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Viguerie A, Song R, Johnson AS, Lyles CM, Hernandez A, Farnham PG. COVID-19-related excess missed HIV diagnoses in the United States in 2021. AIDS 2024; 38:907-911. [PMID: 38181069 DOI: 10.1097/qad.0000000000003829] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) and related disruptions led to a significant decline in HIV diagnoses in the United States in 2020. A previous analysis estimated 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the decline in overall diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021. METHODS We apply previously developed methods analyzing 2021 diagnosis data from the National HIV Surveillance System to determine whether 2021 diagnosis levels of PWH infected pre-2020 are above or below the expected pre-COVID trends. Results are stratified by assigned sex at birth, transmission group, geographic region, and race/ethnicity. RESULTS In 2021, HIV diagnoses returned to pre-COVID levels among all PWH acquiring infection 2011-2019. Among Hispanic/Latino PWH and male individuals, diagnoses returned to pre-COVID levels. White PWH, MSM, and PWH living in the south and northeast showed higher-than-expected levels of diagnosis in 2021. For the remaining populations, there were fewer HIV diagnoses in 2021 than expected. CONCLUSION Although overall diagnoses among persons acquiring HIV pre-2020 returned to pre-COVID levels, the diagnosis gap observed in 2020 remained unclosed at the end of 2021. Fewer than expected diagnoses among certain populations indicate that COVID-19-related disruptions to HIV diagnosis trends remained in 2021. Although some groups showed higher-than-expected levels of diagnoses, such increases were smaller than corresponding 2020 decreases. Expanded testing programs designed to close these gaps are essential.
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Affiliation(s)
- Alex Viguerie
- Division of HIV Prevention, Quantitative Sciences Branch
| | - Ruiguang Song
- Division of HIV Prevention, Quantitative Sciences Branch
| | - Anna Satcher Johnson
- Division of HIV Prevention, HIV Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angela Hernandez
- Division of HIV Prevention, HIV Surveillance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul G Farnham
- Division of HIV Prevention, Quantitative Sciences Branch
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Lawson AA, Barlow E, Brookhart C, Sophie Gibson ME, Golub S, Imbo-Nloga C, Hernandez A, Justice T, King C, Nos A, Truehart A, French AV. Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 4.0. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00186-4. [PMID: 38432289 DOI: 10.1016/j.jpag.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources.
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Affiliation(s)
- Ashli A Lawson
- Department of Pediatric Surgery, Children's Mercy Kansas City, Kansas City, Missouri; School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Erin Barlow
- Department of Obstetrics & Gynecology, Women and Infants Hospital, Brown University, Providence, Rhode Island
| | - Carolyn Brookhart
- Department of Obstetrics & Gynecology, Kaiser San Francisco, San Francisco, California
| | - M E Sophie Gibson
- Department of Obstetrics & Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Sarah Golub
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Camille Imbo-Nloga
- Department of Pediatric and Adolescent Gynecology, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona
| | - Angela Hernandez
- Department of Obstetrics & Gynecology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Tara Justice
- Department of Obstetrics & Gynecology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Carol King
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
| | - Andrea Nos
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Amber Truehart
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| | - Amanda V French
- Department of Obstetrics and Gynecology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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3
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Huebner E, Debiec K, Hernandez A, Yu L. Peri-clitoral Epidermal Inclusion Cyst as Initial Presentation of Lichen Sclerosus in a Pediatric Patient. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00020-2. [PMID: 38278410 DOI: 10.1016/j.jpag.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory disorder, presenting with pruritis and hypopigmentation of the vulvar and anogenital skin. LS presenting as a peri-clitoral mass has not been previously described. CASE A 5-year-old patient with vulvar pruritis and ultrasound showing a homogenous mass was referred for suspected clitoromegaly with normal labs. Examination demonstrated a prepubertal patient with a mobile, soft, peri-clitoral mass and surrounding hypopigmentation consistent with LS. The cyst was excised surgically; pathology revealed an epidermal inclusion cyst. Postoperatively, she began using topical steroids for LS with symptom resolution. CONCLUSION Thorough workup of clitoromegaly negative for hormonal causes requires further investigation to determine an alternative etiology of the mass. We suspect that inflammatory changes of LS and pruritus resulted in the peri-clitoral inclusion cyst.
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Affiliation(s)
- Emily Huebner
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Seattle, Washington; Swedish Medical Center, Department of Obstetrics and Gynecology, Seattle, Washington.
| | - Kate Debiec
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Seattle, Washington; Pediatric and Adolescent Gynecology, Seattle Children's Hospital, Seattle Washington
| | - Angela Hernandez
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Seattle, Washington; Pediatric and Adolescent Gynecology, Seattle Children's Hospital, Seattle Washington
| | - Lissa Yu
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Seattle, Washington; Pediatric and Adolescent Gynecology, Seattle Children's Hospital, Seattle Washington
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Gu X, Rahman FS, Bendale G, Tran B, Miyata JF, Hernandez A, Anand S, Romero-Ortega MI. Pleiotrophin-Neuregulin1 promote axon regeneration and sorting in conduit repair of critical nerve gap injuries. Res Sq 2023:rs.3.rs-3429258. [PMID: 37986821 PMCID: PMC10659554 DOI: 10.21203/rs.3.rs-3429258/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Significant challenges remain in the treatment of critical nerve gap injuries using artificial nerve conduits. We previously reported successful axon regeneration across a 40 mm nerve gap using a biosynthetic nerve implant (BNI) with multi-luminal synergistic growth factor release. However, axon sorting, remyelination, and functional recovery were limited. Neuregulin1 (NRG1) plays a significant role in regulating the proliferation and differentiation of Schwann cells (SCs) during development and after injury. We hypothesize that the release of NRG1 type III combined with pleiotrophin (PTN) in the BNI will enhance axon growth, remyelination, and function of regenerated nerves across a critical gap. A rabbit 40 mm peroneal gap injury model was used to investigate the therapeutic efficacy of BNIs containing either NRG1, PTN, or PTN+NRG1 growth factor release. We found that NRG1 treatment doubled the number of regenerated axons (1276±895) compared to empty controls (633±666) and PTN tripled this number (2270±989). NRG1 also significantly increased the number of SOX10+ Schwann cells in mid-conduit (20.42%±11.78%) and reduced the number of abnormal Remak axon bundles. The combination of PTN+NRG1 increased axon diameter (1.70±1.06) vs control (1.21±0.77) (p<0.01), with 15.35% of axons above 3 μm, comparable to autograft. However, the total number of remyelinated axons was not increased by the added NRG1 release, which correlated with absence of axonal NRG1 type III expression in the regenerated axons. Electrophysiological evaluation showed higher muscle force recruitment (23.8±16.0 mN vs 17.4±1.4 mN) and maximum evoked compound motor action potential (353 μV vs 37 μV) in PTN-NRG1 group versus control, which correlated with the improvement in the toe spread recovery observed in PTN-NRG1 treated animals (0.64±0.02) vs control (0.50±0.01). These results revealed the need of a combination of pro-regenerative and remyelinating growth factor combination therapy for the repair of critical nerve gaps.
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Affiliation(s)
- Xingjian Gu
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - Farial S. Rahman
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - G Bendale
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - B Tran
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - JF Miyata
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - A Hernandez
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
| | - S Anand
- Department of Biomedical Engineering, University of Houston, Houston TX 77204
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Andres R, Hernandez A, Fernandez A, Comin A, Nuño A, Aguirre E, Arevalo E, Millastre E, Alvarez I, Verdun J, Lao J, Murillo L, Galan N, Bueso P, Puertolas T, Hagen C, Inglada-Perez L, Anton A. P158 PONDx Aragon: First spanish prospective study evaluating the impact of the 21-gene test on real praxis for N1 patients after RxPONDER results. Breast 2023. [DOI: 10.1016/s0960-9776(23)00275-8] [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: 03/15/2023] Open
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6
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Viguerie A, Song R, Johnson AS, Lyles CM, Hernandez A, Farnham PG. Isolating the Effect of COVID-19-Related Disruptions on HIV Diagnoses in the United States in 2020. J Acquir Immune Defic Syndr 2023; 92:293-299. [PMID: 36515707 PMCID: PMC10111242 DOI: 10.1097/qai.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diagnoses of HIV in the United States decreased by 17% in 2020 due to COVID-related disruptions. The extent to which this decrease is attributable to changes in HIV testing versus HIV transmission is unclear. We seek to better understand this issue by analyzing the discrepancy in expected versus observed HIV diagnoses in 2020 among persons who acquired HIV between 2010 and 2019 because changes in diagnosis patterns in this cohort cannot be attributed to changes in transmission. METHODS We developed 3 methods based on the CD4-depletion model to estimate excess missed diagnoses in 2020 among persons with HIV (PWH) infected from 2010 to 2019. We stratified the results by transmission group, sex assigned at birth, race/ethnicity, and region to examine differences by group and confirm the reliability of our estimates. We performed similar analyses projecting diagnoses in 2019 among PWH infected from 2010 to 2018 to evaluate the accuracy of our methods against surveillance data. RESULTS There were approximately 3100-3300 (approximately 18%) fewer diagnoses than expected in 2020 among PWH infected from 2010 to 2019. Females (at birth), heterosexuals, persons who inject drugs, and Hispanic/Latino PWH missed diagnoses at higher levels than the overall population. Validation and stratification analyses confirmed the accuracy and reliability of our estimates. CONCLUSIONS The substantial drop in number of previously infected PWH diagnosed in 2020 suggests that changes in testing played a substantial role in the observed decrease. Levels of missed diagnoses differed substantially across population subgroups. Increasing testing efforts and innovative strategies to reach undiagnosed PWH are needed to offset this diagnosis gap. These analyses may be used to inform future estimates of HIV transmission during the COVID-19 pandemic.
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Affiliation(s)
- Alex Viguerie
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Ruiguang Song
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Anna Satcher Johnson
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), HIV Surveillance Branch (HSB)
| | - Cynthia M. Lyles
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
| | - Angela Hernandez
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), HIV Surveillance Branch (HSB)
| | - Paul G. Farnham
- Centers for Disease Control and Prevention (CDC), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Division of HIV Prevention (DHP), Quantitative Sciences Branch (QSB)
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Hernandez A, Thomas L, Baum P, Visvanathan S, Barker J, Løset M, Smith C, Capon F. 272 An exome wide association study identifies new genetic determinants for palmar plantar pustulosis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Hernandez A, Notario L, Quirant B, Felip E, Boigues M, Saigí M, Cucurull M, Torres P, Martinez M, Castella RG, Esteban MR, Martin MB, Carcereny E, Domenech M, Estival A, Pous A, López-Paradís A, Romeo M, Moran T. OA06.04 Immune Response after SARS-CoV-2 Vaccination in Lung Cancer Patients. Update of the Covid Lung Vaccine Cohort. J Thorac Oncol 2022. [PMCID: PMC9452014 DOI: 10.1016/j.jtho.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Richardson K, Hernandez A, Venkat S, Jalaeian H, Bhatia S. Abstract No. 548 Does body habitus affect the outcome of CT-guided lung biopsies? J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Taconne M, Le Rolle V, Panis V, Hubert A, Auffret V, Galli E, Hernandez A, Donal E. How myocardial work could be relevant in patients with an aortic valve stenosis? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.035] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Speckle tracking based myocardial work calculation is an attractive method to assess left ventricular (LV) myocardial function. In case of aortic stenosis (AS), assessment of work indices is challenging because it requires an accurate evaluation of LV-pressure curves. Therefore, we sought to evaluate the performances of two distinct methods for the estimation of myocardial work indices and to provide a quantitative comparison with invasively measured data.
Methods
Model-based and template-based methods were defined and applied for the evaluation of LV pressures on 67 AS patients. Global Constructive (GCW), Wasted (GWW), Positive (GPW), Negative (GNW) myocardial work and Global Work Efficiency (GWE) and Index (GWI) parameters were calculated using the available software computing the indices using brachial blood pressure and trans-aortic mean pressure gradient for estimating the LV pressures versus using a model-based and homemade software. A complete comparison was performed with invasive measurements.
Results
Patients were characterized by mean pressure gradient of 49.8 ± 14.8 mmHg, LV ejection fraction of 59 ± 8%, the global longitudinal strain was -15.0 ± 4.04%, GCW was 2107 ± 800mmHg.% (model-based method) and 2483 ± 1068mmHg.% (template-based method). The root mean square error (RMSE) and correlation were calculated for each patient and for each pressure estimation methods. The mean RMSE are 33.9mmHg and 40.4mmHg and the mean correlation coefficients are 0.81 and 0.72 for the model-based and template-based methods respectively. Correlation coefficient and Bland-Altman analysis were performed for the six work indices. The two methods present correlation coefficient r2 > 0.75 for almost all the indices.
Conclusion
The two non-invasive methods of LV pressure estimation and the work indices computation correlate with invasive measurements and computations for AS patients. Although the model-based approach requires less information and is associated with slightly better performances, the implementation of template-based method is easier and seems more appropriate in a clinical practice. Abstract Figure. SUMMARY
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Affiliation(s)
- M Taconne
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - V Le Rolle
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - V Panis
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - A Hubert
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - V Auffret
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - E Galli
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - A Hernandez
- University of Rennes 1, LTSI INSERM1099, Rennes, France
| | - E Donal
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
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Sarno A, Mettivier G, Bliznakova K, Hernandez A, Boone J, Russo P. Evaluation of glandular dose distribution in 2D and 3D x-ray breast imaging. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00276-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Hernandez A, Meier M, Wagner B, Towler E, Martiniano S, Zemanick E. 32: Relationship between sweat electrolytes and genotype severity in cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Cedillo RE, Cortes BE, Herrera MC, Valadez NH, Pimentel FL, Malfatti E, Hernandez A, Cedeño A, Vargas B, Miranda A, Olamendi N. CONGENITAL MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Casulleras MJ, Barrera JB, Sais E, Hernandez A, Gasusachs M, Carcereny E, Moran T, Vinolas MD, Palmero R, Brenes J, Vilariño N, Ruffinelli J, Fina C, Lorente S, Teule A, Lazaro C, Nadal E. 1272P First results of the early onset lung cancer (EOLUNG) study to characterize genomic alterations using FoundationOne CDx in young patients with non-small cell lung cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Pelari L, López F, Duque V, Retorta P, Hernandez A, Valero M, Sancho S. PO-1513 Radiation-induced cardiac toxicity for oesophageal or oesophagogastric junctional adenocarcinoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stoffel B, McPherson M, Hernandez A, Goess C, Mathieu S, Waegell W, Bryant S, Hobson A, Ruzek M, Pang Y, Kupper H, D’Cunha R, Parmentier J, Radstake T. POS0365 ANTI-TNF GLUCOCORTICOID RECEPTOR MODULATOR ANTIBODY DRUG CONJUGATE FOR THE TREATMENT OF AUTOIMMUNE DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Glucocorticoids (GC) are potent drugs used for treating many inflammatory diseases. While GCs are effective in many immune diseases, dose and duration of administration is limited due to significant side effects. Resting immune cells have very little TNF expression on the cell surface and it is only in an activated state that TNF expression is upregulated. Upon immune cell stimulation, TNF is upregulated and although a significant amount of TNF is cleaved from an activated cell, a portion remains on the cell surface. We have observed that anti-TNF antibodies bind to transmembrane TNF (tmTNF) and undergo endocytosis to the lysosome (1). We have developed a stable antibody drug conjugate (ADC), ABBV-3373, that has a proprietary, highly potent, glucocorticoid receptor modulator (GRM) payload linked to an anti-TNF monoclonal antibody (mAb) that is able to deliver the GC payload to activated immune cells.Objectives:We hypothesized that a TNF ADC with a GRM payload would be able to deliver increased efficacy through both TNF inhibition and targeted GRM payload delivery to activated immune cells while sparing systemic glucocorticoid side effects.Methods:A mouse surrogate TNF GRM ADC was characterized in an acute in vivo contact hypersensitivity model of inflammation (CHS) and in a mouse model of collagen induced arthritis (mCIA). Additionally, the human anti-TNF GRM ADC, ABBV-3373 has been characterized in healthy volunteers.Results:In the CHS model the anti-TNF GRM ADC significantly inhibited the inflammatory response with minimal effect on systemic GC biomarkers. In mCIA a single dose of an anti-TNF GRM ADC, administered at disease onset, was able to completely inhibit arthritis for greater than 30 days while an anti-TNF mAb only partially inhibited disease. ABBV-3373, a human anti-TNF GRM ADC with a GC payload, was evaluated in a Phase 1 study in healthy volunteers. ABBV-3373 demonstrated antibody-like PK profile and ABBV-3373 did not impact cortisol levels at predicted efficacious doses while control subjects that received a single oral dose of 10 mg prednisone demonstrated expected decreases in cortisol levels.Conclusion:These data suggest that an anti-TNF ADC delivering a GRM payload into activated immune cells may provide improved efficacy in immune mediated diseases, while minimizing systemic side effects associated with standard GC treatment.References:[1]Deora, A. et al. MABs. 2017;9(4):680-695.Disclosure of Interests:Bob Stoffel Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Michael McPherson Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Axel Hernandez Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Christian Goess Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Suzanne Mathieu Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Wendy Waegell Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Shaughn Bryant Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Adrian Hobson Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Melanie Ruzek Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Yinuo Pang Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Hartmut Kupper Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Ronilda D’Cunha Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Julie Parmentier Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie, Timothy Radstake Shareholder of: AbbVie, Grant/research support from: AbbVie, Employee of: AbbVie
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Nath K, Law S, Talaulikar D, Sabdia MB, Gunawardana J, Long LM, Shanavas M, Tsang H, Tobin JW, Halliday S, Hernandez A, Cross D, Bird R, Jain S, Keane C, Trotman J, Law P, Gandhi MK. INTRATUMORAL T‐CELLS HAVE A DIFFERENTIAL IMPACT ON FDG‐PET PARAMETERS IN FOLLICULAR LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.76_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K. Nath
- Mater Research Institute University of Queensland Brisbane Australia
| | - Soi‐C. Law
- Mater Research Institute University of Queensland Brisbane Australia
| | - D. Talaulikar
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
| | - M. B. Sabdia
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. Gunawardana
- Mater Research Institute University of Queensland Brisbane Australia
| | - L. M. Long
- Mater Research Institute University of Queensland Brisbane Australia
| | - M. Shanavas
- Mater Research Institute University of Queensland Brisbane Australia
| | - H. Tsang
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. W. Tobin
- Mater Research Institute University of Queensland Brisbane Australia
| | - S.‐J. Halliday
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - A. Hernandez
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - D. Cross
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - R. Bird
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - S. Jain
- Canberra Hospital Department of Anatomical Pathology Canberra Australia
| | - C. Keane
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. Trotman
- Concord Repatriation General Hospital Department of Haematology Sydney Australia
| | - P. Law
- Princess Alexandra Hospital Department of Medical Imaging Brisbane Australia
| | - M. K. Gandhi
- Mater Research Institute University of Queensland Brisbane Australia
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Hernandez A, Zikria J, Howse R, Mehta A, Allakhverdieva E, Mohan P. Abstract No. 22 Predictors of intrahepatic recurrence of hepatocellular carcinoma following percutaneous microwave ablation of tumors larger than 3 cm. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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Galli E, Smiseth OA, Aalen JM, Larsen CK, Sade E, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt JU, Donal E. Prognostic value of diastolic function assessment in patients undergoing cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.030] [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
Funding Acknowledgements
Type of funding sources: None.
Objective
The best modality to assess diastolic function in CRT-candidates is an object of debate and the relationship between diastolic function, CRT-response and survival are not
clearly understood.
Purpose of the study: to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates.
Methods
193 patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Patients were stratified according to DD grades (grade I
to III). CRT-response was defined as a reduction of left ventricular (LV) end-systolic volume >15% at 6-month follow-up (FU). The primary endpoint was defined as a
composite of heart transplantation, LV assisted device implantation or all-cause death during FU.
Results
During FU, 132 (68%) patients were CRT-responders. CRT delivery was associated with diastolic function degradation in non-responders. Grade I DD was able to predict
CRT-response with a sensitivity, specificity and accuracy of 70%, 65%, and 63%, respectively. After a median period of 35 months, the primary endpoint occurred in 29
(15%) patients. Grade I DD was associated with a better outcome [HR 0.26 95% CI: (0.10-0.66)], independently from ischemic cardiomyopathy, LV dyssynchrony and CRT-response (Table 1). Non-responders with grade II or grade III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06) Figure 1.
Conclusions
Grade I DD is associated with LV remodelling after CRT and is an independent predictor of prognosis in CRT candidates.
Abstract Figure.
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Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - JM Aalen
- University of Oslo, Oslo, Norway
| | | | - E Sade
- Baskent University, Ankara, Turkey
| | | | | | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | | | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
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Hubert A, Galard A, Le Rolle V, Galli E, Hernandez A, Donal E. Comparison of two methods to predict CRT-response. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.019] [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
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital university of Rennes INSERM - LTSI
Background
Non-invasive estimation of myocardial work by trans-thoracic echocardiography is a novel tool to analyze myocardial contraction efficiency during systole. Two methods are described, on using Left ventricular (LV) strain and a LV pressure estimation, and another with only LV strain integrals. The present study analyzes their utility in prediction of CRT-response.
Methods and results: 243 patients implanted by a CRT according to current recommendations were retrospectively included in hospital university of Rennes. All patients had a complete trans-thoracic echocardiography at implantation and at 6-moths follow-up. Responders were defined as having a 15% decrease in indexed LV end-systolic volume at follow-up compared to baseline. Baseline characteristics are described in table 1. 25.1% were non-responders. In this group, there were more men, more ischemic cardiomyopathies with more dilated LV. Strain signals ware analyzed only in the most informative loop, the apical 4 cavities. Myocardial work estimation with LV pressure estimation was previously described. The 3 different integral of strain signal were represented in figure 1. According to ROC curves, myocardial work (particularly wasted work in septal wall with AUC = 0.718 ± 0.04) estimated with LV pressure estimation is better than strain integrals to predict LV positive remodeling (best AUC 0.631 ± 0.040) after CRT-implantation.
Conclusion
Left ventricular pressure estimation give useful information on top of strain curves for prediction for CRT-response.
Table 1 Responders n = 182 Non-responders n = 61 Men (%) 109 (59.9%) 52 (85%) Ischemic cardiomyopathy (%) 42 (23.1%) 34 (55.7%) LVEF (%) 28 ± 6 28 ± 7 GLS (%) -9 ± 3 -7 ± 3 LVEDD (mm) 62 ± 8 67 ± 7 LVEDVi (ml/m2) 85 ± 34 88 ± 30 LVEF Left ventricular ejection fraction; GLS: global longitudinal strain; LVEDD: left ventricular end-diastolic diameter; LVEDVi: left ventricular end diastolic volume index Abstract Figure 1
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Affiliation(s)
- A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - A Galard
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
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Hubert A, Owashi KP, Le Rolle V, Hernandez A, Galli E, Donal E. Prospective validation of a non-invasive method to estimate myocardial work in aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): ANR - Maestro project
Background
Stratification of aortic stenosis patients remains challenging and robust indices are required. Myocardial work assessment is a new afterload independent alternative to evaluate left ventricular function. Although, this method was developed in patients with normal aortic valve. We previously developed an integrated cardiovascular system simulated by a computational model to estimate non-invasively myocardial work in aortic stenosis patients* (figure 1A). In the present study, we tested our model in a prospective population of AS patients.
Method and results
9 patients with severe AS (aortic valve area < 1cm2) were included. A complete trans-thoracic echocardiography with a non-invasive blood pressure by brachial artery cuff were realized immediately before a left heart catheterization to have an invasive left ventricular pressure. Myocardial work is then calculated with non-invasive and invasive LV pressure combined to LV strain curves. For constructive and wasted work, root mean squared between invasive and estimated measures were respectively r2 = 0.92 and r2 = 0.94 (figure 1B)
Conclusion
The proposed model is efficient to estimate non-invasively myocardial work indices in AS-patients. These afterload independent indices could permit in future to better stratify this population.
*Owashi KP, Hubert A and al. Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PlosOne 2020. Mar 3;15(3):e0229609
Abstract Figure 1
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Affiliation(s)
- A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - KP Owashi
- Laboratory Signal Processing and Image, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
| | - E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
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Galli E, Le Rolle V, Smiseth OA, Duchenne J, Aalen JM, Larsen CK, Sade E, Hubert A, Anilkumar S, Penicka M, Linde C, Leclercq C, Hernandez A, Voigt JU, Donal E. Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.044] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes.
Objectives
We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches.
Methods
193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients.
Results
From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis.
Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p < 0.0001; log –rank p < 0.0001; Figure 1, Unsupervised Machine Learning Panel).
Conclusions
Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT.
Abstract Figure 1
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Affiliation(s)
- E Galli
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - V Le Rolle
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | | | - JM Aalen
- University of Oslo, Oslo, Norway
| | | | - E Sade
- Baskent University, Ankara, Turkey
| | - A Hubert
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | | | - C Linde
- Karolinska Institute, Stockholm, Sweden
| | - C Leclercq
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | - A Hernandez
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
| | | | - E Donal
- Univ Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France, RENNES, France
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Galli E, Smiseth OA, Aalen JM, Larsen CK, Sade E, Hubert A, Anilkumar S, Penicka M, Linde C, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt JU, Donal E. Prognostic utility of the assessment of diastolic function in patients undergoing cardiac resynchronization therapy. Int J Cardiol 2021; 331:144-151. [PMID: 33535079 DOI: 10.1016/j.ijcard.2021.01.046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Conflicting data exist about the relationship between cardiac resynchronization therapy (CRT) and diastolic function. Aims of the study are to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates. METHODS AND RESULTS: One-hundred ninety-three patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III. CRT-response, defined as a reduction of left ventricular (LV) end-systolic volume > 15% at 6-month follow-up (FU), occurred in 132 (68%) patients. The primary endpoint was a composite of heart transplantation, LV assisted device implantation, or all-cause death during FU and occurred in 29 (15%) patients. CRT was associated with a degradation of DD in non-responders. At multivariable analysis corrected for clinical variables, QRS duration, mitral regurgitation, CRT-response and LV dyssynchrony, grade I DD was associated with a better outcome (HR 0.37, 95% CI: 0.14-0.96). Non-responders with grade II-III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06). CONCLUSIONS: The evaluation of DD in CRT candidates allows the prognostic stratification of patients, independently from CRT-response.
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Affiliation(s)
- E Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - O A Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - J M Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - C K Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - E Sade
- Department of Cardiology, Baskent University Hospital, Ankara, Turkey
| | - A Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - S Anilkumar
- Non-Invasive Cardiac Laboratory, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - V Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - A Hernandez
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - C Leclercq
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - J Duchenne
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - J-U Voigt
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - E Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
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Caobi A, Andre M, Miles J, Tomitaka A, Nikkhah-Moshaie R, Hernandez A, Nair M, Raymond AD. Magnetic Nanoparticle and Exosomal Therapeutic (M-NEXT) Effects on HIV-Associated Neurotoxicity. Crit Rev Biomed Eng 2021; 48:189-198. [PMID: 33389896 DOI: 10.1615/critrevbiomedeng.2020034629] [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]
Abstract
The human immunodeficiency virus (HIV) envelope glycoprotein protein 120 (gp120) induces neurotoxicity associated with HIV-associated neurocognitive disorders (HAND). Mechanism of Gp120-mediated neurotoxicity is primarily apoptosis. Currently, there are no therapeutics that address gp120 neurotoxicity. A biocompatible, efficacious therapeutic that easily crosses the blood-brain barrier (BBB) is needed to treat neuronal toxicity observed in HIV-infected individuals. Magnetic nanoparticles (MNPs) have successfully delivered anti-HIV agents across in vitro BBB transwell model. However, MNPs at high doses may damage cells. Exosomal extracellular vesicles (xEVs) are endogenous nanocarriers capable of crossing the BBB. Unlike MNPs, xEVs interact with cells in a paracrine or juxtracrine manner, lacking long-range site specificity. Here we investigated the efficacy of an MNP and xEV-coupled therapeutic (M-NEXT) as a nanocarrier for targeted delivery of anti-HIV fusion agent across the BBB to inhibit HIV-gp120 associated neuropathology. M-NEXT consisting of MNPs encapsulated within xEV carrying T20 peptide on the surface was synthesized and characterized via zeta potential, dynamic light scattering, and TEM imaging. Preliminary efficacy studies using SH-SY5Y cocultured with the in vitro BBB model showed that the M-NEXT-T20-fusion peptide protected neurons from HIV gp120-mediated neurotoxicity. Additionally, BBB integrity and permeability assessed via trans-endothelial resistance (TEER) and a Dextran-FITC transport assay was unaffected. SH-SY5Y viability measured by XTT assay was not significantly modulated by M-NEXT. In summary, preliminary findings support M-NEXT as effective nanocarriers for delivery of anti-HIV gp120 associated neurotoxicity agents.
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Affiliation(s)
- A Caobi
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - M Andre
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - J Miles
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - Asahi Tomitaka
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA; Advanced Materials Engineering Research Institute, College of Engineering and Computing, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - R Nikkhah-Moshaie
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - A Hernandez
- Advanced Materials Engineering Research Institute, College of Engineering and Computing, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - M Nair
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - Andrea D Raymond
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
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Galli E, Smiseth O, Aalen J, Larsen C, Sade E, Hubert A, Anilkumar S, Sirnes P, Penicka M, Linde C, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt J, Donal E. Better diastolic function in CRT candidates is associated with improved survival after CRT implantation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.092] [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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26
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Galli E, Smiseth O, Aalen J, Duchenne J, Larsen C, Sade E, Hubert A, Anilkumar S, Penicka M, Hernandez A, Leclercq C, Voigt JU, Donal E. Better diastolic function in CRT candidates is associated with improved survival after CRT implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0041] [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 relationship between diastolic dysfunction (DD) and outcome after CRT is debated.
Purpose
Purpose of this study was to evaluate the role of DD in predicting all-cause mortality in heart failure patients undergoing CRT.
Methods
One-hundred ninety-three patients (age: 67±11 years, QRS width: 167±21 ms, LVEF 28±8%) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging. A reduction of LV end-systolic volume >15% at 6-month follow-up (FU) identified CRT-responders and was observed in 132 (68%) patients.
Results
During a median 35 months FU, 29 (15%) patients died. Through multivariable analysis, coronary artery disease, NYHA functional class and grade I DD were shown to be independent predictors of prognosis (Table 1). Grade I DD was associated with a longer survival rate in both responders and non responders (Figure 1). Non responders with grade II-III DD had the worse outcome (HR 12.5 [3.56–44.04], p<0.0001).
Conclusions
Better diastolic function at baseline is associated with an improved survival after CRT implantation, independently of CRT-response.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - J Aalen
- University of Oslo, Oslo, Norway
| | | | - C Larsen
- University of Oslo, Oslo, Norway
| | - E Sade
- Baskent University, Ankara, Turkey
| | - A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - S Anilkumar
- Hamad Medical Corporation Heart Hospital, Doha, Qatar
| | - M Penicka
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
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Soto C, Aguilar Lugo C, Rodríguez S, Palacio L, Lozano Á, Prádanos P, Hernandez A. Enhancement of CO2/CH4 permselectivity via thermal rearrangement of mixed matrix membranes made from an o-hydroxy polyamide with an optimal load of a porous polymer network. Sep Purif Technol 2020. [DOI: 10.1016/j.seppur.2020.116895] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rojas D, Bodden S, Hernandez A, Di Lorio A, Henriquez J. Evaluation of the Nutritional Quality of Processed Foods in Honduras: A Comparison of Three Nutrient Profile Models. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.149] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mann CM, Schanberg LE, Wang M, von Scheven E, Lucas N, Hernandez A, Ringold S, Reeve BB. Identifying clinically meaningful severity categories for PROMIS pediatric measures of anxiety, mobility, fatigue, and depressive symptoms in juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus. Qual Life Res 2020; 29:2573-2584. [PMID: 32410143 PMCID: PMC10505945 DOI: 10.1007/s11136-020-02513-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE A key limitation to widespread adoption of patient-reported outcome (PRO) measures is the lack of interpretability of scores. We aim to identify clinical severity thresholds to distinguish categories of no problems, mild, moderate, and severe along the PROMIS® Pediatric T-score metric for measures of anxiety, mobility, fatigue, and depressive symptoms for use in populations with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematosus (cSLE). METHODS We used a modified standard setting methodology from educational testing to identify clinical severity thresholds (clinical cut scores). Using item response theory-based parameters from PROMIS item banks, we developed a series of clinical vignettes that represented different severity or ability levels along the PROMIS Pediatric T-score metric. In stakeholder workshops, participants worked individually and together to reach consensus on clinical cut scores. Median cut-score placements were taken when consensus was not reached. Focus groups were recorded and qualitative analysis was conducted to identify decision-making processes. RESULTS Nine adolescents (age 13-17 years) with JIA (33% female) and their caregivers, five adolescents (age 14-16 years) with cSLE (100% female) and their caregivers, and 12 pediatric rheumatologists (75% female) participated in bookmarking workshops. Placement of thresholds for bookmarks was highly similar across stakeholder groups (differences from 0 to 5 points on the PROMIS t-score metric) for all but one bookmark placement. CONCLUSION This study resulted in clinical thresholds for severity categories for PROMIS Pediatric measures of anxiety, mobility, fatigue, and depressive symptoms, providing greater interpretability of scores in JIA and cSLE populations.
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Affiliation(s)
- C M Mann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - L E Schanberg
- Department of Pediatrics and Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - M Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E von Scheven
- Division of Pediatric Rheumatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - N Lucas
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - A Hernandez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - S Ringold
- Division of Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - B B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics and Duke Clinical Research Institute, Duke Health, Durham, NC, USA
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30
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Henning‐Smith C, Hernandez A, Lahr M, Kozhimannil K. Rural‐Urban Differences in Access to, Attitudes Toward, and Satisfaction with Care Among Medicare Beneficiaries. Health Serv Res 2020; 55:20-21. [PMCID: PMC7440413 DOI: 10.1111/1475-6773.13351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Research Objective While the entire population is aging, rural areas are aging at a faster rate and have unique barriers to accessing care. As a result, updated analyses on health care access for rural Medicare beneficiaries are necessary to design effective policies and programs to improve access and, ultimately, health outcomes. We sought to identify rural‐urban differences in access to, attitudes toward, and satisfaction with care among Medicare beneficiaries. Study Design Data from the 2016 Medicare Current Beneficiary Survey (MCBS) were used to determine differences across a range of measures (access to, attitudes toward, and satisfaction with health care) by rurality. MCBS data were weighted to account for the complex sampling design. Weighted chi‐squared tests were used to determine bivariate differences between metropolitan, rural micropolitan, and rural non‐core populations. Survey‐weighted logistic regression was used for dichotomous dependent health care variables, and survey‐weighted linear regression was used for continuous dependent health care variables to determine whether differences in health care measures by rurality remained after adjusting for age, sex, marital status, race and ethnicity, annual income, educational attainment, total number of chronic health conditions, self‐rated health, and Medicare advantage status. Population Studied Our study sample included 10 625 Medicare beneficiaries who were 65 and older and “ever enrolled” in Medicare during the survey year. Principal Findings In general, satisfaction with care decreased with increasing rurality. Even after adjusting for covariates, differences in satisfaction persisted for satisfaction with ease of getting to the doctor from home (adjusted odds ratio [AOR] micropolitan: 0.63, P = 0.037; AOR non‐core: 0.61, P = 0.023) and availability of care by specialists (AOR micropolitan: 0.51, P = 0.001; AOR non‐core: 0.61, P < 0.001). Additionally, rurality was also associated with longer travel times to see providers (β micropolitan: 3.25, P = 0.022; β non‐core: 5.81, P < 0.001), and rural Medicare beneficiaries were more likely to avoid going to the doctor (AOR micropolitan: 1.61, P < 0.001; AOR non‐core: 1.71, P < 0.001) or not tell anyone if they were sick (AOR micropolitan: 1.43, P < 0.001; AOR non‐core: 1.50, P < 0.001) as compared to their urban counterparts. However, rurality did not influence whether or not Medicare beneficiaries had a usual source of care (AOR micropolitan: 0.81, P = 0.499; AOR non‐core: 0.73, P = 0.082). Conclusions Rural Medicare beneficiaries reported lower satisfaction with care than their urban counterparts across a variety of measures, and some of these differences remained after adjusting for covariates. Although all beneficiaries, regardless of rurality, had a usual source of care, rural beneficiaries experience long travel times to care and were less likely to seek care when they are sick. Implications for Policy or Practice These findings have implications for access to and quality of care that rural Medicare beneficiaries receive and their subsequent health outcomes. The fact that rural beneficiaries had lower satisfaction with care and were less likely to seek care indicates potential issues with the quality and acceptability of care they receive and may impact care‐seeking behavior to the determinant of continuity and health outcomes. Primary Funding Source Federal Office of Rural Health Policy.
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Affiliation(s)
- C. Henning‐Smith
- School of Public HealthUniversity of MinnesotaMinneapolisMNUnited States
| | - A. Hernandez
- School of Public HealthUniversity of MinnesotaMinneapolisMNUnited States
| | - M. Lahr
- School of Public HealthUniversity of MinnesotaMinneapolisMNUnited States
| | - K. Kozhimannil
- Department of Health Policy & ManagementSchool of Public HealthUniversity of MinnesotaMinneapolisMNUnited States
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Gallego A, Ramon-Patino J, Brenes J, Mendiola M, Berjon A, Casado G, Castelo B, Espinosa E, Hernandez A, Hardisson D, Feliu J, Redondo A. Bevacizumab in recurrent ovarian cancer: could it be particularly effective in patients with clear cell carcinoma? Clin Transl Oncol 2020; 23:536-542. [PMID: 32651885 DOI: 10.1007/s12094-020-02446-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Treatment of recurrent ovarian carcinoma is a challenge, particularly for the clear cell (CCC) subtype. However, there is a preclinical rationale that these patients could achieve a benefit from antiangiogenic therapy. To assess this hypothesis, we used the growth modulation index (GMI), which represents an intrapatient comparison of two successive progression-free survival (PFS). METHODS We conducted a retrospective real-world study performed on 34 patients with recurrent ovarian cancer, treated with bevacizumab-containing regimens from January 2009 to December 2017. The primary endpoint was GMI. An established cut-off > 1.33 was defined as a sign of drug activity. RESULTS 73.5% of patients had high-grade serous ovarian carcinoma (HGSOC), and 17.7% had CCC; 70.6% of patients received carboplatin/gemcitabine/bevacizumab, and 29.4% received weekly paclitaxel/bevacizumab. According to histological subtype, the overall response rate and median PFS were 52% and 14 months for HGSOC and 83.3% and 20 months for CCC, respectively. The overall population median GMI was 0.99; it was 0.95 and 2.36 for HGSOC and CCC, respectively. CCC subtype was significantly correlated with GMI > 1.33 (odds ratio 41.67; 95% confidence interval 3.6-486.94; p = .03). CONCLUSION Adding bevacizumab to chemotherapy in recurrent CCC is associated with a remarkable benefit in this cohort. The efficacy of antiangiogenic drugs in CCC warrants further prospective evaluation.
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Affiliation(s)
- A Gallego
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - J Ramon-Patino
- Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - J Brenes
- Department of Medical Oncology, Instituto Catalán de Oncología, Hospitalet de Llobregat, Barcelona, Spain
| | - M Mendiola
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - A Berjon
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - G Casado
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - B Castelo
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - E Espinosa
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - A Hernandez
- Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - D Hardisson
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Pathology, Hospital Universitario La Paz, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - J Feliu
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - A Redondo
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. .,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain. .,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain.
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Zigler C, Ardalan K, Hernandez A, Caliendo A, Magee K, Terry M, Mann C, Torok K. Exploring the impact of paediatric localized scleroderma on health‐related quality of life: focus groups with youth and caregivers. Br J Dermatol 2020; 183:692-701. [DOI: 10.1111/bjd.18879] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C.K. Zigler
- Center for Health Measurement Department of Population Health Sciences Duke University School of Medicine Durham NC USA
| | - K. Ardalan
- Division of Rheumatology Departments of Pediatrics and Medical Social Sciences Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine Chicago IL USA
| | - A. Hernandez
- Center for Health Measurement Department of Population Health Sciences Duke University School of Medicine Durham NC USA
| | - A.E. Caliendo
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - K.E. Magee
- Department of Psychological Sciences Case Western Reserve University Cleveland OH USA
| | - M.A. Terry
- Behavioral and Community Health Services Public Health University of Pittsburgh Pittsburgh PA USA
| | - C.M. Mann
- Center for Health Measurement Department of Population Health Sciences Duke University School of Medicine Durham NC USA
| | - K.S. Torok
- Division of Rheumatology Department of Pediatrics Children's Hospital of Pittsburgh of UPMC Pittsburgh PA USA
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Hubert A, Le Rolle V, Galli E, Hernandez A, Donal E. 101 Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
AIM
This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE).
METHOD
17 patients with proved cardiac amyloidosis and 18 patients with heart failure with preserved ejection fraction (HFpEF) were compared to 19 controls, from a local database. All TTE were performed using Vivid E95 ultrasound system (General Electrics Healthcare, Horten, Norway). The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel A)
RESULTS (Table 1): LVEF was similar between all groups whereas global longitudinal strain was significantly lower in amyloidosis group than controls (-14.4 vs -20.5%; p < 0.001). HFpEF and amyloidosis groups had a worse diastolic function than controls with a greater left atrial volume index , a faster tricuspid regurgitation, a greater E/e’ ratio with a p < 0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in HFpEF and amyloidosis group than controls (72 vs 36 vs 120.0 %.mL, respectively, p < 0.0001) with an intermediate profile of HFpEF(Figure 1, panel B, HFpEF in green). This area was better correlated with mean e’ (r = 0.650, p < 0.001) than all other indices.
CONCLUSION
LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function.
Main echocardiographic results Controls n = 19 HFpEF n = 18 Amyloidosis n = 17 p-value LVEDV (mL) 105 ± 15 103 ± 30 95 ± 93 0.476 LVEF (%) 65 ± 5 62 ± 7 62 ± 7 0.196 GLS (%) -20.5 ± 1.8 -18.4 ± 4.3 -14.4 ± 3.8 <0.0001 LAVi (ml.m-2) 22 ± 5 51 ± 14 51 ± 22 <0.0001 E/A ratio 2.1 ± 0.4 1.2 ± 0.7 1.7 ± 1.0 0.005 Mitral E/Ea average 5.9 ± 1.4 13.7 ± 5.8 17.3 ± 5.4 <0.0001 Vmax TR (m/s) 2.0 ± 0.3 3.1 ± 0.4 2.7 ± 0.5 <0.0001 V-S loop area (ml.%) 120 ± 54 72 ± 45 37 ± 21 <0.0001
Abstract 101 Figure 1
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Affiliation(s)
- A Hubert
- University Hospital of Rennes, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Galli
- University Hospital of Rennes, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Donal
- University Hospital of Rennes, Rennes, France
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Gallard A, Donal E, Le Rolle V, Hubert A, Bidaut A, Leclercq C, Galli E, Hernandez A. 539 Optimized multiparametric analysis of cardiac dyssynchrony: machine learning and prediction of response to cardiac resynchronization therapy based of the apical 4-chamber view. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.273] [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
Aims. We hypothesized that a multiparametric evaluation, based on the combination of electrocardiographic and echocardiographic parameters, could enhance the appraisal of the likelihood of reverse remodeling and prognosis of favorable clinical evolution after cardiac resynchronization therapy (CRT). Also, we sought to test the respective value of automatically extracted parameters from left ventricular (LV) strain curves recorded in apical 4-chamber view as compared to the other echocardiographic views.
Methods and results;
This is a machine learning study based on a dataset of 161 patients who were treated by CRT according to current ESC-guidelines. The longitudinal strain curves of the 6 LV-segments of the left ventricle were plot for the three different apical views. Several features as times or integrals were extracted as previously published. These features were classified by importance using the out-of-bag method(fig1). Half of the most important features come from the 4-chamber view and a third from the 2-chamber view. The correlation between the most important features was studied to determine the relationship between them. Almost all the features from the 2-chamber and apical long-axis views are correlated with others and generally with one acquired from the 4-chamber view.
Conclusion
The high number of important features indicate the relevance of the 4-chamber as unique view for applying machine learning approaches on strain curves. Optimizing selection of patients for CRT should be possible just on the dataset coming from one apical 4-chamber view.
Abstract 539 Figure. fig1
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Affiliation(s)
- A Gallard
- Laboratory Signal Processing and Image, Rennes, France
| | - E Donal
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, Rennes, France
| | - A Hubert
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - A Bidaut
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - C Leclercq
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - E Galli
- University Hospital of Rennes - Hospital Pontchaillou, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
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Ibero J, Riesgo A, Rodriguez M, Morales M, Muniz J, Salterain N, De La Fuente A, Refoyo E, Hernandez A, Lecumberri R, Garcia Velloso MJ, Diaz I, Gavira JJ. P677 When to look for wtTTR amyloidosis in heart failure: increasing chances of positive gammagraphic study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.355] [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
Introduction
Wild type transtirretin (wtATTR) amyloidosis has become increasingly recognized as a major cause for heart failure (HF). Diagnosis requires complex work up such as DPD scintigraphy (DPDs). Availability of DPDs is limited urging to identify factors to increase its diagnostic rentability.
Methods
Retrospective study of HF patients between 2013 and 2019 with suspected wtATTR and DPDs was performed. Baseline characteristics, biomarkers, EKG findings, TTE parameters (LVEF, LV diastolic function, TAPSE, interventricular septum (IVS), LV mass (LVM), relative LV wall thickness (RWT), indexed LVTD volume and diameter, indexed LA diameter (iAPLAD)) and DPDs results were studied. Two groups were created according to DPDs (SP those with positive results for amyloidosis and SN those with negative results). For statistical SPSS v.21 was used.
Results
37 patients were studied. In our population 54% had positive DPDs for amyloidosis. Among SP patients 50% were classified as grade 2 of Perugini classification meanwhile 50% were grade 3; mean value of heart to contralateral ratio was 2,73 ± 0,8. There were no differences in NYHA classification. Differences among SP and SN patients are reflected in Table 1.
Conclusions
In our population SP was found to have higher biomarkers values and higher IVS, LVM, RWT and iAPLAD with poorer RV function. Further investigation is needed in order to confirm our result and identify prognostic factors.
Table 1: Results Total (37) PS (20) PN (17) p value Age (Y) 78 ± 7,9 80 ± 6,5 75,29 ± 8,7 0,05 Gender (male) (%) 30 (8) 19 (95) 11(64) 0,11 Carpal tunnel sdr (%) 3(8) 3 (15) 0 (0) 0,09 Systolic blood pressure (x ± sd) 127 ± 21 118 ± 18 138,5 ± 19 <0,01 ProBNP (x ± sd) 3596 ± 4002 4615 ± 4538 1761 ± 1927 <0,05 Troponin T (x ± sd) 132 ± 360 66,4 ± 35 43 ± 39 0,09 Pseudoinfarction pattern (%) 26 (70) 17 (85) 9 (52) <0,05 IVS (mm) (x ± sd) 14,6 ± 4,5 16,6 ± 5,3 13 ± 3 <0,01 LVM (g/m2) (x ± sd) 142,5 ± 68 180 ± 80 111 ± 32 <0,01 RWT (x ± sd) 0,68 ± 0,42 0,8 ± 0,24 0,56 ± 0,5 <0,01 LVEF (%) (x ± sd) 57,4 ± 11 54 ± 12 60 ± 10 0,12 iAPLAD (mm/m2) (x ± sd) 25,4 ± 6 28,7 ± 6 22,7 ± 4,3 <0,01 TAPSE (mm) (x ± sd) 18,6 ± 5 16,1 ± 4 20,6 ± 5 <0,05 IVS = interventricular septum; LVM = left ventricular mass; RWT = relative wall thickness; iAPLAD= indexed anteroposterior left atrium diameter.
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Affiliation(s)
- J Ibero
- University Clinic of Navarra, Navarra, Spain
| | - A Riesgo
- University Clinic of Navarra, Navarra, Spain
| | - M Rodriguez
- University Clinic of Navarra, Navarra, Spain
| | - M Morales
- University Clinic of Navarra, Navarra, Spain
| | - J Muniz
- University Clinic of Navarra, Navarra, Spain
| | - N Salterain
- University Clinic of Navarra, Navarra, Spain
| | | | - E Refoyo
- University Clinic of Navarra, Navarra, Spain
| | - A Hernandez
- University Clinic of Navarra, Navarra, Spain
| | | | | | - I Diaz
- University Clinic of Navarra, Navarra, Spain
| | - J J Gavira
- University Clinic of Navarra, Navarra, Spain
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Hubert A, Le Rolle V, Galli E, Hernandez A, Donal E. Semi-automated volume-strain loops: A new tool in TTE to assess diastolic dysfunction. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balut F, Hernandez A, Rojas C, Troncoso M, Lara S, Saez V, Pereira V. Polysomnographic characteristics in a series of Chilean patients with myotonic dystrophy type 1. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.063] [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: 11/30/2022]
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Hubert A, Le Rolle V, Galli E, Hernandez A, Donal E. P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aim
This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis.
Method
18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B)
Results
(Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A).
Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001
Figure 1
Conclusion
LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.
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Affiliation(s)
- A Hubert
- University Hospital of Rennes, Rennes, France
| | - V Le Rolle
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Galli
- University Hospital of Rennes, Rennes, France
| | - A Hernandez
- Laboratory Signal Processing and Image, INSERM U1099, Rennes, France
| | - E Donal
- University Hospital of Rennes, Rennes, France
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Bosch-Barrera J, Priego N, Puigdemont M, Sais E, Quer N, Izquierdo A, Hernandez A, Cuyàs E, Carbó A, Teixidor E, Verdura S, Garcia D, Roselló A, Garriga V, Pedraza S, Brunet J, Calvo A, Menéndez J, Valiente M. P2.01-49 Targeting STAT3-Positive Reactive Astrocytes with Silibinin in the Therapeutic Landscape of Non-Small-Cell Lung Cancer with Brain Metastases. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1392] [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: 10/25/2022]
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Jove M, Moran T, Teule A, Menendez M, Gausachs M, Vilariño N, Sánchez RP, Cirauqui B, Estival A, Carcereny E, Domenech M, Navarro M, Bosch-Barrera J, Fina C, Izquierdo A, Ruffinelli J, Varela M, Mesia C, Hernandez A, Gonzalez S, Lazaro C, Brunet J, Nadal E. P1.01-54 Somatic Genome Alterations in Lung Cancer Patients Diagnosed with Li Fraumeni Syndrome. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.769] [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: 10/25/2022]
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Layer M, Adler A, Reynaert E, Hernandez A, Pagni M, Morgenroth E, Holliger C, Derlon N. Organic substrate diffusibility governs microbial community composition, nutrient removal performance and kinetics of granulation of aerobic granular sludge. Water Res X 2019; 4:100033. [PMID: 31334496 PMCID: PMC6614711 DOI: 10.1016/j.wroa.2019.100033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 05/25/2023]
Abstract
Basic understanding of formation of aerobic granular sludge (AGS) has mainly been derived from lab-scale systems with simple influents containing only highly diffusible volatile fatty acids (VFA) as organic substrate. This study compares start-up of AGS systems fed by different synthetic and municipal wastewaters (WW), characterised by increasing complexity in terms of non-diffusible organic substrate. Four AGS reactors were started with the same inoculum activated sludge and operated for one year. The development of AGS, settling characteristics, nutrient and substrate removal performance as well as microbial community composition were monitored. Our results indicate that the higher the content of diffusible organic substrate in the WW, the faster the formation of AGS. The presence of non-diffusible organic substrate in the influent WW led to the formation of small granules and to the presence of 20-40% (% of total suspended solids) of flocs in the AGS. When AGS was fed with complex influent WW, the classical phosphorus and glycogen accumulating organisms (PAO, GAO) were outcompeted by their fermentative equivalents. Substrate and nutrient removal was observed in all reactors, despite the difference in physical and settling properties of the AGS, but the levels of P and N removal depended on the influent carbon composition. Mechanistically, our results indicate that increased levels of non-diffusible organic substrate in the influent lower the potential for microbial growth deep inside the granules. Additionally, non-diffusible organic substrates give a competitive advantage to the main opponents of AGS formation - ordinary heterotrophic organisms (OHO). Both of these mechanisms are suspected to limit AGS formation. The presented study has relevant implications for both practice and research. Start-up duration of AGS systems treating high complexity WW were one order of magnitude higher than a typical lab-scale system treating VFA-rich synthetic WW, and biomass as flocs persisted as a significant fraction. Finally, the complex synthetic influent WW - composed of VFA, soluble fermentable and particulate substrate - tested here seems to be a more adequate surrogate of real municipal WW for laboratory studies than 100%-VFA WW.
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Affiliation(s)
- M. Layer
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - A. Adler
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - E. Reynaert
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - A. Hernandez
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - M. Pagni
- SIB Swiss Institute of Bioinformatics, 1015, Lausanne, Switzerland
| | - E. Morgenroth
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
- ETH Zürich, Institute of Environmental Engineering, 8093, Zürich, Switzerland
| | - C. Holliger
- Ecole Polytechnique Fédérale de Lausanne (EPFL), ENAC IIE Laboratory for Environmental Biotechnology, 1015, Lausanne, Switzerland
| | - N. Derlon
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland
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Medina LG, Rangel E, Fuchs I, Silva MC, Hernandez A, Cacciamani GE, Sotelo R. Rectourethral Fistula: Operative Technique and Outcomes. Curr Bladder Dysfunct Rep 2019. [DOI: 10.1007/s11884-019-00529-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vives M, Hernandez A, Parramon F, Estanyol N, Pardina B, Muñoz A, Alvarez P, Hernandez C. Acute kidney injury after cardiac surgery: prevalence, impact and management challenges. Int J Nephrol Renovasc Dis 2019; 12:153-166. [PMID: 31303781 PMCID: PMC6612286 DOI: 10.2147/ijnrd.s167477] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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: 11/07/2018] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a major medical problem that is of particular concern after cardiac surgery. Perioperative AKI is independently associated with an increase in short-term morbidity, costs of treatment, and long-term mortality. In this review, we explore the definition of cardiac surgery-associated acute kidney injury (CSA-AKI) and identify diverse mechanisms and risk factors contributing to the renal insult. Current theories of the pathophysiology of CSA-AKI and description of its clinical course will be addressed in this review. Data on the most promising renal protective strategies in cardiac surgery, from well-designed studies, will be scrutinized. Furthermore, diagnostic tools such as novel biomarkers of AKI and their potential utility will be discussed.
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Affiliation(s)
- M Vives
- Department of Anesthesiology & Critical Care, Clinical Research Lead, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Institut d´Investigació Biomédica de Girona (IDIBGI), Girona, Spain
| | - A Hernandez
- Department of Anesthesia & Critical Care, Grupo Policlinica, Ibiza, Spain
| | - F Parramon
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - N Estanyol
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - B Pardina
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - A Muñoz
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - P Alvarez
- Department of Cardiac Surgery, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
| | - C Hernandez
- Department of Anesthesiology & Critical Care Chief, Hospital Universitari Dr Josep Trueta, Universitat de Girona, Girona, Spain
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Caballeros FM, Garcia De Yebenes M, Suarez V, Suarez A, Hernandez A, Hernandez F, Bastarrika G, Refoyo E. P395Not all pericardial thickening is effusion: usefulness of CMR in the characterization of epicardial lipomatous hypertrophy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F M Caballeros
- Clinica Universidad de Navarra. , Radiodiagnóstico, Madrid, Spain
| | | | - V Suarez
- Clinica Universidad de Navarra. , Radiodiagnóstico, Madrid, Spain
| | - A Suarez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - A Hernandez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - F Hernandez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - G Bastarrika
- Clinica Universidad de Navarra. , Radiodiagnóstico, Madrid, Spain
| | - E Refoyo
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
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Garcia De Yebenes M, Caballeros FM, Huerta A, De La Torre M, Cuadrado MJ, Suarez A, Hernandez A, Bastarrika G, Hernandez FM, Refoyo E. 509Idiopathic recurrent myopericarditis: can we keep on talking about idiopathic disease or should we look further? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez105.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - F M Caballeros
- Clinica Universidad de Navarra. , Radiodiagnóstico, Madrid, Spain
| | - A Huerta
- Clinica Universidad de Navarra, Medicina Interna, Madrid, Spain
| | - M De La Torre
- Clinica Universidad de Navarra, Medicina Interna, Madrid, Spain
| | - M J Cuadrado
- Clinica Universidad de Navarra, Reumatología, Madrid, Spain
| | - A Suarez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - A Hernandez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - G Bastarrika
- Clinica Universidad de Navarra. , Radiodiagnóstico, Madrid, Spain
| | - F M Hernandez
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
| | - E Refoyo
- Clinica Universidad de Navarra. , Cardiología, Madrid, Spain
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Lloret M, García-Cabrera L, Hernandez A, Santana N, López-Molina L, Lara PC. Feasibility of a deep hyperthermia and radiotherapy programme for advanced tumors: first Spanish experience. Clin Transl Oncol 2019; 21:1771-1775. [PMID: 31102061 DOI: 10.1007/s12094-019-02097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/19/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hyperthermia (HT) is used to increase the temperature of the tumor-sensitizing cells to the effects of radiation/chemotherapy. We aimed to assess the feasibility, tolerability and safety of hyperthermia treatment in a Radiation Oncology Department. METHODS Between June 2015 and June 2017, 106 patients and a total of 159 tumor lesions were included in a prospective study (EudraCT 2018-001089-40) of HT concomitant with radiotherapy (RT). Systemic treatment was accepted. HT was given twice a week, 60 min per session, during RT treatment by a regional capacitive device (HY-DEEP 600WM system) at 13.56 MHz radiofrequency. RESULTS Most lesions (138 cases, 86.8%) received all HT sessions planned. Thirteen lesions (12 patients) withdrew treatment due to grade ≥3 QMHT toxicity. All these 12 patients completed the prescribed radiotherapy and/or systemic treatment. CONCLUSIONS Regional hyperthermia is a feasible and safe technique to be used in combination with radiotherapy and systemic treatment.
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Affiliation(s)
- M Lloret
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.
- Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
- Instituto Canario de Investigación del Cáncer, Las Palmas de Gran Canaria, Spain.
| | - L García-Cabrera
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - A Hernandez
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - N Santana
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - L López-Molina
- Department of Radiation Oncology, Dr. Negrin Hospital, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain
| | - P C Lara
- Instituto Canario de Investigación del Cáncer, Las Palmas de Gran Canaria, Spain
- Universidad Fernando Pessoa Canarias, Las Palmas, Spain
- Hospital Universitario San Roque, Las Palmas, Spain
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Molokwu J, Dwivedi A, Mallawaarachchi I, Hernandez A, Shokar N. Tiempo de Vacunarte (time to get vaccinated): Outcomes of an intervention to improve HPV vaccination rates in a predominantly Hispanic community. Prev Med 2019; 121:115-120. [PMID: 30776387 DOI: 10.1016/j.ypmed.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to evaluate effects of a culturally tailored evidence-based HPV vaccine educational intervention on psychosocial factors and vaccine completion in a largely low-income Hispanic population. Our study is a prospective community based intervention utilizing a prepost design. We recruited individual's dwelling in a border community aged 18-26 years or parents/guardians of children aged 9-17 years who had not completed the HPV vaccine series. We recruited 2380 participants between June 2015 and February 2018. We included 1796 participants in the final analysis. Mean age of the sample was 22.8 years (SD2.60). Majority of participants 63.99 were female and self-identified as Hispanic (97.4%). A total of 3192 vaccines were administered with an overall vaccine completion rate of 39.8%; 31.6% among adult participants compared to 48.7% among children. The Intervention significantly improved HPV knowledge by 61.66%, HPV awareness by 19.45%, Intention to vaccinate by 13.85%. For both adults and children being born in Mexico significantly improved the odds of vaccine completion (AOR: 2.154 95% CI: 1.439-3.224), while for adults only pre-intervention perceived benefits remained significant (AOR 1.101, CI: 1.002-1.210) and in children the main factor was parental perceived susceptibility of their child (AOR: 1.257 CI: 1.001-1.578). A Community based multicomponent HPV vaccine intervention significantly improved HPV immunization rates in a largely Hispanic population. Factors that affect completion of the HPV series are different among adults and children.
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Affiliation(s)
- J Molokwu
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX 79924, USA.
| | - A Dwivedi
- Department of Biostatistics and Epidemiology, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - I Mallawaarachchi
- Department of Biostatistics and Epidemiology, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - A Hernandez
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - N Shokar
- Department of Family and Community Medicine & Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA; Department of Family and Community Medicine, Paul l. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 9849 Kenworthy Street, El Paso, TX 79924, USA; Department of Biomedical Sciences, Paul l. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, Medical Science Building, 5001 El Paso Drive, El Paso, TX 79905, USA..
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Hamblett KJ, Barnscher SD, Davies RH, Hammond PW, Hernandez A, Wickman GR, Fung VK, Ding T, Garnett G, Galey AS, Zwierzchowski P, Clavette BC, Winters GC, Rich JR, Rowse GJ, Babcook JS, Hausman D. Abstract P6-17-13: ZW49, a HER2 targeted biparatopic antibody drug conjugate for the treatment of HER2 expressing cancers. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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
Abstract
Background: HER2-targeted therapies have transformed the treatment of patients with HER2-expressing breast and gastric cancers. Despite this, there remains a need for new treatments that are well tolerated and effective not only for cancers with high HER2 expression levels but also those with lower levels of expression. ZW49 is an antibody drug conjugate (ADC) that combines a novel auristatin payload (potent anti-cancer agent) with the unique mechanisms of action of the anti-HER2 biparatopic antibody, ZW25, which binds to the same domains as trastuzumab and pertuzumab. In preclinical studies in cancer cell lines with low to high levels of HER2 expression, ZW25 is associated with increased binding and internalization compared to trastuzumab, while the novel N-acyl sulfonamide auristatin payload has demonstrated increased in vivo tolerability compared to other microtubule inhibitors. ZW49 therefore has the potential to address unmet medical need across a range of HER2-expressing cancers.
Methods: Multiple in vitro and in vivo experiments were performed to characterize ZW49 as a potential therapeutic candidate. Internalization and cell growth inhibition of ZW49 were evaluated in HER2-expressing cell lines. Anti-tumor activity was assessed in patient-derived xenograft (PDX) tumor models of HER2 low and high expressing breast cancers. Tolerability was assessed in a 6-week repeat-dose non-GLP toxicology study in non-human primates (NHP) with intravenous administration of ZW49 at either 9 mg/kg or 12 mg/kg once every two weeks.
Results: In vitro, ZW49 was more rapidly internalized into HER2-expressing cells compared to a monospecific trastuzumab-ADC. ZW49 also displayed potent in vitro cell growth inhibition in several breast cancer cell lines with a range of HER2 expression. This activity was confirmed in multiple in vivo PDX models, including a HER2 IHC 3+ HBCx-13b xenograft where two doses of ZW49 at 3 mg/kg or higher generated tumor regressions, and a HER2 IHC 1+ ST-910 xenograft where a single dose of ZW49 at 6 mg/kg or higher generated regressions. In both models, regressions occurred at exposures that were well tolerated in NHP. In a repeat dose pilot non-GLP study the highest dose tested (12 mg/kg) was considered to be the no observed adverse effect level (NOAEL) and a GLP repeat-dose toxicology study was ongoing at the time of abstract submission.
Conclusions: ZW49 is a novel biparatopic HER2-targeted ADC that demonstrated anti-tumor activity in low and high HER2-expressing breast cancer cell lines and PDX models. Notably, tumor regressions were observed at exposure levels that were well tolerated in NHP. These results support the potential of ZW49 as a novel therapeutic agent that may help address unmet medical need in patients with high and low HER2-expressing cancers.
Citation Format: Hamblett KJ, Barnscher SD, Davies RH, Hammond PW, Hernandez A, Wickman GR, Fung VK, Ding T, Garnett G, Galey AS, Zwierzchowski P, Clavette BC, Winters GC, Rich JR, Rowse GJ, Babcook JS, Hausman D. ZW49, a HER2 targeted biparatopic antibody drug conjugate for the treatment of HER2 expressing cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-13.
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Affiliation(s)
- KJ Hamblett
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - SD Barnscher
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - RH Davies
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - PW Hammond
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - A Hernandez
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - GR Wickman
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - VK Fung
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - T Ding
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - G Garnett
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - AS Galey
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - P Zwierzchowski
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - BC Clavette
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - GC Winters
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - JR Rich
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - GJ Rowse
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - JS Babcook
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
| | - D Hausman
- Zymeworks Biopharmaceuticals Inc., Seattle, WA; Zymeworks Inc., Vancouver, BC, Canada
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Stambough K, Hernandez A, Gunn S, Adeyemi-Fowode O. Maternal Placentophagy as a Possible Cause of Breast Budding and Vaginal Bleeding in a Breast-Fed 3-Month-Old Infant. J Pediatr Adolesc Gynecol 2019; 32:78-79. [PMID: 30244191 DOI: 10.1016/j.jpag.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/17/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Placentophagy, or the practice of placental consumption, has grown in popularity over the past decade. Although advocates endorse prevention of postpartum depression, increased breast milk production, reduction in postpartum bleeding, and provision of nutrients postpartum, scientific studies have failed to show benefit. No studies have explored the effect of placental hormone consumption on the hypothalamic-pituitary-ovarian axis of the offspring. CASE We present a case of vaginal bleeding and breast budding in a 3-month-old infant whose mother was exclusively breastfeeding. Maternal history was notable for placentophagy. Upon discontinuation of consuming encapsulated placenta, the infant's vaginal bleeding resolved. SUMMARY AND CONCLUSION Our case raises concerns regarding placentophagy and infant endocrine function. More research is needed to assess maternal and infant exogenous estrogen exposure with maternal placental consumption.
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Affiliation(s)
- Kathryn Stambough
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Angela Hernandez
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Sheila Gunn
- Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Hague C, Hernandez A, McCreary M, Greenberg B, Harder L. C - 66Patient and Parent Satisfaction with Pediatric Tele-Neuropsychological Assessment. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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