesticides scores, riverine invertebrate communities in England have been most impacted in the Anglian region and we evidence chronic insecticide exposure is likely a significant factor in shaping the status of those invertebrate communities.
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Affiliation(s)
- Imogen P Poyntz-Wright
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
| | - Xavier A Harrison
- Centre for Ecology and Conservation, University of Exeter, Penryn TR10 9FE, UK
| | - Andrew Johnson
- Centre for Ecology and Hydrology, MacLean Building, Benson Lane, Crowmarsh Gifford, Wallingford OX10 8BB, UK
| | - Susan Zappala
- JNCC, Quay House, 2 East Station Road, Fletton Quays, Peterborough PE2 8YY, UK
| | - Charles R Tyler
- Biosciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
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Agarwal N, Papanna R, Bergh EP, Hernandez-Andrade E, Backley S, Salazar A, Johnson A, Espinoza J. Management of large placental chorioangioma: two-port laser approach for fetal intervention. Ultrasound Obstet Gynecol 2023; 62:882-890. [PMID: 37448172 DOI: 10.1002/uog.26307] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. METHODS This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. RESULTS Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. CONCLUSIONS In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Salazar
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Adachi I, Adamczyk K, Aggarwal L, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becherer F, Becker J, Behera PK, Bennett JV, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bobrov A, Bodrov D, Bolz A, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heidelbach A, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Horak P, Hsu CL, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Junkerkalefeld H, Kaliyar AB, Kandra J, Kang KH, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kinoshita K, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li Y, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natkaniec Z, Natochii A, Nayak L, Nazaryan G, Nisar NK, Nishida S, Ogawa S, Ono H, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schnepf M, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Veronesi M, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Wach B, Waheed E, Wakai M, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Zani L, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhukova VI, Žlebčík R. Tests of Light-Lepton Universality in Angular Asymmetries of B^{0}→D^{*-}ℓν Decays. Phys Rev Lett 2023; 131:181801. [PMID: 37977641 DOI: 10.1103/physrevlett.131.181801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
We present the first comprehensive tests of the universality of the light leptons in the angular distributions of semileptonic B^{0}-meson decays to charged spin-1 charmed mesons. We measure five angular-asymmetry observables as functions of the decay recoil that are sensitive to lepton-universality-violating contributions. We use events where one neutral B is fully reconstructed in ϒ(4S)→BB[over ¯] decays in data corresponding to 189 fb^{-1} integrated luminosity from electron-positron collisions collected with the Belle II detector. We find no significant deviation from the standard model expectations.
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Pershad Y, Mack T, Poisner H, Jakubek YA, Stilp AM, Mitchell BD, Lewis JP, Boerwinkle E, Loos RJ, Chami N, Wang Z, Barnes K, Pankratz N, Fornage M, Redline S, Psaty BM, Bis JC, Shojaie A, Silverman EK, Cho MH, Yun J, DeMeo D, Levy D, Johnson A, Mathias R, Taub M, Arnett D, North K, Raffield LM, Carson A, Doyle MF, Rich SS, Rotter JI, Guo X, Cox N, Roden DM, Franceschini N, Desai P, Reiner A, Auer PL, Scheet P, Jaiswal S, Weinstock JS, Bick AG. Determinants of mosaic chromosomal alteration fitness. medRxiv 2023:2023.10.20.23297280. [PMID: 37905118 PMCID: PMC10615010 DOI: 10.1101/2023.10.20.23297280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Clonal hematopoiesis (CH) is characterized by the acquisition of a somatic mutation in a hematopoietic stem cell that results in a clonal expansion. These driver mutations can be single nucleotide variants in cancer driver genes or larger structural rearrangements called mosaic chromosomal alterations (mCAs). The factors that influence the variations in mCA fitness and ultimately result in different clonal expansion rates are not well-understood. We used the Passenger-Approximated Clonal Expansion Rate (PACER) method to estimate clonal expansion rate for 6,381 individuals in the NHLBI TOPMed cohort with gain, loss, and copy-neutral loss of heterozygosity mCAs. Our estimates of mCA fitness were correlated (R 2 = 0.49) with an alternative approach that estimated fitness of mCAs in the UK Biobank using a theoretical probability distribution. Individuals with lymphoid-associated mCAs had a significantly higher white blood cell count and faster clonal expansion rate. In a cross-sectional analysis, genome-wide association study of estimates of mCA expansion rate identified TCL1A , NRIP1 , and TERT locus variants as modulators of mCA clonal expansion rate.
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Sileo FG, Accurti V, Baschat A, Binder J, Carreras E, Chianchiano N, Cruz-Martinez R, D'Antonio F, Gielchinsky Y, Hecher K, Johnson A, Lopriore E, Massoud M, Nørgaard LN, Papaioannou G, Prefumo F, Salsi G, Simões T, Umstad M, Vavilala S, Yinon Y, Khalil A. Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study. Ultrasound Obstet Gynecol 2023; 62:540-551. [PMID: 37204929 DOI: 10.1002/uog.26256] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. METHODS This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. RESULTS Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow-up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity-related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). CONCLUSION Monochorionicity-related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F G Sileo
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - V Accurti
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - J Binder
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - E Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Reproductive Medicine, Grup de Recerca en Medicina Materna I Fetal, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - N Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla-Fatebenefratelli Hospital, Palermo, Italy
| | - R Cruz-Martinez
- Fetal Surgery Center, Instituto Medicina Fetal México, Queretaro/Guadalajara, Jalisco, Mexico
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University 'G. d'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Y Gielchinsky
- Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Johnson
- Department of Obstetrics and Gynecology, The Fetal Center at Children's Memorial Hermann Hospital, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - E Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Massoud
- Department of Obstetrics and Fetal Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - L N Nørgaard
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G Papaioannou
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - F Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Salsi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - T Simões
- Department of Maternal-Fetal Medicine and Maternity Dr. Alfredo da Costa, Nova Medica School, Lisbon, Portugal
| | - M Umstad
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - S Vavilala
- Department of Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India
| | - Y Yinon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Harris H, Clarkin C, Rovet J, Crawford A, Johnson A, Kirvan A, Gruszecki S, Wang S, Soklaridis S. Meaningful engagement through critical reflexivity: Engaging people with lived experience in continuing mental health professional development. Health Expect 2023; 26:1793-1798. [PMID: 37365844 PMCID: PMC10485329 DOI: 10.1111/hex.13798] [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: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Engaging people with lived experience of mental health system encounters in the design and actualization of continuing professional development initiatives for mental health professionals can have transformative systemic impacts. Yet, despite evidence that involving people with lived experience benefits mental health professional education, far less focus has been placed on how to engage people with lived experience in continuing professional development initiatives. Tensions persist regarding the role of lived experience perspectives in continuing professional development, as well as how to establish people with lived experience as partners, educators and leaders in a thoughtful way. We propose that meaningful and equitable partnerships with people with lived experience can be realized by engaging in critical reflexivity and by systematically challenging assumptions. This paper explores three topics: (1) the current state of engagement with people with lived experience in continuing professional development initiatives; (2) barriers to meaningful engagement and (3) recommendations for using critical reflexivity to support the involvement and leadership of people with lived experience in continuing professional development for mental health professionals. PATIENT OR PUBLIC INVOLVEMENT: This viewpoint manuscript was co-designed and co-written by people with diverse lived and learned experiences. Each author's professional roles involve meaningfully and equitably partnering with and centring the perspectives of those with lived experience of mental health system encounters. In addition, approximately half of the authorship team identifies as having lived experience of accessing the psychiatric system and/or supporting family members who are navigating challenges related to mental health. These lived and learned experiences informed the conception and writing of this article.
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Affiliation(s)
- Holly Harris
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Chantalle Clarkin
- Talk Suicide CanadaCentre for Addiction and Mental HealthTorontoOntarioCanada
- Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Jordana Rovet
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Allison Crawford
- Talk Suicide CanadaCentre for Addiction and Mental HealthTorontoOntarioCanada
- Virtual Mental Health and OutreachCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioUSA
| | - Andrew Johnson
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Anne Kirvan
- Talk Suicide CanadaCentre for Addiction and Mental HealthTorontoOntarioCanada
- Virtual Mental Health and OutreachCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Sam Gruszecki
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Stephanie Wang
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
- Virtual Mental Health and OutreachCentre for Addiction and Mental HealthTorontoOntarioCanada
- Health Out LoudTorontoOntarioCanada
| | - Sophie Soklaridis
- Department of EducationCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioUSA
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Bansal S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bernieri E, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhardwaj V, Bhuyan B, Bianchi F, Bilka T, Bilokin S, Biswas D, Bobrov A, Bodrov D, Bolz A, Borah J, Bozek A, Bračko M, Branchini P, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Chen YQ, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cinabro D, Cochran J, Corona L, Cremaldi LM, Cunliffe S, Czank T, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Guilliams J, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hirata H, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jaffe DE, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kakuno H, Kaleta M, Kalita D, Kaliyar AB, Kandra J, Kang KH, Kang S, Karl R, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Lautenbach K, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li YB, Libby J, Lieret K, Liu QY, Liu ZQ, Liventsev D, Longo S, Lozar A, Lueck T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Miyake H, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakamura KR, Nakao M, Nakayama H, Nakazawa H, Nakazawa Y, Narimani Charan A, Naruki M, Narwal D, Natkaniec Z, Natochii A, Nayak L, Nayak M, Nazaryan G, Niebuhr C, Nisar NK, Nishida S, Ogawa S, Ono H, Onuki Y, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park J, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Pinna Angioni G, Podesta-Lerma PLM, Podobnik T, Pokharel S, Polat L, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Ramirez Morales A, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Rizzuto LB, Robertson SH, Rodríguez Pérez D, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sanders DA, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schnepf M, Schueler J, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sue Y, Sumihama M, Sumisawa K, Sutcliffe W, Suzuki SY, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tanigawa H, Tenchini F, Thaller A, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Vossen A, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang XL, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Ye H, Yelton J, Yin JH, Yook YM, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhai Y, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhou XY, Zhukova VI, Žlebčík R. Search for a τ^{+}τ^{-} Resonance in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} Events with the Belle II Experiment. Phys Rev Lett 2023; 131:121802. [PMID: 37802942 DOI: 10.1103/physrevlett.131.121802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 10/08/2023]
Abstract
We report the first search for a nonstandard-model resonance decaying into τ pairs in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} events in the 3.6-10 GeV/c^{2} mass range. We use a 62.8 fb^{-1} sample of e^{+}e^{-} collisions collected at a center-of-mass energy of 10.58 GeV by the Belle II experiment at the SuperKEKB collider. The analysis probes three different models predicting a spin-1 particle coupling only to the heavier lepton families, a Higgs-like spin-0 particle that couples preferentially to charged leptons (leptophilic scalar), and an axionlike particle, respectively. We observe no evidence for a signal and set exclusion limits at 90% confidence level on the product of cross section and branching fraction into τ pairs, ranging from 0.7 to 24 fb, and on the couplings of these processes. We obtain world-leading constraints on the couplings for the leptophilic scalar model for masses above 6.5 GeV/c^{2} and for the axionlike particle model over the entire mass range.
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bodrov D, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang P, Cheaib R, Cheema P, Chekelian V, Chen C, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghosh D, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara K, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kaleta M, Kaliyar AB, Kandra J, Kang KH, Kang S, Kar S, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Li C, Li LK, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natochii A, Nayak L, Nayak M, Nazaryan G, Nisar NK, Nishida S, Ono H, Onuki Y, Oskin P, Pakhlov P, Pakhlova G, Paladino A, Paoloni E, Pardi S, Parham K, Park H, Park SH, Passeri A, Patra S, Paul S, Pedlar TK, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schwanda C, Schwartz AJ, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shi XD, Shillington T, Shiu JG, Shtol D, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhang Y, Zhilich V, Zhou QD, Zhukova VI. Measurement of CP Violation in B^{0}→K_{S}^{0}π^{0} Decays at Belle II. Phys Rev Lett 2023; 131:111803. [PMID: 37774261 DOI: 10.1103/physrevlett.131.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 10/01/2023]
Abstract
We report a measurement of the CP-violating parameters C and S in B^{0}→K_{S}^{0}π^{0} decays at Belle II using a sample of 387×10^{6} BB[over ¯] events recorded in e^{+}e^{-} collisions at a center-of-mass energy corresponding to the ϒ(4S) resonance. These parameters are determined by fitting the proper decay-time distribution of a sample of 415 signal events. We obtain C=-0.04_{-0.15}^{+0.14}±0.05 and S=0.75_{-0.23}^{+0.20}±0.04, where the first uncertainties are statistical and the second are systematic.
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Johnson A, Mossack S, Tsambarlis P. Artificial Urinary Sphincters for Moderate Post-Prostatectomy Incontinence: Current Research and Proposed Approach. Cancers (Basel) 2023; 15:4424. [PMID: 37760394 PMCID: PMC10526785 DOI: 10.3390/cancers15184424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.
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Affiliation(s)
- Andrew Johnson
- Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Spencer Mossack
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Peter Tsambarlis
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA;
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Bourget-Murray J, Piroozfar S, Smith C, Ellison J, Bansal R, Sharma R, Evaniew N, Johnson A, Powell JN. Annual incidence and assessment of risk factors for early-onset deep surgical site infection following primary total knee arthroplasty in osteoarthritis. Bone Joint J 2023; 105-B:971-976. [PMID: 37654121 DOI: 10.1302/0301-620x.105b9.bjj-2022-1293.r1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection. Methods This is a retrospective population-based cohort study using prospectively collected patient-level data between 1 January 2013 and 1 March 2020. The diagnosis of deep SSI was defined as per the Centers for Disease Control/National Healthcare Safety Network criteria. The Mann-Kendall Trend test was used to detect monotonic trends in annual rates of early-onset deep SSI over time. Multiple logistic regression was used to analyze the effect of different patient, surgical, and healthcare setting factors on the risk of developing a deep SSI within 90 days from surgery for patients with complete data. We also report 90-day mortality. Results A total of 39,038 patients underwent primary TKA for osteoarthritis during the study period. Of these, 275 patients developed a deep SSI within 90 days of surgery, representing a cumulative incidence of 0.7%. The annual infection rate did not significantly decrease over the seven-year study period (p = 0.162). Overall, 13,885 (35.5%) cases were excluded from the risk analysis due to missing data. Risk factors associated with early-onset deep SSI included male sex, American Society of Anesthesiologists grade ≥ 3, blood transfusion, acute length of stay, and surgeon volume < 30 TKAs/year. Early-onset deep SSI was not associated with increased 90-day mortality. Conclusion This study establishes a reliable baseline infection rate for early-onset deep SSI after TKA for osteoarthritis using robust Infection Prevention and Control surveillance data, and identifies several potentially modifiable risk factors.
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Affiliation(s)
- Jonathan Bourget-Murray
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada
| | | | | | - Jennifer Ellison
- Infection Prevention and Control, Alberta Health Services, Calgary, Canada
| | - Rohit Bansal
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Rajrishi Sharma
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Nathan Evaniew
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Andrew Johnson
- Department of Medicine, Division of Infectious Diseases, University of Calgary, Calgary, Canada
| | - James N Powell
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary Cumming School of Medicine, Calgary, Canada
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Premkumar A, Doggalli N, Rudraswamy S, Manjunatha BS, Peeran SW, Johnson A, Patil K. Sex determination using mandibular ramus flexure in South Indian population - A retrospective study. J Forensic Odontostomatol 2023; 41:2-9. [PMID: 37634171 PMCID: PMC10473455] [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] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Sex determination or sex estimation from a single or fragment of bone is always difficult in the absence of other bones from the same individual. The current study was an attempt to estimate the sex of an individual from the posterior ramus of mandible or the mandibular ramus flexure. A retrospective study was conducted using orthopantomographs (OPGs) of 200 males and 200 females between the age group of 20 - 70 years. Each radiographic image was examined for the presence of a flexure or notching on the posterior border of the ramus in relation to occlusal plane as the method followed by Loth & Henneberg 1996.The study resulted in samples that were correctly classified as females 59.5% and males 57.5 %. The overall correct sex estimation was achieved in 58.5% of the cases. The predictive accuracy or assessment was higher for females compared to males. Consequently, the posterior ramus of mandible or mandibular ramus flexure can be considered as supplementary rather than a definitive means of sex determination. Hence, it is preferable to include as many parameters as possible to attain optimal accuracy.
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Affiliation(s)
- A Premkumar
- Dept. of forensic odontology, Dental College and Hospital, JSSAHER, Mysore. India
| | - N Doggalli
- Dept. Of Oral Medicine and Radiology, Dental College and Hospital, JSSAHER, Mysore. India
| | - S Rudraswamy
- Dept. Of Public Health Dentistry, Dental College and Hospital, JSSAHER, Mysore. India
| | - B S Manjunatha
- Faculty of Dentistry, Taif University, Taif, Kingdom of Saudi Arabia
| | - S W Peeran
- Armed Forces Hospital, Jizan, Kingdom of Saudi Arabia
| | - A Johnson
- School of Forensic Science, National Forensic Sciences University, Gujarat
| | - K Patil
- Dept. of forensic odontology, Dental College and Hospital, JSSAHER, Mysore. India
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Khanna K, Salmond N, Halvaei S, Johnson A, Williams KC. Separation and isolation of CD9-positive extracellular vesicles from plasma using flow cytometry. Nanoscale Adv 2023; 5:4435-4446. [PMID: 37638157 PMCID: PMC10448347 DOI: 10.1039/d3na00081h] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023]
Abstract
Extracellular vesicles (EVs) are nanosized (∼30-1000 nm) lipid-enclosed particles released by a variety of cell types. EVs are found in biological fluids and are considered a promising material for disease detection and monitoring. Given their nanosized properties, EVs are difficult to isolate and study. In complex biological samples, this difficulty is amplified by other small particles and contaminating proteins making the discovery and validation of EV-based biomarkers challenging. Developing new strategies to isolate EVs from complex biological samples is of significant interest. Here, we evaluate the utility of flow cytometry to isolate particles in the nanoscale size range. Flow cytometry calibration was performed and 100 nm nanoparticles and ∼124 nm virus were used to test sorting capabilities in the nanoscale size range. Next, using blood plasma, we assessed the capabilities of flow cytometry sorting for the isolation of CD9-positive EVs. Using flow cytometry, CD9-positive EVs could be sorted from pre-enriched EV fractions and directly from plasma without the need for any EV pre-enrichment isolation strategies. These results demonstrate that flow cytometry can be employed as a method to isolate subpopulations of EVs from biological samples.
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Affiliation(s)
- Karan Khanna
- Faculty of Pharmaceutical Sciences, The University of British Columbia Vancouver V6T 1Z3 Canada
| | - Nikki Salmond
- Faculty of Pharmaceutical Sciences, The University of British Columbia Vancouver V6T 1Z3 Canada
| | - Sina Halvaei
- Faculty of Pharmaceutical Sciences, The University of British Columbia Vancouver V6T 1Z3 Canada
| | - Andrew Johnson
- Faculty of Medicine, UBC Flow Facility, The University of British Columbia Vancouver V6T 1Z3 Canada
| | - Karla C Williams
- Faculty of Pharmaceutical Sciences, The University of British Columbia Vancouver V6T 1Z3 Canada
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Taylor JRN, Rehm CD, de Kock HL, Donoghue S, Johnson A, Thompson C, Berezhnaya Y. South African Consumers' Knowledge, Opinions and Awareness of Whole Grains and Their Health Benefits: A Cross-Sectional Online Survey. Nutrients 2023; 15:3522. [PMID: 37630713 PMCID: PMC10457809 DOI: 10.3390/nu15163522] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Evidence indicates that whole-grain food consumption reduces the risk of cardiovascular disease, type-2 diabetes, and some cancers. Increasing whole-grain consumption in developing countries is likely to significantly benefit the health of the population. However, there is very limited information on consumer whole-grain knowledge, attitudes, and behaviors in developing countries. An online cross-sectional survey was conducted among 1000 South African consumers with sufficient income to make food purchase choices and who were generally representative in terms of gender, age, and ethnicity. Most respondents (64%) were confident of their whole-grain knowledge. However, 60% of all participants selected incorrect definitions of whole grains. Whilst most correctly identified common cereals as whole grains, at most 50% of participants correctly identified common whole-grain foods. Also, whilst most (67%) thought that they were consuming enough whole grains, the majority (62%) underestimated the recommended level of consumption. Furthermore, respondent knowledge regarding whole-grain food attributes and the health benefits of whole-grain consumption was generally poor. Clearly, consumer-focused strategies are needed in developing countries to increase whole-grain food consumption to help the broader population achieve a healthy and sustainable diet. Actions proposed include: simple-to-understand information on whole-grain content relative to recommendations on food product labels, the provision of whole-grain foods in school nutrition schemes, and coordinated social and behavior change communication initiatives.
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Affiliation(s)
- John R. N. Taylor
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.L.d.K.); (S.D.)
| | - Colin D. Rehm
- PepsiCo Global Research & Development, Life Sciences, PepsiCo, Purchase, NY 10577, USA;
| | - Henriëtte L. de Kock
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.L.d.K.); (S.D.)
| | - Suné Donoghue
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria 0002, South Africa; (H.L.d.K.); (S.D.)
| | | | - Chanelle Thompson
- PepsiCo South Africa, Consumer Insights, PepsiCo, Cape Town 7530, South Africa;
| | - Yulia Berezhnaya
- PepsiCo Global Research & Development, Life Sciences, PepsiCo, Cape Town 7530, South Africa;
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Coogan M, Xing D, Su B, Alston V, Johnson A, Khan M, Khalil K, Elaswad A, Li S, Wang J, Lu C, Wang W, Hettiarachchi D, Shang M, Hasin T, Qin Z, Cone R, Butts IAE, Dunham RA. CRISPR/Cas9-mediated knock-in of masu salmon (Oncorhyncus masou) elongase gene in the melanocortin-4 (mc4r) coding region of channel catfish (Ictalurus punctatus) genome. Transgenic Res 2023; 32:251-264. [PMID: 37468714 DOI: 10.1007/s11248-023-00346-w] [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: 07/08/2022] [Accepted: 03/24/2023] [Indexed: 07/21/2023]
Abstract
Channel catfish, Ictalurus punctatus, have limited ability to synthesize Ω-3 fatty acids. The ccβA-msElovl2 transgene containing masu salmon, Oncorhynchus masou, elongase gene driven by the common carp, Cyprinus carpio, β-actin promoter was inserted into the channel catfish melanocortin-4 receptor (mc4r) gene site using the two-hit two-oligo with plasmid (2H2OP) method. The best performing sgRNA resulted in a knockout mutation rate of 92%, a knock-in rate of 54% and a simultaneous knockout/knock-in rate of 49%. Fish containing both the ccβA-msElovl2 transgene knock-in and mc4r knockout (Elovl2) were 41.8% larger than controls at 6 months post-hatch (p = 0.005). Mean eicosapentaenoic acid (EPA, C20:5n-3) levels in Elov2 mutants and mc4r knockout mutants (MC4R) were 121.6% and 94.1% higher than in controls, respectively (p = 0.045; p = 0.025). Observed mean docosahexaenoic acid (DHA, C22:6n-3) and total EPA + DHA content was 32.8% and 45.1% higher, respectively, in Elovl2 transgenic channel catfish than controls (p = 0.368; p = 0.025). To our knowledge this is the first example of genome engineering to simultaneously target transgenesis and knock-out a gene in a commercially important aquaculture species for multiple improved performance traits. With a high transgene integration rate, improved growth, and higher omega-3 fatty acid content, the use of Elovl2 transgenic channel catfish appears beneficial for application on commercial farms.
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Affiliation(s)
- Michael Coogan
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - De Xing
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Baofeng Su
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Veronica Alston
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Andrew Johnson
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Mohd Khan
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
- Department of Fisheries Biology and Genetics, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Karim Khalil
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Ahmed Elaswad
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Shangjia Li
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Jinhai Wang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Cuiyu Lu
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Wenwen Wang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Darshika Hettiarachchi
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Mei Shang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Tasnuba Hasin
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Zhenkui Qin
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Roger Cone
- Life Sciences Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ian A E Butts
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Rex A Dunham
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
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El Ghazal N, Nakanishi H, Martinez-Nunez AE, Al Sabbakh NK, Segun-Omosehin OA, Bourdakos NE, Nasser M, Matar RH, Than C, Danoun OA, Johnson A. The Effects of Deep Brain Stimulation on Mood and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e44177. [PMID: 37753046 PMCID: PMC10519648 DOI: 10.7759/cureus.44177] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.
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Affiliation(s)
- Nour El Ghazal
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | - Hayato Nakanishi
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | | | - Nader K Al Sabbakh
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | - Omotayo A Segun-Omosehin
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | - Natalie E Bourdakos
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | - Maya Nasser
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
| | - Reem H Matar
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Christian Than
- Neurosurgery, St George's University of London, London, GBR
- Neurosurgery, University of Nicosia Medical School, Nicosia, CYP
- Biomedical Sciences, The University of Queensland, Brisbane, AUS
| | | | - Andrew Johnson
- Neurological Institute, Northshore Medical Group, Chicago, USA
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Papanna R, Agarwal N, Bergh EP, Brock C, Espinoza J, Johnson A. Fetoscopic laser ablation in pregnancies with Type-II vasa previa. Ultrasound Obstet Gynecol 2023; 61:779-781. [PMID: 36609872 DOI: 10.1002/uog.26153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 06/03/2023]
Affiliation(s)
- R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - C Brock
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
- Midwest Fetal Center, Minneapolis, MN, USA
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29
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Friedman S, Varga-Szemes A, Schoepf U, Johnson A, Johnson J, Baxley R, Houston B, Litwin S, Atkins J, Tedford R. Effect of Dobutamine on Rv Contractility and Rv-Pa Coupling in the Normal Rv. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.867] [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: 04/05/2023] Open
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Gillrie M, Chow B, Griener T, Johnson A, Church D. Hepatosplenic mucormycosis due to Rhizomucor pusillus identified by panfungal PCR/sequencing of ribosomal ITS2 and LSU regions in a patient with acute myelogenous leukemia: A case report. Journal of the Association of Medical Microbiology and Infectious Disease Canada 2023; 8:105-110. [PMID: 37008581 PMCID: PMC10052907 DOI: 10.3138/jammi-2022-0020] [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] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 03/29/2023]
Abstract
Background: Angioinvasive Rhizomucor pusillus infection with dissemination to the liver and spleen is exceedingly uncommon, representing less than 1% of reported cases of mucormycosis. Methods: Diagnosis of mucormycosis is often difficult using conventional methods that rely on broad-based non-septate hyphae present on histologic examination and morphological identification of the cultured organism. Our laboratory also uses an in-house panfungal molecular assay to rapidly diagnose invasive fungal infection when conventional methods do not provide definitive results. Results: Herein we present a case of disseminated mucormycosis with hepatosplenic involvement in a 49-year-old female with acute myelogenous leukemia following induction chemotherapy. But in this case repeated tissue biopsy cultures were negative. R. pusillus infection was diagnosed using an in-house panfungal PCR/sequencing assay based on dual priming oligonucleotide primers. Conclusions: New molecular assays facilitate prompt diagnosis of invasive fungal infections.
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Affiliation(s)
- Mark Gillrie
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Barbara Chow
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Griener
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Johnson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deirdre Church
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Deirdre Church, Departments of Pathology & Laboratory Medicine and Medicine, University of Calgary, 9-3535 Research Road NW, Calgary, Alberta T2N 2K8 Canada. Telephone: 403-770-3281. E-mail:
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Pashek R, Nkambule B, Chan M, Thibord F, Lachapelle A, Cuhna J, Chen MH, Jacques P, Ma J, Johnson A. Abstract MP63: Higher Alternative Healthy Eating Index Scores Including Greater EPA and DHA Consumption Are Associated With Attenuated Platelet Function in the Framingham Heart Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp63] [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: 03/16/2023]
Abstract
Introduction:
Dietary modification that reflects healthy eating is a notable strategy for CVD prevention on a population level. The cardioprotective role diet plays in hemostasis and thrombosis, particularly in respect to platelet function remains unclear.
Hypothesis:
Healthier Alternative Healthy Eating Index (AHEI) scores associate with attenuated platelet reactivity in a large-scale population cohort.
Methods:
Cross-sectional data was obtained from Framingham Heart Study participants (N=3,429). AHEI scores were derived from self-reported Harvard semi-quantitative food frequency questionnaires. Ranging from 0 to 110, higher AHEI scores reflect healthier overall diet quality. Five bioassays measured platelet reactivity traits across several agonists in whole blood and platelet-rich plasma samples. Linear mixed effects models adjusted for age, sex, aspirin use, family relatedness, daily energy intake, and BMI evaluated associations between platelet reactivity and AHEI scores and components.
Results:
Higher AHEI scores associated with attenuated platelet reactivity among 16 different traits (P<0.01), with notable decreased platelet aggregation to collagen, TRAP6 (PAR1 agonist), ADP, and ristocetin. Of the 11 AHEI components, higher EPA & DHA intake was most strongly associated to decreased platelet function with the greatest number of significant associations to platelet traits (18 traits, P<0.01) and moderate negative effect sizes (Figure 1).
Conclusions:
We report that higher AHEI scores associate with decreased platelet reactivity. Effects appear strongest for EPA & DHA intake consistent with several small randomized controlled trials. However, we found that a holistic AHEI score reflects a better interpretation of diet as a modulator of platelet function compared to individual components. Our results conclude that the impact of a healthier diet in preventing thrombosis may be partially mediated through a decline in platelet reactivity through multiple independent activation pathways.
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Lundquist DM, Jimenez R, Durbin S, Horick N, Healy M, Johnson A, Bame V, Capasso V, McIntyre C, Cashavelly B, Juric D, Nipp RD. Identifying Early-Phase Clinical Trial Participants at Risk for Experiencing Worse Clinical Outcomes. JCO Oncol Pract 2023:OP2200742. [PMID: 36791343 DOI: 10.1200/op.22.00742] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To identify early-phase clinical trial (EP-CT) participants at risk for experiencing worse clinical outcomes and describe receipt of supportive care services. METHODS A retrospective review of the electronic health records of consecutive patients enrolled in EP-CTs from 2017 to 2019 examined baseline characteristics, clinical outcomes, and receipt of supportive care services. The validated Royal Marsden Hospital (RMH) prognosis score was calculated using data at the time of EP-CT enrollment (scores range from 0 to 3; scores ≥ 2 indicate poor prognosis). Differences in patient characteristics, clinical outcomes, and receipt of supportive care services were compared on the basis of RMH scores. RESULTS Among 350 patients (median age = 63.2 years [range, 23.0-84.3 years], 57.1% female, 98.0% metastatic cancer), 31.7% had an RMH score indicating a poor prognosis. Those with poor prognosis RMH scores had worse overall survival (hazard ratio [HR], 2.00; P < .001), shorter time on trial (HR, 1.53; P < .001), and lower likelihood of completing the dose-limiting toxicity period (odds ratio, 0.42; P = .006) versus those with good prognosis scores. Patients with poor prognosis scores had greater risk of emergency room visits (HR, 1.66; P = .037) and hospitalizations (HR, 1.69; P = .016) while on trial, and earlier hospice enrollment (HR, 2.22; P = .006). Patients with poor prognosis scores were significantly more likely to receive palliative care consultation (46.8% v 27.6%; P < .001), but not other supportive care services. CONCLUSION This study found that RMH prognosis score could identify patients at risk for decreased survival, shorter time on trial, and greater use of health care services. The findings underscore the need to develop supportive care interventions targeting EP-CT participants' distinct needs.
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Affiliation(s)
- Debra M Lundquist
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Sienna Durbin
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nora Horick
- Biostats Center, Massachusetts General Hospital, Boston, MA
| | - Megan Healy
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Andrew Johnson
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Viola Bame
- Cancer Center Protocol Office, Massachusetts General Hospital, Boston, MA
| | - Virginia Capasso
- Department of Nursing & Patient Care Services, Massachusetts General Hospital, Boston, MA
| | - Casandra McIntyre
- Department of Nursing & Patient Care Services, Massachusetts General Hospital, Boston, MA
| | - Barbara Cashavelly
- Department of Nursing & Patient Care Services, Massachusetts General Hospital, Boston, MA
| | - Dejan Juric
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ryan D Nipp
- University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK
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Dayyani F, Macarulla T, Johnson A, Wainberg ZA. Second-line treatment options for patients with metastatic pancreatic ductal adenocarcinoma: A systematic literature review. Cancer Treat Rev 2023; 113:102502. [PMID: 36641880 DOI: 10.1016/j.ctrv.2022.102502] [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: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim of this review was to characterize the second- and later-line (≥2L) treatment landscape for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). METHODS This systematic literature review (PROSPERO: CRD42021279753) involved searches of MEDLINE® and Embase to identify results from prospective studies of ≥2L treatment options for metastatic pancreatic cancer published from 2016 to 2021. Publications were screened according to predetermined eligibility criteria; population-level data were extracted using standardized data fields. Publication quality was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The data were analyzed descriptively, grouped by drug class. RESULTS Sixty publications were identified, including 23 relating to comparative trials. GRADE assessment found that, of these 23 trials, 83% reported high or moderate-quality evidence. Of the publications relating to comparative trials, nine (three trials) reported favorable results: the pivotal phase 3 NAPOLI-1 trial for liposomal irinotecan; a phase 3 trial of non-liposomal irinotecan within the FOLFIRINOX regimen; and a phase 2 trial of eryaspase plus chemotherapy. CONCLUSIONS The level of unmet need for ≥2L treatment options for mPDAC remains high. Irinotecan-based regimens currently offer the greatest promise. Investigations into paradigm-changing agents and combination approaches continue.
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Affiliation(s)
| | - Teresa Macarulla
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Zhu A, Srivastava A, Dibianco J, Qi J, Dhir A, Maruf M, Ferrante S, Johnson A, Semerjian A, Davenport M, Mammen L, Dabaja A, Lane B, Ginsburg K, Witzke K, George A. Negative predictive value of prostate MRI in real world practice: Results from a statewide surgical collaborative in the United States. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00940-5] [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: 02/12/2023]
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35
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Thomas HR, Hu B, Boyraz B, Johnson A, Bossuyt VI, Spring L, Jimenez RB. Metaplastic breast cancer: A review. Crit Rev Oncol Hematol 2023; 182:103924. [PMID: 36696934 DOI: 10.1016/j.critrevonc.2023.103924] [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: 07/17/2022] [Revised: 12/19/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Metaplastic breast cancer (MpBC) is an uncommon aggressive malignancy that is associated with a poor prognosis. Due to its rarity, the relationships between the clinical and pathological features of MpBC, treatment approach, and clinical outcomes remain underexplored. In the following review article, we synthesize the existing data on the clinical, pathological and genomic features, management, and outcomes of MpBC. We also identify potential targets for future clinical trials.
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Affiliation(s)
- Horatio R Thomas
- Department of Radiation Oncology, University of California, San Francisco, United States.
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, United States
| | - Baris Boyraz
- Department of Pathology, Massachusetts General Hospital, United States
| | - Andrew Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, United States
| | - Veerle I Bossuyt
- Department of Pathology, Massachusetts General Hospital, United States
| | - Laura Spring
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, United States
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, United States
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36
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto E, Johnson A. Fetal coronary circulation: the middle cardiac vein. Ultrasound Obstet Gynecol 2023; 61:269-270. [PMID: 36056766 DOI: 10.1002/uog.26060] [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] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 08/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- E Hernandez-Andrade
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E S Huntley
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - M F Bartal
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Soto
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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37
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Kyron MJ, Johnson A, Hyett M, Moscovitch D, Wong Q, Bank SR, Erceg-Hurn D, McEvoy PM. Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder. Behav Res Ther 2023; 161:104253. [PMID: 36669272 DOI: 10.1016/j.brat.2023.104253] [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] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Improving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment. The current study explores the dynamic temporal associations between theory-driven cognitive and behavioural mechanisms of symptom change both during and following group CBT. METHODS A randomized controlled trial of imagery-enhanced CBT (n = 51) versus traditional verbal CBT (n = 54) for social anxiety was completed in a community mental health clinic setting. This study included data collected from 12-weekly sessions and a 1-month follow-up session. Mixed models were used to assess magnitude of change over the course of treatment. Cross-lagged panel models were fit to the data to examine temporal relationships between mechanisms (social-evaluative beliefs, safety behaviours) and social interaction anxiety symptoms. RESULTS Participants in both CBT groups experienced significant improvements across all cognitive, behavioural, and symptom measures, with no significant differences in the magnitude of changes between treatments. During treatment, greater social-evaluative beliefs (fear of negative evaluation, negative self-portrayals) at one time point (T) were predictive of more severe SAD symptoms and safety behaviours at T+1. Social-evaluative beliefs (fear of negative evaluation, probability and cost of social failure) and safety behaviours measured at post-treatment were positively associated with SAD symptoms at the 1-month follow-up. CONCLUSIONS The current study identifies social-evaluative beliefs that may be important targets for symptom and avoidance reduction during and following CBT. Assessment of these social-evaluative beliefs throughout treatment may be useful for predicting future SAD symptoms and avoidance, and for adapting treatment to promote optimal change for patients.
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Affiliation(s)
- Michael J Kyron
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - Andrew Johnson
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - Matthew Hyett
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - David Moscovitch
- Centre for Mental Health Research and Treatment, Department of Psychology, University of Waterloo, Canada
| | - Quincy Wong
- School of Psychology, Western Sydney University, Sydney, NSW, Australia
| | | | - David Erceg-Hurn
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia
| | - Peter M McEvoy
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia.
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38
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Xing D, Li S, Shang M, Wang W, Zhang Q, Wang J, Hasin T, Hettiarachchi D, Alston V, Bern L, Parrales AP, Lu C, Coogan M, Johnson A, Qin Z, Su B, Dunham R. A New Strategy for Increasing Knock-in Efficiency: Multiple Elongase and Desaturase Transgenes Knock-in by Targeting Long Repeated Sequences. ACS Synth Biol 2022; 11:4210-4219. [PMID: 36332126 DOI: 10.1021/acssynbio.2c00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CRISPR/Cas9-mediated knock-in (KI) has a wide application in gene therapy, gene function study, and transgenic breeding programs. Unlike gene therapy, which requires accurate KI to correct gene mutation, transgenic breeding programs can accept robust KI as long as integration does not interrupt normal gene functions and result in any negative pleiotropic effects. High KI efficiency is required to reduce the breeding cost and shorten the breeding period, especially in transferring multiple foreign genes to a single individual. To elevate the KI efficacy and achieve multiple gene KIs simultaneously, we introduced a new strategy that enables transgene integration into numerous sites of the genome by targeting long repeated sequences (LRSs). Using this simple strategy, for the first time we successfully generated transgenic fish carrying the masu salmon (Oncorhynchus masou) elovl2 gene and rabbitfish (Siganus canaliculatus) Δ4 fad and Δ6 fad genes, and achieved robust target KI of elovl2 and Δ6 fad genes at multiple sites of LRS1 and LRS3, respectively, in the initial generation. This demonstrated that donor plasmid homology arms, which were nearly identical but not completely the same as the genome sequence, still led to on-target KI. Although the target KI efficiencies at LRS1, LRS2, and LRS3 sites were still relatively low in the current study, it is very promising that 100% KI efficiency in the future could be realized and perfected by selection of better LRSs and optimization of sgRNAs.
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Affiliation(s)
- De Xing
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Shangjia Li
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Mei Shang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Wenwen Wang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Qin Zhang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Jinhai Wang
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Tasnuba Hasin
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Darshika Hettiarachchi
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Veronica Alston
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Logan Bern
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Abel Paladines Parrales
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Cuiyu Lu
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Michael Coogan
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Andrew Johnson
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Zhenkui Qin
- Ministry of Education Key Laboratory of Marine Genetics and Breeding, College of Marine Life Sciences, Ocean University of China, Qingdao266003, China
| | - Baofeng Su
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
| | - Rex Dunham
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, Alabama36849, United States
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Hock G, Johnson A, Barber P, Papa C. Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome. J Athl Train 2022:488563. [PMID: 36395374 DOI: 10.4085/1062-6050-138-22] [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] [Indexed: 02/17/2024]
Abstract
Thoracic outlet syndrome (TOS) involves an inconsistent set of symptoms that provides a challenge for medical providers to treat. Three categories of TOS are neurogenic, arterial, and venous. A combination of symptoms can occur and are most seen in overhead athletes. Symptoms may include pain, numbness, of an athlete to perform at their prior level of sport is impacted. Due to the variance in presentation and poor objective testing, there is not a well-defined examination process. It is suggested to perform an individualized assessment for each athlete. An athlete's medical team must communicate effectively as numerous specialists are usually involved to create a comprehensive treatment plan. Rehabilitation has been identified as a vital component in the recovery process. As an athletic trainer it is imperative to identify TOS and coordinate with the athlete's care team.
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Affiliation(s)
- Greg Hock
- Deparment of Sports Medicine Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew Johnson
- Department of Orthopedics and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick Barber
- Department of Orthopedics and Physical Performance, University of Rochester, Rochester, New York
| | - Cassidy Papa
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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Johnson A, Eltahir M, Xu Y. Histologic Features of a Solitary Fibrous Tumor in the Region of Oral Cavity and Maxillofacial Complex with Recurrence and Distant Metastasis: a Rare Case Report. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.061] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm, and may involve many anatomic locations. Approximately 0.6% of SFTs in the oral cavity and maxillofacial complex may recur and/or develop distant metastasis. Here we report a case of SFT in oral cavity with local recurrence and distant metastasis.
Methods/Case Report
The patient was a 66-year-old male with a past medical history of left buccal mass status post excision with an unclear diagnosis in a foreign country 6 years ago. He presented with a recurrence of the left buccal mass. Computerized tomography (CT) of the head and chest demonstrated a 9 cm expansile mass centered in the left pterygopalatine fossa and a 1.7 cm mass in left upper lobe of the lung, respectively. Biopsy of the lung mass was performed first and displayed a hypercellular mesenchymal tumor, composed of spindle cells arranged in vague short fascicles, and scant fibrous stroma with thin-walled and staghorn-like vasculature. The tumor cells had mild nuclear atypia with 5 mitoses/10 high power fields. No necrosis is identified. There were trapped benign pneumocytes and bronchial epithelial cells in the tumor. The tumor is positive for CD34, CD99, Bcl-2 and STAT6 immunostains. The large left buccal mass was biopsied later and showed similar morphology. The diagnoses of metastatic SFT in the lung and recurrent SFT were rendered, respectively.
Results (if a Case Study enter NA)
NA.
Conclusion
The histologic findings of the recurrent SFT and the pulmonary metastasis are similar in our case. Although marked cellular atypia and necrosis are not observed in either tumor, other features including the large size of recurrent tumor, hypercellularity, and increased mitotic activity are associated with malignant behavior in this report, and warrant the need for long-term follow-up.
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Affiliation(s)
- A Johnson
- Pathology & Immunology, Baylor College of Medicine , Houston, Texas , United States
| | - M Eltahir
- Pathology & Immunology, Baylor College of Medicine , Houston, Texas , United States
| | - Y Xu
- Pathology & Immunology, Baylor College of Medicine , Houston, Texas , United States
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Moody JD, Pollock BB, Sio H, Strozzi DJ, Ho DDM, Walsh CA, Kemp GE, Lahmann B, Kucheyev SO, Kozioziemski B, Carroll EG, Kroll J, Yanagisawa DK, Angus J, Bachmann B, Bhandarkar SD, Bude JD, Divol L, Ferguson B, Fry J, Hagler L, Hartouni E, Herrmann MC, Hsing W, Holunga DM, Izumi N, Javedani J, Johnson A, Khan S, Kalantar D, Kohut T, Logan BG, Masters N, Nikroo A, Orsi N, Piston K, Provencher C, Rowe A, Sater J, Skulina K, Stygar WA, Tang V, Winters SE, Zimmerman G, Adrian P, Chittenden JP, Appelbe B, Boxall A, Crilly A, O'Neill S, Davies J, Peebles J, Fujioka S. Increased Ion Temperature and Neutron Yield Observed in Magnetized Indirectly Driven D_{2}-Filled Capsule Implosions on the National Ignition Facility. Phys Rev Lett 2022; 129:195002. [PMID: 36399755 DOI: 10.1103/physrevlett.129.195002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The application of an external 26 Tesla axial magnetic field to a D_{2} gas-filled capsule indirectly driven on the National Ignition Facility is observed to increase the ion temperature by 40% and the neutron yield by a factor of 3.2 in a hot spot with areal density and temperature approaching what is required for fusion ignition [1]. The improvements are determined from energy spectral measurements of the 2.45 MeV neutrons from the D(d,n)^{3}He reaction, and the compressed central core B field is estimated to be ∼4.9 kT using the 14.1 MeV secondary neutrons from the D(T,n)^{4}He reactions. The experiments use a 30 kV pulsed-power system to deliver a ∼3 μs current pulse to a solenoidal coil wrapped around a novel high-electrical-resistivity AuTa_{4} hohlraum. Radiation magnetohydrodynamic simulations are consistent with the experiment.
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Affiliation(s)
- J D Moody
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B B Pollock
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H Sio
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D J Strozzi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D D-M Ho
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C A Walsh
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G E Kemp
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Lahmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S O Kucheyev
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Kozioziemski
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E G Carroll
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Kroll
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D K Yanagisawa
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Angus
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Bachmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S D Bhandarkar
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J D Bude
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Ferguson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Fry
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Hagler
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M C Herrmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W Hsing
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D M Holunga
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Javedani
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Johnson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Khan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Kalantar
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Kohut
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B G Logan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Masters
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Nikroo
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Orsi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Piston
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Provencher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Rowe
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Sater
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Skulina
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W A Stygar
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - V Tang
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S E Winters
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G Zimmerman
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Adrian
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J P Chittenden
- Centre for Inertial Fusion Studies, The Blackett Laboratory, Imperial College, London SW7 2AZ, United Kingdom
| | - B Appelbe
- Centre for Inertial Fusion Studies, The Blackett Laboratory, Imperial College, London SW7 2AZ, United Kingdom
| | - A Boxall
- Centre for Inertial Fusion Studies, The Blackett Laboratory, Imperial College, London SW7 2AZ, United Kingdom
| | - A Crilly
- Centre for Inertial Fusion Studies, The Blackett Laboratory, Imperial College, London SW7 2AZ, United Kingdom
| | - S O'Neill
- Centre for Inertial Fusion Studies, The Blackett Laboratory, Imperial College, London SW7 2AZ, United Kingdom
| | - J Davies
- University of Rochester, New York 14623, USA
| | - J Peebles
- Laboratory for Laser Energetics, New York 14623, USA
| | - S Fujioka
- Institute for Laser Engineering, Osaka University, 2-6 Yamada-Oka, Suita, Osaka 565-0871, Japan
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Perros P, Basu A, Boelaert K, Dayan C, Vaidya B, Williams GR, Lazarus JH, Hickey J, Drake WM, Crown A, Orme SM, Johnson A, Ray DW, Leese GP, Jones TH, Abraham P, Grossman A, Rees A, Razvi S, Gibb FW, Moran C, Madathil A, Žarković MP, Plummer Z, Jarvis S, Falinska A, Velusamy A, Sanderson V, Pariani N, Atkin SL, Syed AA, Sathyapalan T, Nag S, Gilbert J, Gleeson H, Levy MJ, Johnston C, Sturrock N, Bennett S, Mishra B, Malik I, Karavitaki N. Postradioiodine Graves' management: The PRAGMA study. Clin Endocrinol (Oxf) 2022; 97:664-675. [PMID: 35274331 DOI: 10.1111/cen.14719] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post-RI and compare effectiveness of common management strategies. DESIGN Retrospective, multicentre and observational study. PATIENTS Adult patients with Graves' disease treated with RI with 12 months' follow-up. MEASUREMENTS Euthyroidism was defined as both serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and <10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4. RESULTS Of 812 patients studied post-RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%-28.7%). No negative outcomes (new-onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events) were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres. CONCLUSIONS Dysthyroidism in the 12 months post-RI was common. Differences between post-RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism.
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Affiliation(s)
- Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ansu Basu
- Department of Endocrinology and Diabetes, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Imperial College London, London, UK
| | - John H Lazarus
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | - William M Drake
- Department of Endocrinology, St Bartholomews Hospital, London, UK
| | - Anna Crown
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Stephen M Orme
- Department of Endocrinology, St. James's University Hospital, Leeds, UK
| | - Andrew Johnson
- Department of Endocrinology and Diabetes, North Bristol NHS Trust, Bristol, UK
| | - David W Ray
- Manchester Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK
| | - Graham P Leese
- Department of Endocrinology and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Prakash Abraham
- Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ashley Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Aled Rees
- School of Medicine, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, Edinburgh, UK
| | - Carla Moran
- Addenbrooke's Hospital, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Asgar Madathil
- Department of Endocrinology and Metabolic Medicine, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Miloš P Žarković
- Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Sheba Jarvis
- Molecular Endocrinology Laboratory, Imperial College London, London, UK
| | | | - Anand Velusamy
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Violet Sanderson
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Nadia Pariani
- Addenbrooke's Hospital, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Stephen L Atkin
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
| | - Akheel A Syed
- Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Sath Nag
- Department of Endocrinology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jackie Gilbert
- Department of Endocrinology, King's College Hospital, London, UK
| | - Helena Gleeson
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Miles J Levy
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Colin Johnston
- Department of Endocrinology and Diabetes, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
| | - Nigel Sturrock
- Department of Endocrinology and Metabolic Medicine, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - Stuart Bennett
- Department of Endocrinology and Metabolic Medicine, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Biswa Mishra
- Department of Endocrinology and Metabolic Medicine, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Oldham, UK
| | - Isha Malik
- Department of Endocrinology and Metabolic Medicine, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Oldham, UK
| | - Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Fishel Bartal M, Bergh EP, Tsao K, Austin MT, Moise KJ, Fletcher SA, Garnett J, Mann L, Hernandez-Andrade E, Johnson A, Papanna R. Primary vs patch-based skin closure for in-utero spina bifida repair. Ultrasound Obstet Gynecol 2022; 60:666-672. [PMID: 35751885 DOI: 10.1002/uog.26018] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE During in-utero spina bifida (SB) repair, closure of large defects is often challenging, requiring tissue graft for watertight skin closure. No prior studies have compared primary skin closure vs patch-based repair. Our objective was to compare neonatal and 1-year outcomes associated with these two types of skin closure for in-utero SB repair. METHODS This was a prospective cohort study of 102 patients undergoing open prenatal SB repair from September 2011 to August 2021 at a single institution. All patients met the inclusion criteria of the Management of Myelomeningocele Study (MOMS), and the surgical procedure for in-utero SB repair was similar to that described in the MOMS trial. During the surgery, if primary skin approximation was not feasible due to the large size of the defect, the decision was at the discretion of the pediatric neurosurgeon to utilize a patch for closure. Neonatal outcomes at birth and 1-year outcomes were compared between the primary skin and patch-based closure groups. RESULTS Of 102 patients included in the study, 70 (68.6%) underwent primary skin closure and 32 (31.4%) patch-based closure. The patch type included acellular bovine skin matrix (Durepair®; n = 31) and human acellular dermal matrix (Alloderm®; n = 1). Fetuses with myeloschisis were more likely to require patch-based repair than those with myelomeningocele. The median time of fetal repair was 4 min longer for patch-based compared with primary skin closure (37 vs 33 min; P = 0.001). Following patch-based repair, neonates had a longer length of stay in the neonatal intensive care unit (NICU) by 24 days (adjusted risk ratio, 2.40 (95% CI, 1.41-4.29)) compared to those that underwent primary skin closure. There was no difference between the two groups in the other neonatal outcomes, including the need for ventriculoperitoneal shunt placement and cerebrospinal fluid leakage. Outcome at 1 year of age was available for 90 infants. Need for wound revision within their first year after birth was more common in infants who underwent patch-based vs those with primary skin closure (19.4% vs 5.1%; P = 0.05). There was no difference between the two groups in other 1-year outcomes, including the need for ventriculoperitoneal shunt placement by 1 year of age and surgery for tethered cord. CONCLUSIONS Patch-based closure during SB repair is often needed in fetuses with myeloschisis and is associated with prolonged fetal surgery time, long NICU stay and need for wound revision within the first year after birth. Further studies are required to identify optimal patches for SB repair or alternative methods to improve outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Fishel Bartal
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E P Bergh
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Tsao
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M T Austin
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K J Moise
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S A Fletcher
- Pediatric Neurosurgery, Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Garnett
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Mann
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Hernandez-Andrade
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Papanna
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Minto T, Abdelrahman T, Jones L, Wheat J, Key T, Shivakumar N, Ansell J, Seddon O, Cronin A, Tomkinson A, Theron A, Trickett RW, Sagua N, Sultana S, Clark A, McKay E, Johnson A, Behera K, Towler J, Kynaston H. Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board. Surg Open Sci 2022; 10:168-173. [PMID: 36211629 PMCID: PMC9531361 DOI: 10.1016/j.sopen.2022.09.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39–70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non–Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19–positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.
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Affiliation(s)
- T Minto
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Abdelrahman
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - L Jones
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Wheat
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - T Key
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Shivakumar
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - J Ansell
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - O Seddon
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Cronin
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Tomkinson
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - A Theron
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - RW Trickett
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW
| | - N Sagua
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - S Sultana
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Clark
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - E McKay
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - A Johnson
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - Karishma Behera
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - J Towler
- School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN
| | - H Kynaston
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XW,School of Medicine, Cardiff University, University Hospital of Wales Main Bldg, Heath Park, Cardiff, United Kingdom CF14 4XN,Corresponding author at: School of Medicine, Cardiff University, Cardiff, United Kingdom CF14 4XN.
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Fischer J, Bouhana K, Chicarelli M, Dahlke J, Fell B, Fulton J, Guarnieri A, Haygood L, Jalluri R, Johnson A, McLean B, Max M, Rieger R, Robinson J, Rodriguez M, Sullivan F, Wang Y, Winski S, Zhou Y. In Vivo Pre-clinical characterization of a Novel Series of FGFR2 Selective Inhibitors with Potency Against Clinically Relevant Mutations. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01016-4] [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: 11/03/2022]
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Durbin S, Lundquist D, Healy M, Lynch K, Bame V, Martin T, Johnson A, Heldreth H, Turbini V, McIntyre C, Juric D, Jimenez R, Nipp RD. Time toxicity in early phase clinical trials (EP-CTs). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.236] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
236 Background: EP-CTs are an increasingly important treatment option for patients with cancer, yet often require intensive monitoring. Little is known about the time that EP-CT participants spend in-hospital, and how that time compares to study requirements. Methods: We retrospectively reviewed the electronic health record (EHR) of consecutive patients enrolled in EP-CTs at Massachusetts General Hospital from 2017-2019 to obtain patient characteristics (demographics and clinical factors) and EP-CT investigational agent (immunomodulatory therapy [IM], targeted inhibitor [TI], antibody drug conjugate [ADC]/chemotherapy prodrug). We identified protocol requirements by reviewing the study calendar for in-hospital days for any reason, including clinician visits and diagnostic tests. We identified the real-world number of days spent at the hospital by reviewing the EHR for in-hospital days. We used descriptive statistics to compare patient characteristics and outcomes for those with higher time toxicity, defined as 5+ real-world visits during the first 28 days on trial, versus lower time toxicity. Results: Among 421 patients (median age = 63.0 years, 56.9% female, 97.6% metastatic disease), 43.2% participated in IM trials, 43.0% TI, and 13.8% ADC. Most common tumor types were gastrointestinal (GI) (22.3%) and lung (20.0%). Over the first 28 days on trial, protocol requirements listed an average of 5.2 in-hospital days, yet real-world data demonstrated that patients had an average of 6.6 in-hospital days (p < 0.001). TI trial participants had the highest average number of anticipated protocol visits compared with those on other trials (5.5 [TI] vs 5.3 [ADC] vs 5.0 [IM], p = 0.027). In real-world data, those on ADC trials had the highest average number of visits (7.5 [ADC] vs 7.1 [TI] vs 5.7 [IM], p < 0.001). Those with 5+ real-world visits during the first 28 days were more likely to have GI cancer (25.8% vs 13.9%, p = 0.011) and less likely to have lung cancer (16.7% vs 27.9%, p = 0.011). Patients with more visits were also less likely to have traveled 50+ miles to the hospital (48.8% vs 59.8%, p = 0.04). Notably, 19.5% of patients (N = 82) were hospitalized during the first 28 days on trial, with an average length of stay of 4.9 days. Those with 5+ visits had fewer days, on average, from trial start to admission (371.9 vs 650.8, p < 0.001) and fewer days on trial (mean 156.0 vs 235.0, p = 0.001). There was no significant difference in days from trial start to death for those with higher versus lower time toxicity (mean 464.6 vs 526.4, p = 0.177). Conclusions: EP-CTs represent a potentially time-intensive treatment option, as we found that patients spend over one-fifth of their first 28 days on trial at the hospital for various visits. Our findings indicate that patients may often experience more in-hospital days than what the protocol states. These data could help inform patient-clinician discussions regarding EP-CT participation and the potential time toxicity involved.
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Affiliation(s)
| | | | | | | | - Viola Bame
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Coogan M, Alston V, Su B, Khalil K, Elaswad A, Khan M, Johnson A, Xing D, Li S, Wang J, Simora RMC, Lu C, Page-McCaw P, Chen W, Michel M, Wang W, Hettiarachchi D, Hasin T, Butts IAE, Cone RD, Dunham RA. Improved Growth and High Inheritance of Melanocortin-4 Receptor (mc4r) Mutation in CRISPR/Cas-9 Gene-Edited Channel Catfish, Ictalurus punctatus. Mar Biotechnol (NY) 2022; 24:843-855. [PMID: 35943638 DOI: 10.1007/s10126-022-10146-8] [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] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Effects of CRISPR/Cas9 knockout of the melanocortin-4 receptor (mc4r) gene in channel catfish, Ictalurus punctatus, were investigated. Three sgRNAs targeting the channel catfish mc4r gene in conjunction with Cas9 protein were microinjected in embryos and mutation rate, inheritance, and growth were studied. Efficient mutagenesis was achieved as demonstrated by PCR, Surveyor® assay, and DNA sequencing. An overall mutation rate of 33% and 33% homozygosity/bi-allelism was achieved in 2017. Approximately 71% of progeny inherited the mutation. Growth was generally higher in MC4R mutants than controls (CNTRL) at all life stages and in both pond and tank environments. There was a positive relationship between zygosity and growth, with F1 homozygous/bi-allelic mutants reaching market size 30% faster than F1 heterozygotes in earthen ponds (p = 0.022). At the stocker stage (~ 50 g), MC4R × MC4R mutants generated in 2019 were 40% larger than the mean of combined CNTRL × CNTRL families (p = 0.005) and 54% larger than F1 MC4R × CNTRL mutants (p = 0.001) indicating mutation may be recessive. With a high mutation rate and inheritance of the mutation as well as improved growth, the use of gene-edited MC4R channel catfish appears to be beneficial for application on commercial farms.
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Affiliation(s)
- Michael Coogan
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - Veronica Alston
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Baofeng Su
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Karim Khalil
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Ahmed Elaswad
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
- Department of Animal Wealth Development, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Mohd Khan
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
- Department of Fisheries Biology and Genetics, Agricultural University, Mymensingh, 2202, Bangladesh
| | - Andrew Johnson
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - De Xing
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Shangjia Li
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Jinhai Wang
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Rhoda M C Simora
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
- College of Fisheries and Ocean Sciences, University of the Philippines Visayas, 5023, Miagao, Iloilo, Philippines
| | - Cuiyu Lu
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Patrick Page-McCaw
- Department of Molecular and Integrative Physiology, Vanderbilt University, Nashville, TN, 37203-5721, USA
| | - Wenbiao Chen
- Department of Molecular and Integrative Physiology, Vanderbilt University, Nashville, TN, 37203-5721, USA
| | - Max Michel
- Department of Molecular and Integrative Physiology, Vanderbilt University, Nashville, TN, 37203-5721, USA
| | - Wenwen Wang
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | | | - Tasnuba Hasin
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Ian A E Butts
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
| | - Roger D Cone
- Department of Molecular and Integrative Physiology, Vanderbilt University, Nashville, TN, 37203-5721, USA
| | - Rex A Dunham
- Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA
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Ngoi N, Pilie P, Piha-Paul S, Dumbrava E, Fu S, Hong D, Karp D, Naing A, Pant S, Rodon Ahnert J, Subbiah V, Tsimberidou A, Salguero C, Brown C, Hoadley W, Johnson A, Yuan Y, Westin S, Meric-Bernstam F, Yap T. DNA Damage Response (DDR) Basket of Baskets (D-BOB) Trial: Phase 1/2 Study of the ATR inhibitor (ATRi) berzosertib and PD-L1 inhibitor avelumab in patients (pts) with advanced solid tumors with DDR molecular alterations. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00828-0] [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: 11/03/2022]
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Lundquist D, Pelletier A, Durbin S, Bame V, Turbini V, Lynch K, Johnson A, Heldreth H, Healy M, McIntyre C, Juric D, Jimenez R, Ferrell BR, Nipp RD. Patient-reported hope, quality of life, symptom burden, coping, and financial toxicity in early-phase clinical trial participants. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.275] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
275 Background: Early phase clinical trials (EP-CTs) investigate novel treatment options in oncology, with recent advances in personalized therapy leading to improved outcomes and offering hope to patients with cancer. However, little research has sought to understand associations of patient-reported hope with quality of life (QOL), symptom burden, coping, and financial toxicity in EP-CT participants. Methods: We prospectively enrolled consecutive adults with cancer participating in EP-CTs at Massachusetts General Hospital from 04/2021-05/2022. Participants completed baseline surveys prior to treatment initiation that assessed hope (Herth Hope Index [HHI], higher scores indicate greater hope), QOL (Functional Assessment of Cancer Therapy-General), symptom burden (physical: Edmonton Symptom Assessment System [ESAS]; psychological: Patient Health Questionaire-4 [PHQ4]), coping (Brief COPE: self-blame, acceptance, denial, emotional support, active, behavioral disengagement), and financial toxicity (COST tool, higher scores indicate greater financial wellbeing). We used regression models to determine associations of hope scores with patient-reported QOL, symptom burden, coping, and financial toxicity. Results: Of 157 eligible patients, we enrolled 129 (enrollment rate 82.2%, median age = 62.5 years [range 33.0-83.0], 53.9% female, and 96.0% metastatic cancer). Most common cancer types were gastrointestinal (37.5%), breast (20.3%), lung (8.6%), and head and neck (7.8%). Patients had an average HHI score of 27.5 (range 15.3 – 36.0), with 30.5% reporting high levels of hope. We found associations of higher hope scores with better QOL (B = 0.24, p < 0.001) and lower symptom burden (ESAS-physical: B = -0.14, p < 0.001; PHQ4-depression: B = -2.07, p < 0.001; PHQ4-anxiety: B = -0.93, p = 0.001). We also found that hope scores were associated with patients’ coping (self-blame [B = -1.44, p < 0.001]; acceptance [B = 1.40, p < 0.001], denial [B = -1.12, p = 0.004], emotional support [B = 0.99, p < 0.001], active [B = 1.02. p = 0.001], behavioral disengagement [B = -2.52, p < 0.001]). Lastly, we found that higher hope scores were associated with greater financial wellbeing (B = 0.11, p = 0.026). Conclusions: In this prospective cohort study, we demonstrated a substantial proportion of EP-CT participants had high baseline hope and identified associations of hope scores with other important patient-reported outcomes. Specifically, we found novel associations of higher hope scores with better QOL, lower symptom burden, more adaptive coping mechanisms, and greater financial wellbeing, underscoring the importance of targeting these patient-reported outcomes when seeking to enhance the care experience of EP-CT participants.
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Affiliation(s)
| | | | | | - Viola Bame
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Heslop E, Cammish P, McNiff M, Pegg K, Irvin A, Reuben E, Johnson A, Gaeta A, Turner C, Fischer R, Peay H, Muntoni F, Childs A, Straub V, Guglieri M. P.125 DMD Hub: A UK network enabling trials in Duchenne muscular dystrophy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.241] [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: 11/05/2022]
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