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Lewis TL, Trowbridge S, Franklin S, Lau B, Shehata R, Lyle S, Ray R. Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up. Foot Ankle Surg 2024:S1268-7731(24)00103-6. [PMID: 38744636 DOI: 10.1016/j.fas.2024.05.003] [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: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. METHODS A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). RESULTS Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. CONCLUSION This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom.
| | - S Trowbridge
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Franklin
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - B Lau
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Shehata
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Lyle
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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Lau B, March MK, Harmer AR, Caruana S, Mahony C, Dennis S. Experiences of Boosting Inpatient Exercise After HipFracture Surgery Using An Alternative Workforce - A Qualitative Study. BMC Geriatr 2024; 24:183. [PMID: 38395780 PMCID: PMC10893611 DOI: 10.1186/s12877-024-04756-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Thrice-daily physiotherapy immediately following surgical repair of hip fracture has been shown to be safe and to reduce total hospital length of stay. However, implementing this is challenging with respect to health service funding and staffing. A novel approach may be to utilize an alternative workforce (allied health staff and student physiotherapists) to deliver two of the three daily treatments. However, how patients and staff may view such an approach is unknown. Thus, the aim of this qualitative study was to explore the views of inpatients with surgical repair of a hip fracture, their carers, health care professionals, and physiotherapy students about the implementation and acceptability of thrice-daily physiotherapy, with two sessions delivered by the alternative workforce (the BOOST study). METHODS Semi-structured interviews and focus groups with patients, carers, health professionals and physiotherapy students. All interviews were digitally recorded and transcribed via verbatim. The transcripts were coded, and the data analysed via inductive thematic analysis. RESULTS A total of 37 interviews (32 one-to-one interviews and five focus group interviews) were analysed. Five main themes were identified: (1) individual perceptions of the intervention: inpatients/carer/staff/student, (2) implementation within the service and organisational context, (3) implementation strategies that were effective, (4) improvements to implementation strategies/barriers to implementation/unsuccessful strategies and (5) future directions of BOOST. CONCLUSIONS The qualitative data revealed that higher frequency physiotherapy was well-received by inpatients and that staff/students involved in providing care perceived it as a safe, acceptable and valuable practice. Implementation of higher daily frequency of physiotherapy using an alternative workforce may feasibly be adopted for inpatients following hip fracture surgery. TRIAL REGISTRATION This study was approved by the Human Research Ethics Committee (HREC) of the Western Sydney Local Health District (2020/ETH02718). Mutual recognition of approval was subsequently obtained from Northern Sydney Local Health District HREC.
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Affiliation(s)
- Benny Lau
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Physiotherapy Department, Fairfield Hospital, South Western Sydney Local Health District, Warwick Farm, Australia
| | - Marie K March
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, Australia.
| | - Alison R Harmer
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Sarah Caruana
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, Australia
| | - Christopher Mahony
- Physiotherapy Department, Hornsby Ku-ring-gai Hospitals, Northern Sydney Local Health District, Hornsby, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Physiotherapy Department, Fairfield Hospital, South Western Sydney Local Health District, Warwick Farm, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
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Lau B, Kothari V, Trowbridge S, Lewis TL, Ray R. Tourniquet use in ankle arthroscopy: A systematic review. Foot Ankle Surg 2024; 30:50-56. [PMID: 37866989 DOI: 10.1016/j.fas.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/23/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Ankle arthroscopy is commonly performed using a thigh tourniquet and is thought to improve visibility and reduce operative time. However, the current evidence is unclear as to whether the use of a tourniquet provides these benefits. The aim of this study was to investigate whether there is any clinical benefit of using a tourniquet in ankle arthroscopy. METHODS A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until January 2023 reporting on the use of a tourniquet in ankle arthroscopy were included. RESULTS 180 studies were identified of which 3 (164 patients) met the inclusion criteria. All studies showed no statistically significant difference in mean surgical time and complication rate between the tourniquet and non-tourniquet groups. Overall, the quality of the evidence was moderate to poor without data in favour or against the routine use of tourniquets in ankle arthroscopy. CONCLUSION The current literature suggests that there are no significant differences in mean surgical time and complication rate between the tourniquet and non-tourniquet groups.
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Affiliation(s)
- B Lau
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK.
| | - V Kothari
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - S Trowbridge
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
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Jiang H, Fu J, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Graves EE, Casey K, Rankin E, Lu W, Loo BW, Gu X. An Online AI-Powered Interactive Histological Image Annotation Platform for Analyzing Intestinal Regenerating Crypts in Post-Irradiated Mice. Int J Radiat Oncol Biol Phys 2023; 117:e676. [PMID: 37785993 DOI: 10.1016/j.ijrobp.2023.06.2130] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The goal of this project is to build an online AI-powered interactive annotation platform to accurately and efficiently annotate intestinal regenerating crypts in histological images of mice after abdominal irradiation. MATERIALS/METHODS The proposed platform is developed by the seamless integration of a front-end web client and a back-end server. Such client/server design allows the users to access the platform without software installation on local computers. Our front-end client is developed with SvelteJS + WebGL technology stack, allowing access from any common web browsers and enabling user interaction, such as image importing/visualization, interactive crypt annotating, and annotation saving/deleting. The back-end server is responsible for executing the tasks requested from the web client, for instance, image pre-processing, AI-based crypts automatic identification, and database management. The image preprocessing is designed to extract a single cross section image using morphological operations because multiple hematoxylin and eosin (H&E) stained jejunum cross sections from post-irradiated mice are scanned within one slide. The auto-crypt identification is powered by a trained and validated AI engine U-Net, classifying image grid tiles into two groups with and without regenerating crypts. The database is implemented with the self-contained SQLite to support recording and indexing the annotated grid tiles with regenerating crypts. The workflow for crypt analysis on this interactive platform has 5 steps: 1) manually import a whole H&E slide image; 2) auto-preprocess the slide by extracting single cross-section images; 3) auto-identify regenerating crypts with an AI engine; 4) interactively annotate (add, delete, modify) auto-identified crypt markers; 5) save and/or output the annotation to the database or the local drive. RESULTS The performance of the developed interactive crypt analysis platform was evaluated in aspects of accuracy and efficiency. The AI-powered crypt auto-identification accuracy was assessed by computing the mean absolute error (MAE) on crypt number per cross section between manual and auto annotation using a testing dataset containing 80 cross sections. It achieved an MAE of 3.5±4.8 crypts per cross section, and 81.25% of the cross sections have no more than 5 crypts difference. The efficiency was assessed under two conditions with the server on the cloud and a local computer. It took about 2-3 minutes to finish the entire workflow on the cloud, while 1-2 minutes on the local by saving ∼1 minute on image uploading. CONCLUSION The developed web client/server platform enables online automatic identification and interactive annotation of mice crypts in minutes. It is a convenient tool that allows accurate and efficient crypt analysis and can be extended for other histologic image analyses.
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Affiliation(s)
| | - J Fu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - V Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L A Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S J Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - E E Graves
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - K Casey
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA
| | - E Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - W Lu
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - B W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - X Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Lau B, Vo J, Shing J, Pollom E, Taparra K. A Large National Study on Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Cancer Patients Who Refuse Radiation Therapy and Surgery. Int J Radiat Oncol Biol Phys 2023; 117:e33. [PMID: 37785166 DOI: 10.1016/j.ijrobp.2023.06.720] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Asian Americans (AAs) are the only race for whom cancer is the leading cause of death in the US. Despite radiation therapy (RT) and surgery being curative treatments, prior work demonstrated AAs refuse RT/surgery at a higher rate than other races. Given AAs are often aggregated with Native Hawaiians and other Pacific Islanders (NHPIs), rates of RT/surgery refusal within this community are poorly understood. We aimed to 1) assess RT/surgery refusal on overall survival (OS) using propensity-score (PS) matched groups, 2) identify AA and NHPI populations that refuse RT/surgery and 3) determine predictors of refusing RT/surgery. MATERIALS/METHODS A US hospital-based retrospective cohort study of the National Cancer Database was conducted. Patients included were ≥18 years old, AA by ethnogeographic region (South AA, East AA, and Southeast AA) or NHPI race, with a confirmed diagnosis of 1 of the 10 most common US cancers during 2004-2017 who were recommended for RT/surgery. Cox proportional hazard models with adjusted Hazard Ratios (aHR) assessed propensity-score matched groups (1:10) based on age, race, cancer stage, comorbidity index, rurality, facility type, facility location, and year of diagnosis. Adjusted odds ratios (aOR) were calculated and 95% confidence intervals (95% CI) for treatment refusal using logistic regression. Population heterogeneity for treatment refusal by race was assessed with likelihood ratio tests (p-heterogeneity). RESULTS The cohort of 147,685 patients who met the inclusion criteria were predominantly East AA (43%), diagnosed with breast cancer (42%), and had a <2 comorbidity index (99%). Median age was 61 years. Median follow-up was 58 months. Overall, 2,888 (5%) patients refused RT, and 1,073 (1%) refused surgery. RT refusal by race was 5.7% (East AA), 7.9% (NHPI), 4.6% (South AA), and 4.6% (Southeast AA). Surgery refusal rates were 1.5% (East AA), 1.9% (NHPI), 1.1% (South AA) and 1.2% (Southeast AA). RT refusal significantly predicted poorer OS (aHR = 1.15, 95% CI = 1.06-1.25) whereas surgery refusal did not. Compared to East AA, NHPIs had a higher risk of RT refusal (aOR = 1.44, 95% CI = 1.27-1.62), whereas South AA (aOR = 0.85, 95% CI = 0.75-0.95) and Southeast AA (aOR = 0.82, 95% CI = 0.75-0.90) had a significantly lower risk (p-heterogeneity<.0001). Predictors of RT refusal were older patient age, high comorbidity index, oral cavity cancer, urban-rural residence, Midwest or West US region, and diagnosis 2011-2017. CONCLUSION Among AA and NHPI patients with cancers in the US, RT refusal predicted poorer OS. NHPI had the highest risk of RT refusal. Given AA and NHPI are not monolithic groups, data disaggregation is necessary to understand racial/ethnic disparities for treatment refusal. Sociocultural and historical contexts of AA and NHPI populations on treatment refusal are necessary to improve cancer outcomes among these populations.
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Affiliation(s)
- B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Vo
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - J Shing
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - E Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - K Taparra
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Fu J, Jiang H, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Graves EE, Casey K, Rankin E, Lu W, Loo BW, Gu X. Deep Learning-Based Pipeline for Automatic Identification of Intestinal Regenerating Crypts in Mouse Histological Images. Int J Radiat Oncol Biol Phys 2023; 117:S117-S118. [PMID: 37784305 DOI: 10.1016/j.ijrobp.2023.06.451] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A classical approach for evaluating normal tissue radiation response is to count the number of intestinal regenerating crypts in mouse histological images acquired after abdominal radiation. However, manual counting is time-consuming and subject to inter-observer variations. The goal of this study is to build a deep learning-based pipeline for automatically identifying intestinal regenerating crypts to facilitate high-throughput studies. MATERIALS/METHODS Sixty-six healthy C57BL/6 female mice underwent 16 MeV whole abdominal electron irradiation. The small bowel was collected from each mouse 4 days post-irradiation, and 9 jejunal cross-sections from each were processed together in a single slide. The slides were stained with hematoxylin and eosin (H&E) and subsequently scanned (x20), providing one electronic histological image per mouse. Regenerating crypts, consisting of more than 10 basophilic crypt epithelial cells, were manually identified using point annotations in histological images. The pipeline was built to take the input of the image containing 9 cross sections and automatically identify the regenerating crypts on each cross section. It mainly consists of two components, cross section segmentation using intensity thresholding and morphological operations and crypt identification using a UNet. The dataset was randomly split into 46, 10, and 10 slide images for UNet training, validation, and testing. Each slide image was split into grid tiles with a voxel size of 200 × 200, and 40 × 40 square masks were placed with centers at manual point annotations on tiles with regenerating crypts. 5203/5198 tiles (w/wo crypt mask) were extracted to train UNet by minimizing dice loss. The mask probability map generated by the UNet was post-processed to identify the crypt position. Postprocessing hyperparameters were tuned using the validation dataset. The model accuracy was evaluated using the testing dataset by computing the mean absolute error (MAE) of the crypt number averaged across all cross sections. RESULTS The number of regenerating crypts on testing cross sections ranges from 1 to 63. The testing cross-section-wise MAE achieved by the platform is 3.5±4.8 crypts. 81.25% of testing cross sections have absolute number differences less than or equal to 5 crypts. CONCLUSION Our established deep learning-based pipeline can accurately count the number of regenerating crypts in mouse intestinal histological images. We have integrated it into an online platform that enables automatic crypt identification and allows users to interactively modify auto-identified crypt annotations. The acquired annotations from the platform will be used to finetune the deep learning model to achieve better identification performance.
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Affiliation(s)
- J Fu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - S Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - V Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L A Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S J Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - E E Graves
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - K Casey
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA
| | - E Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - W Lu
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - B W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - X Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Yang Z, Fu J, Melemenidis S, Viswanathan V, Dutt S, Lau B, Soto LA, Manjappa R, Skinner L, Yu SJ, Surucu M, Casey K, Rankin E, Lu W, Jr BWL, Gu X. Equivalent Dose Estimation in FLASH Irradiation with a Deep Learning Approach. Int J Radiat Oncol Biol Phys 2023; 117:e272. [PMID: 37785029 DOI: 10.1016/j.ijrobp.2023.06.1241] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Ultra-high dose rate (FLASH) irradiation has been reported to provide decreased normal tissue toxicity without compromising tumor control compared with conventional (CONV) irradiation. However, a comprehensive understanding of the FLASH biological effect requires precise quantification of radiobiology. The study is to explore whether deep learning (DL) can tackle the task. As a proof of concept, we investigate a DL model for estimating FLASH dose to its equivalent CONV dose. MATERIALS/METHODS Healthy C57Bl/6 female mice underwent FLASH (200Gy/s; n = 43) or CONV (0.12Gy/s; n = 41) whole abdominal irradiation using ∼16 MeV electron beams with a dose escalation scheme of 5 groups (n = 8 or 9) at 1Gy increments: 12-16Gy FLASH, 11-15Gy CONV. 4 days post-irradiation, 9 jejunum cross-sections per mouse were H&E stained for histological analysis. Each cross-section image was processed to remove lumen background and oversampled into multiple large-scale and small-scale patches along jejunal circumference. In CONV dataset, we randomly selected the data of 32 mice (80%) for model training and the rest (20%) for model validation. A ResNet101-based DL model, pre-trained with an unsupervised contrastive learning scheme, was retrained with only CONV training set to estimate corresponding CONV dose. For comparison, a crypt counting (CC) approach was implemented by manually counting the number of regenerating crypts on each cross-section image. An exponential function of dose vs crypt number was fitted with the CONV training set and used for dose estimation on the testing set. Mean squared error (MSE) was used to assess the accuracy of DL and CC approaches in estimating dose levels in CONV irradiation. The validated DL model was applied to the FLASH set to project FLASH dose into corresponding CONV dose that results in equivalent biological response. RESULTS The CONV dose estimated by DL and CC approaches and DL-estimated FLASH equivalent dose were summarized in Table 1. The DL model achieved an MSE of 0.21 Gy2 on CONV testing set compared with 0.32 Gy2 of the CC approach. FLASH equivalent dose estimated by DL model for 12, 13, 14, 15 and 16Gy were 12.16±0.40, 12.53±0.32, 12.72±0.24, 12.85±0.20 and 13.04±0.27 Sv, respectively. CONCLUSION Our proposed DL model can accurately estimate the CONV dose based on histological images. The DL predictions of FLASH dataset demonstrate that FLASH may reduce normal tissue toxicity with a lower equivalent dose, especially at high irradiated dose levels. Our study indicates that deep learning can be potentially used to assess the equivalent dose of FLASH irradiation to normal tissue.
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Affiliation(s)
- Z Yang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - J Fu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - V Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L A Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S J Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - K Casey
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA
| | - E Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - W Lu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - B W Loo Jr
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - X Gu
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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9
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Butler SS, Raclin T, Lau B, Raja N, Chin AL, Skinner L, Diehn M, Loo BW, Vitzthum L. Hyperfractionated Reirradiation for Locally Recurrent Thoracic Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e9. [PMID: 37786208 DOI: 10.1016/j.ijrobp.2023.06.666] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For patients with locally recurrent thoracic tumors or second primaries within previously irradiated volumes, hyperfractionated reirradiation (re-RT) may mitigate late toxicity compared to conventional fractionation, but clinical outcomes have not been extensively studied. We herein report our institutional experience with thoracic hyperfractionated reirradiation. MATERIALS/METHODS We identified 26 cases among 23 patients treated with re-RT to either primary or metastatic thoracic tumors, 60 Gy in 50 fractions, twice daily over 5 weeks using highly conformal image guided RT with motion management. Nineteen patients had dosimetry data available. The primary outcome was Grade (G2) or higher toxicity rates per CTCAEv5.0. Secondary endpoints were 12-month local control (LC), progression free survival (PFS)-determined by treating physician and/or multidisciplinary tumor board-and overall survival (OS). RESULTS Median follow-up was 13 months. Half had non-small cell lung cancer, 95.8% had ultracentral tumors, 57.7% had single prior thoracic RT course; 38.5%, 11.5% and 11.5% received concurrent chemotherapy, immunotherapy, and targeted agents, respectively. Minimum and median intervals between RT courses were 10 and 39.5 months, respectively; 94.7% of re-irradiation plans had overlapping 80% isodose volumes. Median OS and PFS were 13 and 10 months, respectively. Crude 12-month LC was 73.1%. Of those with a recurrence, the first recurrence occurred locally in 6 (54.6%), regionally in 3 (27.3%), and distantly in 8 (72.7%) patients. ≥G2 and ≥G3 toxicity rates were 30.8% and 7.69%, respectively (one G3 atrial fibrillation; one G5 pneumonitis). Using the American Radium Society guidelines for thoracic reirradiation, only 10.5% met all dose volume constraint recommendations. CONCLUSION Definitive hyperfractionated thoracic re-RT was well tolerated with promising local control. ≥G3 toxicities were rare. Patients should be counseled on the low but potential risk of life-threatening toxicity. Consensus guidelines for dose constraints may be difficult to meet in reirradiation setting; in this cohort, rates of severe toxicity were low despite exceeding putative constraints in most patients.
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Affiliation(s)
- S S Butler
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - T Raclin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Raja
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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10
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Hui C, Ewongwo A, Lau B, Fisher GA, Poultsides G, Rahimy E, Pollom E, Vitzthum L. Patterns of Failure for Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e304. [PMID: 37785108 DOI: 10.1016/j.ijrobp.2023.06.2324] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Peri-operative chemotherapy has emerged as the standard of care in the treatment of locally advanced gastric cancer. Improved treatment strategies are needed for patients with a poor response to neoadjuvant chemotherapy and postoperative chemoradiation has been proposed as a potential method of treatment intensification. We aimed to describe the patterns of failure for patients with no or partial response (NR, PR) to pre-operative chemotherapy. MATERIALS/METHODS We retrospectively reviewed charts of patients with locally advanced gastric cancer treated at our institution from 2008 to 2022 with pre-operative chemotherapy followed by surgery with a D2 resection. We excluded patients who received pre-operative or post-operative radiation therapy, or patients who had a complete response (CR) following neoadjuvant chemotherapy. Cumulative incidence of locoregional failure (LRF) and distant metastases (DM) were calculated from the time of diagnosis with competing risk analysis with death as a competing risk and censored at the last follow up. Overall survival (OS) was analyzed using Kaplan-Meier. RESULTS A total of 57 patients were identified and 60% are male. Median follow-up time was 31.3 months (range 6.9-181.5 months), and the median age at diagnosis was 68 years old (range 30-86). The most used pre-operative chemotherapy regimen was FLOT (38.6%), followed by FOLFOX (29.8%), and ECF/ECX/EOX (19.3%), and a majority of patients (57.9%) received adjuvant chemotherapy. The most common histology was adenocarcinoma (85.9%), and 61.4% of patients had poorly differentiated disease. Thirty-three (57.9%), and 9 patients (15.8%) were characterized as PR and NR to neoadjuvant therapy by pathology, respectively. The distribution of pathologic stages following neoadjuvant chemotherapy were as follows: 17 patients (29.8%) with Stage IA-B, 12 patients (21.1%) with Stage IIA-B, 15 patients (26.3%) with Stage IIIA, 9 patients (15.8%) with Stage IIIB, and 3 patients (5.3%) with Stage IIIC disease. Two patients had positive lymph nodes with a T0 primary tumor. Median OS was 51.4 months (95% confidence interval [CI] 39.8-68.4) for the entire cohort, and 92.1 months (95% CI 34.6-73.0) versus 42.8 months (95% CI 23.1-88.0) for patients with a PR, and NR, respectively (p = 0.14). The 2-year cumulative incidence of LRF and DM was 7.4% (95% CI 0.4-14.3) and 36.3% (95% CI 23.6-49.1), respectively. Of the five patients who experienced LRF, three of the patients also eventually or concurrently developed DM. 60% of these patients would have had their first site of recurrence covered by standard post-operative radiation treatment volumes. CONCLUSION Patients with locally advanced gastric cancer who do have less than a CR to chemotherapy have poor outcomes due to high rates of DM. Adjuvant locoregional therapy such as radiation is unlikely to affect survival while DM is the predominant pattern of progression. Further studies are needed to identify adjuvant therapies to improve distant control.
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Affiliation(s)
- C Hui
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A Ewongwo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - G A Fisher
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - G Poultsides
- Department of Medicine, Stanford University, Palo Alto, CA
| | - E Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - E Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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11
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Wu YF, Lau B, Fu J, Cui S, Pham D, Dubrowski P, Eswarappa S, Zgrabik J, Candow L, Skinner L, Shirato H, Taguchi H, Gensheimer MF, Gee HE, Diehn M, Chin AL, Loo BW, Vitzthum L. Predicting Local Control with Dosimetric Parameters in Patients Receiving Individualized Stereotactic Ablative Radiotherapy for Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e76. [PMID: 37786175 DOI: 10.1016/j.ijrobp.2023.06.814] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic ablative radiotherapy (SABR) is an effective treatment option for lung tumors. The individualized lung tumor SABR (iSABR) trial was a phase II single-arm study that personalized lung tumor SABR dose and fractionation based on tumor size, location, and histology with very low rates of local recurrence (LR). A secondary analysis of this trial was conducted to assess for potential dosimetric predictors of LR, in order to help guide future clinical treatment planning. MATERIALS/METHODS From 2011 to 2018, local, regional and distant recurrence data were prospectively collected from 204 patients (261 lung SABR treatments) enrolled in a prospective trial. Baseline characteristics and treatment details were evaluated. Dosimetric and treatment plan parameters were evaluated for their potential to predict LR, using logistic regression and chi-squared analyses. RESULTS The majority of treated tumors were peripheral (71%, vs 29% central), primary lesions (76%, versus 24% metastatic), and of adenocarcinoma histology (67%, versus 13% squamous cell carcinoma and 19% other). The median follow-up was 24 months (range 2-95). Twenty-seven (10.3%) LRs occurred, with a median time to LR of 15 months (range 6-81 months). There were no significant associations between the overall cohort and the dosimetric parameters. However, for the multi-fraction cohort, an increased proportion of the PTV receiving 110% and 115% of the prescription dose were associated with lower LR (p = 0.01 and p = 0.01 respectively). Specifically for the 50 Gy in 4 fraction cohort, an increased D1cc, D0.03cc, as well as the proportion of the PTV receiving 110%, 115%, and 120% of the prescription dose were associated with lower LR (p < 0.001, p = 0.001, p = 0.003, p < 0.001, p = 0.004, respectively). There was no association of LR with prescription dose expressed as biologically effective dose using an alpha/beta of 10 Gy (BED10), D99%, or single- versus multi-fraction regimens. CONCLUSION SABR for lung tumors using the individualized protocol on this trial showed excellent LR rates. We identified dosimetric parameters that were associated with LR, including V110% and V115% within the multi-fraction cohort, as well as the 50 Gy in 4 fraction cohort the D1cc, D0.03cc, and proportions of the PTV receiving 110%, 115%, and 120% of the prescription dose in the 50 Gy in 4 fraction cohort. Optimal thresholds for these parameters will be identified in further analyses. There did not appear to be an association with LR and BED10, D99%, or comparing single- vs multi-fraction regimens.
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Affiliation(s)
- Y F Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Fu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - S Cui
- University of Michigan, Ann Arbor, Ann Arbor, MI
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - P Dubrowski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - L Candow
- MIM Software Inc., Beachwood, OH
| | - L Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - H Shirato
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Taguchi
- Obihiro Kosei Hospital, Obihiro, Japan
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - H E Gee
- Children's Medical Research Institute, Sydney, Australia
| | - M Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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12
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Wu Y, No H, Dworkin M, Manjappa R, Ashraf R, Skinner L, Lau B, Melemenidis S, Viswanathan V, Yu S, Surucu M, Schueler E, Graves E, Maxim P, Loo B. Assessing Clinical Feasibility of a LINAC-Based Electron FLASH Radiotherapy System Using an Anthropomorphic Phantom under Realistic Clinical Conditions. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.605] [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: 11/25/2022]
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13
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No H, Wu Y, Dworkin M, Ashraf R, Manjappa R, Skinner L, Lau B, Melemenidis S, Viswanathan V, Yu S, Surucu M, Schueler E, Graves E, Maxim P, Loo B. Clinical LINAC-Based Electron FLASH: Pathway for Practical Translation to Trials of FLASH Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2152] [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: 10/31/2022]
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14
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Hui C, Baclay J, Lau B, Von Eyben R, Vitzthum L, Pollom E, Chang D. Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated with Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1062] [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: 10/31/2022]
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15
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Lau B, Wu Y, Fu J, Cui S, Pham D, Gee H, Skinner L, Shirato H, Taguchi H, Chin A, Gensheimer M, Diehn M, Loo B, Vitzthum L. OA14.04 Chest Wall Toxicity after Individualized Stereotactic Ablative Radiotherapy for Lung Tumors. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.069] [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: 11/30/2022]
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16
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Moulson N, Robinson J, Chan S, Cuff D, Ignaszewski A, Isserow S, Lau B, Ordano N, Sung L, Werry J, Taylor C. Virtual cardiac rehabilitation during the COVID-19 pandemic: a tertiary site experience. Eur J Prev Cardiol 2022. [PMCID: PMC9383983 DOI: 10.1093/eurjpc/zwac056.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): University of British Columbia Clinician Investigator Program
Background
The COVID-19 pandemic resulted in the abrupt suspension of centre-based cardiac rehabilitation (CR). Multidisciplinary virtual CR (VCR) with the use of digital, telephone, and video communication was implemented for continued care access. Exercise therapy was delivered through synchronous video-supervised sessions, pre-recorded sessions, and self-directed physical activity.
Purpose
To describe patient characteristics, completion rates, and safety outcomes in a real-world VCR population.
Methods
Prospective observational study of a tertiary academic CR program. VCR was implemented at pandemic onset (March 2020). Patients who were enrolled in, and either completed or dropped out, during the study period were included. Completers were defined as completing 6 months of virtual enrolment and an exit assessment. Risk was defined by the AACPVR 2020 risk categorization. Adverse cardiovascular events were defined as a patient-initiated event requiring medical assessment and stratified as exercise or non-exercise related. Continuous variables are presented as means and SD or medians and IQR. Student’s t-test was used for between group comparisons. Categorical variables are presented as n (%) and compared using the χ2 test or Fischer’s exact test. A p-value <0.05 was considered significant.
Results
Between March 13th, 2020, and August 31st, 2021, 222 [mean age 61.8 years (SD, 12.6) 77% male], were enrolled and discharged from the VCR program (Table 1). There were 160 completers and 62 non-completers (completion rate 72%). Among the non-completers 26 attended the MD intake assessment only. The remaining 36 completed a median of 85 days (IQR 25-197). This cohort included 21 (9%) high-risk and 35 (16%) moderate risk patients. Those at moderate risk were more likely to be non-completers and those at low risk were more likely to be completers (Table 1). Two exercise and 17 non-exercise adverse events were observed (median clinical surveillance 217 days [IQR 205-240]) (Table 2). Exercise related adverse events included neurally mediated syncope during a synchronous video exercise session in a low risk patient. This was responded to as per centre developed virtual safety protocols. A second syncope related to heart block occurred in a moderate risk patient during independent physical activity and required permanent pacemaker insertion. Both patients completed the program. Three non-exercise adverse cardiac events resulted in cessation of participation included one death and two heart failure hospitalizations (Table 2). One stroke and 13 emergency department visits for cardiac symptoms occurred in completers.
Conclusion
Real world VCR is feasible, including in those at moderate to high risk. Modest completion rates and a low exercise related adverse event rate were observed. Synchronous video exercise sessions with video monitoring and safety protocols may improve response to adverse exercise related events.
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Affiliation(s)
- N Moulson
- University of British Columbia, Vancouver, Canada
| | - J Robinson
- University of British Columbia, Vancouver, Canada
| | - S Chan
- University of British Columbia, Vancouver, Canada
| | - D Cuff
- St Paul's Hospital, Vancouver, Canada
| | | | - S Isserow
- University of British Columbia, Vancouver, Canada
| | - B Lau
- University of British Columbia, Vancouver, Canada
| | - N Ordano
- St Paul's Hospital, Vancouver, Canada
| | - L Sung
- Vancouver General Hospital, Vancouver, Canada
| | - J Werry
- St Paul's Hospital, Vancouver, Canada
| | - C Taylor
- University of British Columbia, Vancouver, Canada
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17
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Lewis J, Lau B, Pitney M, Borrie A, Lee L, Lau A. Blunt Chest Trauma (BCT): An Uncommon Association With Anterior STEMI in Patients With Pre-Existing Bulky LAD Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.565] [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: 11/17/2022]
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18
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Devine M, Merriott D, Say C, Yoo C, Yi E, Lau B, Ko R, Shaheen S, Neal J, Wakelee H, Das M, Loo B, Diehn M, Chin A, Vitzthum L. Patterns of Care in Patients With Isolated Nodal Recurrence After Definitive Stereotactic Ablative Radiotherapy for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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No H, Wu Y, Manjappa R, Skinner L, Lau B, Melemenidis S, Yu S, Surucu M, Schueler E, Bush K, Graves E, Maxim P, Loo B. Feasibility of Clinically Practical Ultra-High Dose Rate (FLASH) Radiation Delivery by a Reversible Configuration of a Standard Clinical-Use Linear Accelerator. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.099] [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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20
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Wu Y, No H, Manjappa R, Skinner L, Yu S, Lau B, Surucu M, Schueler E, Bush K, Graves E, Maxim P, Loo B. Validation of a Novel Cone-Less Set-up for Electron FLASH Radiation Delivery on a Clinical-Use Linear Accelerator. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.314] [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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21
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Lau B, Menzies AM, Joshua AM. Ongoing partial response at 6 months to olaparib for metastatic melanoma with somatic PALB2 mutation after failure of immunotherapy: a case report. Ann Oncol 2020; 32:280-282. [PMID: 33308898 DOI: 10.1016/j.annonc.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- B Lau
- Kinghorn Cancer Centre, Department of Medical Oncology, St Vincent's Hospital Sydney and Garvan Institute of Medical Research, Sydney, Australia
| | - A M Menzies
- Melanoma Institute of Australia, Sydney, Australia
| | - A M Joshua
- Kinghorn Cancer Centre, Department of Medical Oncology, St Vincent's Hospital Sydney and Garvan Institute of Medical Research, Sydney, Australia; Melanoma Institute of Australia, Sydney, Australia.
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22
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Moulson N, Bewick D, Selway T, Harris J, Suskin N, Oh P, Coutinho T, Singh G, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi AUR, Roifman I, Ruel M, Sapp J, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, Krahn AD. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. Can J Cardiol 2020; 36:1317-1321. [PMID: 32553606 PMCID: PMC7293761 DOI: 10.1016/j.cjca.2020.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 02/04/2023] Open
Abstract
Cardiac rehabilitation programs across Canada have suspended in-person services as a result of large-scale physical distancing recommendations designed to flatten the COVID-19 pandemic curve. Virtual cardiac rehabilitation (VCR) offers an alternate mechanism of care delivery, capable of providing similar patient outcomes and safety profiles compared with centre-based programs. To minimize care gaps, all centres should consider developing and implementing a VCR program. The process of this rapid implementation, however, can be daunting. Centres should initially focus on the collation, utilization, and repurposing of existing resources, equipment, and technology. Once established, programs should then focus on ensuring that quality indicators are met and care processes are protocolized. This should be followed by the development of sustainable VCR solutions to account for care gaps that existed before COVID-19, and to improve cardiac rehabilitation delivery, moving forward. This article reviews the potential challenges and obstacles of this process and aims to provide pragmatic guidance to aid clinicians and administrators during this challenging time.
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Affiliation(s)
- Nathaniel Moulson
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada.
| | - Tracy Selway
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Jennifer Harris
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thais Coutinho
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Departments of Critical Care Medicine and Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services BC, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yoan Lamarche
- Department of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Howard Leong-Poi
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill University Health Center, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ata Ur Rehman Quraishi
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ricky Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Lloyd TD, Neal‐Smith G, Fennelly J, Claireaux H, Bretherton C, Carr AJ, Murphy M, Kendrick BJ, Palmer AJR, Wong J, Sharma P, Osei‐Bonsu PK, Ashcroft G, Baigent T, Shirland E, Espey R, Stokes M, Liew I, Dhawal A, Watchorn D, Lum J, Qureshi M, Khaled AS, Kauser S, Hodhody G, Rogers S, Haywood‐Alexander B, Sheikh G, Mahapatra P, Twaij H, Chicco M, Arnaout F, Atherton T, Mutimer J, Sinha P, Oliver E, Stedman T, Gadd R, Kutuzov V, Sattar M, Robiati L, Plastow R, Howe T, Hassan A, Lau B, Collins J, Doshi A, Tan G, Baskaran D, Hari Sunil Kumar K, Agarwal R, Horner M, Gwyn R, Masud S, Beaumont O, Pilarski A, Lebe M, Dawson‐Bowling S, Nolan D, Tsitskaris K, Beamish RE, Jordan C, Alsop S, Hibbert E, Deshpande G, Gould A, Briant‐Evans T, Kilbane L, Crowther I, Ingoe H, Naisbitt A, Gourbault L, Muscat J, Goh EL, Gill J, Elbashir M, Modi N, Archer J, Ismael S, Petrie M, O'Brien H, McCormick M, Koh NP, Lloyd T, King A, Ikram A, Peake J, Yoong A, Rye DS, Newman M, Naraen A, Myatt D, Kapur R, Sgardelis P, Kohli S, Culverhouse‐Mathews M, Haynes S, Boden H, Purmah A, Shenoy R, Raja S, Koh NP, Donovan R, Yeomans D, Ritchie D, Larkin R, Aladwan R, Hughes K, Unsworth R, Cooke R, Samra I, Barrow J, Michael K, Byrne F, Anwar R, Karatzia L, Drysdale H, Wilson H, Jones R, Dass D, Liaw F, Aujla R, Kheiran A, Bell K, Ramavath AL, Telfer R, Nachev K, Lawrence H, Garg V, Shenoy P, Lacey A, Byrom I, Simons M, Manning C, Cheyne N, Williams J. Peri‐operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study. Anaesthesia 2020; 75:1050-1058. [DOI: 10.1111/anae.15056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Affiliation(s)
- T. D. Lloyd
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - G. Neal‐Smith
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - J. Fennelly
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - H. Claireaux
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - C. Bretherton
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - A. J. Carr
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - M. Murphy
- University of Oxford UK
- NHS Blood and Transplant Oxford UK
| | - B. J. Kendrick
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - A. J. R. Palmer
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
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24
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Virani A, Singh G, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lamarche Y, Lau B, Légaré JF, Leong-Poi H, Mansour S, Marelli A, Quraishi A, Roifman I, Ruel M, John Sapp, Small G, Turgeon R, Wood DA, Zieroth S, Virani S, Krahn AD. Guiding Cardiac Care During the COVID-19 Pandemic: How Ethics Shapes Our Health System Response. Can J Cardiol 2020; 36:1313-1316. [PMID: 32505633 PMCID: PMC7270812 DOI: 10.1016/j.cjca.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022] Open
Abstract
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.
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Affiliation(s)
- Alice Virani
- Department of Medical Genetics, University of British Columbia, British Columbia, Canada.
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Division of Cardiac Surgery, Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services BC, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Yoan Lamarche
- Department of Surgery, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Howard Leong-Poi
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- Department of Medicine, McGill University Health Center, McGill University, Montréal, Québec, Canada
| | - Ata Quraishi
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- QEII Health Sciences Center, Division of Cardiology, Dalhousie University Halifax, Halifax, Nova Scotia, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ricky Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Turgeon RD, Zieroth S, Bewick D, Chow CM, Clarke B, Cowan S, Fordyce CB, Fournier A, Gin K, Gupta A, Hardiman S, Jackson S, Lau B, Leong-Poi H, Mansour S, Marelli A, Quraishi AR, Roifman I, Ruel M, Sapp J, Singh G, Small G, Virani S, Wood DA, Krahn A. Use of Renin-Angiotensin System Blockers During the COVID-19 Pandemic: Early Guidance and Evolving Evidence. Can J Cardiol 2020; 36:1180-1182. [PMID: 32502522 PMCID: PMC7265831 DOI: 10.1016/j.cjca.2020.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - David Bewick
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian Clarke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Simone Cowan
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Kenneth Gin
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anil Gupta
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Sean Hardiman
- Cardiac Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Simon Jackson
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Benny Lau
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Leong-Poi
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samer Mansour
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill University Health Center, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ata Rehman Quraishi
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - John Sapp
- Queen Elizabeth II Health Sciences Center, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gurmeet Singh
- Mazankowski Alberta Hearth Institute, Division of Cardiac Surgery, Departments of Critical Care Medicine and Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Gary Small
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sean Virani
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
OPINION STATEMENT Cardiovascular diseases are a common cause of morbidity and mortality in cancer survivors. Furthermore, some cancer therapies are now being increasingly recognized to have negative cardiovascular effects, or cardiotoxicity. Exercise therapy has been found to improve cardiorespiratory fitness in patients with cancer as well as attenuate the cardiotoxic effects of cancer therapy. It is the centerpiece for cardiac and pulmonary rehabilitation programs. It is also an important component in cardio-oncology rehabilitation. Exercise is generally safe, and its benefit is observed when started as soon as the diagnosis of cancer and throughout cancer survivorship.
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Affiliation(s)
- Calvin K W Tong
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Benny Lau
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Margot K Davis
- Division of Cardiology, University of British Columbia, 2775 Laurel St., 9th Floor, Vancouver, BC, V5Z 1M9, Canada.
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27
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May C, Brcic V, Lau B. Characteristics and complexity of chronic pain patients referred to a community-based multidisciplinary chronic pain clinic. Can J Pain 2018; 2:125-134. [PMID: 35005372 PMCID: PMC8730665 DOI: 10.1080/24740527.2018.1453751] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/15/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community-based care fills an important service gap for patients living with chronic pain. Better understanding of unmet patient needs in the community may inform improved policy and resource allocation. AIMS The aim of this study was to describe patients presenting to a community-based, multidisciplinary chronic pain clinic in Vancouver, British Columbia. METHODS This is a retrospective cross-sectional study of 935 unique consecutive patients who completed an intake questionnaire between January 2016 and March 2017. All data were patient reported. RESULTS Nine hundred thirty-five patient records were analyzed for descriptive characteristics. The mean age of the population was 49.5 (SD = 14.9) years; 70% were female. Approximately 50% of patients lived below the poverty line in Vancouver; 30% were not working due to disability, 51% had pain for more than 5 years, and 63% reported severe functional impairment. CONCLUSIONS Substantial unmet need is demonstrated in this patient population accessing a community-based chronic pain clinic. The population described is mainly of working age with significant functional impairment, reflecting a high level of need due to severity and duration of symptoms, poverty, and other characteristics described.
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Affiliation(s)
- C. May
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - V. Brcic
- Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B. Lau
- Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, BC, Canada
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28
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Abstract
A 28-year-old woman ingested 20 g of hydroxychloroquine sulphate for suicidal attempt. She developed hypotension, cardiac conduction disturbance, hypokalemia and hypoglycemia. Despite treatment with mechanical ventilation, epinephrine, sodium bicarbonate, diazepam and potassium replacement, she succumbed 10 hours post-overdose. Previous case reports of hydroxychloroquine overdose are summarised and the therapeutic choices are discussed.
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29
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Lau B. CAREGIVING WITH GRATEFULNESS: THE ROLE OF GRATITUDE IN COPING WITH DEMENTIA CAREGIVING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B. Lau
- University of Hong Kong, Hong Kong, Hong Kong
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30
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Soerjadi N, Lau B, Srikusalanukul W, Fisher A. RENAL IMPAIRMENT AND ANAEMIA IN HOSPITALISED OLDER PATIENTS: IMPACT ON SHORT-TERM OUTCOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3275] [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: 11/13/2022] Open
Affiliation(s)
- N. Soerjadi
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia,
| | - B. Lau
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia,
| | - W. Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia,
| | - A. Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia,
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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31
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Mustafa M, Shearer D, Kahn J, Lau B, Wu HH, Chokotho L. Cost Analysis of Intramedullary (IM) Nailing and Skeletal Traction for
Treatment of Femoral Shaft Fractures in Malawi. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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32
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Loh E, Guy SD, Mehta S, Moulin DE, Bryce TN, Middleton JW, Siddall PJ, Hitzig SL, Widerström-Noga E, Finnerup NB, Kras-Dupuis A, Casalino A, Craven BC, Lau B, Côté I, Harvey D, O'Connell C, Orenczuk S, Parrent AG, Potter P, Short C, Teasell R, Townson A, Truchon C, Bradbury CL, Wolfe D. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: introduction, methodology and recommendation overview. Spinal Cord 2017; 54 Suppl 1:S1-6. [PMID: 27444714 DOI: 10.1038/sc.2016.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Clinical practice guidelines. OBJECTIVES The objective was to develop the first Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. METHODS The guidelines were developed in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS The Working Group developed 12 recommendations for screening and diagnosis, 12 recommendations for treatment and 5 recommendations for models of care. Important clinical considerations accompany each recommendation. CONCLUSIONS The Working Group recommendations for the management of neuropathic pain after SCI should be used to inform practice.
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Affiliation(s)
- E Loh
- Lawson Health Research Institute, London, Ontario, Canada.,St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S D Guy
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - S Mehta
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - D E Moulin
- St. Joseph's Health Care Pain Clinic, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - T N Bryce
- Mount Sinai Hospital, New York, NY, USA
| | - J W Middleton
- The University of Sydney, Sydney, New South Wales, Australia
| | - P J Siddall
- The University of Sydney, Sydney, New South Wales, Australia
| | - S L Hitzig
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | | | | | - A Casalino
- Parkwood Institute, London, Ontario, Canada
| | - B C Craven
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - B Lau
- University of British Columbia, Vancouver, British Columbia, Canada
| | - I Côté
- Center interdisciplinaire de reserche en réadaptation et integration sociale, Quebec City, Quebec
| | - D Harvey
- Spinal Cord Injury Ontario, Ontario, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
| | - S Orenczuk
- Parkwood Institute, London, Ontario, Canada
| | - A G Parrent
- Western University, London, Ontario, Canada.,London Health Sciences Center, London, Ontario, Canada
| | - P Potter
- Western University, London, Ontario, Canada.,Parkwood Institute, London, Ontario, Canada
| | - C Short
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Teasell
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
| | - A Townson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - C Truchon
- Institut National d'Excellence en Santé et Services Sociaux, Montreal, Quebec
| | - C L Bradbury
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - D Wolfe
- Lawson Health Research Institute, London, Ontario, Canada.,Western University, London, Ontario, Canada
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33
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Krishna BA, Spiess K, Poole EL, Lau B, Voigt S, Kledal TN, Rosenkilde MM, Sinclair JH. Targeting the latent cytomegalovirus reservoir with an antiviral fusion toxin protein. Nat Commun 2017; 8:14321. [PMID: 28148951 PMCID: PMC5296658 DOI: 10.1038/ncomms14321] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/16/2016] [Indexed: 12/26/2022] Open
Abstract
Reactivation of human cytomegalovirus (HCMV) in transplant recipients can cause life-threatening disease. Consequently, for transplant recipients, killing latently infected cells could have far-reaching clinical benefits. In vivo, myeloid cells and their progenitors are an important site of HCMV latency, and one viral gene expressed by latently infected myeloid cells is US28. This viral gene encodes a cell surface G protein-coupled receptor (GPCR) that binds chemokines, triggering its endocytosis. We show that the expression of US28 on the surface of latently infected cells allows monocytes and their progenitor CD34+ cells to be targeted and killed by F49A-FTP, a highly specific fusion toxin protein that binds this viral GPCR. As expected, this specific targeting of latently infected cells by F49A-FTP also robustly reduces virus reactivation in vitro. Consequently, such specific fusion toxin proteins could form the basis of a therapeutic strategy for eliminating latently infected cells before haematopoietic stem cell transplantation.
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Affiliation(s)
- B A Krishna
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB20QQ, UK
| | - K Spiess
- Laboratory for Molecular Pharmacology, Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - E L Poole
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB20QQ, UK
| | - B Lau
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB20QQ, UK
| | - S Voigt
- Department of Infectious Diseases, Robert Koch Institute, Nordufer 20, Berlin 13353, Germany.,Department of Pediatric Oncology/Hematology/SCT, Charité-Universitätsmedizin, Berlin 13353, Germany
| | - T N Kledal
- Section for Virology, The National Veterinary Institute, Technical University of Denmark, Frederiksberg DK-1870, Denmark
| | - M M Rosenkilde
- Laboratory for Molecular Pharmacology, Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - J H Sinclair
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB20QQ, UK
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Zhao L, Ji G, Le X, Luo Z, Wang C, Feng M, Xu L, Zhang Y, Lau WB, Lau B, Yang Y, Lei L, Yang H, Xuan Y, Chen Y, Deng X, Yi T, Yao S, Zhao X, Wei Y, Zhou S. An integrated analysis identifies STAT4 as a key regulator of ovarian cancer metastasis. Oncogene 2017; 36:3384-3396. [PMID: 28114283 DOI: 10.1038/onc.2016.487] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/26/2016] [Accepted: 11/21/2016] [Indexed: 02/05/2023]
Abstract
Epithelial ovarian cancer (EOC) is one of the most common gynecological cancers, with diagnosis often at a late stage. Metastasis is a major cause of death in patients with EOC, but the underlying molecular mechanisms remain obscure. Here, we utilized an integrated approach to find potential key transcription factors involved in ovarian cancer metastasis and identified STAT4 as a critical player in ovarian cancer metastasis. We found that activated STAT4 was overexpressed in epithelial cells of ovarian cancer and STAT4 overexpression was associated with poor outcome of ovarian cancer patients, which promoted metastasis of ovarian cancer in both in vivo and in vitro. Although STAT4 mediated EOC metastasis via inducing epithelial-to-mesenchymal transition (EMT) of ovarian cancer cells in vivo, STAT4 failed to induce EMT directly in vitro, suggesting that STAT4 might mediate EMT process via cancer-stroma interactions. Further functional analysis revealed that STAT4 overexpression induced normal omental fibroblasts and adipose- and bone marrow-derived mesenchymal stem cells to obtain cancer-associated fibroblasts (CAF)-like features via induction of tumor-derived Wnt7a. Reciprocally, increased production of CAF-induced CXCL12, IL6 and VEGFA within tumor microenvironment could enable peritoneal metastasis of ovarian cancer via induction of EMT program. In summary, our study established a model that STAT4 promotes ovarian cancer metastasis via tumor-derived Wnt7a-induced activation of CAFs.
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Affiliation(s)
- L Zhao
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - G Ji
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - X Le
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Z Luo
- College of Biological Sciences, Sichuan University, Chengdu, China
| | - C Wang
- College of Biological Sciences, Sichuan University, Chengdu, China
| | - M Feng
- Department of Pathology, West China Second Hospital, Sichuan University, Chengdu, China
| | - L Xu
- Department of Pathology, West China Second Hospital, Sichuan University, Chengdu, China
| | - Y Zhang
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - W B Lau
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - B Lau
- Department of Surgery, Emergency Medicine, Kaiser Santa Clara Medical Center, Affiliate of Stanford University, Santa Clara, CA, USA
| | - Y Yang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - L Lei
- West China School of Medicine, Sichuan University, Chengdu, China
| | - H Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Y Xuan
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Y Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - X Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - T Yi
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - S Yao
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - X Zhao
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Y Wei
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
| | - S Zhou
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second Hospital and State Key Laboratory of Biotherapy/Collaborative Innovation Center, West China Hospital, Sichuan University, Chengdu, China
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Canan CE, Lau B, McCaul ME, Keruly J, Moore RD, Chander G. Effect of alcohol consumption on all-cause and liver-related mortality among HIV-infected individuals. HIV Med 2016; 18:332-341. [PMID: 27679418 DOI: 10.1111/hiv.12433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of the study was to examine the association between levels of past and current alcohol consumption and all-cause and liver-related mortality among people living with HIV (PLWH). METHODS A prospective cohort study of 1855 PLWH in Baltimore, MD was carried out from 2000 to 2013. We ascertained alcohol use by (1) self-report (SR) through a computer-assisted self interview, and (2) medical record abstraction of provider-documented (PD) alcohol use. SR alcohol consumption was categorized as heavy (men: > 4 drinks/day or > 14 drinks/week; women: > 3 drinks/day or > 7 drinks/week), moderate (any alcohol consumption less than heavy), and none. We calculated the cumulative incidence of liver-related mortality and fitted adjusted cause-specific regression models to account for competing risks. RESULTS All-cause and liver-related mortality rates (MRs) were 43.0 and 7.2 per 1000 person-years (PY), respectively. All-cause mortality was highest among SR nondrinkers with PD recent (< 6 months) heavy drinking (MR = 85.4 deaths/1000 PY) and lowest among SR moderate drinkers with no PD history of heavy drinking (MR = 23.0 deaths/1000 PY). Compared with SR moderate drinkers with no PD history of heavy drinking, SR nondrinkers and moderate drinkers with PD recent heavy drinking had higher liver-related mortality [hazard ratio (HR) = 7.28 and 3.52, respectively]. However, SR nondrinkers and moderate drinkers with a PD drinking history of > 6 months ago showed similar rates of liver-related mortality (HR = 1.06 and 2.00, respectively). CONCLUSIONS Any heavy alcohol consumption was associated with all-cause mortality among HIV-infected individuals, while only recent heavy consumption was associated with liver-related mortality. Because mortality risk among nondrinkers varies substantially by drinking history, current consumption alone is insufficient to assess risk.
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Affiliation(s)
- C E Canan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - B Lau
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M E McCaul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Keruly
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R D Moore
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Chander
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Krishna BA, Lau B, Jackson SE, Wills MR, Sinclair JH, Poole E. Transient activation of human cytomegalovirus lytic gene expression during latency allows cytotoxic T cell killing of latently infected cells. Sci Rep 2016; 6:24674. [PMID: 27091512 PMCID: PMC4835774 DOI: 10.1038/srep24674] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/04/2016] [Indexed: 12/15/2022] Open
Abstract
Human cytomegalovirus (HCMV) latency in the myeloid lineage is maintained by repressive histone modifications around the major immediate early promoter (MIEP), which results in inhibition of the lytic viral life cycle. We now show that pharmacological inhibition of histone deacetylases (HDACs) relieves this repression of the MIEP and induces transient expression of the viral lytic immediate early (IE) antigens but, importantly, not full virus reactivation. In turn, these latently infected cells now become targets for IE-specific cytotoxic T cells (CTLs) which are present at high frequency in all normal healthy HCMV positive carriers but would normally be unable to target latent (lytic antigen-negative) cells. This approach of transiently inducing viral lytic gene expression by HDAC inhibition, in otherwise latently infected cells, offers a window of opportunity to target and purge the latent myeloid cell reservoir by making these normally immunologically undetectable cells visible to pre-existing host immune responses to viral lytic antigens.
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Affiliation(s)
- B. A. Krishna
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
| | - B. Lau
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
| | - S. E. Jackson
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
| | - M. R. Wills
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
| | - J. H. Sinclair
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
| | - E. Poole
- Department of Medicine, University of Cambridge, Level 5 Laboratories Block, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
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Roe C, Myhre K, Marchand GH, Lau B, Leivseth G, Bautz-Holter E. Measurement Properties of the Nordic Questionnaire for Psychological and Social Factors at Work: A Rasch Analysis. J Appl Meas 2016; 17:227-238. [PMID: 28009586] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The main aim of this study was to evaluate the measurement properties of the Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic) and the domains of demand, control and support. The Rasch analysis (RUMM 2030) was based on responses from 226 subjects with back pain who completed the QPS Nordic dimensions of demand, control, and social support (30 items) at one year follow up. The Rasch analysis revealed disordered thresholds in a total of 25 of the 30 items. The domains of demand, control and support fit the Rasch model when analyzed separately. The demand domain was well targeted, whereas patients with current neck and back pain had lower control and higher support than reflected by the questions. Two items revealed DIF by gender, otherwise invariance to age, gender, occupation and sick-leave was documented. The demand, control support domains of QPS Nordic comprised unidimensional constructs with adequate measurement properties.
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Affiliation(s)
- C Roe
- Cecilie Roe, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway,
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Virbel-Fleischman C, Collomb-Clerc A, Fernandez-Vidal S, Belaid H, Lau B, Bardinet E, Karachi C, Welter ML. Dysfonctionnement du noyau sous-thalamique et troubles de la marche et de l’équilibre chez les patients avec maladie de Parkinson : une étude électrophysiologique chez l’homme. Neurophysiol Clin 2015. [DOI: 10.1016/j.neucli.2015.10.008] [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] Open
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Koethe JR, Jenkins CA, Lau B, Shepherd BE, Silverberg MJ, Brown TT, Blashill AJ, Anema A, Willig A, Stinnette S, Napravnik S, Gill J, Crane HM, Sterling TR. Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010. HIV Med 2015; 16:572-7. [PMID: 25960080 DOI: 10.1111/hiv.12259] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count. METHODS We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels < 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site. RESULTS A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9 kg/m(2) ) and 15% were obese (BMI > 30 kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P < 0.001), but the relationship was nonlinear (P < 0.001). Compared with a reference of 22 kg/m(2) , a BMI of 30 kg/m(2) was associated with a 36 cells/μL [95% confidence interval (CI) 14, 59 cells/μL] greater CD4 T-cell count recovery among women and a 19 cells/μL (95% CI 9, 30 cells/μL) greater recovery among men at 12 months. At a BMI > 30 kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant. CONCLUSIONS A BMI of approximately 30 kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.
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Affiliation(s)
- J R Koethe
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - C A Jenkins
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - B Lau
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - B E Shepherd
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - T T Brown
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - A Anema
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - A Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Stinnette
- University of North Carolina, Chapel Hill, NC, USA
| | - S Napravnik
- University of North Carolina, Chapel Hill, NC, USA
| | - J Gill
- Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, AB, Canada
| | - H M Crane
- Center for AIDS Research, University of Washington, Seattle, WA, USA
| | - T R Sterling
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Demain A, Ewenczyk C, Welter ML, El Helou A, Lau B, François C, Karachi C, Grabli D. Effet de la stimulation du noyau pédonculopontin à basse fréquence sur les troubles de la marche et de l’équilibre au stade avancé de la maladie de Parkinson. Neurophysiol Clin 2014. [DOI: 10.1016/j.neucli.2013.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lau B, Overby CL, Wirtz HS, Devine EB. The association between use of a clinical decision support tool and adherence to monitoring for medication-laboratory guidelines in the ambulatory setting. Appl Clin Inform 2013; 4:476-98. [PMID: 24454577 PMCID: PMC3885910 DOI: 10.4338/aci-2013-06-ra-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stage 2 Meaningful Use criteria require the use of clinical decision support systems (CDSS) on high priority health conditions to improve clinical quality measures. Although CDSS hold great promise, implementation has been fraught with challenges, evidence of their impact is mixed, and the optimal method of content delivery is unknown. OBJECTIVE The authors investigated whether implementation of a simple clinical decision support (CDS) tool was associated with improved prescriber adherence to national medication-laboratory monitoring guidelines for safety (hepatic function, renal function, myalgias/rhabdomyolysis) and intermediate outcomes for antidiabetic (Hemoglobin A(1c); HbA(1c)) and antihyperlipidemic (low density lipoprotein; LDL) medications prescribed within a diabetes registry. METHODS This was a retrospective observational study conducted in three phases of CDS implementation (2008-2009): pre-, transition-, and post-Prescriptions evaluated were ordered from an electronic health record within a multispecialty medical group. Adherence was evaluated within and without applying guideline-imposed time constraints. RESULTS Forty-thousand prescriptions were ordered over three timeframes. For hepatic and renal function, the proportion of prescriptions for which labs were monitored at any time increased from 52% to 65% (p<0.001); those that met time guidelines, from 14% to 21% (p<0.001). Only 6% of required labs were drawn to monitor for myalgias/rhabdomyolysis, regardless of timeframe. Over 90% of safety labs were within normal limits. The proportion of labs monitored at any time for LDL increased from 56% to 64% (p<0.001); those that met time guidelines from 11% to 17% (p<0.001). The proportion of labs monitored at any time for HbA(1c) remained the same (72%); those that met time guidelines decreased from 45% to 41% (p<0.001). CONCLUSION A simple CDS tool may be associated with improved adherence to guidelines. Efforts are needed to confirm findings and improve the timeliness of monitoring; investigations to optimize alerts should be ongoing.
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Affiliation(s)
- B. Lau
- Department of Health Services, University of Washington, Seattle, WA
| | | | - H. S. Wirtz
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
| | - E. B. Devine
- EB Devine PhD, PharmD, MBA Associate Professor, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Box 357630, Seattle, WA 98195–7630, Phone: 1-206-221-5760, Fax: 1-206-543-3835,
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Lau B, Jue J. 662 Utility of Doppler Mitral Inflow Pattern in Assessing Mitral Regurgitation. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Fok MC, Lan J, Choi H, Tsai G, Lau B, Fitzgerald M. Improving Pneumococcal Vaccination Rates in Patients With Chronic Obstructive Pulmonary Disease. Chest 2010. [DOI: 10.1378/chest.10220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lau B, Bakic P, Reiser I, Carton AK, Maidment A, Nishikawa R. TH-D-201B-08: An Anthropomorphic Software Breast Phantom for Tomosynthesis Simulation: Power Spectrum Analysis of Phantom Reconstructions. Med Phys 2010. [DOI: 10.1118/1.3469567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Touryan J, Lau B, Dan Y. Nonlinear analysis of complex cells in cat visual cortex. J Vis 2010. [DOI: 10.1167/1.3.34] [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: 11/24/2022] Open
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Lau B, Jäger G, Thiel E, Rodt H, Huhn D, Pachmann K, Netzel B, Böning L, Thierfelder S, Dörmer P. Growth of the Reh Cell Line in Diffusion Chambers: Evidence for Differentiation Along the T- and B-Cell Pathway. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1600-0609.1979.tb02863.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lau B, Reiser I, Nishikawa R. TH-C-332-09: The Effect of Variable Exposure Distribution On Microcalcification Detectability in Tomosynthesis. Med Phys 2008. [DOI: 10.1118/1.2962875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chen Y, Lau B, Becchetti F. SU-FF-T-405: The Effect of Magnetic Field On Relative Biological Effectiveness in Yeast Cells. Med Phys 2007. [DOI: 10.1118/1.2761130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sterud T, Hem E, Ekeberg A, Lau B. Occupational stress and alcohol use: A study of two nationwide samples of operational ambulance personnel and police in norway. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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