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Twigg E, Roberts E, Sharp A, Iraba J, Chapa P, Freeland H, Mavura D. Daylight photodynamic therapy as a treatment for actinic field change in patients diagnosed with oculocutaneous albinism in sub-Saharan Africa. Clin Exp Dermatol 2024; 49:484-490. [PMID: 37995284 DOI: 10.1093/ced/llad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Oculocutaneous albinism (OCA) is a genetically inherited condition, whereby melanin is reduced or absent in the skin. A lack of melanin predisposes people to actinic damage and skin malignancies. In Tanzania, a resource-limited country, the treatment of choice for precancerous skin lesions is cryotherapy. OBJECTIVES To investigate whether daylight photodynamic therapy (dPDT) is a safe and well-tolerated treatment for actinic field change in the OCA population in Tanzania. METHODS Twelve participants with actinic damage were recruited from a Standing Voice skin surveillance clinic and treated with dPDT. Study participants completed tolerability and acceptability questionnaires at day 5 and 3 months after treatment. A dermatologist assessed their clinical response to dPDT at 3 months. RESULTS dPDT was well-tolerated and acceptable to the majority of patients. Actinic damage was reduced by 25-90%. No skin cancers developed during the treatment. CONCLUSIONS This pilot study suggests that dPDT is a safe and tolerable treatment for actinic damage in people with OCA in Tanzania. Further work is required to compare the efficacy of dPDT against other topical therapies for actinic field change.
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Affiliation(s)
- Emily Twigg
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elizabeth Roberts
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Sharp
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Peter Chapa
- Dodoma Regional Referral Hospital, Dodoma, Tanzania
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Liu S, Sharp A, Lane S, Villanueva EV, Lu Z, Ma ZF. Low Iodine Nutrition Knowledge in Chinese Breastfeeding Women despite Adequate Iodine Status. Nutrients 2024; 16:491. [PMID: 38398815 PMCID: PMC10891795 DOI: 10.3390/nu16040491] [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: 01/09/2024] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
There has been a scarcity of evidence about iodine nutrition knowledge among women during pregnancy and lactation. The aim of this study was to determine women's iodine knowledge and the relationship between knowledge and iodine status during pregnancy and lactation. Women were recruited from a hospital in the western part of China in the third trimester of pregnancy and followed until the end of the first week of lactation. The women's iodine status was measured by their urinary iodine concentration (UIC) and an iodine-specific, validated food frequency questionnaire (FFQ). Iodine nutrition knowledge was assessed using an iodine nutrition knowledge questionnaire. A total of 200 women (mean age of 29.0 ± 4.2 years) completed the whole study. The majority of the women did not consume enough iodine during both pregnancy and lactation (231.89 vs. 237.26 µg/day). The overall mean iodine knowledge scores in our sample of women during pregnancy and lactation were 4.77 and 4.87, indicating low iodine knowledge. The use of iodized salt and a higher education level were significantly associated with an increased iodine knowledge score. In conclusion, this study reported poor iodine nutrition knowledge in women, highlighting a public health concern. Therefore, the iodine knowledge of women should be improved, possibly via maternal health campaigns to avoid the consequences of iodine deficiency disorders in newborns.
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Affiliation(s)
- Shuchang Liu
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L8 7SS, UK
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool L16 9JD, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Steven Lane
- Health Data Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Elmer V. Villanueva
- School of Science, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- First Year College, Victoria University, Footscray, VIC 3011, Australia
| | - Zhiliang Lu
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Zheng Feei Ma
- School of Science, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, University of the West of England, Bristol BS16 1QY, UK
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Liu S, Sharp A, Luo X, Lane S, Villanueva EV, Lu Z, Ma ZF. The use of breast milk iodine concentration in the first week of lactation as a biomarker of iodine status in breast-feeding women. Br J Nutr 2024; 131:286-295. [PMID: 37642155 DOI: 10.1017/s0007114523001897] [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] [Indexed: 08/31/2023]
Abstract
Breast milk iodine concentration (BMIC) is a promising indicator of iodine status in lactating women. However, there are limited data on its usefulness to reflect maternal iodine deficiency. Therefore, the aim of our study was to assess iodine concentration in breast milk and urine samples in exclusively breast-feeding women. Eligible pregnant women undergoing routine antenatal care in a large hospital in Shaanxi Province, China, were followed up from the third trimester of pregnancy until the first week of lactation. Urine samples (20 ml) were collected during pregnancy and lactation. Iodine concentration in samples was measured based on Sandell-Kolthoff reaction. Breast milk samples (5 ml) were provided during lactation. A receiver operating curve (ROC) was constructed to determine the diagnostic performance of BMIC. An iodine-specific FFQ was completed twice during pregnancy and lactation. A total of 200 women completed the study. The overall median BMIC was 89 μg/l, indicating iodine sufficiency (i.e. BMIC reference range between 60 and 465 μg/l). Women reported similar median urinary iodine concentration (UIC) during pregnancy and lactation (112 and 113 μg/l, respectively), but their iodine status differed - mild-to-moderate iodine deficiency during pregnancy and iodine sufficiency during lactation. The ROC for BMIC using UIC as a reference standard was 0·755 (95 % CI: 0·644, 0·866). In conclusion, this study demonstrated that women were iodine sufficient in the first week of lactation as assessed by UIC, which was consistent with BMIC. These findings suggested that BMIC is a useful biomarker to assess iodine status in lactating women.
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Affiliation(s)
- Shuchang Liu
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou215123, People's Republic of China
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, LiverpoolL8 7SS, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, LiverpoolL8 7SS, UK
| | - Xiaoqin Luo
- School of Public Health, Xi'an Jiaotong University, Xi'an710006, People's Republic of China
| | - Steven Lane
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Elmer V Villanueva
- School of Science, Xi'an Jiaotong-Liverpool University, Suzhou215123, People's Republic of China
- Victoria University, Footscray Victoria Melbourne3011, Australia
| | - Zhiliang Lu
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou215123, People's Republic of China
| | - Zheng Feei Ma
- School of Science, Xi'an Jiaotong-Liverpool University, Suzhou215123, People's Republic of China
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, University of the West of England, BristolBS16 1QY, UK
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Matsumura M, Maehara A, Davis JE, Kumar G, Sharp A, Samady H, Seto AH, Cohen D, Patel MR, Ali ZA, Stone GW, Jeremias A. Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy. EUROINTERVENTION 2023; 19:e903-e912. [PMID: 38031488 PMCID: PMC10719742 DOI: 10.4244/eij-d-23-00517] [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] [Received: 06/27/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Justin E Davis
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Andrew Sharp
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | | | - David Cohen
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
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Liu S, Sharp A, Lu Z, Ma ZF. Maternal iodine intake and adherence to iodine supplement recommendations in a group of Chinese women: the results from the WIN cohort study - CORRIGENDUM. Proc Nutr Soc 2023; 82:492. [PMID: 37078399 DOI: 10.1017/s0029665123002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- S Liu
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - A Sharp
- Harris-Wellbeing Research Centre, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Z Lu
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Z F Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
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Mayer AW, Sharp A, Aziz S, Balasubramanian SP. Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism. J Laryngol Otol 2023; 137:1226-1232. [PMID: 36876328 DOI: 10.1017/s002221512300035x] [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] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. METHODS A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. RESULTS Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). CONCLUSION Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.
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Affiliation(s)
- A W Mayer
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Sharp
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Aziz
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Demetri A, Davies A, Bakhbakhi D, Ijaz S, Dawson S, McGuinness S, Beasor G, Clayton G, Johnson A, de Souza C, Dempsey A, Snook G, Sharp A, Lissauer D, McGoldrick E, Burden C, Merriel A. Vaginal birth core information set: study protocol for a Delphi study to achieve a consensus on a 'core information set' for vaginal birth. BMJ Open 2023; 13:e070215. [PMID: 37550021 PMCID: PMC10407363 DOI: 10.1136/bmjopen-2022-070215] [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: 11/17/2022] [Accepted: 05/05/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Studies have shown that women are often underinformed about potential benefits and risks of vaginal birth. This is in contrast to other modes of birth, such as caesarean birth, for which the risks/benefits are often conveyed prior to undergoing the procedure. A core information set (CIS) is an agreed set of information points that should be discussed with all patients prior to undergoing a procedure or intervention. This CIS could improve the quality of information given regarding mode of birth options, as women will be given information prioritised by patients and stakeholders regarding vaginal birth, empowering them to make informed decisions about their birth. We aim to describe the protocol for the development of this vaginal birth CIS. METHODS AND ANALYSIS We will develop the CIS by: (1) Compiling a 'long-list' of information points about vaginal birth by: undertaking a scoping review of studies and patient information leaflets; interviews with antenatal/postnatal women, an online survey of stakeholders. (2) Collating the 'long-list' of information points and developing the Delphi survey. Think-aloud interviews will refine the survey. (3) Conducting a two-round Delphi survey. 200 stakeholder participants will be recruited. Items rated critically important by ≥80% of participants in one stakeholder group, or with no consensus, will be carried through to a stakeholder consensus meeting to decide the final CIS. Planned start date is 1 June 2022. Planned end date is 31 August 2023. ETHICS AND DISSEMINATION This project has been given a favourable ethics opinion by the University of Bristol Research Ethics Committee (Ref: 10530). Approval from the ethics committee will be sought for any protocol amendments, and the principal investigator will be responsible for these changes. Findings will be presented at relevant conferences and published in a high-impact journal. We will disseminate the CIS, via Policy Bristol, to clinical policy and guideline developers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Aine Dempsey
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Andrew Sharp
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - David Lissauer
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Abi Merriel
- University of Bristol, Bristol, UK
- Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
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Stampalija T, Bhide A, Heazell AEP, Sharp A, Lees C. Computerized cardiotocography and Dawes-Redman criteria: how should we interpret criteria not met? Ultrasound Obstet Gynecol 2023; 61:661-666. [PMID: 36905681 DOI: 10.1002/uog.26198] [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: 01/11/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/03/2023]
Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - A Bhide
- 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
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - C Lees
- Institute of Developmental and Reproductive Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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Gent J, Oliver E, Quigley H, Sharp A. Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2023; 286:23-27. [PMID: 37167810 DOI: 10.1016/j.ejogrb.2023.04.024] [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: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. STUDY DESIGN Retrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. RESULTS A total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant. DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003-0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28-0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25-0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. CONCLUSION Our data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.
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Affiliation(s)
- J Gent
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom.
| | - E Oliver
- University of Liverpool, United Kingdom
| | - H Quigley
- University of Liverpool, United Kingdom
| | - A Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, United Kingdom
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Ohene Y, Harris WJ, Powell E, Wycech NW, Smethers KF, Lasič S, South K, Coutts G, Sharp A, Lawrence CB, Boutin H, Parker GJM, Parkes LM, Dickie BR. Filter exchange imaging with crusher gradient modelling detects increased blood-brain barrier water permeability in response to mild lung infection. Fluids Barriers CNS 2023; 20:25. [PMID: 37013549 PMCID: PMC10071630 DOI: 10.1186/s12987-023-00422-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023] Open
Abstract
Blood-brain barrier (BBB) dysfunction occurs in many brain diseases, and there is increasing evidence to suggest that it is an early process in dementia which may be exacerbated by peripheral infection. Filter-exchange imaging (FEXI) is an MRI technique for measuring trans-membrane water exchange. FEXI data is typically analysed using the apparent exchange rate (AXR) model, yielding estimates of the AXR. Crusher gradients are commonly used to remove unwanted coherence pathways arising from longitudinal storage pulses during the mixing period. We first demonstrate that when using thin slices, as is needed for imaging the rodent brain, crusher gradients result in underestimation of the AXR. To address this, we propose an extended crusher-compensated exchange rate (CCXR) model to account for diffusion-weighting introduced by the crusher gradients, which is able to recover ground truth values of BBB water exchange (kin) in simulated data. When applied to the rat brain, kin estimates obtained using the CCXR model were 3.10 s-1 and 3.49 s-1 compared to AXR estimates of 1.24 s-1 and 0.49 s-1 for slice thicknesses of 4.0 mm and 2.5 mm respectively. We then validated our approach using a clinically relevant Streptococcus pneumoniae lung infection. We observed a significant 70 ± 10% increase in BBB water exchange in rats during active infection (kin = 3.78 ± 0.42 s-1) compared to before infection (kin = 2.72 ± 0.30 s-1; p = 0.02). The BBB water exchange rate during infection was associated with higher levels of plasma von Willebrand factor (VWF), a marker of acute vascular inflammation. We also observed 42% higher expression of perivascular aquaporin-4 (AQP4) in infected animals compared to non-infected controls, while levels of tight junction proteins remain consistent between groups. In summary, we propose a modelling approach for FEXI data which removes the bias in estimated water-exchange rates associated with the use of crusher gradients. Using this approach, we demonstrate the impact of peripheral infection on BBB water exchange, which appears to be mediated by endothelial dysfunction and associated with an increase in perivascular AQP4.
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Affiliation(s)
- Yolanda Ohene
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK.
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - William J Harris
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elizabeth Powell
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Neuroinflammation, UCL, London, UK
| | - Nina W Wycech
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine F Smethers
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Samo Lasič
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Random Walk Imaging, Lund, Sweden
| | - Kieron South
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Graham Coutts
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Andrew Sharp
- Evotec (UK) Ltd., Alderley Park, Block 23F, Mereside, Cheshire, SK10 4TG, UK
| | - Catherine B Lawrence
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hervé Boutin
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Geoff J M Parker
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering and Department of Neuroinflammation, UCL, London, UK
- Bioxydyn Limited, Manchester, UK
| | - Laura M Parkes
- Division of Psychology, Communication and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Oxford Road, Manchester, M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ben R Dickie
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Oliver E, Navaratnam K, Gent J, Khalil A, Sharp A. Comparison of International Guidelines on the Management of Twin Pregnancy. Eur J Obstet Gynecol Reprod Biol 2023; 285:97-104. [PMID: 37087836 DOI: 10.1016/j.ejogrb.2023.04.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To review current international clinical guidelines on the antenatal and intrapartum management of twin pregnancies, examining areas of consensus and conflict. METHODS We conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted. RESULTS We identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS). For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring. The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management. CONCLUSIONS This review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.
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12
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Taylor J, Sharp A, Rannard SP, Arrowsmith S, McDonald TO. Nanomedicine strategies to improve therapeutic agents for the prevention and treatment of preterm birth and future directions. Nanoscale Adv 2023; 5:1870-1889. [PMID: 36998665 PMCID: PMC10044983 DOI: 10.1039/d2na00834c] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 06/19/2023]
Abstract
The World Health Organisation (WHO) estimates 15 million babies worldwide are born preterm each year, with 1 million infant mortalities and long-term morbidity in survivors. Whilst the past 40 years have provided some understanding in the causes of preterm birth, along with development of a range of therapeutic options, notably prophylactic use of progesterone or uterine contraction suppressants (tocolytics), the number of preterm births continues to rise. Existing therapeutics used to control uterine contractions are restricted in their clinical use due to pharmacological drawbacks such as poor potency, transfer of drugs to the fetus across the placenta and maternal side effects from activity in other maternal systems. This review focuses on addressing the urgent need for the development of alternative therapeutic systems with improved efficacy and safety for the treatment of preterm birth. We discuss the application of nanomedicine as a viable opportunity to engineer pre-existing tocolytic agents and progestogens into nanoformulations, to improve their efficacy and address current drawbacks to their use. We review different nanomedicines including liposomes, lipid-based carriers, polymers and nanosuspensions highlighting where possible, where these technologies have already been exploited e.g. liposomes, and their significance in improving the properties of pre-existing therapeutic agents within the field of obstetrics. We also highlight where active pharmaceutical agents (APIs) with tocolytic properties have been used for other clinical indications and how these could inform the design of future therapeutics or be repurposed to diversify their application such as for use in preterm birth. Finally we outline and discuss the future challenges.
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Affiliation(s)
- Jessica Taylor
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
| | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool Crown Street Liverpool L8 7SS UK
| | - Steve P Rannard
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool Liverpool L7 3NY UK
| | - Sarah Arrowsmith
- Department of Life Sciences, Manchester Metropolitan University Chester Street Manchester M1 5GD UK
| | - Tom O McDonald
- Department of Chemistry, University of Liverpool Crown Street Liverpool L69 7ZD UK
- Department of Materials, Henry Royce Institute, The University of Manchester Manchester M13 9PL UK
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13
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Al Bahhawi T, Aqeeli A, Harrison SL, Lane DA, Skjøth F, Buchan I, Sharp A, Auger N, Lip GYH. Pregnancy-Related Complications and Incidence of Atrial Fibrillation: A Systematic Review. J Clin Med 2023; 12:jcm12041316. [PMID: 36835851 PMCID: PMC9959873 DOI: 10.3390/jcm12041316] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Pregnancy-related complications are associated with a higher risk of various incident cardiovascular diseases, but their specific potential relationship with incident atrial fibrillation (AF) is less clear. This systematic review summarises the available evidence from observational studies which have examined associations between pregnancy-related complications and the risk of AF. MEDLINE and EMBASE (Ovid) were searched for studies between 1990 to 10 February 2022. Pregnancy-related complications examined included hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, small-for-gestational-age and stillbirth. Study selection, data extraction and quality assessment were completed independently by two reviewers. Narrative synthesis was used to evaluate the results of the included studies. Nine observational studies were included, with eight eligible for narrative synthesis. Sample sizes ranged from 1839 to 2,359,386. Median follow-up ranged from 2 to 36 years. Six studies reported that pregnancy-related complications were associated with a significantly increased risk of incident AF. Hazard ratios (HRs) (95% confidence intervals) for the four studies that evaluated HDP ranged from 1.1 (0.8-1.6) to 1.9 (1.4-2.7). For the four studies that evaluated pre-eclampsia, HRs ranged from 1.2 (0.9-1.6) to 1.9 (1.7-2.2). Current evidence from observational studies suggests pregnancy-related complications are associated with a significantly higher risk of incident AF. However, only a small number of studies examining each pregnancy-related complication were identified, and considerable statistical heterogeneity was observed. Further large-scale prospective studies are required to confirm the association between pregnancy-related complications and incident AF.
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Affiliation(s)
- Tariq Al Bahhawi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Faculty of Medicine, Jazan University, Jazan 82817, Saudi Arabia
| | - Abdulwahab Aqeeli
- Faculty of Medicine, Jazan University, Jazan 82817, Saudi Arabia
- Joint Program of Preventive Medicine, Saudi Commission for Health Specialties, Jeddah 21589, Saudi Arabia
| | - Stephanie L. Harrison
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
| | - Flemming Skjøth
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9100 Aalborg, Denmark
| | - Iain Buchan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Research Centre, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, School of Public Health, University of Montreal, Montreal, QC H2X 0A9, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
- Correspondence: ; Tel.: +44-(0)151-794-9020
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14
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Abstract
While there is not a wide range of pregnancy-specific drugs, there are some very specific high-risk areas of obstetric care for which unique pharmacological approaches have been established. In preterm birth, labor induction and augmentation, and the management of postpartum hemorrhage, these pharmacological approaches have become the bedrock in managing some of the most common and problematic areas of antenatal and intrapartum care. In this review, we summarize the existing established and emerging evidence that supports and broadens these pharmacological approaches to obstetric management and its impact on clinical practice. It is clear that existing therapeutics are limited. They have largely been developed from our knowledge of the physiology of the myometrium and act on hormonal receptors and their signaling pathways or on ion channels influencing excitability. Newer drugs in development are mostly refinements of these two approaches, but novel agents from plants and improved formulations are also discussed.
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Affiliation(s)
- Susan Wray
- Women's & Children's Health, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, United Kingdom;
| | - Sarah Arrowsmith
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Andrew Sharp
- Women's & Children's Health, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, United Kingdom;
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15
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Kinnaird T, Gallagher S, Farooq V, Protty M, Back L, Devlin P, Anderson R, Sharp A, Ludman P, Copt S, Mamas MA, Curzen N. Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017. Circ Cardiovasc Interv 2023; 16:e012350. [PMID: 36649390 DOI: 10.1161/circinterventions.122.012350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain. METHODS Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI. RESULTS Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events. CONCLUSIONS Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.).,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom (T.K., M.A.M.)
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Vasim Farooq
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Majd Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Liam Back
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Peadar Devlin
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Andrew Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., V.F., M.P., L.B., P.D., R.A., A.S.)
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, United Kingdom (P.L.)
| | - Samuel Copt
- Division of Statistics, Biosensors SA, Morges, Switzerland (S.C.)
| | - Mamas A Mamas
- Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.).,Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom (T.K., M.A.M.)
| | - Nick Curzen
- Department of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom (N.C.)
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16
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Navaratnam K, Khairudin D, Chilton R, Sharp A, Attilakos G, Stott D, Relph S, Spencer R, Badr DA, Carlin A, Jani J, Kilby MD, Sebghati M, Khalil A, Alfirevic Z. Foetal loss after chorionic villus sampling and amniocentesis in twin pregnancies: A multicentre retrospective cohort study. Prenat Diagn 2022; 42:1554-1561. [PMID: 36097373 PMCID: PMC9828484 DOI: 10.1002/pd.6237] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We aimed to determine foetal losses for DCDA and MCDA twins following transabdominal CVS or amniocentesis performed <22+0 weeks. METHODS Retrospective cohort study conducted in the UK and Belgium 01/01/00-01/06/20. Cases with unknown chorionicity, monochorionic complications or complex procedures were excluded. Uncomplicated DCDA and MCDA twins without invasive procedures were identified as controls. We reported foetal losses <24+0 weeks and losses of genetically and structurally normal foetuses. RESULTS Outcomes were compared for DCDA foetuses; 258 after CVS with 3406 controls, 406 after amniocentesis with 3390 controls plus MCDA foetuses, 98 after CVS with 1124 controls, and 160 after amniocentesis with 1122 controls. There were more losses <24+0 weeks with both procedures in DCDA (CVS RR 5.54 95% CI 3.38-9.08, amniocentesis RR 2.36 95% CI 1.22-4.56) and MCDA twins (CVS RR 5.14 95% CI 2.51-10.54, amniocentesis RR 7.01 95% CI 3.86-12.74). Losses of normal foetuses were comparable to controls (DCDA CVS RR 0.39 95% CI 0.05-2.83, DCDA amniocentesis RR 1.16 95% CI 0.42-3.22, MCDA CVS RR 2.3 95% CI 0.71-7.56, and MCDA amniocentesis RR 1.93 95% CI 0.59-6.38). CONCLUSIONS This study indicates increased foetal losses for DCDA and MCDA twins following CVS and amniocentesis with uncertain risk to normal foetuses.
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Affiliation(s)
- Kate Navaratnam
- Fetal Medicine UnitLiverpool Women’s HospitalLiverpoolUK,Harris‐Wellbeing Research CentreUniversity of LiverpoolLiverpoolUK
| | | | - Robyn Chilton
- Harris‐Wellbeing Research CentreUniversity of LiverpoolLiverpoolUK
| | - Andrew Sharp
- Fetal Medicine UnitLiverpool Women’s HospitalLiverpoolUK,Harris‐Wellbeing Research CentreUniversity of LiverpoolLiverpoolUK
| | - George Attilakos
- Fetal Medicine UnitUniversity College London Hospital NHS Foundation Trust and Institute for Women's HealthUniversity College LondonLondonUK
| | - Daniel Stott
- Fetal Medicine UnitUniversity College London Hospital NHS Foundation Trust and Institute for Women's HealthUniversity College LondonLondonUK
| | - Sophie Relph
- Fetal Medicine UnitUniversity College London Hospital NHS Foundation Trust and Institute for Women's HealthUniversity College LondonLondonUK
| | - Rebecca Spencer
- University of Leeds and Fetal Medicine UnitLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Dominique A. Badr
- Department of Obstetrics and GynecologyUniversity Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Andrew Carlin
- Department of Obstetrics and GynecologyUniversity Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Jacques Jani
- Department of Obstetrics and GynecologyUniversity Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Mark D. Kilby
- Institute of Metabolism & Systems ResearchCollege of Medical & Dental SciencesUniversity of BirminghamBirminghamUK,Fetal Medicine CentreBirmingham Women's and Children's Foundation TrustBirminghamUK
| | - Mercede Sebghati
- Fetal Medicine UnitSt George's HospitalSt George's University of LondonLondonUK
| | - Asma Khalil
- Fetal Medicine UnitLiverpool Women’s HospitalLiverpoolUK,Fetal Medicine UnitSt George's HospitalSt George's University of LondonLondonUK
| | - Zarko Alfirevic
- Fetal Medicine UnitLiverpool Women’s HospitalLiverpoolUK,Harris‐Wellbeing Research CentreUniversity of LiverpoolLiverpoolUK
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17
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Dudyrev E, Semenkov I, Kuznetsov SO, Gusev G, Sharp A, Pianykh OS. Human knowledge models: Learning applied knowledge from the data. PLoS One 2022; 17:e0275814. [PMID: 36264864 PMCID: PMC9584406 DOI: 10.1371/journal.pone.0275814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Artificial intelligence and machine learning have demonstrated remarkable results in science and applied work. However, present AI models, developed to be run on computers but used in human-driven applications, create a visible disconnect between AI forms of processing and human ways of discovering and using knowledge. In this work, we introduce a new concept of "Human Knowledge Models" (HKMs), designed to reproduce human computational abilities. Departing from a vast body of cognitive research, we formalized the definition of HKMs into a new form of machine learning. Then, by training the models with human processing capabilities, we learned human-like knowledge, that humans can not only understand, but also compute, modify, and apply. We used several datasets from different applied fields to demonstrate the advantages of HKMs, including their high predictive power and resistance to noise and overfitting. Our results proved that HKMs can efficiently mine knowledge directly from the data and can compete with complex AI models in explaining the main data patterns. As a result, our study reveals the great potential of HKMs, particularly in the decision-making applications where "black box" models cannot be accepted. Moreover, this improves our understanding of how well human decision-making, modeled by HKMs, can approach the ideal solutions in real-life problems.
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Affiliation(s)
| | - Ilia Semenkov
- HSE University, Moscow, Russia
- Artificial Intelligence Research Institute, Moscow, Russia
| | | | - Gleb Gusev
- Artificial Intelligence Research Institute, Moscow, Russia
| | - Andrew Sharp
- Medical Analytics Group, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Oleg S. Pianykh
- Medical Analytics Group, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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18
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Bullough S, Lip GYH, Fauchier G, Herbert J, Sharp A, Bisson A, Ducluzeau PH, Fauchier L. A nationwide cohort study on the impact of gestational diabetes on future cardiovascular events. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The link between hypertensive disease in pregnancy and future cardiovascular events is well established, as is the increased risk of developing type 2 diabetes mellitus after gestational diabetes (GDM). What is less well understood is the impact of GDM on future cardiovascular events. The literature is conflicting although suggestive that the risk of cardiovascular events with a history of GDM is 2 fold higher.
Purpose
Using the largest cohort to date and utilising robust data acquisition procedures and follow up we assessed the prognostic value of GDM for future cardiovascular events.
Methods
All female patients discharged from French hospitals in 2013 with at least 5 years of subsequent follow-up were identified. Those with a previous major adverse cardiovascular event, history of hypertensive disease, pre-existing diabetes or under the age of 18 years old were excluded. They were grouped depending on their history of GDM. After propensity score matching, patients with GDM were matched 1:1 with patients with no GDM. Hazard ratios for cardiovascular events during follow-up were adjusted by age at baseline.
Results
A total of, 1,738,101 women were included in the analysis, leaving 1,141,743 women (mean age 52.2, SD 19.7) once exclusion criteria were applied: 6998 (0.6%) had a history of GDM and the mean follow-up was 5.1 years (SD 1.3 years). Those with a history of GDM had a lower risk of new onset heart failure (HF) (hazard ratio [HR] 0.66, 95% confidence interval [CI]: 0.45–0.98) and all-cause death (HR 0.61, 95% CI 0.47–0.79). There was no significant difference in risk for myocardial infarction (HR 0.88, 95% CI 0.38–2.03), ischaemic stroke (HR 0.94, 95% CI 0.55–1.63), new onset atrial fibrillation (AF) (HR 0.61, 95% CI 0.33–1.11), cardiovascular death (HR 1.25, 95% CI 0.47–3.36) and major cardiovascular events (i.e. in-hospital cardiovascular death, myocardial infarction, ischaemic stroke or new-onset HF (MACE-HF)) (HR 0.75, 95% CI 0.56–1.01).
Conclusions
In a large contemporary analysis of female patient seen in French hospitals and utilising a robust data set we present the largest population analysis of the association between GDM and future cardiovascular events. Those with a history of GDM do not have a higher risk of myocardial infarction, ischaemic stroke, new onset AF, cardiovascular death or MACE-HF. Contrary to what is widely thought, a history of GDM confers a lower risk of new onset HF and all-cause death when compared to those women with no history of GDM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Bullough
- Liverpool Womens Hospital , Liverpool , United Kingdom
| | - G Y H Lip
- Liverpool Centre for Cardiovascular Science , Liverpool , United Kingdom
| | - G Fauchier
- University of Tours - Faculty of Medicine , Tours , France
| | - J Herbert
- University of Tours - Faculty of Medicine , Tours , France
| | - A Sharp
- Liverpool Womens Hospital , Liverpool , United Kingdom
| | - A Bisson
- University of Tours - Faculty of Medicine , Tours , France
| | - P H Ducluzeau
- University of Tours - Faculty of Medicine , Tours , France
| | - L Fauchier
- University of Tours - Faculty of Medicine , Tours , France
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19
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Al Bahhawi T, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Abbasizanjani H, Akbari A, Torabi F, Halcox J, Lip GYH. Role of multiple- and single-pregnancy complications with incident cardiovascular diseases: a nationwide data linkage study in Wales. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prior evidence has suggested that pregnancy complications are associated with a higher risk of cardiovascular disease in women. However, associations between coexisting multiple pregnancy complications and incident cardiovascular disease remains unclear.
Purpose
To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of multiple pregnancy complications and women with a history of single-pregnancy complications, compared to women without pregnancy complications.
Methods
This retrospective cohort included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Cox proportional hazard regression was used to evaluate the association between multiple or specific single pregnancy complications and incidence of cardiovascular disease.
Results
A total of 298,515 women were included in the study, of which 64,794 (21.7%) women experienced a single pregnancy complication, and 10,038 (3.38%) women experienced more than one complication during their first pregnancy. During the a median of 9.7 years of follow-up, 2,484 women developed incident cardiovascular disease. IHD had the highest incidence rate among women with multiple pregnancy complications at 9.06 (7.36–11.15) per 10,000 person-years, compared to 4.24 (3.77–4.78) among women with a single pregnancy complication and 2.40 (2.20–2.61) among women without any pregnancy complications. After adjusting for potential confounding factors, compared to no previous pregnancy complications, a history of multiple pregnancy complications was associated with a higher risk of heart failure [hazard ratio (HR) 3.18 (95% confidence interval (CI) 2.34–4.32)], IHD [HR 2.88 (95% CI 2.27–3.67)], stroke [HR 2.03 (95% CI 1.55–2.65)] and atrial fibrillation [HR 1.80 (95% CI 1.20–2.72)]. There was also a consistent trend for a higher risk of all outcomes in women with a history of single-pregnancy complications compared to women without complications during the first pregnancy (Figure 1).
Conclusion
This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. In almost 300,000 women with a previous pregnancy, multiple pregnancy complications were associated with a higher risk of incident cardiovascular disease, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Women who experience multiple pregnancy complications may benefit from targeted intervention strategies to reduce their risk of incident cardiovascular disease.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Saudi Arabia governmental PhD studentship
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences , Liverpool , United Kingdom
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg , Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre , Liverpool , United Kingdom
| | - H Abbasizanjani
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - A Akbari
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - F Torabi
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - J Halcox
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
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Al Bahhawi T, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Abbasizanjani H, Akbari A, Torabi F, Halcox J, Lip GYH. Associations between pregnancy complications and incident cardiovascular disease: a nationwide data linkage study in Wales. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have associated pregnancy complications with a higher risk of cardiovascular disease. However, previous studies have not sufficiently evaluated the impact of broad range of pregnancy complications or common cardiovascular conditions individually. Furthermore, most previous studies have relied on data from hospital admission records only, which may not have adequately accounted for conditions that may not result in an inpatient hospital admission, such as atrial fibrillation.
Purpose
To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of pregnancy complications compared to women without pregnancy complications in a large nationwide study using linked routinely collected data.
Methods
A retrospective cohort study was conducted using the Secure Anonymised Information Linkage (SAIL) Databank and included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Survival analyses were conducted using Cox proportional hazard regression models adjusted for hypertension, diabetes, hyperlipidaemia, congenital and valvular heart diseases, multifetal pregnancy ethnicity, maternal age, calendar year of first birth and index of multiple deprivation.
Results
A total of 298,515 women were included in the study, of which 74,832 (25.1%) had a history of any pregnancy complication during their first pregnancy. During a median of 9.7 years follow-up time, 2,484 women developed at least one cardiovascular condition. Among women with a history of pregnancy complication in their first pregnancy, IHD had the highest incidence rate at 4.94 (95% confidence interval (CI) 4.44–5.49) per 10,000 person-years, and atrial fibrillation was the lowest at 1.92 (95% CI 1.62–2.28). The history of any pregnancy complication during the first pregnancy was associated with a higher risk of all cardiovascular conditions examined, including heart failure [hazard ratio (HR) 1.93 95% CI 1.61–2.31)], IHD [HR 1.82 (95% CI 1.58–2.10)], stroke [HR 1.39 (95% CI 1.20–1.61)] and atrial fibrillation [HR 1.33 (95% CI 1.08–1.65) (Figure 1).
Conclusion
This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. A history of pregnancy complications during first pregnancy was associated with a higher risk of incident cardiovascular conditions, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Applying primary preventive measures and risk assessments for cardiovascular disease after the first pregnancy may mitigate the higher risk among these women.
Funding Acknowledgement
Type of funding sources: Other.
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences , Liverpool , United Kingdom
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg , Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre , Liverpool , United Kingdom
| | - H Abbasizanjani
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - A Akbari
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - F Torabi
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - J Halcox
- Swansea University, Population Data Science, Swansea University Medical School, United Kingdom , Swansea , United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine , Liverpool , United Kingdom
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Sharp A, Azizi M, Mahfoud F, Fisher N, Lobo M, Weber M, Kirtane A. TCT-211 Home Blood Pressure Response to Ultrasound Renal Denervation—A Patient-Level Pooled Analysis of the RADIANCE-HTN SOLO and TRIO Randomised, Sham-Controlled Trials. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Lee DP, Kandzari DE, Tunev S, Schlaich MP, Finn A, TRUDEL J, Sharp A. Abstract P245: Catheter-based Radiofrequency Renal Denervation In Normotensive Pigs Leads To Long-term Pathological Changes In Renal Nerves. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p245] [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: 11/16/2022]
Abstract
Objective:
Pre-clinical data of renal nerve regrowth following radiofrequency (RF) renal denervation (RDN) are lacking. In this analysis of RF RDN in normotensive pigs, we assessed the specificity and durability of RF ablation to the perivascular tissues around the renal arteries.
Design and Method:
RF ablations were delivered to the renal arteries in pigs. To assess specificity, serial tissue samples were harvested from 6 pigs at day 7, and 8 pigs at day 28. Surrounding tissues (ureter, kidney, lymph nodes, skeletal muscle, adrenal glands, and renal nerves) were evaluated with a semi-quantitative scoring system (
Figure
). To assess durability, RF RDN was performed in a separate group of pigs with an additional control group. Serial tissue examination at day 7 (n=6 animals per group) and day 180 (n=8 per group) included quantification of cortical norepinephrine (NE) levels and renal cortical axon density, and evaluation for fibrosis, necrosis, and nerve fiber atrophy.
Results:
Disruption to non-target perivascular tissues was rare, whereas artery nerve disruption and axonal loss were sustained through 28 days (
Figure
). At 180 days, there was nerve atrophy from axonal destruction around the ablation regions. Necrosis was evident at day 7 but not day 180. Fibrosis was confined to the ablated regions. Renal cortical axon density and cortical NE levels were significantly reduced at 7 and 180 days in the RDN group vs. control.
Conclusion:
RF RDN specifically disrupted the renal nerves leading to axonal loss. Cortical axon density, NE reduction, and nerve atrophy were sustained through 180 days. These results support the existing clinical evidence of the specificity and durability of RF RDN.
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Vela D, Sharp A, Zhang R, Nguyen T, Hoang A, Pianykh OS. Temporal quality degradation in AI models. Sci Rep 2022; 12:11654. [PMID: 35803963 PMCID: PMC9270447 DOI: 10.1038/s41598-022-15245-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
As AI models continue to advance into many real-life applications, their ability to maintain reliable quality over time becomes increasingly important. The principal challenge in this task stems from the very nature of current machine learning models, dependent on the data as it was at the time of training. In this study, we present the first analysis of AI “aging”: the complex, multifaceted phenomenon of AI model quality degradation as more time passes since the last model training cycle. Using datasets from four different industries (healthcare operations, transportation, finance, and weather) and four standard machine learning models, we identify and describe the main temporal degradation patterns. We also demonstrate the principal differences between temporal model degradation and related concepts that have been explored previously, such as data concept drift and continuous learning. Finally, we indicate potential causes of temporal degradation, and suggest approaches to detecting aging and reducing its impact.
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Affiliation(s)
- Daniel Vela
- Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | | | - Richard Zhang
- Massachusetts Institute of Technology, Cambridge, USA
| | | | - An Hoang
- Whitehead Institute for Biomedical Research, Cambridge, USA
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Schmieder RE, Cao K, Esler M, Kandzari D, Lobo M, Sharp A, Mancia G, Böhm M, Pietzch J. MO085: 10-Year Clinical Events Avoided in Diabetic and Chronic Kidney Disease Hypertension Patients Treated With Radiofrequency Renal Denervation: Projections Based on 3-Year Data From the Global Symplicity Registry. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac133.006] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Clinical event rates over 3 years have been published for patients with uncontrolled hypertension treated with radiofrequency renal denervation (RDN) in the Global SYMPLICITY Registry (GSR). We estimated 10-year clinical event reductions following RDN versus a simulated control group without RDN, for the type 2 diabetes (T2DM) and chronic kidney disease (CKD) subgroups and the full GSR cohort.
METHOD
A Markov model based on Framingham and other multivariate risk equations [1] was used to compare projected 10-year clinical events [stroke, myocardial infarction (MI), cardiovascular death (CVD), heart failure (HF), all-cause death (ACD) and a composite of major adverse cardiac events (MACE, calculated as sum of stroke, MI and CVD)] for RDN patients versus a hypothetical control for the T2DM subgroup (n = 1007; 64 ± 10 years), the CKD subgroup (n = 630; 65 ± 12 years), and for all GSR patients (n = 2651; 61 ± 12 years). The simulated control assumed maintenance of baseline office systolic blood pressure (oSBP) over time. The model was calibrated to 3-year stroke and MI events reported in the GSR and used published meta-regression data [2] to calculate risk reduction based on cohort-specific changes in oSBP from baseline. Relative risks (RRs), events avoided, and numbers needed to treat (NNTs) were calculated at 3 and 10 years, along with the ratio of 10- versus 3-year projected events avoided.
RESULTS
Ten-year MACE rates were 35.8% versus 48.5% (-12.7%, RR = 0.74) for RDN versus simulated control for all patients, 40.5% versus 54.0% (-13.5%, RR = 0.75) for the T2DM subgroup and 48.4% versus 61.3% (-12.9%, RR = 0.79) for the CKD subgroup. Across the studied subgroups, avoided stroke events contributed the most to overall event reductions. RRs of events were lowest for HF (0.53–0.61) and highest for all-cause death (0.88–0.90) across the three subgroups (Table 1). Ten-year NNTs for MACE were comparable between the three cohorts, estimated between 7 and 8. The ratio of 10- versus 3-year events avoided ranged from 4.44 to 4.87 for stroke, 3.74 to 3.96 for MI and 4.22 to 5.20 for MACE across studied cohorts.
CONCLUSION
Based on 10-year model projections from the GSR, RDN may lead to meaningful clinical event reductions in diabetic and chronic kidney disease patients. Ten-year events avoided can be expected to be 3 to 5 times higher than those recently reported for a 3-year horizon.
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Affiliation(s)
| | - Khoa Cao
- Wing Tech, Inc., Menlo Park, CA, USA
| | - Murray Esler
- Baker Heart and Diabetes Institute, Melbourne, Australia
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26
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Latorre G, Pizarro M, Ford J, Gándara V, Muñoz G, Araya J, Bellolio E, Villaseca MÁ, Fuentes-López E, Cortés P, Rollán A, Bufadel M, Araya R, Vargas J, Espino A, Sharp A, Agüero C, Donoso A, Bresky G, Pedrero P, Rueda C, Calvo A, Odagaki T, Moriyama T, Ishida T, Parra-Blanco A, Camargo M, González R, Corvalán A, Riquelme A. Evaluation of Trefoil Factor 3 as a Non-Invasive Biomarker of Gastric Intestinal Metaplasia and Gastric Cancer in a High-Risk Population. Gastroenterología y Hepatología 2022; 46:411-418. [DOI: 10.1016/j.gastrohep.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 01/06/2023]
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27
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Affiliation(s)
- Rebecca Wiles
- Department of radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beth Hankinson
- Department of radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Emily Benbow
- Liverpool Babies Patient and Public Involvement and Engagement Group, Department of women's and children's health, University of Liverpool, Liverpool, UK
| | - Andrew Sharp
- Department of women's and children's health, University of Liverpool, Liverpool, UK
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28
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Beck EJ, Loncar D, Mandalia S, Patel NH, Lwanga J, Sharp A, Fox J. Hospital and community care costs for people newly diagnosed of living with HIV in London, UK. AIDS Care 2022; 35:719-728. [PMID: 35277095 DOI: 10.1080/09540121.2022.2038362] [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: 10/18/2022]
Abstract
This study of people newly diagnosed of living with HIV (ND-PLHIV) calculated the use, cost and outcome of HIV services at a London HIV centre. ND-PLHIV were followed July 2017-October 2018. Hospital data included inpatient days (IP), outpatient (OP), dayward (DW) visits, tests and procedures, and anti-retroviral drugs (ARVs). Community services were recorded in daily diaries. Mean per patient-year (MPPY) use was multiplied by unit costs. 13.6 MPPY (95%CI 12.4-14.9) OP visits, 0.4 MPPY (95%CI 0.1-0.7) IP days, 0.09 MPPY (95%CI 0.01-0.2) DW visits and 4.6 MPPY community services (95%CI 3.4-5.8). Total annual costs per patient-year (CPPY) was £11,483 (95%CI £10,369-12,597): ARVs comprised 63% and community services 2%. White participants used fewer hospital and more community services compared with minority ethnic community (MEC) participants. Costs for White ND-PLHIV was £10,778 CPPY (95%CI £9629-11,928); £13,214 (95%CI £10,656-15,772) for MEC ND-PLHIV (p < 0.06). Annual costs were inversely related to CD4 count at entry (r = -5.58, p = 0.02); mean CD4 count was 476 cells/mm3 (95%CI 422-531) versus 373 cells/mm3 (95%CI 320-425) for White and MEC participants respectively (p = 0.03). Annual costs for ND-PLHIV with CD4 ≤ 350 cells/mm3 was £2478 PPY higher compared with CD4 count >350 cells/mm3 (p = 0.04).
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | - D Loncar
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - N H Patel
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Lwanga
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Sharp
- Kings College London, London, UK
| | - J Fox
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Kings College London, London, UK
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Chauvette L, Fournier P, Sharp A. The frequency-following response to assess the neural representation of spectral speech cues in older adults. Hear Res 2022; 418:108486. [DOI: 10.1016/j.heares.2022.108486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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Mahfoud F, Bloch M, Azizi M, Wang Y, Schmieder R, Lobo M, Sharp A, Daemen J, Basile J, Weber M, Scicli A, McClure C, Kirtane A. Changes in blood pressure after crossover to ultrasound renal denervation in patients initially treated with sham in the RADIANCE-HTN SOLO trial. EUROINTERVENTION 2021; 17:e1024-e1032. [PMID: 34236037 PMCID: PMC9724980 DOI: 10.4244/eij-d-21-00295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The multicentre, randomised, sham-controlled RADIANCE-HTN SOLO trial reported the blood pressure (BP)-lowering efficacy and safety of ultrasound renal denervation (RDN) in the absence (2 months) and presence (6 and 12 months) of antihypertensive medications in patients with mild-to-moderate hypertension. AIMS The aim of this report was to evaluate patients originally assigned to the sham group who crossed over to RDN. METHODS After the primary endpoint was met, patients in the sham arm who remained uncontrolled were allowed to cross over to receive RDN. All patients were unblinded and treated with standard of care medications at the time of crossover. Ambulatory BP was evaluated 2 and 6 months after crossover. RESULTS Among 72 subjects of the sham arm, 33 underwent ultrasound RDN after an average follow-up of 23±6 months. Prior to crossover, patients had a daytime ambulatory BP of 144.1±10.1/89.9±8.4 mmHg and received 1.2±0.8 antihypertensive medications. Mean change in daytime ambulatory BP from pre-crossover to 2 and 6 months post RDN was -11.2±13.7/-7.1±8.9 mmHg (n=33; p<0.001; p<0.001) and -10.8±17.3/-7.8±11.6 mmHg (n=27; p=0.002; p<0.001). The number of antihypertensive medications did not change from pre-crossover baseline to 2 and 6 months. Eighteen of 33 (54.5%) patients had their daytime ambulatory BP controlled (<135/85 mmHg) at 2 months and 44.4% (12/27) at 6 months post RDN. No major procedure-related adverse events occurred. CONCLUSIONS During unblinded long-term follow-up of the RADIANCE-HTN SOLO study, patients originally assigned to a sham procedure who remained uncontrolled had significant reductions in BP following crossover treatment with ultrasound RDN.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, IMED, Geb. 41, 66421 Homburg/Saar, Germany
E-mail:
| | - Michael Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV, USA
| | - Michel Azizi
- Université de Paris, Paris, and AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, and DMU CARTE, Paris, France
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Roland Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Melvin Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Andrew Sharp
- University Hospital of Wales, Cardiff, and University of Exeter, Exeter, United Kingdom
| | - Joost Daemen
- Erasmus University Medical Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Michael Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | | | - Ajay Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, NY, USA
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Liauw J, Groom K, Ganzevoort W, Gluud C, McKinlay CJD, Sharp A, Mackay L, Kariya C, Lim K, von Dadelszen P, Limpens J, Jakobsen JC. Short-term outcomes of phosphodiesterase type 5 inhibitors for fetal growth restriction: a study protocol for a systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis. Syst Rev 2021; 10:305. [PMID: 34861900 PMCID: PMC8643016 DOI: 10.1186/s13643-021-01849-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early onset fetal growth restriction secondary to placental insufficiency can lead to severe maternal and neonatal morbidity and mortality. Pre-clinical studies and a few small randomised clinical trials have suggested that phosphodiesterase type 5 (PDE-5) inhibitors may have protective effects against placental insufficiency in this context; however, robust evidence is lacking. The STRIDER Consortium conducted four randomised trials to investigate the use of a PDE-5 inhibitor, sildenafil, for the treatment of early onset fetal growth restriction. We present a protocol for the pre-planned systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis of these and other eligible trials. The main objective of this study will be to evaluate the effects of PDE-5 inhibitors on neonatal morbidity compared with placebo or no intervention among pregnancies with fetal growth restriction. METHODS We will search the following electronic databases with no language or date restrictions: OVID MEDLINE, OVID EMBASE, the Cochrane Controlled Register of Trials (CENTRAL), and the clinical trial registers Clinicaltrials.gov and World Health Organisation International Clinical Trials Registry Platform (ICTRP). We will identify randomised trials of PDE-5 inhibitors in singleton pregnancies with growth restriction. Two reviewers will independently screen all citations, full-text articles, and abstract data. Our primary outcome will be infant survival without evidence of serious adverse neonatal outcome. Secondary outcomes will include gestational age at birth and birth weight z-scores. We will assess bias using the Cochrane Risk of Bias 2 tool. We will conduct aggregate meta-analysis using fixed and random effects models, Trial Sequential Analysis, and individual participant data meta-analysis using one- and two-stage approaches. The certainty of evidence will be assessed with GRADE. DISCUSSION This pre-defined protocol will minimise bias during analysis and interpretation of results, toward the goal of providing robust evidence regarding the use of PDE-5 inhibitors for the treatment of early onset fetal growth restriction. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42017069688).
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Affiliation(s)
- Jessica Liauw
- Department of Obstetrics and Gynaecology, University of British Columbia, Room C420-4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada.
| | - Katie Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wessel Ganzevoort
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Centre, University of Liverpool, Liverpool, UK
| | - Laura Mackay
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Ken Lim
- Department of Obstetrics and Gynaecology, University of British Columbia, Room C420-4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | | | - Jacqueline Limpens
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
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Sharp A, Tunev S, Schlaich M, Lee D, Finn A, Mahfoud F, Trudel J, Kandzari D. TCT-19 Durability of Radio-Frequency Catheter-Based Renal Denervation Associated With Lack of Functional Nerve Recovery at 6 Months in Normotensive Swine Model. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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33
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Care AG, Gupta JK, Goodfellow L, Zhang G, Monangi N, Belling E, Landero J, Chappell J, Sharp A, Alfirevic A, Müller-Myhsok B, Muglia LJ, Alfirevic Z. Maternal selenium levels and whole genome screen in recurrent spontaneous preterm birth population: A nested case control study. Eur J Obstet Gynecol Reprod Biol 2021; 265:203-211. [PMID: 34534736 DOI: 10.1016/j.ejogrb.2021.08.015] [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: 06/18/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To establish if low maternal selenium (Se) was associated with sPTB in women with recurrent sPTB and identify genetic link with maternal Se levels. DESIGN Nested case-control study. SETTING Tertiary Maternity Hospital. POPULATION Plasma and whole blood from pregnant women with history of early sPTB/PPROM < 34+0 and European ancestry were obtained at 20 weeks (range 15-24 weeks). 'Cases' were recurrent PTB/PPROM < 34+0 weeks and term (≥37+0) deliveries were classified as 'high-risk controls.' Women with previous term births and index birth ≥ 39 weeks were 'low-risk controls'. METHODS Maternal plasma Se measured by ICP-MS was used as a continuous phenotype in a GWAS analysis. Se was added to a logistic regression model using PTB predictor variables. MAIN OUTCOME MEASURES Maternal Se concentration, recurrent early sPTB/PPROM. RESULTS 53/177 high-risk women had a recurrent sPTB/PPROM < 34+0weeks and were 2.7 times more likely to have a Se level < 83.3 ppm at 20weeks of pregnancy compared with low-risk term controls (n = 179), (RR 2.7, 95%CI 1.5-4.8; p = .001). One SNP from a non-coding region (FOXN3 intron variant, rs55793422) reached genome-wide significance level (p = 3.73E-08). Targeted analysis of Se gene variant did not show difference between preterm and term births. (χ2 test, OR = 0.95; 95%CI = 0.59-1.56; p = 0.82). When Se levels were added to a clinical prediction model, only an additional 5% of cases (n = 3) and 0.6% (n = 1) of controls were correctly identified. CONCLUSIONS Low plasma Se is associated with sPTB risk but is not sufficiently predictive at individual patient level. We did not find a genetic association between maternal Se levels and Se-related genes.
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Affiliation(s)
- Angharad G Care
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom.
| | - Juhi K Gupta
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Laura Goodfellow
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ge Zhang
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nagendra Monangi
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Elizabeth Belling
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Julio Landero
- Department of Chemistry, University of Cincinnati, Cincinnati, OH, United States
| | - Joanne Chappell
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Andrew Sharp
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Ana Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom; Wolfson Centre for Personalised Medicine, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Bertram Müller-Myhsok
- Waterhouse Building, University of Liverpool, Liverpool, United Kingdom; Max Plank Institute of Psychiatry, Munich, Germany
| | - Louis J Muglia
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Zarko Alfirevic
- Harris Wellbeing Preterm Birth Research Centre, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom
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Sharp A, Tunev S, Schlaich MP, LEE DP, Finn A, TRUDEL J, Kandzari DE. Abstract P195: No Functional Nerve Recovery To 6 Months Post Renal Denervation With Rf Energy In A Normotensive Pig Model. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The safety and efficacy of catheter-based radio frequency (RF) renal denervation (RDN) have been demonstrated in randomized, sham-controlled trials. Long-term durability of blood pressure reduction following RDN has also been demonstrated by all-comer registries, although published pre-clinical reports of functional renal nerve regrowth are not consistent. We quantified the processes that support RDN procedural durability utilizing animal models.
Methods:
Animal studies were conducted in accordance with published guidelines. RDN was performed (4 lesions in the main renal artery) in normotensive swine using the Symplicity Spyral™ RDN system (Medtronic, Santa Rosa, CA, USA). Two additional groups not undergoing RDN served as control. Serial histological tissue samples were obtained in separate groups at 7 (n=12/group) and 180 (N=16/group) days post-procedure in all animals followed by bioanalytical quantification of cortical norepinephrine (NE) levels and immunohistochemical analysis of renal cortical axon density in matched samples.
Results:
Renal cortical axon density and NE levels were significantly reduced at 7 days and persisted through 180 days following RDN compared with control (
Figure
). Nerve fibrosis and necrosis were observed in the region of ablation, while nerve body atrophy was apparent distal to ablation location at 180 days.
Conclusions:
Reductions in both NE and renal cortical axon density were sustained at 7 and 180 days post-RDN procedure using RF renal denervation in a normotensive swine model. These data confirm and extend other pre-clinical and clinical evidence of long-term durability of the RDN procedure using RF energy.
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Affiliation(s)
| | | | | | | | - Aloke Finn
- CVPath Institute, Inc., Gaithersburg, MD
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Sharp A, Mehmood Z, Haque F, Schofield R. Disruptive Power Of CTCA In A DGH’s Endeavour Towards Value Based Health Care. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Warn P, Thommes P, Sharp A, Sattar A, Undre N, Palacios-Fabrega JA, Karas A. Intermittent micafungin for prophylaxis in a rat model of chronic Candida albicans gut colonization. J Antimicrob Chemother 2021; 75:2919-2924. [PMID: 32719853 DOI: 10.1093/jac/dkaa243] [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: 06/13/2019] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During antifungal prophylaxis, micafungin is generally infused IV once daily over 1 h. In practice, less-frequent dosing could improve the quality of life in patients requiring long-term treatment or prophylaxis. The feasibility of this approach was assessed using humanized doses of daily or infrequent micafungin regimens. OBJECTIVES To evaluate the effectiveness of intermittent high-dose micafungin, simulating human exposure, for prophylaxis of invasive candidiasis in a rat model of chronic Candida albicans gastrointestinal colonization and systemic dissemination. METHODS Two weeks post-infection with an oral challenge of C. albicans, Sprague-Dawley rats were immunocompromised with a cytotoxic drug and a steroid. Rats received IV infusions of: daily vehicle control; daily subcutaneous micafungin (20 mg/kg SC); high-dose micafungin (20 mg/kg bolus SC + 80 mg/kg infusion/72 h, to simulate intermittent human dosing of 300 mg/72 h); or daily fluconazole by mouth (10 mg/kg PO). The effects of antifungal prophylaxis on faecal fungal burden and systemic C. albicans dissemination were evaluated. RESULTS A rat model of chronic C. albicans gastrointestinal colonization and systemic dissemination was established, characterized by a sustained microbiological burden over 29 days and fungal recovery from normally sterile tissues. Using this model, intermittent high-dose micafungin (delivered via iPrecio pumps) to simulate humanized doses of 300 mg/72 h was significantly more effective than vehicle control, as effective as once-daily micafungin and similar to daily fluconazole at reducing faecal burden and preventing systemic dissemination. CONCLUSIONS These data indicate that intermittent high-dose micafungin can be as effective as daily therapy, supporting clinical assessment in high-risk patients requiring long-term antifungal prophylaxis.
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Affiliation(s)
- Peter Warn
- Evotec (UK) Ltd, Block 23 Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - Pia Thommes
- Evotec (UK) Ltd, Block 23 Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - Andrew Sharp
- Evotec (UK) Ltd, Block 23 Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - Abdul Sattar
- Evotec (UK) Ltd, Block 23 Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - Nasrullah Undre
- Astellas Pharma Inc., 300 Dashwood Lang Road, Bourne Business Park, Addlestone KT15 2NX, UK
| | | | - Andreas Karas
- Astellas Pharma Inc., 300 Dashwood Lang Road, Bourne Business Park, Addlestone KT15 2NX, UK
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Goodfellow L, Verwijs MC, Care A, Sharp A, Ivandic J, Poljak B, Roberts D, Bronowski C, Gill AC, Darby AC, Alfirevic A, Muller-Myhsok B, Alfirevic Z, van de Wijgert J. Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study. BJOG 2021; 128:2061-2072. [PMID: 34139060 DOI: 10.1111/1471-0528.16816] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM). DESIGN Nested case-control study. SETTING UK tertiary referral hospital. SAMPLE High-risk women with previous sPTB/PPROM <34+0 weeks' gestation who had a recurrence (n = 22) or delivered at ≥37+0 weeks without PPROM (n = 87). METHODS Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR. MAIN OUTCOME MEASURE Recurrent early sPTB/PPROM. RESULTS Of the 109 high-risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (Lactobacillus iners 36/109, Lactobacillus crispatus 23/109, or other 22/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log10 cells/mcl, adjusted odds ratio [aOR] 1.90, 95% CI 1.01-3.56, P = 0.047) and estimated Lactobacillus concentration (8.59 versus 7.48 log10 cells/mcl, aOR 2.35, (95% CI 1.20-4.61, P = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners domination (aOR 3.44, 95% CI 1.06-11.15, P = 0.040). Women with anaerobic dysbiosis or L. iners domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log10 cells/mcl, respectively). CONCLUSIONS Vaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts. TWEETABLE ABSTRACT Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
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Affiliation(s)
- L Goodfellow
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - M C Verwijs
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A Care
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - A Sharp
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - J Ivandic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - B Poljak
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - D Roberts
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - C Bronowski
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A C Gill
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A C Darby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - A Alfirevic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - B Muller-Myhsok
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK.,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Z Alfirevic
- Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK
| | - Jhhm van de Wijgert
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Kinnaird T, Gallagher S, Sharp A, Protty M, Salim T, Ludman P, Copt S, Curzen N, Mamas MA. Operator Volumes and In-Hospital Outcomes: An Analysis of 7,740 Rotational Atherectomy Procedures From the BCIS National Database. JACC Cardiovasc Interv 2021; 14:1423-1430. [PMID: 34147386 DOI: 10.1016/j.jcin.2021.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to use a national percutaneous coronary intervention (PCI) registry to study temporal changes in procedure volumes of PCI using rotational atherectomy (ROTA-PCI), the patient and procedural factors associated with differing quartiles of operator ROTA-PCI volume, and the relationship between operator ROTA-PCI volumes and in-hospital patient outcomes. BACKGROUND Whether higher operator volume is associated with improved outcomes after ROTA-PCI is poorly defined. METHODS Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all ROTA-PCI procedures performed in the United Kingdom between 2013 and 2016. Individual logistic regressions were performed to quantify the independent association between annual operator ROTA-PCI volume and in-hospital outcomes. RESULTS In total, 7,740 ROTA-PCI procedures were performed, with a negatively skewed distribution and an annualized operator volume median of 2.5 procedures/year (range 0.25 to 55.25). Higher volume operators undertook more complex procedures in patients with greater comorbid burdens than lower volume operators. A significant inverse association was observed between operator ROTA-PCI volume and in-hospital mortality (odds ratio [OR]: 0.986/case; 95% confidence interval [CI]: 0.975 to 0.996; p = 0.007) and major adverse cardiac and cerebral events (OR: 0.983/case; 95% CI: 0.975 to 0.993; p < 0.001). Additionally, lower rates of emergency cardiac surgery (OR: 0.964/case; 95% CI: 0.939 to 0.991; p = 0.008), arterial complications (OR: 0.975/case; 95% CI: 0.975 to 0.982; p < 0.001) and in-hospital major bleeding (OR: 0.985/case; 95% CI: 0.977 to 0.993; p < 0.001) were associated with higher ROTA-PCI operator volume. Sensitivity analyses in several subgroups demonstrated a consistency of improved outcomes as annual ROTA-PCI volume increased. An annual volume of <4 ROTA-PCI procedures/year was observed to be associated with increased major adverse cardiac and cerebral events, with 239 of 432 operators (55%) not exceeding this threshold. CONCLUSIONS In-hospital adverse outcomes occurred less frequently as ROTA-PCI operator volume increased. These data suggest that operator volume is an important factor determining outcome after ROTA-PCI.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Andrew Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Majd Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Tariq Salim
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Samuel Copt
- Division of Statistics, Biosensors, Morges, Switzerland
| | - Nick Curzen
- Department of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
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Al Bahhawi T, Aqeeli A, L Harrison S, A Lane D, Buchan I, Skjoth F, Sharp A, Lip GYH. Pregnancy-related complications and incidence of atrial fibrillation: a systematic review and meta-analysis. Europace 2021. [DOI: 10.1093/europace/euab116.145] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pregnancy-related complications have been previously associated with incident cardiovascular disease. However, data are scarce on the association between pregnancy-related complications and incident atrial fibrillation (AF). This systematic review examines associations between pregnancy-related complications and incident AF.
Methods
A systematic search of the literature utilising MEDLINE and EMBASE (Ovid) was conducted from 1990 to 6 April 2020. Observational studies examining the association between pregnancy-related complications including hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, low birth weight, small-for-gestational-age and stillbirth, and incidence of AF were included. Screening and data extraction were conducted independently by two reviewers. Inverse-variance random-effects models were used to pool hazard ratios.
Results: Six observational studies met the inclusion criteria
one case-control study and five retrospective cohort studies, with four studies eligible for meta-analysis. Sample sizes ranged from 1,839-1,303,365. Mean/median follow-up for the cohort studies ranged from 7-36 years. Most studies reported an increased risk of incident AF associated with pregnancy-related complications. The pooled summary statistic from four studies reflected a greater risk of incident AF for HDP (hazard ratio (HR) 1.47, 95% confidence intervals (CI) 1.18-1.84; I2 = 84%) and from three studies for pre-eclampsia (HR 1.71, 95% CI 1.41-2.06; I2 = 64%; Figure).
Conclusions
The results of this review suggest that pregnancy-related complications particularly pre-eclampsia appear to be associated with higher risk of incident AF. The small number of included studies and the significant heterogeneity in the pooled results suggest further large-scale prospective studies are required to confirm the association between pregnancy-related complications and AF. Abstract Figure.
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Affiliation(s)
- T Al Bahhawi
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Aqeeli
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - S L Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - I Buchan
- University of Liverpool, Department of Public Health and Policy, Faculty of Health and Life Sciences, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - F Skjoth
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg, Denmark
| | - A Sharp
- University of Liverpool, Harris-Wellbeing Preterm Birth Research Centre, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences and Department of Cardiovascular and Metabolic Medicine, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Goodfellow L, Care A, Harrold J, Sharp A, Ivandic J, Poljak B, Roberts D, Alfirevic A, Müller-Myhsok B, Gibson R, Makrides M, Alfirevic Z. Plasma long-chain omega-3 fatty acid status and risk of recurrent early spontaneous preterm birth: a prospective observational study. Acta Obstet Gynecol Scand 2021; 100:1401-1411. [PMID: 33742474 DOI: 10.1111/aogs.14147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A 2018 Cochrane review found that omega-3 supplementation in pregnancy was associated with a risk reduction of early preterm birth of 0.58; prompting calls for universal supplementation. Recent analysis suggests the benefit may be confined to women with a low baseline omega-3 fatty acid status. However, the contemporary omega-3 fatty acid status of pregnant women in the UK is largely unknown. This is particularly pertinent for women with a previous preterm birth, in whom a small relative risk reduction would have a larger reduction of absolute risk. This study aimed to assess the omega-3 fatty acid status of a UK pregnant population and determine the association between the long-chain omega-3 fatty acids and recurrent spontaneous early preterm birth. MATERIAL AND METHODS A total of 283 high-risk women with previous early preterm birth were recruited to the prospective observational study in Liverpool, UK. Additionally, 96 pregnant women with previous term births and birth ≥39+0 weeks in the index pregnancy provided a low-risk population sample. Within the high-risk group we assessed the odds ratio of recurrent early preterm birth compared with birth at ≥37+0 weeks of gestation according to plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA) at 15-22 weeks of gestation. RESULTS Our participants had low EPA+DHA; 62% (143/229) of women with previous preterm birth and 69% (68/96) of the population sample had levels within the lowest two quintiles of a previously published pregnancy cohort. We found no association between long-chain omega-3 status and recurrent early preterm birth (n = 51). The crude odds ratio of a recurrent event was 0.91 (95% CI 0.38-2.15, p = 0.83) for women in the lowest, compared with the highest three quintiles of EPA+DHA. CONCLUSIONS In the majority of our participants, levels of long-chain omega-3 were low; within the range that may benefit from supplementation. However, levels showed no association with risk of recurrent early spontaneous preterm birth. This could be because our population levels were too low to show benefit in being omega-3 "replete"; or else omega-3 levels may be of lesser importance in recurrent early preterm birth.
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Affiliation(s)
- Laura Goodfellow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | - Angharad Care
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | - Jane Harrold
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
| | | | | | | | - Ana Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, KE, UK
| | - Bertram Müller-Myhsok
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Robert Gibson
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, KE, UK.,Liverpool Women's Hospital, Liverpool, KE, UK
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Duhig KE, Myers JE, Gale C, Girling JC, Harding K, Sharp A, Simpson NAB, Tuffnell D, Seed PT, Shennan AH, Chappell LC. Placental growth factor measurements in the assessment of women with suspected Preeclampsia: A stratified analysis of the PARROT trial. Pregnancy Hypertens 2021; 23:41-47. [PMID: 33221705 PMCID: PMC7909322 DOI: 10.1016/j.preghy.2020.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/08/2020] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Placental growth factor testing decreases time to recognition of preeclampsia and may reduce severe maternal adverse outcomes. This analysis aims to describe the clinical phenotype of women by PlGF concentration, and to determine the mechanism(s) underpinning the reduction in severe maternal adverse outcomes in the PARROT trial, in order to inform how PlGF testing may be optimally used within clinical management algorithms. STUDY DESIGN This was a planned secondary analysis from the PARROT trial that compared revealed PlGF testing and management guidance with usual care in the assessment of women with suspected preterm preeclampsia. MAIN OUTCOME MEASURES Maternal and perinatal outcomes following stratification of women by trial group, and measured PlGF concentration. RESULTS 1006 women were included. PlGF < 100 pg/ml identified women with more marked hypertension, increased adverse maternal outcomes and preterm delivery rates, and higher rates of small for gestational age infants. There was a reduction in adverse maternal outcomes in women whose results were revealed when PlGF levels were 12-100 pg/ml compared to usual care (3.8% vs 6.9%; aOR 0.15(95% CI 0.03-0.92). There was no significant difference in gestation at delivery between concealed or revealed groups in any PlGF categories. CONCLUSION Low PlGF concentrations are associated with severe preeclampsia. The reduction in severe adverse maternal outcomes may be mediated through quicker diagnosis and intensive surveillance, as recommended by the management algorithm for those at increased risk. PlGF is particularly beneficial in those who test 12-100 pg/ml, as these may be women with silent multi-organ disease who otherwise may go undetected.
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Affiliation(s)
- Kate E Duhig
- Department of Women and Children's Health, School of Life Course Sciences, King's College London (KED, PTS, AHS, LCC), United Kingdom.
| | - Jenny E Myers
- The Division of Developmental Biology and Medicine, University of Manchester, United Kingdom.
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, United Kingdom.
| | - Joanna C Girling
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, United Kingdom.
| | - Kate Harding
- Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
| | - Andrew Sharp
- University of Liverpool and Liverpool Women's Hospital, members of Liverpool Health Partners, United Kingdom.
| | - Nigel A B Simpson
- Department of Women's and Children's Health, Faculty of Medicine and Health, University of Leeds, United Kingdom.
| | | | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London (KED, PTS, AHS, LCC), United Kingdom; The Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, United Kingdom.
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London (KED, PTS, AHS, LCC), United Kingdom; The Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, United Kingdom.
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London (KED, PTS, AHS, LCC), United Kingdom; The Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, United Kingdom.
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Bullough S, Southward J, Sharp A. Vaginal prostaglandin E 2 versus double-balloon catheter for induction of labour for vaginal birth after caesarean section: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 259:90-94. [PMID: 33610830 DOI: 10.1016/j.ejogrb.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the success of the double-balloon catheter (DBC) versus prostaglandin gel (PGE2) for induction of labour in women with one previous caesarean section. DESIGN Retrospective cohort study using routinely collected maternity data in a Tertiary NHS hospital, North West England, UK. Women with a live singleton cephalic pregnancy induced using DBC or PGE2 after one previous birth by caesarean section from 1st April 2017 to 1st July 2019 were included. The core outcomes assessed were the inability to perform artificial rupture of membranes, requirement of oxytocin, vaginal birth and uterine rupture. RESULTS 208 women met the inclusion criteria, 127 were induced using the DBC and 81 using PGE2. The two groups were well matched for demographics and characteristics. Women induced for prolonged ruptured membranes with PGE2 were excluded from the study leaving 127 managed with DBC and 69 with PGE2. There were no significant differences observed between the two groups. Vaginal birth rates were 52.7% for the DBC and 66.6% for the PGE2 (relative risk 0.79 (confidence interval 0.63-1.00); P = 0.05). A single uterine rupture was reported following DBC usage. CONCLUSIONS The DBC and PGE2 appear to be equally effective for induction of labour in women with one previous caesarean section.
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Affiliation(s)
- Siân Bullough
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom.
| | - Jessica Southward
- Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
| | - Andrew Sharp
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
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Gent J, Bullough S, Harrold J, Jackson R, Woolfall K, Andronis L, Kenny L, Cornforth C, Heazell AEP, Benbow E, Alfirevic Z, Sharp A. The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks' gestation. Pilot Feasibility Stud 2020; 6:179. [PMID: 33292754 PMCID: PMC7677818 DOI: 10.1186/s40814-020-00722-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth. Methods PLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman’s pregnancy will be managed as per the local NHS hospital policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians. Discussion Our aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus. Trial registration ISRCTN58254381. Registered on 4 July 2019
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Affiliation(s)
- Joanna Gent
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Sian Bullough
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Jane Harrold
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lazaros Andronis
- Division of Health Sciences and Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Kenny
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Alexander E P Heazell
- Maternal and Fetal Research Centre, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, 5th Floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Emily Benbow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK.
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Sacre H, Bird A, Clement-Jones M, Sharp A. Effectiveness of the fetal pillow to prevent adverse maternal and fetal outcomes at full dilatation cesarean section in routine practice. Acta Obstet Gynecol Scand 2020; 100:949-954. [PMID: 33141937 DOI: 10.1111/aogs.14038] [Citation(s) in RCA: 2] [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] [Received: 07/15/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The fetal pillow has been suggested to reduce maternal trauma and fetal adverse outcomes when used to disimpact the fetal head at full dilatation cesarean section. MATERIAL AND METHODS We performed a retrospective cohort study of the use of the fetal pillow device at full dilatation cesarean section between September 2014 and March 2018 at Liverpool Women's Hospital, a large UK teaching hospital. RESULTS There were 471 cases of full dilatation cesarean section during the study period and 391 were included for the analysis; 170 used the fetal pillow and 221 were delivered without. We did not demonstrate any benefit in the significant maternal outcomes of estimated blood loss >1000 mL or >1500 mL, need for blood transfusion, or duration of hospital stay, from the use of the fetal pillow. We did not demonstrate any improvement in fetal outcome following use of the fetal pillow for arterial pH <7.1, Apgar score <7 at 5 minutes or admission to the neonatal unit. For deliveries undertaken at or below the level of the ischial spines there was likewise no benefit from fetal pillow use, except in a reduced risk of an arterial pH <7.1 (relative risk 0.39, 95% CI 0.20-0.80, P = .01); however, admission to the neonatal unit was unaffected. CONCLUSIONS This is the largest study to date on the use of the fetal pillow at full dilatation cesarean section. We did not demonstrate any statistically significant benefit from the use of the fetal pillow to prevent any maternal or fetal adverse outcomes at full dilatation cesarean section in routine clinical use. Further randomized studies are required to prove clinical benefit from this device before more widespread use.
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Affiliation(s)
| | - Alice Bird
- Liverpool Women's Hospital, Liverpool, UK
| | | | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool and Liverpool Women's NHS Foundation Trust, Liverpool, UK
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Sharp A, Patient C, Pickett J, Belham M. Pregnancy related inappropriate sinus tachycardia: a distinct arrhythmia? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The syndrome of inappropriate sinus tachycardia (IST) is well recognized and affects ∼1% of the population. We believe IST in pregnancy is a relatively frequent yet under-recognized phenomenon that may represent a distinct arrhythmia. To date, there are only three case reports in the literature.
Purpose
To further understand the natural history of IST in pregnancy, and to explore maternal outcomes.
Methods
A retrospective, observational cohort analysis.
Results
19 pregnant women presented to our institute with a definitive diagnosis of IST (as defined by task force criteria) between January 2016 and January 2017. Symptom onset was 4–36 weeks gestation (mean 20 weeks). Of those in their second or subsequent pregnancy (n=8), 50% described symptoms compatible with IST in previous pregnancies. 42% attended the emergency department on ≥1 occasion with symptoms of IST. 32% required hospital admission. 26% required pharmacological therapy (beta-blockers in all). There were no maternal deaths, instances of heart failure or acute coronary syndrome, no thromboembolic or haemorrhagic complications during pregnancy. Rates of Caesarean section were similar to the background rate of our unit; however, rates of induction were notably elevated (58% vs 25%), with 55% of these women being induced purely for symptoms of IST. Following delivery, symptoms resolved within one week for 17 of the women in the cohort, 1 had symptoms resolve after 4 month and 1 had persistent symptoms as she became pregnant again.
Conclusion
IST in pregnancy likely represents a distinct arrhythmia; the majority of individuals here had symptoms only during pregnancy, which resolved rapidly postpartum. Additionally, half of the women in a second or subsequent pregnancy had suffered IST symptoms during previous pregnancies, with no symptoms in between pregnancies. It is biologically plausible and may represent an exaggerated cardio-autonomic response to the physiological changes of pregnancy such as increased sympathetic tone and change in baroreceptor reflex sensitivity. Recognition of the condition is important given it is associated with significant morbidity, the distressing nature of symptoms leading to high rates of hospitalization and induction of labour.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Sharp
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C Patient
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Pickett
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M Belham
- Addenbrooke's Hospital, Cambridge, United Kingdom
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Diez P, Bourner J, Sharp A, Hoskin P, McCormack M. OC-1037: Real world interpretation of GEC-ESTRO image-guided brachytherapy recommendations for cervix cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Juhasz M, Mavura D, Kini L, Kanachanapoomi Levin M, Sharp A. Response to "Identifying and characterizing basal cell carcinomas in persons with albinism". Int J Dermatol 2020; 60:e1. [PMID: 33128456 DOI: 10.1111/ijd.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Margit Juhasz
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Daudi Mavura
- Regional Dermatology Training Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Standing Voice, Mwanza, Tanzania
| | - Lullyrita Kini
- Regional Dermatology Training Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Standing Voice, Mwanza, Tanzania
| | - Melissa Kanachanapoomi Levin
- Standing Voice, Mwanza, Tanzania.,The Ronald O. Perelman Department of Dermatology, New York University, New York, NY, USA.,Entiere Dermatology, New York, NY, USA
| | - Andrew Sharp
- Standing Voice, Mwanza, Tanzania.,Department of Dermatology, University Hospitals of Leicester, Leicester, UK
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Rajkumar C, Shun-Shin M, Seligman H, Ahmad Y, Warisawa T, Cook C, Howard J, Amarin L, Nowbar A, Foley M, Assomull R, Keenan N, Sehmi J, Keeble T, Davies J, Tang K, Gerber R, Cole G, O'Kane P, Sharp A, Khamis R, Kanaganayagam G, Petraco R, Ruparelia N, Malik I, Nijjer S, Sen S, Francis D, Al-Lamee R. TCT CONNECT-385 Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease: A Secondary Analysis From ORBITA. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sharp A, Tunev S, Schlaich M, Lee D, Finn A, Mahfoud F, Melder R, Trudel J, Coates P, Kandzari D. TCT CONNECT-418 Evaluation of Nerve Injury and Regrowth Following Renal Denervation in Swine Model. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shlofmitz E, Torguson R, Mintz GS, Zhang C, Sharp A, Hodgson JM, Shah B, Kumar G, Singh J, Inderbitzen B, Weintraub WS, Garcia-Garcia HM, Di Mario C, Waksman R. The IMPact on Revascularization Outcomes of intraVascular ultrasound-guided treatment of complex lesions and Economic impact (IMPROVE) trial: Study design and rationale. Am Heart J 2020; 228:65-71. [PMID: 32866927 DOI: 10.1016/j.ahj.2020.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown in clinical trials, registries, and meta-analyses to reduce recurrent major adverse cardiovascular events after PCI. However, IVUS utilization remains low. An increasing number of high-risk or complex coronary artery lesions are treated with PCI, and we hypothesize that the impact of IVUS in guiding treatment of these complex lesions will be of increased importance in reducing major adverse cardiovascular events while remaining cost-effective. The "IMPact on Revascularization Outcomes of intraVascular ultrasound-guided treatment of complex lesions and Economic impact" trial (registered on clinicaltrials.gov: NCT04221815) is a multicenter, international, clinical trial randomizing subjects to IVUS-guided versus angiography-guided PCI in a 1:1 ratio. Patients undergoing PCI involving a complex lesion are eligible for enrollment. Complex lesion is defined as involving at least 1 of the following characteristics: chronic total occlusion, in-stent restenosis, severe coronary artery calcification, long lesion (≥28 mm), or bifurcation lesion. The clinical investigation will be conducted at approximately 120 centers in North America and Europe, enrolling approximately 2,500 to 3,100 randomized subjects with an adaptive design. The primary clinical end point is the rate of target vessel failure at 12 months, defined as the composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. The co-primary imaging end point is the final post-PCI minimum stent area assessed by IVUS. The primary objective of this study is to assess the impact of IVUS guidance on the PCI treatment of complex lesions.
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