1
|
Cohen SA, Brant A, Fisher AC, Pershing S, Do D, Pan C. Dr. Google vs. Dr. ChatGPT: Exploring the Use of Artificial Intelligence in Ophthalmology by Comparing the Accuracy, Safety, and Readability of Responses to Frequently Asked Patient Questions Regarding Cataracts and Cataract Surgery. Semin Ophthalmol 2024:1-8. [PMID: 38516983 DOI: 10.1080/08820538.2024.2326058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Patients are using online search modalities to learn about their eye health. While Google remains the most popular search engine, the use of large language models (LLMs) like ChatGPT has increased. Cataract surgery is the most common surgical procedure in the US, and there is limited data on the quality of online information that populates after searches related to cataract surgery on search engines such as Google and LLM platforms such as ChatGPT. We identified the most common patient frequently asked questions (FAQs) about cataracts and cataract surgery and evaluated the accuracy, safety, and readability of the answers to these questions provided by both Google and ChatGPT. We demonstrated the utility of ChatGPT in writing notes and creating patient education materials. METHODS The top 20 FAQs related to cataracts and cataract surgery were recorded from Google. Responses to the questions provided by Google and ChatGPT were evaluated by a panel of ophthalmologists for accuracy and safety. Evaluators were also asked to distinguish between Google and LLM chatbot answers. Five validated readability indices were used to assess the readability of responses. ChatGPT was instructed to generate operative notes, post-operative instructions, and customizable patient education materials according to specific readability criteria. RESULTS Responses to 20 patient FAQs generated by ChatGPT were significantly longer and written at a higher reading level than responses provided by Google (p < .001), with an average grade level of 14.8 (college level). Expert reviewers were correctly able to distinguish between a human-reviewed and chatbot generated response an average of 31% of the time. Google answers contained incorrect or inappropriate material 27% of the time, compared with 6% of LLM generated answers (p < .001). When expert reviewers were asked to compare the responses directly, chatbot responses were favored (66%). CONCLUSIONS When comparing the responses to patients' cataract FAQs provided by ChatGPT and Google, practicing ophthalmologists overwhelming preferred ChatGPT responses. LLM chatbot responses were less likely to contain inaccurate information. ChatGPT represents a viable information source for eye health for patients with higher health literacy. ChatGPT may also be used by ophthalmologists to create customizable patient education materials for patients with varying health literacy.
Collapse
Affiliation(s)
- Samuel A Cohen
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Arthur Brant
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Caroline Fisher
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzann Pershing
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Diana Do
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Carolyn Pan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Boyer D, Hu A, Warrow D, Xavier S, Gonzalez V, Lad E, Rosen RB, Do D, Schneiderman T, Ho A, Munk MR, Jaffe G, Tedford SE, Croissant CL, Walker M, Rückert R, Tedford CE. LIGHTSITE III: 13-Month Efficacy and Safety Evaluation of Multiwavelength Photobiomodulation in Nonexudative (Dry) Age-Related Macular Degeneration Using the Lumithera Valeda Light Delivery System. Retina 2024; 44:487-497. [PMID: 37972955 PMCID: PMC10885856 DOI: 10.1097/iae.0000000000003980] [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: 05/03/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The LIGHTSITE III study evaluated multiwavelength photobiomodulation (PBM) therapy in nonexudative (dry) age-related macular degeneration (AMD) using the LumiThera Valeda Light Delivery System. METHODS LIGHTSITE III is a randomized, controlled trial to assess the safety and effectiveness of PBM in dry AMD. Subjects were given multiwavelength PBM (590, 660, and 850 nm) or Sham treatment delivered in a series of nine sessions over 3 to 5 weeks every four months over 24 months. Subjects were assessed for efficacy and safety outcomes. Data from the 13-month analysis are presented in this report. RESULTS A total of 100 subjects (148 eyes) with dry AMD were randomized. LIGHTSITE III met the primary efficacy best-corrected visual acuity endpoint with a significant difference between PBM (n = 91 eyes) and Sham (n = 54 eyes) groups (Between group difference: 2.4 letters (SE 1.15), CI: -4.7 to -0.1, P = 0.02) (PBM alone: 5.4 letters (SE 0.96), CI: 3.5 to 7.3, P < 0.0001; Sham alone: 3.0 letters (SE 1.13), CI: 0.7-5.2, P < 0.0001). The PBM group showed a significant decrease in new onset geographic atrophy ( P = 0.024, Fisher exact test, odds ratio 9.4). A favorable safety profile was observed. CONCLUSION LIGHTSITE III provides a prospective, randomized, controlled trial showing improved clinical and anatomical outcomes in intermediate dry AMD following PBM therapy.
Collapse
Affiliation(s)
- David Boyer
- Retina Vitreous Associates Medical Group, Beverly Hills, California
| | - Allen Hu
- Cumberland Valley Retina Consultants, Hagerstown, Maryland
| | - David Warrow
- Cumberland Valley Retina Consultants, Chambersburg, Pennsylvania
| | | | | | - Eleonora Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Richard B. Rosen
- New York Ear and Eye Infirmary of Mount Sinai, New York, New York
| | - Diana Do
- Byers Eye Institute, Stanford University, Palo Alto, California
| | | | - Allen Ho
- Mid Atlantic Retina, Cherry Hill, New Jersey
| | - Marion R. Munk
- Department of Ophthalmology, Inselspital University Hospital Bern, Bern, Switzerland
- Augenarzt-Praxisgemeinschaft Gutblick AG, Pfäffikon, Switzerland
| | - Glenn Jaffe
- Duke Reading Center, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | | |
Collapse
|
3
|
Suhaj P, Do D, Olejar T, Pichova R, Lang O, Matej R. PPY-cell hyperplasia accompanying NENs: Immunohistochemical and nuclear medicine analysis. Pathol Res Pract 2024; 253:154941. [PMID: 38000200 DOI: 10.1016/j.prp.2023.154941] [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: 07/03/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
Pancreatic polypeptide cell hyperplasia (PPY-H) is a multiplication of the neuroendocrine cells producing pancreatic polypeptide (PPY). The development and role of PPY-H and its corresponding clinical and imaging findings still need to be fully elucidated. We present 12 cases of PPY-H accompanying pancreatic neuroendocrine neoplasias (NEN). PPY-H was analyzed with the help of immunohistochemistry and confocal microscopy; preoperative clinical data and imaging studies were evaluated retrospectively. We observed PPY-H emerging from pancreatic ducts, and in some cases, we observed simultaneous NKX6.1 positivity in ducts and PPY-H. Additional clinical-pathological correlations suggests that gastrointestinal symptoms (e.g., epigastric pain and cholestasis) could be more related to PPY-H than to NEN hormonal production. In particular cases, SSTR2 expression was strong in PPY-H and correlated with distinguishable accumulation of activity next to NEN on 99 mTc EDDA/Hynic-TOC SPECT/CT. In another case, 18F-FDG-PET/CT showed increased metabolic activity in the area of PPY-H surrounding NEN. Our data suggest that PPY-H originates in the lining of pancreatic ducts. Confirmation of SSTR2 in PPY-H, using immunohistochemistry, suggests the utility of 99 mTc EDDA/Hynic-TOC or 68Ga-DOTA radiotracers in clinical diagnostics; however, studies with larger cohort are needed.
Collapse
Affiliation(s)
- P Suhaj
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine and Thomayer University Hospital (TUH), Czechia.
| | - D Do
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Radiology and Nuclear Medicine, University Hospital of Kralovske Vinohrady (UHKV), Czechia
| | - T Olejar
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine and Thomayer University Hospital (TUH), Czechia
| | - R Pichova
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Radiology and Nuclear Medicine, University Hospital of Kralovske Vinohrady (UHKV), Czechia
| | - O Lang
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Radiology and Nuclear Medicine, University Hospital of Kralovske Vinohrady (UHKV), Czechia
| | - R Matej
- 3rd Faculty of Medicine, Charles University in Prague, Czechia; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine and Thomayer University Hospital (TUH), Czechia; Department of Pathology, University Hospital of Kralovske Vinohrady (UHKV), Czechia
| |
Collapse
|
4
|
Zhong AY, Lui AJ, Kuznetsova S, Kallis K, Hussain T, Conlin CC, Do D, Rojo Domingo M, Manger R, Hua P, Karunamuni R, Kuperman J, Dale AM, Rakow-Penner R, Hahn ME, Moore KL, Ray X, Seibert TM. Clinical Impact of Contouring Variability for Prostate Cancer Tumor Boost. Int J Radiat Oncol Biol Phys 2023; 117:e455. [PMID: 37785460 DOI: 10.1016/j.ijrobp.2023.06.1644] [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) In the FLAME randomized phase III trial, adding a focal radiotherapy (RT) boost to tumors visible on MRI improved prostate cancer disease-free survival, local control, and regional/distant metastasis-free survival without increasing toxicity. In a prospective study (ReIGNITE RT Boost), we found substantial variability in radiation oncologists' attempts to contour prostate cancer tumors on MRI. Participants' accuracy and reliability improved when they used a quantitative MRI biomarker for cancer called the restriction spectrum imaging restriction score (RSIrs). Here, we measure the impact of radiation oncologists' tumor contour attempts on RT plans and predicted probability of biochemical failure. MATERIALS/METHODS A total of 44 radiation oncologists (participants) from multiple institutions contoured prostate tumors on 30 patient cases, some with only conventional MRI and some with conventional MRI plus RSIrs maps. We developed a knowledge-based planning automated algorithm to generate RT plans with focal tumor boost per the FLAME trial protocol: 77 Gy in 35 fractions to prostate and integrated boost up to 95 Gy to the focal target, provided no normal tissue constraints were violated. We applied this algorithm to each participant's tumor contour and compared dosimetric parameters to those achieved when using the expert-defined tumor (consensus of two radiologists and a radiation oncologist). The primary metric was dose covering 98% of the expert-defined tumor (D98%), which was associated with probability of biochemical failure in a model published with the FLAME trial. RESULTS In this preliminary analysis, 42 target volumes were analyzed from 20 participants and two patient cases: case 1 was contoured with conventional MRI alone and case 2 with RSIrs. All plans had adequate coverage of the prostate and met all key normal tissue constraints. For case 1 (without RSIrs), the expert's D98% was 87.1 Gy. By comparison, median D98% for participants was 82.2 Gy (IQR 77.8 - 84.6 Gy). Per the FLAME trial model, the predicted probability of biochemical failure at 7 years is 6% for the expert, but participants' plans yielded a median failure probability of 11% (IQR 18 - 9%). For case 2 (with RSIrs), the expert's D98% was 82.8 Gy, while median D98% for participants was 80.6 Gy (IQR 80.0 - 81.0 Gy). Predicted probability of biochemical failure is 12% for the expert-defined target and median 13% (IQR 14 - 13%) for participants. CONCLUSION Variability in radiation oncologists' prostate tumor contours can lead to clinically meaningful changes to focal RT boost plans. The probability of biochemical failure for one patient case increased from 6% to a median of 11% when using conventional MRI alone. Use of RSIrs may mitigate this problem by increasing the accuracy and reliability of radiation oncologists' tumor contours.
Collapse
Affiliation(s)
- A Y Zhong
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - A J Lui
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - S Kuznetsova
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - K Kallis
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - T Hussain
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - C C Conlin
- Department of Radiology, University of California San Diego, La Jolla, CA
| | - D Do
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - M Rojo Domingo
- Department of Bioengineering, University of California San Diego, La Jolla, CA
| | - R Manger
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - P Hua
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - R Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - J Kuperman
- Department of Radiology, University of California San Diego, La Jolla, CA
| | - A M Dale
- Department of Radiology, University of California San Diego, La Jolla, CA; Department of Neurosciences, University of California San Diego, La Jolla, CA
| | - R Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA
| | - M E Hahn
- Department of Radiology, University of California San Diego, La Jolla, CA
| | - K L Moore
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - X Ray
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - T M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA; Department of Radiology, University of California San Diego, La Jolla, CA
| |
Collapse
|
5
|
Sharma A, Holz FG, Regillo CD, Freund KB, Sarraf D, Khanani AM, Baumal C, Holekamp N, Tadayoni R, Kumar N, Parachuri N, Kuppermann BD, Bandello F, Querques G, Loewenstein A, Özdek Ş, Rezai K, Laurent K, Bilgic A, Lanzetta P, Zur D, Yannuzzi N, Corradetti G, Kaiser P, Hilely A, Boyer D, Rachitskaya A, Chakravarthy U, Wintergerst M, Sarao V, Parolini B, Mruthyunjaya P, Nguyen QD, Do D, Keane PA, Hassan T, Sridhar J, Eichenbaum D, Grewal D, Splitzer M. Biosimilars for retinal diseases: United States-Europe awareness survey (Bio-USER - survey). Expert Opin Biol Ther 2023; 23:851-859. [PMID: 36726203 DOI: 10.1080/14712598.2023.2176218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the awareness of biosimilar intravitreal anti-VEGF agents among retina specialists practicing in the United States (US) and Europe. METHODS A 16-question online survey was created in English and distributed between Dec 01, 2021 and Jan 31, 2022. A total of 112 respondents (retinal physicians) from the US and Europe participated. RESULTS The majority of the physicians (56.3%) were familiar with anti-VEGF biosimilars. A significant number of physicians needed more information (18.75%) and real world data (25%) before switching to a biosimilar. About one half of the physicians were concerned about biosimilar safety (50%), efficacy (58.9 %), immunogenicity (50%), and their efficacy with extrapolated indications (67.8 %). Retinal physicians from the US were less inclined to shift from off-label bevacizumab to biosimilar ranibizumab or on-label bevacizumab (if approved) compared to physicians from Europe (p=0.0001). Furthermore, physicians from the US were more concerned about biosimilar safety (p=0.0371) and efficacy compared to Europe (p= 0.0078). CONCLUSIONS The Bio-USER survey revealed that while the majority of retinal physicians need additional information regarding the safety, efficacy and immunogenicity when making clinical decisions regarding their use. Retinal physicians from US are more comfortable in continuing to use off-label bevacizumab compared to physicians from Europe.
Collapse
Affiliation(s)
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - David Sarraf
- Stein Eye Institute, UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA and The University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Caroline Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts
| | | | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, St Louis and Fondation Adolphe de Rothschild hospitals, Paris, France
| | | | | | - Baruch D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Mobasserian A, Zaidi M, Halim S, Hwang JJ, Regenold J, Akhavanrezayat A, Karaca I, Khojasteh Jafari H, Yavari N, Matsumiya W, Yasar C, Than NTT, Uludag G, Do D, Ghoraba H, Nguyen QD. Effect of Pupil Size on Fixed-Luminance Flicker Full-Field Electroretinogram Magnitude. Clin Ophthalmol 2022; 16:3733-3740. [PMID: 36389637 PMCID: PMC9664919 DOI: 10.2147/opth.s382207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Diopsys® NOVA fixed-luminance flicker full-field electroretinogram (ffERG) device is a potential adjunct to conventional flicker ffERG testing for assessing cone cell function. Magnitude of measured electrical response is known to vary with pupil size in conventional ffERG testing. The index study characterizes the relationship between magnitude of measured electrical activity and pupil size, both pupil diameter and pupil area, for this device. Methods Seventeen patients (34 eyes) with no known ocular diseases were enrolled in the study. Electrophysiologic function of cone cells was evaluated using fixed-luminance flicker ffERG before and after dilation. Linear regression models, with inter-eye correlations controlled as fixed-effects, were used to characterize the effect of pupil dilation on the magnitude of the measured responses. Results Mean age of study patients was 33.5 (standard deviation 7.4 years), and 35.3% of the subjects were female. Mean value of electrical response magnitude was 10.07±2.79µV before dilation and 15.30±4.08µV after dilation. The correlations of ERG magnitude with pupil diameter and with pupil area were not significant for either dilated or undilated eyes considered separately but were highly significant (p<0.001) for dilated and undilated eyes considered in aggregate. ERG magnitude tended to increase by 1.08 µV for every 1 mm increase in pupillary diameter. Conclusion An increase in pupil size, both pupil diameter and pupil area, is significantly associated with an increase in flicker ffERG magnitude recorded by the Diopsys device, suggesting that pupil size should be measured and considered when making clinical judgments based on the flicker ffERGs recorded by the device, and that pupil size-specific reference ranges could improve the clinical utility of the device.
Collapse
Affiliation(s)
- Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA,Ocular Imaging Research and Reading Center, Sunnyvale, CA, USA
| | - Jaclyn Joyce Hwang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA,Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hassan Khojasteh Jafari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA,Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA,Department of Ophthalmology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey
| | - Ngoc Tuong Trong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gunay Uludag
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Diana Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA,Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA, Tel +1 650 725-7245, Fax +1 650 736-8232, Email
| |
Collapse
|
7
|
Hua HU, Rayess N, Li AS, Do D, Rahimy E. Quality, Readability, and Accessibility of Online Content From a Google Search of “Macular Degeneration”: Critical Analysis. Journal of VitreoRetinal Diseases 2022; 6:437-442. [PMID: 37009540 PMCID: PMC9954772 DOI: 10.1177/24741264221094683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work aims to assess the quality, accountability, readability, accessibility, and presence of Spanish translation in online material through a Google search of “macular degeneration”. Methods: In this retrospective cross-sectional analysis of website results from a Google search of “macular degeneration”, the quality and accountability for each website were assessed using the DISCERN criteria and the Health on the Net Foundation Code of Conduct (HONcode) principles. All 31 sites were independently graded by 2 ophthalmologists. Readability was evaluated using an online tool. The presence of accessibility features on the website and Spanish translation was recorded. The primary outcome measure was the DISCERN and HONcode quality and accountability scores of each website. Secondary outcome measures included the readability, accessibility, and presence of Spanish translation. Results: The mean ± SD of each criterion across all 15 DISCERN questions was 2.761 ± 0.666 (out of 5). The mean HONcode score for all websites was 7.355 ± 3.123. The mean consensus reading grade level was 10.258 ± 2.49. There were no statistically significant differences in any score between the top 5 websites and the bottom 26 websites evaluated. Accessibility was available on 10 of 31 websites. Spanish translation was available on 10 of 31 websites. Conclusions: The top 5 websites that appeared on a Google search did not have better quality or readability of online content. Improving quality, accountability, and readability can help improve patients’ health literacy regarding macular degeneration.
Collapse
Affiliation(s)
- Hong-Uyen Hua
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nadim Rayess
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Angela S. Li
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ehsan Rahimy
- Palo Alto Medical Foundation, Department of Ophthalmology, Palo Alto, CA, USA
| |
Collapse
|
8
|
Ghoraba HH, Akhavanrezayat A, Karaca I, Yavari N, Lajevardi S, Hwang J, Regenold J, Matsumiya W, Pham B, Zaidi M, Mobasserian A, DongChau AT, Or C, Yasar C, Mishra K, Do D, Nguyen QD. Ocular Gene Therapy: A Literature Review with Special Focus on Immune and Inflammatory Responses. Clin Ophthalmol 2022; 16:1753-1771. [PMID: 35685379 PMCID: PMC9173725 DOI: 10.2147/opth.s364200] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/19/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hashem H Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jaclyn Hwang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Brandon Pham
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Anthony Toan DongChau
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Kapil Mishra
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, USA, Tel +1 6507257245, Fax +1 6507368232, Email
| |
Collapse
|
9
|
Ghoraba HH, Matsumiya W, Khojasteh H, Akhavanrezayat A, Karaca I, Or C, Yavari N, Lajevardi S, Hwang J, Yasar C, Do D, Nguyen QD. Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis. Clin Ophthalmol 2022; 16:1697-1706. [PMID: 35673349 PMCID: PMC9167570 DOI: 10.2147/opth.s366370] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Hashem H Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hassan Khojasteh
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jaclyn Hwang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, USA, Tel +16507257245, Fax +1 6507368232, Email
| |
Collapse
|
10
|
Thinh N, Doan B, Dang P, Canh N, Giang N, Minh L, Do D. Modelling growth curve of Eastern spot-billed ducks
( Anas zonorhyncha) raised in Vietnam. J Anim Feed Sci 2021. [DOI: 10.22358/jafs/133959/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Nguyen T, Dermauw V, Dahma H, Bui-Thi D, Le T, Phi N, Lempereur L, Losson B, Vandenberg O, Do D, Dorny P. Clonorchis sinensis in rural communities in northern Vietnam and associated risk factors. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1125] [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
|
12
|
Garcia EG, Veloso A, Oliveira ML, Allen JR, Loontiens S, Brunson D, Do D, Yan C, Morris R, Iyer S, Garcia SP, Iftimia N, Van Loocke W, Matthijssens F, McCarthy K, Barata JT, Speleman F, Taghon T, Gutierrez A, Van Vlierberghe P, Haas W, Blackburn JS, Langenau DM. PRL3 enhances T-cell acute lymphoblastic leukemia growth through suppressing T-cell signaling pathways and apoptosis. Leukemia 2020; 35:679-690. [PMID: 32606318 PMCID: PMC8009053 DOI: 10.1038/s41375-020-0937-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023]
Abstract
T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes and is largely driven by the NOTCH/MYC pathway. Yet, additional oncogenic drivers are required for transformation. Here, we identify protein tyrosine phosphatase type 4 A3 (PRL3) as a collaborating oncogenic driver in T-ALL. PRL3 is expressed in a large fraction of primary human T-ALLs and is commonly co-amplified with MYC. PRL3 also synergized with MYC to initiate early-onset ALL in transgenic zebrafish and was required for human T-ALL growth and maintenance. Mass spectrometry phosphoproteomic analysis and mechanistic studies uncovered that PRL3 suppresses downstream T cell phosphorylation signaling pathways, including those modulated by VAV1, and subsequently suppresses apoptosis in leukemia cells. Taken together, our studies have identified new roles for PRL3 as a collaborating oncogenic driver in human T-ALL and suggest that therapeutic targeting of the PRL3 phosphatase will likely be a useful treatment strategy for T-ALL.
Collapse
Affiliation(s)
- E G Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - A Veloso
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - M L Oliveira
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - J R Allen
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S Loontiens
- Cancer Research Institute Ghent, Ghent, Belgium
| | - D Brunson
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - D Do
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - C Yan
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - R Morris
- Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - S Iyer
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S P Garcia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - N Iftimia
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - W Van Loocke
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - F Matthijssens
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - K McCarthy
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J T Barata
- Instituto de Medicina Molecular João Lobo Antunes Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - F Speleman
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - T Taghon
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - A Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - P Van Vlierberghe
- Cancer Research Institute Ghent, Ghent, Belgium.,Department of Biomolecular Medicine and Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - W Haas
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA.,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA.,Harvard Stem Cell Institute, Boston, MA, 02114, USA.,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J S Blackburn
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - D M Langenau
- Department of Pathology, Massachusetts General Research Institute, Boston, MA, 02114, USA. .,Center of Cancer Research, Massachusetts General Hospital, Charlestown, MA, 02129, USA. .,Harvard Stem Cell Institute, Boston, MA, 02114, USA. .,Center of Regenerative Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
| |
Collapse
|
13
|
Bommakanti KK, Smith LL, Liu L, Do D, Cuevas-Mota J, Collins K, Munoz F, Rodwell TC, Garfein RS. Requiring smartphone ownership for mHealth interventions: who could be left out? BMC Public Health 2020; 20:81. [PMID: 31959145 PMCID: PMC6971938 DOI: 10.1186/s12889-019-7892-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. This raises the question of whether disparities in access to mobile technology could accentuate disparities in mHealth mediated care. This study addresses whether programs planning to implement mHealth interventions risk creating or perpetuating health disparities based on inequalities in smartphone ownership. METHODS Video Directly Observed Therapy (VDOT) is an mHealth intervention for monitoring tuberculosis (TB) treatment adherence through videos sent by patients to their healthcare provider using smartphones. We conducted secondary analyses of data from a single-arm trial of VDOT for TB treatment monitoring by San Diego, San Francisco, and New York City health departments. Baseline and follow-up treatment interviews were used to assess participant smartphone ownership, sociodemographics and TB treatment perceptions. Univariate and multivariable logistic regression analyses were used to identify correlates of smartphone ownership. RESULTS Of the 151 participants enrolled, mean age was 41 years (range: 18-87 years) and 41.1% were female. Participants mostly identified as Asian (45.0%) or Hispanic/Latino (29.8%); 57.8% had at most a high school education. At baseline, 30.4% did not own a smartphone, which was similar across sites. Older participants (adjusted odds ratio [AOR] = 1.09 per year, 95% confidence interval [CI]: 1.05-1.12), males (AOR = 2.86, 95% CI: 1.04-7.86), participants having at most a high school education (AOR = 4.48, 95% CI: 1.57-12.80), and those with an annual income below $10,000 (AOR = 3.06, 95% CI: 1.19, 7.89) had higher odds of not owning a smartphone. CONCLUSIONS Approximately one-third of TB patients in three large United States of America (USA) cities lacked smartphones prior to the study. Patients who were older, male, less educated, or had lower annual income were less likely to own smartphones and could be denied access to mHealth interventions if personal smartphone ownership is required.
Collapse
Affiliation(s)
- Krishna K. Bommakanti
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Laramie L. Smith
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
- Center for Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA USA
| | - Lin Liu
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Diana Do
- San Diego State University, 5500 Campanile Drive, San Diego, California 92182 USA
| | - Jazmine Cuevas-Mota
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Kelly Collins
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Fatima Munoz
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Timothy C. Rodwell
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Richard S. Garfein
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
- Department of Family Medicine & Public Health, 9500 Gilman Drive, La Jolla, CA 92093 USA
| |
Collapse
|
14
|
Pauleikhoff D, Bonelli R, Dubis AM, Gunnemann F, Rothaus K, Charbel Issa P, Heeren TFC, Peto T, Clemons TE, Chew EY, Bird AC, Sallo FB, Bakri S, Bernstein PS, Blodi B, Brucker A, Bucher F, Chung M, Comer G, Constable I, Cooney M, Do D, Duncan J, Egan C, Elman MJ, Fawzi A, Friedlander M, Gaudric A, Gillies MC, Goldberg R, Googe JM, Guymer R, Higgins P, Holz F, Houghton O, Hoyng CB, Hubschman J, Jhaveri C, Khanani A, Lally D, Lee C, Lee M, Miller JW, Miller D, Moisseiev J, Murphy R, Narayanan R, Randhawa S, Raphaelian PV, Rich R, Rosen R, Rosenfeld P, Ruys J, Sahel J, Schwartz S, Singerman L, Sneed S, Soubrane G, Vingerling JR, Warrow D, Weinberg D, Wolf S, Wykoff C, Yan J, Yannuzzi LA, Zhuk SA. Progression characteristics of ellipsoid zone loss in macular telangiectasia type 2. Acta Ophthalmol 2019; 97:e998-e1005. [PMID: 30968592 DOI: 10.1111/aos.14110] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/14/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate the progression characteristics of ellipsoid zone (EZ) loss in eyes with macular telangiectasia type 2 (MacTel) as reflected by area and linear measurements, and their relevance for visual acuity. METHODS Participants were selected from the MacTel Study cohort. Linear and area measurements of EZ loss were performed in Spectral-Domain Optical Coherence Tomograph (SD-OCT) volume scans. Progression characteristics and correlations between linear and area measurements were analysed using linear mixed effects models. RESULTS A total of 134 eyes of 70 patients were included (85 eyes with follow-up, mean 4.7 years, range: 1.4-8 years). Ellipsoid zone (EZ) loss significantly progressed at a mean annual increment of 0.057 mm2 (p = 0.005). The progression rate was non-linear and interacted significantly with initial EZ lesion size indicating an exponential growth before reaching a plateau. There was a strong heterogeneity in area sizes between fellow eyes. EZ break length had a significant linear effect on EZ break area (b = 1.06, p < 0.001) and could predict it. The location of the EZ break had a significant impact on visual acuity. CONCLUSION Ellipsoid zone (EZ) loss in MacTel has a non-linear progression characteristic, and its rate depends on area size at baseline, which must be taken into account at sample selection in clinical trials. Our results show a good correlation of linear and area measures of EZ loss and a segregation of best-corrected visual acuity by EZ location, which may help routine clinical practice.
Collapse
Affiliation(s)
- Daniel Pauleikhoff
- Department of Ophthalmology St. Franziskus Hospital Münster Germany
- Department of Ophthalmology University of Duisburg‐Essen Duisburg Germany
| | - Roberto Bonelli
- Population Health and Immunity Walter and Eliza Hall Institute of Medical Research Parkville Victoria Australia
- Department of Medical Biology University of Melbourne Melbourne Victoria Australia
| | - Adam M Dubis
- UCL Institute of Ophthalmology London UK
- Department of Research and Development Moorfields Eye Hospital London UK
| | | | - Kai Rothaus
- Department of Ophthalmology St. Franziskus Hospital Münster Germany
| | - Peter Charbel Issa
- Nuffield Laboratory of Ophthalmology Department of Clinical Neurosciences Oxford Eye Hospital Oxford University Hospitals NHS Foundation Trust University of Oxford Oxford UK
| | - Tjebo FC Heeren
- UCL Institute of Ophthalmology London UK
- Department of Research and Development Moorfields Eye Hospital London UK
- Department of Ophthalmology University Hospital Bonn Bonn Germany
| | - Tunde Peto
- Faculty of Medicine, Health and Life Sciences Queen's University Belfast Belfast UK
- NIHR Biomedical Research Center for Ophthalmology UCL Institute of Ophthalmology Moorfields Eye Hospital NHS Foundation Trust London UK
| | | | - Emily Y Chew
- National Eye Institute National Institutes of Health Bethesda Maryland USA
| | - Alan C Bird
- Inherited Eye Disease Moorfields Eye Hospital London UK
| | - Ferenc B Sallo
- UCL Institute of Ophthalmology London UK
- Department of Research and Development Moorfields Eye Hospital London UK
- Department of Ophthalmology Hôpital Ophtalmique Jules‐Gonin Fondation Asile des Aveugles University of Lausanne Lausanne Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Iyer S, Do D, Akshoomoff N, Malcarne VL, Hattrup K, Berger SP, Gahagan S, Needlman R. Development of a Brief Screening Tool for Early Literacy Skills in Preschool Children. Acad Pediatr 2019; 19:464-470. [PMID: 30453093 DOI: 10.1016/j.acap.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preschool children develop early literacy skills (ELS) needed for reading acquisition. Screening for delayed ELS could trigger interventions to prevent reading problems. OBJECTIVE To develop a brief screening test for ELS delays, the Early Literacy Skills Assessment Tool (ELSAT). METHODS This study included 4-year-old, typically developing, English language-predominant children attending preschool. The ELSAT comprised 63 items relating to 3 main ELS domains and was piloted with 21 children. After we excluded items that were nondiscriminatory, 57 items remained and were administered to 96 children. Items were compared with reference measures of ELS (Get Ready to Read-Revised), and language (Peabody Picture Vocabulary Test-4 and Phonological Awareness from the Comprehensive Test of Phonological Processing-2). Within-domain reliability was calculated for each of the 3 ELS domains and item correlations between all ELSAT items and the reference measures were calculated. RESULTS A final set of 10 items was retained that represented all 3 ELS domains and that maximized correlations with reference measures. Cronbach alpha for the refined 10-item ELSAT was 0.868; correlations between individual items and a composite of the reference measures ranged from 0.409 to 0.617 (all Ps < .01). In a receiver operating characteristic curve analysis, a cut-off score of ≤5 predicted a below-average score for any of the reference measures with sensitivity of 90%, specificity of 71.4%, and area under the curve of 0.872. CONCLUSIONS The 10-item ELSAT shows strong psychometric properties and with further validation may prove valuable in screening preschool children for ELS delays.
Collapse
Affiliation(s)
- Sai Iyer
- Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California (S Iyer), Los Angeles; Department of Pediatrics, Northwestern University Feinberg School of Medicine (SPBerger), Chicago, Ill.
| | - Diana Do
- Graduate School of Public Health, San Diego State University (D Do)
| | - Natacha Akshoomoff
- Department of Psychiatry, University of California, San Diego (N Akshoomoff)
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University (VL Malcarne and K Hattrup)
| | - Kate Hattrup
- Department of Psychology, San Diego State University (VL Malcarne and K Hattrup)
| | - Susan P Berger
- Department of Pediatrics, University of California, SanDiego (S Iyer and S Gahagan), San Diego, Calif
| | - Sheila Gahagan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine (SPBerger), Chicago, Ill
| | - Robert Needlman
- Department of Pediatrics, MetroHealth Medical Center, CaseWestern Reserve University (R Needlman), Cleveland, Ohio
| |
Collapse
|
16
|
Do D, Garfein RS, Cuevas-Mota J, Collins K, Liu L. Change in Patient Comfort Using Mobile Phones Following the Use of an App to Monitor Tuberculosis Treatment Adherence: Longitudinal Study. JMIR Mhealth Uhealth 2019; 7:e11638. [PMID: 30707103 PMCID: PMC6376328 DOI: 10.2196/11638] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022] Open
Abstract
Background As mHealth apps proliferate, it is necessary for patients to feel capable and comfortable using devices that run them. However, limited research is available on changes in comfort level before and after the use of an mHealth app. Objective The objective of this study was to determine whether patients with tuberculosis who used an mHealth app called Video Directly Observed Therapy (VDOT) to monitor their antituberculosis treatment became more comfortable using mobile phones after the intervention and to identify factors associated with change in comfort. Methods We analyzed data from a longitudinal study assessing the feasibility and acceptability of the VDOT app among patients receiving antituberculosis treatment from public health departments in San Diego, San Francisco, and New York City. Comfort levels on six domains of mobile phone use (making phone calls, taking pictures, recording videos, text messaging, internet and email use on the phone) were measured on a 10-point scale (1=very uncomfortable; 10=very comfortable) at the start and end of treatment using VDOT via telephone interviews. The main outcomes were change in comfort level on each domain (recoded as binary measures) and an overall change score (sum of individual measures). Linear and logistic regression analyses were performed to assess whether sociodemographics, risk factors, and VDOT perceptions were associated with change of comfort measures. Results Among 120 participants with complete data, mean age was 39.8 years (SD 14.8, range 18-87 years), 46.7% (56/120) were female, and 76.7% (92/120) were foreign born. The combined comfort level at baseline was high overall (mean 48.8, SD 14.2, interquartile range 43.0-60.0) and the mean comfort score increased by 1.92 points at follow-up (P=.07). Statistically significant increases in comfort on individual domains included taking pictures (P=.02) and recording videos (P=.002). Females were more likely to have increased comfort in using the internet on the phone compared to males (odds ratio [OR] 3.03, 95% CI 1.08-8.52, P=.04). Participants who worked less hours per week were more likely to have increased comfort recording videos although this did not meet statistical significance (OR 1.03, 95% CI 1.00-1.05, P=.06). Conclusions Findings suggest that, despite a high level of comfort using mobile phones at baseline, experience using the VDOT app was associated with increased comfort using mobile phone features. Additional research involving participants with lower baseline mobile phone experience is needed. An implication of these findings is that as patients begin to use mHealth apps for one health condition, they could acquire skills and confidence to more quickly adapt to using mHealth apps for other conditions.
Collapse
Affiliation(s)
- Diana Do
- San Diego State University, San Diego, CA, United States
| | - Richard S Garfein
- University of California San Diego, School of Medicine, La Jolla, CA, United States
| | - Jazmine Cuevas-Mota
- University of California San Diego, School of Medicine, La Jolla, CA, United States
| | - Kelly Collins
- University of California San Diego, School of Medicine, La Jolla, CA, United States
| | - Lin Liu
- University of California San Diego, School of Medicine, La Jolla, CA, United States
| |
Collapse
|
17
|
Fomenky B, Do D, Talbot G, Bissonnette N, Lessard M, Chouinard Y, Ibeagha-Awemu E. PSXV-11 Modulation of bacterial composition in the gastrointestinal tract of calves fed Lactobacillus acidophilus during the early period of growth. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.519] [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 Fomenky
- Agriculture and Agri-Food canada,Québec, QC, Canada
| | - D Do
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - G Talbot
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - N Bissonnette
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - M Lessard
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | | | | |
Collapse
|
18
|
Affiliation(s)
- X Zhao
- Department of Animal Science, McGill University, Ste. Anne de Bellevue, QC, Canada
| | - D Do
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | | |
Collapse
|
19
|
Fomenky B, Do D, Talbot G, Bissonnette N, Lessard M, Chouinard Y, Ibeagha-Awemu E. 452 Supplementation of Saccharomyces cerevisiae boulardii and an antibiotic growth promoter affects bacterial composition of the gastrointestinal tract of calves during the pre- and post-weaning periods. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.510] [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: 11/12/2022] Open
Affiliation(s)
- B Fomenky
- Agriculture and Agri-Food canada,Sherbrooke, QC, Canada
| | - D Do
- Agriculture and Agri-Food canada,Sherbrooke, QC, Canada
| | - G Talbot
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - N Bissonnette
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - M Lessard
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | | | | |
Collapse
|
20
|
Ibeagha-Awemu E, Do D, Dudemaine P, Bissonnette N. PSXIV-17 Gene co-expression network analysis identifies important modules and genes for cow’s response to Mycobacterium avium ssp. paratuberculosis infection in the small intestine. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - D Do
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - P Dudemaine
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - N Bissonnette
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| |
Collapse
|
21
|
Do D, Dudemaine P, Bissonnette N, Ibeagha-Awemu E. 237 Jejunum lymph node transcriptome reveals the importance of genes of phagosome and T cell receptor signalling pathways in Mycobacterium avium ssp. paratuberculosis infection. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.050] [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)
- D Do
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - P Dudemaine
- Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | - N Bissonnette
- Agriculture et Agroalimentaire Canada / Agriculture and Agri-Food Canada,Sherbrooke, QC, Canada
| | | |
Collapse
|
22
|
Abstract
Despite recent advances in the diagnosis and treatment of diabetic retinopathy, this complication remains a steadfast challenge to patients and physicians. This review summarizes recent progress in the diagnosis and management of diabetic retinopathy, including automated screening, optical coherence tomography, control of systemic risk factors, surgical techniques, laser treatment, and pharmaceutical treatment, including vascular endothelial growth factor inhibitors. Recent advances in pharmaceutical treatments, in particular, hold strong promise of halting and sometimes reversing the disease process. Clinicians nevertheless must remain vigilant in their efforts to diagnose and treat this disease early in its course.
Collapse
Affiliation(s)
- Matthew Powers
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Margaret Greven
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Robert Kleinman
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Diana Do
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| |
Collapse
|
23
|
Goldstein DA, Do D, Noronha G, Kissner JM, Srivastava SK, Nguyen QD. Suprachoroidal Corticosteroid Administration: A Novel Route for Local Treatment of Noninfectious Uveitis. Transl Vis Sci Technol 2016; 5:14. [PMID: 27980877 PMCID: PMC5156441 DOI: 10.1167/tvst.5.6.14] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/10/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose To evaluate the safety, tolerability, and preliminary efficacy of suprachoroidal injection of triamcinolone acetonide (TA) in patients with noninfectious uveitis. Methods In this Phase 1/2 open-label clinical study, a single suprachoroidal injection of 4-mg TA in 100 μL was performed in the study eye of patients with noninfectious intermediate, posterior, or pan-uveitis, and follow-up obtained for 26 weeks. Results Nine individuals with chronic uveitis were enrolled. There were 38 reported adverse events (AEs); most were mild or moderate in severity. Approximately half the AEs were ocular. The most common AE was reported by four subjects who experienced ocular pain at or near the time of the injection. All systemic AEs were unrelated to study drug. No steroid-related increases in intraocular pressure (IOP) were observed and no subject required IOP-lowering medication. All eight efficacy-evaluable subjects had improvements in visual acuity. Four subjects, who did not need additional therapy, had on average a greater than 2-line improvement in visual acuity through week 26. Three of four had macular edema at baseline, and two of three had at least a 20% reduction in macular edema at week 26. Conclusions The safety and preliminary efficacy data support further investigations of suprachoroidally administered TA as a therapeutic option for the treatment of noninfectious uveitis. Translational Relevance Targeted suprachoroidal administration of corticosteroid is a potential local route for the treatment of ocular inflammatory disease, which merits further investigation. (www.ClinicalTrials.gov, NCT01789320)
Collapse
Affiliation(s)
- Debra A Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Diana Do
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | - Quan D Nguyen
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
24
|
Gao K, Knight J, Le T, Do D, James A, Green T, Dickinson A, Nguyen M, Kangas L, Tolentino J, Worlock A, Linnen J. Performance of the Aptima® HBV Quant assay on the fully automated Panther® system. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.045] [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]
|
25
|
Zhu M, Do D, Dela Cruz CR, Dun Z, Zhou HD, Mahanti SD, Ke X. Tuning the magnetic exchange via a control of orbital hybridization in Cr(2)(Te(1-x)W(x))O(6). Phys Rev Lett 2014; 113:076406. [PMID: 25170719 DOI: 10.1103/physrevlett.113.076406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 06/03/2023]
Abstract
We report the complex magnetic phase diagram and electronic structure of Cr_{2}(Te_{1-x}W_{x})O_{6} systems. While compounds with different x values possess the same crystal structure, they display different magnetic structures below and above x_{c}=0.7, where both the transition temperature T_{N} and sublattice magnetization (M_{s}) reach a minimum. Unlike many known cases where magnetic interactions are controlled either by injection of charge carriers or by structural distortion induced via chemical doping, in the present case it is achieved by tuning the orbital hybridization between Cr 3d and O 2p orbitals through W 5d states. The result is supported by ab initio electronic structure calculations. Through this concept, we introduce a new approach to tune magnetic and electronic properties via chemical doping.
Collapse
Affiliation(s)
- M Zhu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - D Do
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - C R Dela Cruz
- Quantum Condensed Matter Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - Z Dun
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - H D Zhou
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA and National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32306, USA
| | - S D Mahanti
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - X Ke
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| |
Collapse
|
26
|
Do D, Orrego S, Majd H, Ryou H, Mutluay MM, Xu HHK, Arola D. Accelerated fatigue of dentin with exposure to lactic acid. Biomaterials 2013; 34:8650-8659. [PMID: 23948166 DOI: 10.1016/j.biomaterials.2013.07.090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 05/28/2013] [Accepted: 07/26/2013] [Indexed: 11/19/2022]
Abstract
Composite restorations accumulate more biofilm than other dental materials. This increases the likelihood for the hard tissues supporting a restoration (i.e. dentin and enamel) to be exposed to acidic conditions beyond that resulting from dietary variations. In this investigation the fatigue strength and fatigue crack growth resistance of human coronal dentin were characterized within a lactic acid solution (with pH = 5) and compared to that of controls evaluated in neutral conditions (pH = 7). A comparison of the fatigue life distributions showed that the lactic acid exposure resulted in a significant reduction in the fatigue strength (p ≤ 0.001), and nearly 30% reduction in the apparent endurance limit (from 44 MPa to 32 MPa). The reduction in pH also caused a significant decrease (p ≤ 0.05) in the threshold stress intensity range required for the initiation of cyclic crack growth, and significant increase in the incremental rate of crack extension. Exposure of tooth structure to lactic acid may cause demineralization, but it also increases the likelihood of restored tooth failures via fatigue, and after short time periods.
Collapse
Affiliation(s)
- D Do
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
| | - S Orrego
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
| | - H Majd
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
| | - H Ryou
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
| | - M M Mutluay
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
- Adhesive Dentistry Research Group, Institute of Dentistry, University of Turku, Turku, Finland
| | - Hockin H K Xu
- Department of Endodontics, Prosthodontics, and Operative Dentistry, Dental School, University of Maryland, Baltimore, MD 21201
| | - D Arola
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, MD USA
- Department of Endodontics, Prosthodontics, and Operative Dentistry, Dental School, University of Maryland, Baltimore, MD 21201
| |
Collapse
|
27
|
Qiu C, Burton P, Do D, Kersten D, Olman C. Interregional connections across early visual areas in contour processing. J Vis 2013. [DOI: 10.1167/13.9.1039] [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
|
28
|
Gates M, Caraway J, Owens J, Do D, Wright T, D'Agostino H. Transrectal and transvaginal drainages: safe, effective, and underutilized. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.128] [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: 11/27/2022] Open
|
29
|
Kim S, Dodson T, Do D, Wadhwa G, Chuang S. Poster 07: Factors Associated With Crestal Bone Loss Following Dental Implant Placement. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
30
|
Keo H, Do D, Husmann M, Baumgartner I. Oral sirolimus for prevention of recurrent infrainguinal arterial obstructions after surgical and endovascular revascularizations. VASA 2008; 37:285-8. [PMID: 18690598 DOI: 10.1024/0301-1526.37.3.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
No data are currently available on the role of oral sirolimus in the prevention of recurrent stenosis in the periphery. We report the effects of oral sirolimus in the prevention of recurrent infrainguinal obstructions in patients with complex peripheral arterial disease. Three patients with ischemic rest pain of the lower limbs and repeated short-term need for surgical and/or endovascular revascularization: 9 times within 12 months, 7 times within 15 months, 11 times within 26 months, respectively. Oral sirolimus on a case by case basis, resulted in less frequent restenosis and longer intervention-free intervals: three re-interventions within 37 months in the first patient, one balloon angioplasty within 17 months in the second, and three re-interventions within 21 months in the third patient, respectively. Side effects, in particular dyspepsia and diarrhoea, were mild and tolerable. To our knowledge, this is the first report to show that oral sirolimus was successfully administered in patients with recurrent excessive neointimal proliferation after revascularization of peripheral arterial lesions lowering the necessity of re-intervention and hence prolonging intervention-free intervals.
Collapse
Affiliation(s)
- H Keo
- Swiss Cardiovascular Center, Division of Angiology, Inselspital, University Hospital and University of Bern, Switzerland.
| | | | | | | |
Collapse
|
31
|
Do D, Mukhopadhyay A, Lim I, Phan T. The Role of Epithelial-Mesenchymal Interactions in Tissue Repair, Fibrogenesis and Carcinogenesis. ACTA ACUST UNITED AC 2007. [DOI: 10.2174/157436207781745346] [Citation(s) in RCA: 2] [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: 11/22/2022]
|
32
|
Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J. Exercise capacity and mortality among men referred for exercise testing. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1062-1458(02)00697-9] [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: 11/29/2022]
|
33
|
Abstract
OBJECTIVES The goal of this study was to validate the prognostic value of the drop in heart rate (HR) after exercise, compare it to other test responses, evaluate its diagnostic value and clarify some of the methodologic issues surrounding its use. BACKGROUND Studies have highlighted the value of a new prognostic feature of the treadmill test-rate of recovery of HR after exercise. These studies have had differing as well as controversial results and did not consider diagnostic test characteristics. METHODS All patients were referred for evaluation of chest pain at two university-affiliated Veterans Affairs Medical Centers who underwent treadmill tests and coronary angiography between 1987 and 1999 as predicted after a mean seven years of follow-up. All-cause mortality was the end point for follow-up, and coronary angiography was the diagnostic gold standard. RESULTS There were 2,193 male patients who had treadmill tests and coronary angiography. Heart rate recovery at 2 min after exercise outperformed other time points in prediction of death; a decrease of <22 beats/min had a hazard ratio of 2.6 (2.4 to 2.8 95% confidence interval). This new measurement was ranked similarly to traditional variables including age and metabolic equivalents but failed to have diagnostic power for discriminating those who had angiographic disease. CONCLUSIONS Heart rate at 1 or 2 min of recovery has been validated as a prognostic measurement and should be recorded as part of all treadmill tests. This new measurement does not replace, but is supplemental to, established scores.
Collapse
Affiliation(s)
- K Shetler
- Division of Cardiovascular Medicine, Stanford University Medical Center and the Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lipinski M, Do D, Froelicher V, Osterberg L, Franklin B, West J, Atwood E. Comparison of exercise test scores and physician estimation in determining disease probability. Arch Intern Med 2001; 161:2239-44. [PMID: 11575981 DOI: 10.1001/archinte.161.18.2239] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The recent American College of Cardiology/American Heart Association exercise testing guidelines provided equations to calculate treadmill scores and recommended their use to improve the predictive accuracy of the standard exercise test. However, if physicians can estimate the probability of coronary artery disease as well as the scores can, there would be no reason to add this complexity to test interpretation. To compare the exercise test scores with physician's estimation of disease probability, we used clinical, exercise test, and coronary angiographic data to compute the recommended scores and print patient summaries and treadmill reports. OBJECTIVE To determine whether exercise test scores can be as effective as expert cardiologists in diagnosing coronary disease. METHODS Five hundred ninety-nine consecutive male patients without previous myocardial infarction with a mean +/- SD age of 59 +/- 11 years were considered for this analysis. With angiographic disease defined as any coronary lumen occlusion of 50% or more, 58% had disease. The clinical/treadmill test reports were sent to expert cardiologists and to 2 other groups, including randomly selected cardiologists and internists, who classified the patients as having high, low, or intermediate probability of disease and estimated a numerical probability from 0% to 100%. RESULTS Forty-five expert cardiologists returned estimates on 336 patients, 37 randomly chosen practicing cardiologists returned estimates on 129 patients, 29 randomly chosen practicing internists returned estimates on 106 patients, 13 academic cardiologists returned estimates on 102 patients, and 27 academic internists returned estimates on 174 patients. When probability estimates were compared, the scores were superior to all physician groups (0.76 area under the receiver operating characteristic curve to 0.70 for experts [P=.046], 0.73 to 0.58 for cardiologists [P=.003], and 0.76 to 0.61 for internists [P=.006]). Using a probability cut point of greater than 70% for abnormal, predictive accuracy was 69% for scores compared with 64% for experts, 63% to 62% for cardiologists, and 70% to 57% for internists. CONCLUSION Although most similar to the disease estimates of the presence of clinically significant angiographic coronary artery disease provided by the expert cardiologists, the scores outperformed the nonexpert physicians.
Collapse
Affiliation(s)
- M Lipinski
- Cardiology Division (111C), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | | | | | | | | | | | | |
Collapse
|
35
|
Prakash M, Myers J, Froelicher VF, Marcus R, Do D, Kalisetti D, Atwood JE. Clinical and exercise test predictors of all-cause mortality: results from > 6,000 consecutive referred male patients. Chest 2001; 120:1003-13. [PMID: 11555539 DOI: 10.1378/chest.120.3.1003] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To report the prevalence of abnormal treadmill test responses and their association with mortality in a large consecutive series of patients referred for standard exercise tests, with testing performed and reported in a standardized fashion. BACKGROUND Exercise testing is widely performed, but few databases exist of large numbers of consecutive tests performed on patients referred for routine clinical purposes using standardized methods. Even fewer of the available databases have information regarding all-cause mortality as an outcome. METHODS All patients referred for evaluation at two university-affiliated Veterans Affairs medical centers who underwent exercise treadmill testing for clinical indications between 1987 and 2000 were determined to be dead or alive using the Social Security death index after a mean 6.2 years (median, 7 years) of follow-up. Clinical and exercise test variables were collected prospectively according to standard definitions; testing and data management were performed in a standardized fashion using a computer-assisted protocol. All-cause mortality was utilized as the end point for follow-up. Standard survival analysis was performed, including Kaplan-Meier curves and a Cox hazard model. RESULTS There were 6,213 male patients (mean +/- SD age, 59 +/- 11 years) who underwent standard exercise ECG treadmill testing over the study period with a mean follow-up duration of 6.2 +/- 3.7 years. There were no complications of testing in this clinically referred population, 78% of whom were referred for chest pain, or risk factors or signs or symptoms of ischemic heart disease. Overlapping thirds had typical angina or history of myocardial infarction (MI). Five hundred seventy-nine patients had prior coronary artery bypass surgery, and 522 patients had a history of congestive heart failure (CHF). Indications for testing were in accordance with published guidelines. Twenty percent died over the follow-up period, for an average annual mortality rate of 2.6%. Cox hazard function chose the following variables in rank order as independently and significantly associated with time to death: exercise capacity (metabolic equivalents < 5, age > 65 years, history of CHF, and history of MI. A score based on these variables (summing up the four variables [if yes = 1 point]) classified patients into low-risk, medium-risk, and high-risk groups. The high-risk group (score > or = 3) has a hazard ratio of 5.0 (95% confidence interval, 4.7 to 5.3) and a 5-year mortality rate of 31%. CONCLUSION This comprehensive analysis provides rates of various abnormal responses that can be expected in patients referred for exercise testing at a typical medical center. Four simple variables combined as a score powerfully stratified patients according to prognosis.
Collapse
Affiliation(s)
- M Prakash
- Division of Cardiovascular Medicine, Stanford University Medical Center and the University of California Irvine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE Our purpose was to report the prevalence of abnormal treadmill test responses and their association with mortality in a large consecutive series of patients referred for standard diagnostic exercise tests, with testing performed and reported in a standardized fashion. BACKGROUND Exercise testing is widely performed, but an analysis of responses has not been presented for a large number of consecutive tests performed on patients referred for diagnosis of cardiac disease. METHODS All patients referred for evaluation at 2 university-affiliated Veterans Affairs Medical Centers who underwent exercise treadmill tests for clinical indications between 1987 and 2000 were determined to be dead or alive according to the Social Security Death Index after a mean 5.9-year follow-up. Patients with established heart disease (ie, prior coronary bypass surgery, myocardial infarction, or congestive heart failure) were excluded from analyses. Clinical and exercise test variables were collected prospectively according to standard definitions; testing and data management were performed in a standardized fashion with a computer-assisted protocol. All-cause mortality was used as the end point for follow-up. Standard survival analysis was performed, including Kaplan-Meier curves and a Cox hazard model. RESULTS After the exclusions, 3974 men (mean age 57.5 +/- 11 years) had standard diagnostic exercise testing over the study period with a mean of 5.9 (+/-3.7) years of follow-up (64% of all tested). There were no complications of testing in this clinically referred population, 82% of whom were referred for chest pain, risk factors, or signs and symptoms of ischemic heart disease. Five hundred forty-nine (14%) had a history of typical angina. Indications for testing were in accordance with published guidelines. A total of 545 died, yielding an annual mortality rate of 1.8%. The Cox hazard model chose the following variables in rank order as independently associated with time to death: change in rate pressure product, age greater than 65 years, METs less than 5, and electrocardiographic left ventricular hypertrophy. A score based on these variables classified patients into low-, medium-, and high-risk groups. The high-risk group with a score greater than 3 has a hazard ratio of 4 (95% confidence interval 3.82-4.27) and an annual mortality rate of 4%. CONCLUSION This comprehensive analysis provides rates of various abnormal responses that can be expected in men referred for diagnostic exercise testing at typical Veterans Administration Medical Centers. Four simple variables combined as a score predict all-cause mortality after clinical decisions for therapy are prescribed.
Collapse
Affiliation(s)
- M Prakash
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, Calif., USA
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE Our aim was to derive and validate a simplified treadmill score for predicting the probability of angiographically confirmed coronary artery disease (CAD). BACKGROUND The American College of Cardiology/American Heart Association guidelines for exercise testing recommend the use of multivariable equations to enhance the diagnostic characteristics of the standard treadmill test. Most of these equations use complicated statistical techniques to provide diagnostic estimates of CAD. Simplified scores derived from such equations that require physicians only to add points have been developed for pretest estimates of disease and for prognosis. However, no simplified score has been developed specifically for the diagnosis of CAD using exercise test results. METHODS Consecutive patients referred for evaluation of chest pain who underwent standard treadmill testing followed by coronary angiography were studied. A logistic regression model was used to predict clinically significant (> or = 50% stenosis) CAD and then the variables and coefficients were used to derive a simplified score. The simplified score was calculated as follows: (6 x maximal heart rate code) + (5 x ST-segment depression code) + (4 x age code) + angina pectoris code + hypercholesterolemia code + diabetes code + treadmill angina index code. The simplified score had a range from 6 to 95, with < 40 designated as low probability, between 40 and 60 was intermediate probability, and > 60 was high probability for CAD. RESULTS A total of 1,282 male patients without a prior myocardial infarction underwent exercise treadmill testing and coronary angiography in the derivation group, and there were 476 male patients in the validation group from another institution. The area under the receiver operating characteristic curve (+/- SE) for the ST-segment response alone was 0.67 as compared to 0.79 +/- 0.01 for the diagnostic score (p > 0.001). The prevalence of significant disease for the men was 27% in the low-probability group, 62% in the intermediate-probability group, and 92% in the high-probability group, which was similar to the prevalence in the validation group, with 22%, 58%, and 92% in low-, intermediate-, and high-probability groups, respectively. The low-probability group had < 4% prevalence of severe disease. In both populations, 7 more patients out of 100 were correctly classified than with the use of ST-segment criteria. When used as a clinical management strategy, the score has a sensitivity of 88% and a specificity of 96%. CONCLUSION This simplified exercise score that estimates the probability of CAD can be easily applied without a calculator and is a useful and valid tool that can help physicians manage patients presenting with chest pain.
Collapse
Affiliation(s)
- V Raxwal
- Divisions of Cardiovascular Medicine, Stanford University Medical Center, and the Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Quaglino F, Borello M, Cumbo P, Pietribiasi F, Poma A, Seglie E, Do D. [Gastrointestinal stromal tumors. A case of small intestine stromal tumor (SIST) with an uncertain biological aspect]. MINERVA CHIR 2000; 55:347-51. [PMID: 10953571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Tumors of the small intestine are relatively rare. The diagnosis is difficult to establish because the symptoms are vague and non-specific. Although the small intestine constitutes 75% of the length and over 90% of the mucosal surface area of the gastrointestinal tract, only 1 to 2% of gastrointestinal malignancies occur in this segment. Metastases are usually present at the time of diagnosis. The outcome of these patients can be improved if the possibility of a malignant small bowel tumor is considered in all cases of unexplained abdominal pain or gastrointestinal bleeding, especially in younger age. Malignant tumors occur with increasing frequency in distal small bowel with a preponderance of malignant lesions in the ileum compared with the jejunum and the duodenum. Adenocarcinoma is the most common tumor of the primary malignant small bowel tumors, followed by carcinoid, lymphoma and leiomyosarcoma. Mesenchymal tumors of the gastrointestinal tract, traditionally regarded as smooth muscle tumors, have demonstrated different cellular differentiations based on immunohistochemical and ultrastructural features. Therefore the terms leiomyoma and leiomyosarcoma have been replaced by a more encompassing term, gastrointestinal stromal tumor (GIST). The majority of GISTs occurs in the stomach; stromal tumors involving the small intestine (SISTs) are far less common but seem to have greater malignant potential. The clinical a case of a small intestinal stromal tumor (SIST), localised in the jejunum and characterised by an uncertain histological aspect, is presented and a review of the literature is made.
Collapse
Affiliation(s)
- F Quaglino
- Divisione di Chirurgia Generale, Presidio Ospedaliero di Moncalieri, Torino
| | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Two patients with renal artery involvement in type B dissection of the aorta were treated by percutaneous stent implantation. Both of them were hypertensive and showed increasing serum creatinine levels. After stent implantation in the renal arteries blood pressure and renal function improved, and the renal arteries were patent in duplex ultrasound 15 and 30 months after treatment respectively.
Collapse
Affiliation(s)
- P Behrendt
- Division of Angiology, University Hospital Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
41
|
Wu X, Hepner K, Castelino-Prabhu S, Do D, Kaye MB, Yuan XJ, Wood J, Ross C, Sawyers CL, Whang YE. Evidence for regulation of the PTEN tumor suppressor by a membrane-localized multi-PDZ domain containing scaffold protein MAGI-2. Proc Natl Acad Sci U S A 2000; 97:4233-8. [PMID: 10760291 PMCID: PMC18208 DOI: 10.1073/pnas.97.8.4233] [Citation(s) in RCA: 305] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PTEN is a tumor suppressor gene mutated in human cancers. Although many mutations target the phosphatase domain, others create a truncated protein lacking the C-terminal PDZ-binding motif or a protein that extends beyond the PDZ-binding motif. Using the yeast two-hybrid system, we isolated a membrane-associated guanylate kinase family protein with multiple PDZ domains [AIP-1 (atrophin interacting protein 1), renamed MAGI-2 (membrane associated guanylate kinase inverted-2)]. MAGI-2 contains eight potential protein-protein interaction domains and is localized to tight junctions in the membrane of epithelial cells. PTEN binds to MAGI-2 through an interaction between the PDZ-binding motif of PTEN and the second PDZ domain of MAGI-2. MAGI-2 enhances the ability of PTEN to suppress Akt activation. Furthermore, certain PTEN mutants have reduced stability, which is restored by adding the minimal PDZ-binding motif back to the truncated protein. We propose that MAGI-2 improves the efficiency of PTEN signaling through assembly of a multiprotein complex at the cell membrane.
Collapse
Affiliation(s)
- X Wu
- Department of Medicine, Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Accurately establishing prognosis in severe heart failure has become increasingly important in assessing the efficacy of treatment modalities and in appropriately allocating scarce resources for transplantation. Peak exercise oxygen uptake appears to have an important role in risk stratification of patients with heart failure, but the optimal cutpoint value to separate survivors from nonsurvivors is not clear. METHODS Six hundred forty-four patients referred for heart failure evaluation over a 10-year period participated in the study. After pharmacologic stabilization at entrance into the study, all participants underwent cardiopulmonary exercise testing. Survival analysis was performed with death as the end point. Transplantation was considered a censored event. Four-year survival was determined for patients who achieved peak oxygen uptake values greater than and less than 10, 11, 12, 13, 14, 15, 16, and 17 mL/kg/min. RESULTS Follow-up information was complete for 98.3% of the cohort. During a mean follow-up period of 4 years, 187 patients (29%) died and 101 underwent transplantation. Actuarial 1- and 5-year survival rates were 90.5% and 73.4%, respectively. Peak ventilatory oxygen uptake (VO(2)) was an independent predictor of survival and was a stronger predictor than work rate achieved and other exercise and clinical variables. A difference in survival of approximately 20% was achieved by dichotomizing patients above versus below each peak VO(2) value ranging between 10 and 17 mL/kg/min. Survival rate was significantly higher among patients achieving a peak VO (2) above than among those achieving a peak VO (2) below each of these values (P <.01), but each cutpoint was similar in its ability to separate survivors from nonsurvivors. CONCLUSION Peak VO (2) is an important measurement in predicting survival from heart failure, but whether an optimal cutpoint exists is not clear. Peak VO(2) may be more appropriately used as a continuous variable in multivariate models to predict prognosis in severe chronic heart failure.
Collapse
Affiliation(s)
- J Myers
- Palo Alto Veterans Affairs Health Care System, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 96305, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
This study investigated the effects of different rearing conditions on neural and cognitive development of male rhesus monkeys (Macaca mulatta). Infants raised individually in a nursery from 2 to 12 months of age (NURSERY, n=9) were compared to age-matched infants raised in a semi-naturalistic, social environment (CONTROL, n=11). Various brain regions were measured by MRI. Although overall brain volumes did not differ between NURSERY and CONTROL animals, corpus callosum (CC) size, measured in mid-sagittal sections, was significantly decreased in the NURSERY group. Group differences were most evident in the posterior aspects of the corpus callosum and appeared to result from changes in the number of cross-hemispheric projections rather than from a decrease in cortical gray matter volume. The decrease in corpus callosum size in the NURSERY animals persisted after 6 months of social housing in a peer-group. Rearing group differences were not found in other structures analyzed, including the hippocampus, cerebellum and anterior commissure. In cognitive testing, NURSERY animals had more difficulty acquiring the delayed non-matching to sample (DNMS) task, but showed no deficits in subsequent memory performance when a 2 or 10 min delay was imposed. The NURSERY infant monkeys were also impaired in object, but not in spatial, reversal learning, although there were no differences in a simple object discrimination task. The cognitive deficits exhibited by the NURSERY animals were significantly correlated with the alterations found in the CC. In summary, rearing environment was associated with sustained differences in cross-hemispheric projections, white matter volume and cognitive performance.
Collapse
Affiliation(s)
- M M Sánchez
- Department of Psychiatry and Behavioral Sciences, Yerkes Regional Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | | | | | | | | |
Collapse
|
44
|
Do D, Marcus R, Froelicher V, Janosi A, West J, Atwood JE, Myers J, Chilton R, Froning J. Predicting severe angiographic coronary artery disease using computerization of clinical and exercise test data. Chest 1998; 114:1437-45. [PMID: 9824025 DOI: 10.1378/chest.114.5.1437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Currently the standard exercise test is shifting from being a tool for the cardiologist to utilization by the nonspecialist. This change could be facilitated by computerization similar to the interpretation programs available for the resting ECG. Therefore, we sought to determine if computerization of both exercise ECG measurements and prediction equations can substitute for visual analysis performed by cardiologists to predict which patients have severe angiographic coronary artery disease. We performed a retrospective analysis of consecutive patients referred for evaluation of possible or known coronary artery disease who underwent both exercise testing with digital recording of their exercise ECGs and coronary angiography at two university-affiliated Veteran's Affairs medical centers and a Hungarian hospital. There were 2,385 consecutive male patients with complete data who had exercise tests between 1987 and 1997. Measurements included clinical and exercise test data, and visual interpretation of the ECG paper tracings and > 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized ECG measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were only able to correctly classify two or three more patients out of 100 tested than ECG measurements alone. beta-Blockers had no effect on test characteristics while ST depression on the resting ECG decreased specificity. By setting probability limits using the scores from the equations, the population was divided into high-, intermediate-, and low-probability groups. A strategy using further testing in the intermediate group resulted in 86% sensitivity and 85% specificity for identifying patients with severe coronary disease. We conclude that computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist and computerized scores only minimally improved the discriminatory power of the test. However, using these scores in a stratification algorithm allows the nonspecialist physician to improve the discriminatory characteristics of the standard exercise test even when resting ST depression is present. Computerization permitted accurate identification of patients with severe coronary disease who require referral.
Collapse
Affiliation(s)
- D Do
- University of Texas in San Antonio, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation programs available for the resting electrocardiograph (ECG), we performed this analysis. A secondary aim was to demonstrate the effects of medication status and resting ECG abnormalities on test diagnostic characteristics because these factors affect utility of the exercise test by the generalist. METHODS AND RESULTS A retrospective analysis was performed of consecutive patients referred at 2 university-affiliated Veteran's Affairs Medical Centers and a Hungarian Hospital for evaluation of chest pain and possible ischemic heart disease. There were 1384 consecutive male patients without a prior myocardial infarction with complete data who had exercise tests and coronary angiography between 1987 and 1997. Measurements included clinical, exercise test data, and visual interpretation of the ECG recordings as well as more than 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were superior to single ECG measurements. Beta-blockers had no effect on test characteristics, whereas resting ST depression was associated with decreased specificity and increased sensitivity. CONCLUSIONS Computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist; computerized scores that included clinical and exercise test results exhibited the greatest diagnostic power. Applying scores with a computer allows the practicing physician to improve the diagnostic characteristics of the standard exercise test. This approach is successful even when there is resting ST depression, thus lessening the need for more expensive nuclear or imaging studies.
Collapse
Affiliation(s)
- J E Atwood
- Cardiology Division at the Veterans Affairs Palo Alto Health Care System, Calif 94304, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Myers J, Gullestad L, Vagelos R, Do D, Bellin D, Ross H, Fowler MB. Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure. Ann Intern Med 1998; 129:286-93. [PMID: 9729181 DOI: 10.7326/0003-4819-129-4-199808150-00004] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Accurate prognosis in chronic heart failure has become increasingly important in assessing the efficacy of treatment and in appropriately allocating scarce resources for transplantation. Previous studies of severe heart failure have been limited by short follow-up periods and few deaths. OBJECTIVE To establish clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients with heart failure. DESIGN Retrospective study. SETTING Hospital-based outpatient heart failure clinic. PARTICIPANTS 644 patients referred for evaluation of heart failure over 10 years. MEASUREMENTS Age, cause of heart failure, body surface area, cardiac index, ejection fraction, pulmonary capillary wedge pressure, left ventricular dimensions, watts achieved during exercise, heart rate, maximum systolic blood pressure, and oxygen uptake (VO2) at the ventilatory threshold and at peak exercise were measured at baseline. Univariate and multivariate analyses were done for clinical, hemodynamic, and exercise test predictors of death. A Cox hazards model was developed for time of death. RESULTS During a mean follow-up period of 4 years, 187 patients (29%) died and 101 underwent transplantation. Actuarial 1-year and 5-year survival rates were 90.5% and 73.4%, respectively. Resting systolic blood pressure, watts achieved, peak VO2, VO2 at the ventilatory threshold, and peak heart rate were greater among survivors than among nonsurvivors. Cause of heart failure (coronary artery disease or cardiomyopathy) was a strong determinant of death (relative risk for coronary artery disease, 1.73; P< 0.01). By multivariate analysis, only peak VO2 was a significant predictor of death. Stratification of peak VO2 above and below 12, 14, and 16 mL/kg per minute demonstrated significant differences in risk for death, but each cut-point predicted risk to a similar degree. CONCLUSIONS Peak VO2 outperforms clinical variables, right-heart catheterization data, exercise time, and other exercise test variables in predicting outcome in severe chronic heart failure. Direct measurement of VO2 should be included when clinical or surgical decisions are being made in patients referred for evaluation of heart failure or those considered for transplantation.
Collapse
Affiliation(s)
- J Myers
- Palo Alto Veterans Affairs Health Care System, California 94304, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Froelicher VF, Lehmann KG, Thomas R, Goldman S, Morrison D, Edson R, Lavori P, Myers J, Dennis C, Shabetai R, Do D, Froning J. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Veterans Affairs Cooperative Study in Health Services #016 (QUEXTA) Study Group. Quantitative Exercise Testing and Angiography. Ann Intern Med 1998; 128:965-74. [PMID: 9625682 DOI: 10.7326/0003-4819-128-12_part_1-199806150-00001] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Empirical scores, computerized ST-segment measurements, and equations have been proposed as tools for improving the diagnostic performance of the exercise test. OBJECTIVE To compare the diagnostic utility of these scores, measurements, and equations with that of visual ST-segment measurements in patients with reduced workup bias. DESIGN Prospective analysis. SETTING 12 university-affiliated Veterans Affairs Medical Centers. PATIENTS 814 consecutive patients who presented with angina pectoris and agreed to undergo both exercise testing and coronary angiography. MEASUREMENTS Digital electrocardiographic recorders and angiographic calipers were used for testing at each site, and test results were sent to core laboratories. RESULTS Although 25% of patients had previously had testing, workup bias was reduced, as shown by comparison with a pilot study group. This reduction resulted in a sensitivity of 45% and a specificity of 85% for visual analysis. Computerized measurements and visual analysis had similar diagnostic power. Equations incorporating nonelectrocardiographic variables and either visual or computerized ST-segment measurement had similar discrimination and were superior to single ST-segment measurements. These equations correctly classified 5 more patients of every 100 tested (areas under the receiver-operating characteristic curve, 0.80 for equations and 0.68 for visual analysis; P < 0.001) in this population with a 50% prevalence of disease. CONCLUSIONS Standard exercise tests had lower sensitivity but higher specificity in this population with reduced work-up bias than in previous studies. Computerized ST-segment measurements were similar to visual ST-segment measurements made by cardiologists. Considering more than ST-segment measurements can enhance the diagnostic power of the exercise test.
Collapse
Affiliation(s)
- V F Froelicher
- Palo Alto Veterans Affairs Health Care System, CA 94304, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Gullestad L, Myers J, Ross H, Rickenbacher P, Slauson S, Bellin D, Do D, Vagelos R, Fowler M. Serial exercise testing and prognosis in selected patients considered for cardiac transplantation. Am Heart J 1998; 135:221-9. [PMID: 9489968 DOI: 10.1016/s0002-8703(98)70085-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates. BACKGROUND Variables such as peak VO2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality. METHODS AND RESULTS Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9+/-0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO2, left ventricular dimensions, or ejection fraction. CONCLUSION Although peak VO2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation.
Collapse
Affiliation(s)
- L Gullestad
- Falk Cardiovascular Research Center, Stanford University School of Medicine, CA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Braunschweig M, Do D, Triller J. [Symptomatic arteriovenous fistula of the thyrocervical trunk. A rare complication after implanting a subclavian catheter]. Radiologe 1997; 37:835-8. [PMID: 9454277 DOI: 10.1007/s001170050290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
After the incidental puncture of a sidebranch of the thyreocervical trunk during a subclavian vein catheterization, a symptomatic avfistula developed. The diagnosis was confirmed by angiography. Using a microcatheter system the fistula was occluded with micro-coils.
Collapse
Affiliation(s)
- M Braunschweig
- Institut für Diagnostische Radiologie, Inselspital, Universität, Bern
| | | | | |
Collapse
|
50
|
Abstract
OBJECTIVE To demonstrate that an agreement approach to applying equations on the basis of clinical and exercise test variables is an accurate, self-calibrating, and cost-efficient method for predicting severe coronary artery disease in clinical populations. DESIGN Retrospective analysis of consecutive patients with complete data from exercise testing and coronary angiography referred for evaluation of possible coronary artery disease. After developing an equation in a training set, this equation and two other equations developed by other investigators were validated in a test set. The study was performed at two university-affiliated Veteran's Affairs medical centers. PATIENTS 1080 consecutive men studied between 1985 and 1995 who had coronary angiography within 3 months of the treadmill test. The population was randomly divided into a training set of 701 patients and a test set of 379 patients. Patients with previous coronary artery bypass surgery, valvular heart disease, marked degrees of resting ST depression, and left bundle branch block were excluded. MEASUREMENTS Recording of clinical and exercise test data along with visual interpretation of the electrocardiogram recordings on standardized forms and abstraction of visually interpreted angiographic data from clinical catheterization reports. RESULTS Simple clinical and exercise test variables improved the standard application of exercise-induced ST criteria for predicting severe coronary artery disease. By setting probability thresholds for severe disease of <20% and >40% for the three prediction equations, the agreement approach divided the test set into three groups: low risk (patients with all three equations predicting <21% probability of severe coronary disease), no agreement, and high risk (all three equations with >39% probability) for severe coronary artery disease. Because the patients in the no agreement group would be sent for further testing and would eventually be correctly classified, the sensitivity of the agreement approach was 89% and the specificity was 96%. The agreement approach appeared to be unaffected by disease prevalence, missing data, variable definitions, or even angiographic criteria. CONCLUSIONS Requiring diagnosis of severe coronary disease to be dependent on agreement between these three equations has made them likely to function in all clinical populations. The agreement approach should be an efficient method for the evaluation of populations with varying prevalence of coronary artery disease, limiting the use of more expensive noninvasive and invasive testing to patients with a higher probability of left main or triple-vessel coronary artery disease. This approach provides a strategy that can be applied by inputting the results of basic clinical assessment into a programmable calculator or a computer to assist the practitioner in deciding when further evaluation is appropriate, thus assuring patients access to subspecialty care.
Collapse
Affiliation(s)
- D Do
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, CA 94304, USA
| | | | | | | | | |
Collapse
|