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He F, Rao J, Zhou J, Fu W, Wang Y, Zhang Y, Zuo F, Shi H. Fabrication of 3D printed Ca 3Mg 3(PO 4) 4-based bioceramic scaffolds with tailorable high mechanical strength and osteostimulation effect. Colloids Surf B Biointerfaces 2023; 229:113472. [PMID: 37487286 DOI: 10.1016/j.colsurfb.2023.113472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/01/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
Calcium, magnesium and phosphate are predominant constituents in the human bone. In this study, magnesium-calcium phosphate composite bioceramic scaffolds were fabricated utilizing Mg3(PO4)2 and β-Ca3(PO4)2 as starting materials, and their pore structure was constructed by 3D printing. The porosity and compressive strength of the composite bioceramic scaffolds could be adjusted by altering the sintering temperature and the formula of starting materials. The composite bioceramic scaffolds prepared from 60 wt% Mg3(PO4)2 and 40 wt% β-Ca3(PO4)2 were dominated by the Ca3Mg3(PO4)4 phase, and this Ca3Mg3(PO4)4-based bioceramic scaffolds possessed the highest compressive strength (12.7 - 92.4 MPa). Moreover, the Ca3Mg3(PO4)4-based bioceramic scaffolds stimulated cellular growth and osteoblastic differentiation of bone marrow stromal cells. The Ca3Mg3(PO4)4-based bioceramic scaffolds as bone regenerative biomaterials are flexible to the requirement of bone defects at various sites.
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Affiliation(s)
- Fupo He
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Jin Rao
- School of Stomatology, Jinan University, Guangzhou 510632, People's Republic of China
| | - Jielin Zhou
- School of Stomatology, Jinan University, Guangzhou 510632, People's Republic of China
| | - Wenhao Fu
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Yao Wang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Yihang Zhang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Fei Zuo
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Haishan Shi
- School of Stomatology, Jinan University, Guangzhou 510632, People's Republic of China.
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Brault C, Mancebo J, Suarez Montero JC, Bentall T, Burns KEA, Piraino T, Lellouche F, Bouchard PA, Charbonney E, Carteaux G, Maraffi T, Beduneau G, Mercat A, Skrobik Y, Zuo F, Lafreniere-Roula M, Thorpe K, Brochard L, Bosma KJ. The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing. Crit Care 2022; 26:188. [PMID: 35739553 PMCID: PMC9219177 DOI: 10.1186/s13054-022-04063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study. Methods The algorithm included five steps: enrollment criteria, pressure support ventilation (PSV) tolerance trial, weaning criteria, continuous positive airway pressure (CPAP) tolerance trial (0 cmH2O during 2 min) and spontaneous breathing trial (SBT): on fraction of inspired oxygen (FiO2) 40% for 30–120 min. Patients who failed the weaning criteria, CPAP Zero trial, or SBT were randomized. We describe the characteristics of patients who were initially enrolled, but passed all steps in the algorithm and consequently were not randomized. Results Among the 374 enrolled patients, 93 (25%) patients passed all five steps. At time of enrollment, most patients were on PSV (87%) with a mean (± standard deviation) FiO2 of 34 (± 6) %, PSV of 8.7 (± 2.9) cmH2O, and positive end-expiratory pressure of 6.1 (± 1.6) cmH2O. Minute ventilation was 9.0 (± 3.1) L/min with a respiratory rate of 17.4 (± 4.4) breaths/min. Patients were liberated from MV with a median [interquartile range] delay between initial screening and extubation of 5 [1–49] hours. Only 7 (8%) patients required reintubation. Conclusion The trial algorithm permitted identification of 93 (25%) patients who were ready to extubate, while their clinicians predicted a duration of ventilation higher than 24 h. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04063-4.
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Saposnik G, Andhavarapu S, Fernández Ó, Kim HJ, Wiendl H, Foss M, Zuo F, Havrdová EK, Celius E, Caceres F, Magyari M, Bermel R, Costa A, Terzaghi M, Kalincik T, Popescu V, Amato MP, Montalban X, Oh J. Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study. Mult Scler Relat Disord 2022; 58:103404. [PMID: 35216786 DOI: 10.1016/j.msard.2021.103404] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/19/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care. METHODS 300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. RESULTS Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists. CONCLUSIONS Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.
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Affiliation(s)
- G Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario M5C 1R6, Canada; Director and Founder, NeuroEconSolutions© (www.neuroeconsolutions.com), Toronto, Canada; Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada.
| | - S Andhavarapu
- Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ó Fernández
- Department of Pharmacology, Faculty of Medicine, University of Malaga, Institute of Biomedical Research of Malaga, Regional University Hospital of Malaga, Spain
| | - H J Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - H Wiendl
- Department of Neurology, Institute of Translational Neurology, University of Münster, Germany
| | - M Foss
- Bootstrap Analytics, Calgary, Canada
| | - F Zuo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
| | - E K Havrdová
- Department of Neurology, First Medical Faculty, Center for Clinical Neuroscience, Charles University, Prague, Czech Republic
| | - E Celius
- Department of Neurology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Caceres
- Institute of Restorative Neurosciences, Buenos Aires, Argentina
| | - M Magyari
- Danish Multiple Sclerosis Center, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - R Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - A Costa
- Neurology Department, Faculty of Medicine University of Porto, Centro Hospitalar Universitário São João, Portugal
| | - M Terzaghi
- Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
| | - T Kalincik
- Department of Medicine, MS Centre, Royal Melbourne Hospital Core Unit, University of Melbourne, Melborne, Australia
| | - V Popescu
- University MS Centre, Noorderhart Hospital, Pelt, Belgium; Hasselt University, Hasselt, Belgium
| | - M P Amato
- Department of Neurofarba, IRCCS Fondazione Don Carlo Gnocchi, University of Florence, Florence, Italy
| | - X Montalban
- Department of Neurology, Hospital Vall d´Hebron, Centre d'Esclerosi Mútiple de Catalunya, Universitat Autonoma de Barcelona, Spain
| | - J Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario M5C 1R6, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
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Saposnik G, Andhavarapu S, Fernández Ó, Kim HJ, Wiendl H, Foss M, Zuo F, Havrdová EK, Celius EG, Caceres F, Magyari M, Bermel R, Costa A, Terzaghi M, Kalincik T, Popescu V, Amato MP, Montalban X, Oh J. Effect of desire for pregnancy on decisions to escalate treatment in multiple sclerosis care: Differences between MS specialists and non-MS specialists. Mult Scler Relat Disord 2022; 57:103389. [PMID: 35158479 DOI: 10.1016/j.msard.2021.103389] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/24/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Therapeutic inertia (TI) is a worldwide phenomenon that affects 60 to 90% of neurologists and up to 25% of daily treatment decisions during management of multiple sclerosis (MS) patients. A large volume of MS patients are women of childbearing age, and desire for pregnancy is a complex variable often affecting MS care. The objective of this study was to determine the effect of desire for pregnancy on decisions to escalate treatment during management of MS patients. METHODS 300 neurologists with expertise in MS from 20 countries were invited to participate in the study. Participants were presented with 12 pairs of simulated MS patient profiles reflective of case scenarios encountered in clinical practice. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. Disaggregated discrete choice experiments were used to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. An excel calculator that provides estimates as the percentage of participants that would escalate treatment for a simulated case-scenario was constructed. RESULTS 229 (76.3%) completed the study. The mean age (SD) of study participants was 44 (±10) years. The mean (SD) number of MS patients seen per month by each neurologist was 18 (±16). Non-MS specialists were significantly less likely to escalate treatment than MS specialists across mild, moderate, and severe patient cases. These differences were accentuated when case scenarios introduced a desire for pregnancy. The findings were consistent when MRI-lesions, severity of symptoms, and number of relapses were included. CONCLUSIONS Desire for pregnancy differentially influences decisions to escalate treatment, suggesting knowledge-to-action gaps between MS and non-MS specialists. Our findings indicate the need for educational strategies to overcome these gaps and improve clinical outcomes for MS patients who desire pregnancy.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Zurich Center for Neuroeconomics (ZNE), Department of Economics, University of Zurich, Switzerland; Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada.
| | - Sanketh Andhavarapu
- Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Óscar Fernández
- Department of Pharmacology, Faculty of Medicine, University of Malaga, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Spain
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Germany
| | - Mona Foss
- Bootstrap Analytics, Calgary, Canada
| | - Fei Zuo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, First Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fernando Caceres
- Institute of Restorative Neurosciences (INERE), Buenos Aires, Argentina
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Robert Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Andreia Costa
- Neurology Department, Centro Hospitalar Universitário São João, Faculty of Medicine University of Porto, Portugal
| | - Maria Terzaghi
- Clinical Outcomes and Decision Neuroscience Unit, St Michael's Hospital, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
| | - Tomas Kalincik
- MS Centre, Royal Melbourne Hospital, Melborne, Australia; CORe, Department of Medicine, University of Melbourne, SA
| | - Veronica Popescu
- University MS Centre, Noorderhart Hospital, Pelt, Belgium; Hasselt University, Hasselt, Belgium
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Xavier Montalban
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Department of Neurology. Cemcat. Hospital Vall d´Hebron. Universitat Autonoma de Barcelona. Spain
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada
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Zuo F, Zhai S. The Influence of China's COVID-19 Treatment Policy on the Sustainability of Its Social Health Insurance System. Risk Manag Healthc Policy 2021; 14:4243-4252. [PMID: 34703336 PMCID: PMC8523901 DOI: 10.2147/rmhp.s322040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background While past experiences show that a health system financing mechanism can support resilience to shocks, the impact on the sustainability of the financing system is exceptionally important considering the magnitude of the COVID-19 pandemic. The role of Social Health Insurance (SHI) in responding to the pandemic brings about an influence on insurance system sustainability. This study investigates the impact of China’s COVID-19 treatment policy on the sustainability of its SHI system, explores influences of the policy on Wuhan’s system, and discusses the effects of an assumed equivalent emergency on SHI funds for five other provincial capital cities in China. Methods The study was conducted using pay-as-you-go actuarial models of Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) funds, which constitute China’s basic health insurance system. Current and accumulated balances of the funds in 2020 are predicted and utilized to measure the sustainability of health insurance funds during emergencies. Results The findings suggest a disparity in the capacities of insurance schemes and localities. If the surplus before 2018 is not considered, it is likely that the URRBMI fund of Wuhan would suffer a deficit, whereas the UEBMI would retain a considerable surplus. To maintain the current actuarial balance of the URRBMI fund, coverage for ordinary inpatient and outpatient expenses would have to be significantly reduced in Wuhan, potentially affecting enrollees’ wellbeing. A similar situation may occur in three other cities, some with underdeveloped economies and lower per capita income are likely to be encountered with worse situation than Wuhan. Conclusion Concerning fragmentation of China’s SHI system, to strengthen longer-term preparedness to manage future emergencies, this study suggests the integration of insurance schemes and provincial pooling, fund balance adjusting and an emergency safety net are also advised. All options call for more public health investments.
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Affiliation(s)
- Fei Zuo
- Department of Finance, Economics and Management School, Northwest University, Xi'an, Shaanxi Province, People's Republic of China
| | - Shaoguo Zhai
- Department of Social Security, Public Management School, Northwest University, Xi'an, Shaanxi Province, People's Republic of China
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Sholzberg M, Tang GH, Rahhal H, AlHamzah M, Kreuziger LB, Áinle FN, Alomran F, Alayed K, Alsheef M, AlSumait F, Pompilio CE, Sperlich C, Tangri S, Tang T, Jaksa P, Suryanarayan D, Almarshoodi M, Castellucci LA, James PD, Lillicrap D, Carrier M, Beckett A, Colovos C, Jayakar J, Arsenault MP, Wu C, Doyon K, Andreou ER, Dounaevskaia V, Tseng EK, Lim G, Fralick M, Middeldorp S, Lee AYY, Zuo F, da Costa BR, Thorpe KE, Negri EM, Cushman M, Jüni P. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ 2021; 375:n2400. [PMID: 34649864 PMCID: PMC8515466 DOI: 10.1136/bmj.n2400] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards. DESIGN Randomised controlled, adaptive, open label clinical trial. SETTING 28 hospitals in Brazil, Canada, Ireland, Saudi Arabia, United Arab Emirates, and US. PARTICIPANTS 465 adults admitted to hospital wards with covid-19 and increased D-dimer levels were recruited between 29 May 2020 and 12 April 2021 and were randomly assigned to therapeutic dose heparin (n=228) or prophylactic dose heparin (n=237). INTERVENTIONS Therapeutic dose or prophylactic dose heparin (low molecular weight or unfractionated heparin), to be continued until hospital discharge, day 28, or death. MAIN OUTCOME MEASURES The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an intensive care unit, assessed up to 28 days. The secondary outcomes included all cause death, the composite of all cause death or any mechanical ventilation, and venous thromboembolism. Safety outcomes included major bleeding. Outcomes were blindly adjudicated. RESULTS The mean age of participants was 60 years; 264 (56.8%) were men and the mean body mass index was 30.3 kg/m2. At 28 days, the primary composite outcome had occurred in 37/228 patients (16.2%) assigned to therapeutic heparin and 52/237 (21.9%) assigned to prophylactic heparin (odds ratio 0.69, 95% confidence interval 0.43 to 1.10; P=0.12). Deaths occurred in four patients (1.8%) assigned to therapeutic heparin and 18 patients (7.6%) assigned to prophylactic heparin (0.22, 0.07 to 0.65; P=0.006). The composite of all cause death or any mechanical ventilation occurred in 23 patients (10.1%) assigned to therapeutic heparin and 38 (16.0%) assigned to prophylactic heparin (0.59, 0.34 to 1.02; P=0.06). Venous thromboembolism occurred in two patients (0.9%) assigned to therapeutic heparin and six (2.5%) assigned to prophylactic heparin (0.34, 0.07 to 1.71; P=0.19). Major bleeding occurred in two patients (0.9%) assigned to therapeutic heparin and four (1.7%) assigned to prophylactic heparin (0.52, 0.09 to 2.85; P=0.69). CONCLUSIONS In moderately ill patients with covid-19 and increased D-dimer levels admitted to hospital wards, therapeutic heparin was not significantly associated with a reduction in the primary outcome but the odds of death at 28 days was decreased. The risk of major bleeding appeared low in this trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04362085.
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Affiliation(s)
- Michelle Sholzberg
- Departments of Medicine, and Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Grace H Tang
- Haematology-Oncology Clinical Research Group, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hassan Rahhal
- Internal Medicine Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), University of São Paulo, São Paulo, Brazil
| | - Musaad AlHamzah
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Vascular Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Fionnuala Ní Áinle
- Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Irish Network for Venous Thromboembolism Research, Dublin, Ireland
| | - Faris Alomran
- Department of Vascular Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Alayed
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alsheef
- Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad AlSumait
- Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Carlos Eduardo Pompilio
- Internal Medicine Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), University of São Paulo, São Paulo, Brazil
| | - Catherine Sperlich
- Charles-Lemoyne Hospital, CISSS of Montérégie-Centre, University of Sherbrooke, Greenfield Park, QC, Canada
| | - Sabrena Tangri
- Department of Medicine, William Osler Health System, Brampton, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Department of Medicine, University of Toronto, ON, Canada
| | - Peter Jaksa
- St Joseph's Health Centre, Unity Health Toronto, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deepa Suryanarayan
- Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | | | - Lana A Castellucci
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Andrew Beckett
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, Ontario, Canada
| | - Christos Colovos
- Division of Acute Care Surgery, Department of Surgery, University of Vermont Medical Center, VT, USA
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Jai Jayakar
- Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada
| | | | - Cynthia Wu
- Division of Haematology, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Karine Doyon
- Hospital of the Sacred Heart of Montreal, University of Montréal, Montréal, QC, Canada
| | | | - Vera Dounaevskaia
- Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Eric K Tseng
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Gloria Lim
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Fralick
- General Internal Medicine, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Agnes Y Y Lee
- Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Fei Zuo
- Applied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - Bruno R da Costa
- Applied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Kevin E Thorpe
- Applied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elnara Márcia Negri
- Laboratory of Medical Investigation (LIM-59), Cellular Biology, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Mary Cushman
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, University of Vermont Medical Center, Burlington, VT, USA
| | - Peter Jüni
- Applied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
- Departments of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Luo RX, Kermani M, Guo ZL, Dong J, Hu CF, Zuo F, Grasso S, Jiang BB, Nie GL, Yan ZQ, Wang Q, Gan YL, He FP, Lin HT. Ultrafast high-temperature sintering of silicon nitride: A comparison with the state-of-the-art techniques. Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2021.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca D, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Correction to: Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1714. [PMID: 34548061 PMCID: PMC8456665 DOI: 10.1186/s12889-021-11700-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - P Donnelly
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,University of St. Andrews, Scotland, UK
| | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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9
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Lofters AK, O'Brien MA, Sutradhar R, Pinto AD, Baxter NN, Donnelly P, Elliott R, Glazier RH, Huizinga J, Kyle R, Manca DM, Pietrusiak MA, Rabeneck L, Riordan B, Selby P, Sivayoganathan K, Snider C, Sopcak N, Thorpe K, Tinmouth J, Wall B, Zuo F, Grunfeld E, Paszat L. Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial. BMC Public Health 2021; 21:1496. [PMID: 34344340 PMCID: PMC8329623 DOI: 10.1186/s12889-021-11452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial. METHODS We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40-64 years residing in the neighbourhoods. Public health nurses trained as "prevention practitioners" held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline. RESULTS Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22-1.84]). CONCLUSION Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage. TRIAL REGISTRATION NCT03052959 , registered February 10, 2017.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada. .,Women's College Hospital Research Institute, Toronto, Canada. .,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada. .,Ontario Health (Cancer Care Ontario), Toronto, Canada. .,ICES, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
| | - M A O'Brien
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - R Sutradhar
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A D Pinto
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - R Elliott
- Durham Region Health Department, Whitby, Canada
| | - R H Glazier
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - J Huizinga
- Durham Region Health Department, Whitby, Canada
| | - R Kyle
- Durham Region Health Department, Whitby, Canada
| | - D M Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | | | - L Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - B Riordan
- Durham Region Health Department, Whitby, Canada
| | - P Selby
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - K Sivayoganathan
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Durham Region Health Department, Whitby, Canada
| | - C Snider
- Durham Region Health Department, Whitby, Canada
| | - N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - K Thorpe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - J Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - B Wall
- Durham Region Health Department, Whitby, Canada
| | - F Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - E Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.,Women's College Hospital Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - L Paszat
- ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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10
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Ha ACT, Verma S, Mazer CD, Quan A, Yanagawa B, Latter DA, Yau TM, Jacques F, Brown CD, Singal RK, Yamashita MH, Saha T, Teoh KH, Lam BK, Deyell MW, Wilson M, Hibino M, Cheung CC, Kosmopoulos A, Garg V, Brodutch S, Teoh H, Zuo F, Thorpe KE, Jüni P, Bhatt DL, Verma A. Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121867. [PMID: 34448866 PMCID: PMC8397929 DOI: 10.1001/jamanetworkopen.2021.21867] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) occurring after cardiac surgery is associated with adverse outcomes. Whether POAF persists beyond discharge is not well defined. OBJECTIVE To determine whether continuous cardiac rhythm monitoring enhances detection of POAF among cardiac surgical patients during the first 30 days after hospital discharge compared with usual care. DESIGN, SETTING, AND PARTICIPANTS This study is an investigator-initiated, open-label, multicenter, randomized clinical trial conducted at 10 Canadian centers. Enrollment spanned from March 2017 to March 2020, with follow-up through September 11, 2020. As a result of the COVID-19 pandemic, enrollment stopped on July 17, 2020, at which point 85% of the proposed sample size was enrolled. Cardiac surgical patients with CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex) score greater than or equal to 4 or greater than or equal to 2 with risk factors for POAF, no history of preoperative AF, and POAF lasting less than 24 hours during hospitalization were enrolled. INTERVENTIONS The intervention group underwent continuous cardiac rhythm monitoring with wearable, patch-based monitors for 30 days after randomization. Monitoring was not mandated in the usual care group within 30 days after randomization. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative AF and/or atrial flutter lasting 6 minutes or longer detected by continuous cardiac rhythm monitoring or by a 12-lead electrocardiogram within 30 days of randomization. Prespecified secondary outcomes included cumulative AF lasting 6 hours or longer and 24 hours or longer within 30 days of randomization, death, myocardial infarction, ischemic stroke, non-central nervous system thromboembolism, major bleeding, and oral anticoagulation prescription. RESULTS Of the 336 patients randomized (163 patients in the intervention group and 173 patients in the usual care group; mean [SD] age, 67.4 [8.1] years; 73 women [21.7%]; median [interquartile range] CHA2DS2-VASc score, 4.0 [3.0-4.0] points), 307 (91.4%) completed the trial. In the intent-to-treat analysis, the primary end point occurred in 32 patients (19.6%) in the intervention group vs 3 patients (1.7%) in the usual care group (absolute difference, 17.9%; 95% CI, 11.5%-24.3%; P < .001). AF lasting 6 hours or longer was detected in 14 patients (8.6%) in the intervention group vs 0 patients in the usual care group (absolute difference, 8.6%; 95% CI, 4.3%-12.9%; P < .001). CONCLUSIONS AND RELEVANCE In post-cardiac surgical patients at high risk of stroke, no preoperative AF history, and AF lasting less than 24 hours during hospitalization, continuous monitoring revealed a significant increase in the rate of POAF after discharge that would otherwise not be detected by usual care. Studies are needed to examine whether these patients will benefit from oral anticoagulation therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793895.
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Affiliation(s)
- Andrew C. T. Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C. David Mazer
- Department of Anesthesiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Quan
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David A. Latter
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Terrence M. Yau
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frédéric Jacques
- University Institute of Cardiology and Respirology of Québec, Quebec City, Quebec, Canada
| | - Craig D. Brown
- Division of Cardiac Surgery, New Brunswick, Saint John, New Brunswick, Canada
| | - Rohit K. Singal
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Tarit Saha
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Kevin H. Teoh
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
| | - Buu-Khanh Lam
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc W. Deyell
- Division of Cardiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Marnee Wilson
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Makoto Hibino
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Kosmopoulos
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Garg
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shira Brodutch
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Atul Verma
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
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11
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Sholzberg M, Tang GH, Rahhal H, AlHamzah M, Kreuziger LB, Ní Áinle F, Alomran F, Alayed K, Alsheef M, AlSumait F, Pompilio CE, Sperlich C, Tangri S, Tang T, Jaksa P, Suryanarayan D, Almarshoodi M, Castellucci L, James PD, Lillicrap D, Carrier M, Beckett A, Colovos C, Jayakar J, Arsenault MP, Wu C, Doyon K, Andreou ER, Dounaevskaia V, Tseng EK, Lim G, Fralick M, Middeldorp S, Lee AYY, Zuo F, da Costa BR, Thorpe KE, Negri EM, Cushman M, Jüni P. Heparin for Moderately Ill Patients with Covid-19. medRxiv 2021. [PMID: 34268513 DOI: 10.1101/2021.07.08.21259351] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Heparin, in addition to its anticoagulant properties, has anti-inflammatory and potential anti-viral effects, and may improve endothelial function in patients with Covid-19. Early initiation of therapeutic heparin could decrease the thrombo-inflammatory process, and reduce the risk of critical illness or death. Methods We randomly assigned moderately ill hospitalized ward patients admitted for Covid-19 with elevated D-dimer level to therapeutic or prophylactic heparin. The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation or ICU admission. Safety outcomes included major bleeding. Analysis was by intention-to-treat. Results At 28 days, the primary composite outcome occurred in 37 of 228 patients (16.2%) assigned to therapeutic heparin, and 52 of 237 patients (21.9%) assigned to prophylactic heparin (odds ratio, 0.69; 95% confidence interval [CI], 0.43 to 1.10; p=0.12). Four patients (1.8%) assigned to therapeutic heparin died compared with 18 patients (7.6%) assigned to prophylactic heparin (odds ratio, 0.22; 95%-CI, 0.07 to 0.65). The composite of all-cause mortality or any mechanical ventilation occurred in 23 (10.1%) in the therapeutic heparin group and 38 (16.0%) in the prophylactic heparin group (odds ratio, 0.59; 95%-CI, 0.34 to 1.02). Major bleeding occurred in 2 patients (0.9%) with therapeutic heparin and 4 patients (1.7%) with prophylactic heparin (odds ratio, 0.52; 95%-CI, 0.09 to 2.85). Conclusions In moderately ill ward patients with Covid-19 and elevated D-dimer level, therapeutic heparin did not significantly reduce the primary outcome but decreased the odds of death at 28 days. Trial registration numbers: NCT04362085 ; NCT04444700.
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12
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Parkin PC, Borkhoff CM, Macarthur C, Abdullah K, Birken CS, Fehlings D, Koroshegyi C, Maguire JL, Mamak E, Mamdani M, Thorpe KE, Zlotkin SH, Zuo F, Malhi T, Thompson J, Kowal C, Mason D, Thompson L, Barozzino T, Campbell D, Chisamore B, Danayan K, Do A, Jacobson S, Kadar P, Lau E, Naymark S, Peer M, Perlmutar M, Persaud N, Saunderson J, Sgro M, Wong P, Zajdman M. Randomized Trial of Oral Iron and Diet Advice versus Diet Advice Alone in Young Children with Nonanemic Iron Deficiency. J Pediatr 2021; 233:233-240.e1. [PMID: 33548262 DOI: 10.1016/j.jpeds.2021.01.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the effects of 2 treatment options on neurodevelopmental and laboratory outcomes in young children with nonanemic iron deficiency. STUDY DESIGN A blinded, placebo-controlled, randomized trial of children 1-3 years with nonanemic iron deficiency (hemoglobin ≥110 g/L, serum ferritin <14 μg/L) was conducted in 8 primary care practices in Toronto, Canada. Interventions included ferrous sulfate or placebo for 4 months; all parents received diet advice. The primary outcome was the Early Learning Composite (ELC) using the Mullen Scales of Early Learning (mean 100, SD 15). Secondary outcomes included serum ferritin. Measurements were obtained at baseline and 4 and 12 months. Sample size was calculated to detect a between-group difference of 6-7 points in ELC. RESULTS At enrollment (n = 60), mean age was 24.2 (SD 7.4) months and mean serum ferritin was 10.0 (SD 2.4) μg/L. For ELC, the mean between-group difference at 4 months was 1.1 (95% CI -4.2 to 6.5) and at 12 months was 4.1 (95% CI -1.9 to 10.1). For serum ferritin, at 4 months, the mean between-group difference was 16.9 μg/L (95% CI 6.5 to 27.2), and no child randomized to ferrous sulfate had a serum ferritin <14 μg/L (0% vs 31%, P = .003). CONCLUSIONS For young children with nonanemic iron deficiency, treatment options include oral iron and/or diet advice. We remain uncertain about which option is superior with respect to cognitive outcomes; however, adding ferrous sulfate to diet advice resulted in superior serum ferritin outcomes after 4 months. Shared decision-making between practitioners and parents may be considered when selecting either option. TRIAL REGISTRATION Clinicaltrials.gov: NCT01481766.
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Affiliation(s)
- Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Colin Macarthur
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kawsari Abdullah
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Jonathon L Maguire
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada; Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Eva Mamak
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Stanley H Zlotkin
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Munk School of Global Affairs, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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13
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Muni RH, Francisconi CLM, Felfeli T, Mak MYK, Berger AR, Wong DT, Altomare F, Giavedoni LR, Kohly RP, Kertes PJ, Figueiredo N, Zuo F, Thorpe KE, Hillier RJ. Vision-Related Functioning in Patients Undergoing Pneumatic Retinopexy vs Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A Post Hoc Exploratory Analysis of the PIVOT Randomized Clinical Trial. JAMA Ophthalmol 2021; 138:826-833. [PMID: 32556156 DOI: 10.1001/jamaophthalmol.2020.2007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Although rhegmatogenous retinal detachment (RRD) repair techniques have high anatomical reattachment rates, there may be differences in various aspects of postoperative vision-related quality of life (VRQoL). Objective To explore the differences in various aspects of VRQoL between pneumatic retinopexy (PnR) and pars plana vitrectomy (PPV) following RRD repair. Design, Setting, and Participants Post hoc exploratory analysis of the the Pneumatic Retinopexy vs Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes randomized clinical trial conducted between August 2012 and May 2017 at St Michael's Hospital, Toronto, Ontario, Canada. Patients with RRD with a single break or multiple breaks within 1 clock hour of detached retina in the superior 8 clock hours of the retina with any number, location, and size of retinal breaks or lattice degeneration in attached retina. Main Outcomes and Measures Differences in the 25-Item National Eye Institute Visual Function Questionnaire 12 subscale scores between the PnR and PPV groups at 6 months following RRD repair. Results A total of 160 patients were included in this analysis, with 81 patients (92%) and 79 patients (90%) in the PnR and PPV groups, respectively. The PnR group consisted of 32% women with a mean (SD) age of 60.9 (9.3) years, while the PPV group consisted of 38% women with a mean (SD) age of 60.3 (7.6) years. For the 152 patients with 6-month follow-up (75 patients in PnR [85%] and 77 patients in PPV [88%]), there was evidence for an association of PnR with superior vision-related functioning compared with PPV for several subscales. There were no differences between groups at 1 year. After adjusting for age, sex, baseline macular status, visual acuity in the nonstudy eye, and lens status, patients who underwent PnR had higher scores for distance activities (mean [SD] PnR, 88.7 [13.4]; PPV, 82.8 [17.1]; adjusted difference, 6.5; 95% CI, 1.6-11.4; P = .01), mental health (mean [SD] PnR, 84.3 [17.4]; PPV, 78.7 [21.1]; adjusted difference, 6.7; 95% CI, 0.4-13; P = .04), dependency (mean [SD] PnR, 96.1 [10.1]; PPV, 91.1 [18.6]; adjusted difference, 5.7; 95% CI, 0.6-10.8; P = .03), and peripheral vision (mean [SD] PnR, 91.6 [16.2]; PPV, 81.2 [24.4]; adjusted difference, 10.8; 95% CI, 4.3-17.4; P = .001) at 6 months. Conclusions and Relevance These findings demonstrate that patients undergoing PnR for RRD report higher mental health scores and superior vision-related functioning scores in several subscales of the 25-Item National Eye Institute Visual Function Questionnaire during the first 6 months postoperatively compared with PPV. Trial Registration ClinicalTrials.gov Identifier: NCT01639209.
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Affiliation(s)
- Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolina L M Francisconi
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michael Y K Mak
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alan R Berger
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada
| | - Louis R Giavedoni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada.,The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada.,The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalia Figueiredo
- St Michael's Hospital, Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, England.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, England
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14
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Mason T, Coelho-Filho OR, Verma S, Chowdhury B, Zuo F, Quan A, Thorpe KE, Bonneau C, Teoh H, Gilbert RE, Leiter LA, Jüni P, Zinman B, Jerosch-Herold M, Mazer CD, Yan AT, Connelly KA. Empagliflozin Reduces Myocardial Extracellular Volume in Patients With Type 2 Diabetes and Coronary Artery Disease. JACC Cardiovasc Imaging 2021; 14:1164-1173. [PMID: 33454272 DOI: 10.1016/j.jcmg.2020.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 09/04/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study sought to evaluate the effects of empagliflozin on extracellular volume (ECV) in individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). BACKGROUND Empagliflozin has been shown to reduce left ventricular mass index (LVMi) in patients with T2DM and CAD. The effects on myocardial ECV are unknown. METHODS This was a prespecified substudy of the EMPA-HEART (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes) CardioLink-6 trial in which 97 participants were randomized to receive empagliflozin 10 mg daily or placebo for 6 months. Data from 74 participants were included: 39 from the empagliflozin group and 35 from the placebo group. The main outcome was change in left ventricular ECV from baseline to 6 months determined by cardiac magnetic resonance (CMR). Other outcomes included change in LVMi, indexed intracellular compartment volume (iICV) and indexed extracellular compartment volume (iECV), and the fibrosis biomarkers soluble suppressor of tumorgenicity (sST2) and matrix metalloproteinase (MMP)-2. RESULTS Baseline ECV was elevated in the empagliflozin group (29.6 ± 4.6%) and placebo group (30.6 ± 4.8%). Six months of empagliflozin therapy reduced ECV compared with placebo (adjusted difference: -1.40%; 95% confidence interval [CI]: -2.60 to -0.14%; p = 0.03). Empagliflozin therapy reduced iECV (adjusted difference: -1.5 ml/m2; 95% CI: -2.6 to -0.5 ml/m2; p = 0.006), with a trend toward reduction in iICV (adjusted difference: -1.7 ml/m2; 95% CI: -3.8 to 0.3 ml/m2; p = 0.09). Empagliflozin had no impact on MMP-2 or sST2. CONCLUSIONS In individuals with T2DM and CAD, 6 months of empagliflozin reduced ECV, iECV, and LVMi. No changes in MMP-2 and sST2 were seen. Further investigation into the mechanisms by which empagliflozin causes reverse remodeling is required. (Effects of Empagliflozin on Cardiac Structure in Patients With Type 2 Diabetes [EMPA-HEART]; NCT02998970).
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Affiliation(s)
- Tamique Mason
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Otavio R Coelho-Filho
- Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil; Division of Cardiology, Department of Medicine, State University of Campinas, Campinas, Brazil
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Biswajit Chowdhury
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Bonneau
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Richard E Gilbert
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Zinman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael Jerosch-Herold
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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15
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Peterson MD, Garg V, Mazer CD, Chu MWA, Bozinovski J, Dagenais F, MacArthur RGG, Ouzounian M, Quan A, Jüni P, Bhatt DL, Marotta TR, Dickson J, Teoh H, Zuo F, Smith EE, Verma S. A randomized trial comparing axillary versus innominate artery cannulation for aortic arch surgery. J Thorac Cardiovasc Surg 2020; 164:1426-1438.e2. [PMID: 33431219 DOI: 10.1016/j.jtcvs.2020.10.152] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral protection remains the cornerstone of successful aortic surgery; however, there is no consensus as to the optimal strategy. OBJECTIVE To compare the safety and efficacy of innominate to axillary artery cannulation for delivering antegrade cerebral protection during proximal aortic arch surgery. METHODS This randomized controlled trial (The Aortic Surgery Cerebral Protection Evaluation CardioLink-3 Trial, ClinicalTrials.gov Identifier: NCT02554032), conducted across 6 Canadian centers between January 2015 and June 2018, allocated 111 individuals to innominate or axillary artery cannulation. The primary safety outcome was neuroprotection per the appearance of new severe ischemic lesions on the postoperative diffusion-weighted-magnetic resonance imaging. The primary efficacy outcome was the difference in total operative time. Secondary outcomes included 30-day all-cause mortality and postoperative stroke. RESULTS One hundred two individuals (mean age, 63 ± 11 years) were in the primary safety per-protocol analysis. Baseline characteristics between the groups were similar. New severe ischemic lesions occurred in 19 participants (38.8%) in the axillary versus 18 (34%) in the innominate group (P for noninferiority = .0009). Total operative times were comparable (median, 293 minutes; interquartile range, 222-411 minutes) for axillary versus (298 minutes; interquartile range, 231-368 minutes) for innominate (P for superiority = .47). Stroke/transient ischemic attack occurred in 4 (7.1%) participants in the axillary versus 2 (3.6%) in the innominate group (P = .43). Thirty-day mortality, seizures, delirium, and duration of mechanical ventilation were similar in both groups. CONCLUSIONS diffusion-weighted magnetic resonance imaging assessments indicate that antegrade cerebral protection with innominate cannulation is safe and affords similar neuroprotection to axillary cannulation during aortic surgery, although the burden of new neurological lesions is high in both groups.
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Affiliation(s)
- Mark D Peterson
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Garg
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
| | - Michael W A Chu
- Division of Cardiac Surgery, Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - François Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maral Ouzounian
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Peter Jüni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Thomas R Marotta
- Department of Medicine, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Diagnostic and Therapeutic Neuroradiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Medical Imaging, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Dickson
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Eric E Smith
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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16
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Chan V, Mazer C, Mesana T, De Varennes B, Gregory A, Bouchard D, Zuo F, Mohamad Ali F, Tsang W, Latter D, Juni P, Teoh H, Quan A, Leong-Poi H, Verma S. A randomized surgical trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis – primary results of the CAMRA CardioLink-2 trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The gold standard treatment for mitral valve regurgitation due to prolapse involves surgery with annuloplasty and either leaflet resection or leaflet preservation, with placement of artificial neochordae. It has been suggested that leaflet resection may be prone to functional mitral stenosis, whereby a patient may have a higher mitral gradient at peak exercise compared to a leaflet preservation strategy. Although both techniques are widely used, there has been no prospective randomized study conducted to compare these two techniques, particularly in regard to functional mitral stenosis.
Methods
A total of 104 patients with posterior leaflet prolapse were randomized to undergo mitral repair with either leaflet resection (N=54) or leaflet preservation (N=50) at 7 specialized Canadian cardiac centers. Patient age, proportion of female patients, and mean Society of Thoracic Surgeons risk score was 63.9±10.4 years, 19%, and 1.4% for those who underwent leaflet resection, and 66.3±10.8 years, 16%, and 1.9% for those who underwent leaflet preservation, respectively. The primary endpoint was the mean trans-mitral repair gradient at peak exercise 12-months after repair.
Results
Baseline characteristics were similar between the groups. At 12-months, the mean trans-mitral repair gradient at peak exercise in patients who underwent leaflet resection and preservation was 9.1±5.2 and 8.3±3.3 mmHg (P=0.4), respectively. The two groups had similar mean mitral valve gradient at rest (3.2±1.9 mmHg following resection and 3.1±1.1 mmHg following leaflet preservation, P=0.7). There was no between-group difference for the 6-minute walk distance (451±147 m and 481±95 m for the resection and preservation groups, respectively, P=0.3).
Conclusion
We report the first prospective surgical randomized trial to evaluate commonly used mitral valve repair strategies for posterior leaflet prolapse. Leaflet resection and leaflet preservation both yield acceptable results with no difference in postoperative valve gradient and functional status 12-months after surgical mitral valve repair.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heart and Stroke Foundation of Canada
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Affiliation(s)
- V Chan
- University of Ottawa Heart Institute, Ottawa, Canada
| | - C.D Mazer
- St. Michael's Hospital, Anesthesia, Toronto, Canada
| | - T Mesana
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - A.J Gregory
- Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - D Bouchard
- Montreal Heart Institute, Montreal, Canada
| | - F Zuo
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | | | - W Tsang
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - D.A Latter
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - P Juni
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - H Teoh
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - A Quan
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - H Leong-Poi
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
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17
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Chan V, Mazer CD, Ali FM, Quan A, Ruel M, de Varennes BE, Gregory AJ, Bouchard D, Whitlock RP, Chu MW, Dokollari A, Mesana T, Bhatt DL, Latter DA, Zuo F, Tsang W, Teoh H, Jüni P, Leong-Poi H, Verma S. Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis. Circulation 2020; 142:1342-1350. [DOI: 10.1161/circulationaha.120.046853] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis.
Methods:
One hundred four patients with degenerative mitral regurgitation surgically amenable to either leaflet resection or preservation were randomized at 7 specialized cardiac surgical centers. Exclusion criteria included anterior leaflet or commissural prolapse, as well as a mixed cause for mitral valve disease. Using previous data, we determined that a sample size of 88 subjects would provide 90% power to detect a 5–mm Hg difference in mean mitral valve gradient at peak exercise, assuming an SD of 6.7 mm with a 2-sided test with α=5% and 10% patient attrition. The primary end point was the mean mitral gradient at peak exercise 12 months after repair.
Results:
Patient age, proportion who were female, and Society of Thoracic Surgeons risk score were 63.9±10.4 years, 19%, and 1.4±2.8% for those who were assigned to leaflet resection (n=54), and 66.3±10.8 years, 16%, and 1.9±2.6% for those who underwent leaflet preservation (n=50). There were no perioperative deaths or conversions to replacement. At 12 months, moderate mitral regurgitation was observed in 3 subjects in the leaflet resection group and 2 in the leaflet preservation group. The mean transmitral gradient at 12 months during peak exercise was 9.1±5.2 mm Hg after leaflet resection and 8.3±3.3 mm Hg after leaflet preservation (
P
=0.43). The participants had similar resting peak (8.3±4.4 mm Hg versus 8.4±2.6 mm Hg;
P
=0.96) and mean resting (3.2±1.9 mm Hg versus 3.1±1.1 mm Hg;
P
=0.67) mitral gradients after leaflet resection and leaflet preservation, respectively. The 6-minute walking distance was 451±147 m for those in the leaflet resection versus 481±95 m for the leaflet preservation group (
P
=0.27).
Conclusions:
In this adequately powered randomized trial, repair of mitral prolapse with either leaflet resection or leaflet preservation was associated with similar transmitral gradients at peak exercise at 12 months postoperatively. These data do not support the hypothesis that a strategy of leaflet resection (versus preservation) is associated with a risk of functional mitral stenosis.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier NCT02552771.
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Affiliation(s)
- Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
- School of Epidemiology, Public Health and Preventive Medicine (V.C.), University of Ottawa, ON, Canada
| | - C. David Mazer
- Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine (C.D.M.), University of Toronto, ON, Canada
- Department of Physiology (C.D.M.), University of Toronto, ON, Canada
| | - Faeez Mohamad Ali
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
- Department of Cellular and Molecular Medicine (M.R.), University of Ottawa, ON, Canada
| | - Benoit E. de Varennes
- Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montréal, QC, Canada (B.E.d.V.)
| | - Alexander J. Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, AB, Canada (A.J.G.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute of Alberta, Calgary, Canada (A.J.G.)
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, QC, Canada (D.B.)
| | - Richard P. Whitlock
- Division of Cardiac Surgery (R.P.W.), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (R.P.W.), McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada (R.P.W.)
| | - Michael W.A. Chu
- Division of Cardiac Surgery, London Health Sciences Center, University of Western Ontario, Canada (M.W.A.C.)
| | - Aleksander Dokollari
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - David A. Latter
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery (D.A.L., S.V.), University of Toronto, ON, Canada
| | - Fei Zuo
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Wendy Tsang
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism (H.T.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Peter Jüni
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (P.J.), University of Toronto, ON, Canada
| | - Howard Leong-Poi
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery (D.A.L., S.V.), University of Toronto, ON, Canada
- Department of Pharmacology and Toxicology (S.V.), University of Toronto, ON, Canada
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18
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He F, Lu T, Fang X, Feng S, Feng S, Tian Y, Li Y, Zuo F, Deng X, Ye J. Novel Extrusion-Microdrilling Approach to Fabricate Calcium Phosphate-Based Bioceramic Scaffolds Enabling Fast Bone Regeneration. ACS Appl Mater Interfaces 2020; 12:32340-32351. [PMID: 32597161 DOI: 10.1021/acsami.0c07304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study proposes a novel approach, termed extrusion-microdrilling, to fabricate three-dimensional (3D) interconnected bioceramic scaffolds with channel-like macropores for bone regeneration. The extrusion-microdrilling method is characterized by ease of use, high efficiency, structural flexibility, and precision. The 3D interconnected β-tricalcium phosphate bioceramic (EM-TCP) scaffolds prepared by this method showed channel-like square macropores (∼650 μm) by extrusion and channel-like round macropores (∼570 μm) by microdrilling as well as copious micropores. By incorporating a strontium-containing phosphate-based glass (SrPG), the obtained calcium phosphate-based bioceramic (EM-TCP/SrPG) scaffolds had noticeably higher compressive strength, lower porosity, and smaller macropore size, tremendously enhanced in vitro proliferation and osteogenic differentiation of mouse bone marrow stromal cells, and suppressed in vitro osteoclastic activities of RAW264.7 cells, as compared with the EM-TCP scaffolds. In vivo assessment results indicated that at postoperative week 6, new vessels and a large percentage of new bone tissues (24-25%) were formed throughout the interconnected macropores of EM-TCP and EM-TCP/SrPG, which were implanted in the femoral defects of rabbits; the bone formation of the EM-TCP group was comparable to that of the EM-TCP/SrPG group. At 12 weeks postimplantation, the bone formation percentage of EM-TCP was slightly reduced, while that of EM-TCP/SrPG with a slower degradation rate was pronouncedly increased. This work provides a new strategy to fabricate interconnected bioceramic scaffolds allowing for fast bone regeneration, and the EM-TCP/SrPG scaffolds are promising for efficiently repairing bone defects.
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Affiliation(s)
- Fupo He
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
- Jihua Laboratory, Foshan 528200, People's Republic of China
| | - Teliang Lu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China
| | - Xibo Fang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Songheng Feng
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Shenglei Feng
- School of Civil Engineering, Hebei University of Engineering, Handan 056038, People's Republic of China
| | - Ye Tian
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Yanhui Li
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Fei Zuo
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Xin Deng
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
- Jihua Laboratory, Foshan 528200, People's Republic of China
| | - Jiandong Ye
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China
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19
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Garg V, Verma S, Connelly KA, Yan AT, Sikand A, Garg A, Dorian P, Zuo F, Leiter LA, Zinman B, Jüni P, Verma A, Teoh H, Quan A, Mazer CD, Ha ACT. Does empagliflozin modulate the autonomic nervous system among individuals with type 2 diabetes and coronary artery disease? The EMPA-HEART CardioLink-6 Holter analysis. Metabol Open 2020; 7:100039. [PMID: 32812924 PMCID: PMC7424781 DOI: 10.1016/j.metop.2020.100039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 01/10/2023] Open
Abstract
Context We examined if empagliflozin was associated with modulation of cardiac autonomic tone among subjects with type 2 diabetes and stable coronary artery disease (CAD) relative to placebo. Methods Using ambulatory 24-h Holter electrocardiographic data prospectively collected from a randomized trial, we compared changes in heart rate variability (HRV) parameters between empagliflozin- and placebo-assigned subjects over a follow-up period of 6 months. Measured HRV domains included: standard deviation (SD) of NN intervals (SDNN), SD of average NN intervals per 5-min (SDANN), root mean square of successive RR interval differences (RMSSD), % successive NN intervals differing >50 ms (ms) (pNN50), low frequency (LF), high frequency (HF) and the LF/HF ratio (LF:HF). Differences in HRV parameters between the 2 groups were compared with analysis of covariance (ANCOVA). Statistical measures of significance were reported as adjusted differences between the 2 groups and their corresponding 95% confidence intervals. Results Sixty-six subjects completed 24-h Holter monitoring at baseline and 6-months. Over 6 months, the change in HRV was similar between subjects treated with empagliflozin vs. placebo for the following parameters: RMSSD -1.2 ms (-6.0 to 3.6 ms); pNN50 0.5% (-2.6 to 3.6%); VLF -907.8 ms2 (-2388.8 to 573.1 ms2); LF -341 ms2 (-878.7 to 196.7 ms2); HF -33.8 ms2 (-111.1 to 43.5 ms2); LF:HF -0.1 (-0.4 to 0.2). Subjects who received placebo experienced an increase in SDNN 18.6 ms (2.8–34.3 ms) and SDANN 20.2 ms (3.2–37.3 ms) relative to those treated with empagliflozin. Conclusion Compared to placebo, empagliflozin did not result in changes in autonomic tone among individuals with type 2 diabetes and stable coronary artery disease. Sodium-glucose cotransporter-2 (SGLT2) inhibitors’ mechanism of cardiovascular benefit is unknown. Impaired autonomic tone is associated with adverse cardiac events. Cardiac autonomic tone was assessed with Holter studies from a randomized trial. Similar autonomic tone noted between subjects treated with empagliflozin and placebo.
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Affiliation(s)
- Vinay Garg
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Aditya Sikand
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ankit Garg
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lawrence A Leiter
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Bernard Zinman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter Jüni
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - C David Mazer
- Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew C T Ha
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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20
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Stratos K, Lee L, Dai D, Pavenski K, Zuo F, Rotstein D. Evaluation of ethnicity as a predictor of diagnostic phenotype and prognosis in neuromyelitis optica spectrum disorder in Toronto, Canada. Mult Scler Relat Disord 2020; 40:101950. [DOI: 10.1016/j.msard.2020.101950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
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21
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Livingston MH, Mahant S, Connolly B, MacLusky I, Laberge S, Giglia L, Yang C, Roberts A, Shawyer A, Brindle M, Parsons S, Stoian C, Walton JM, Thorpe KE, Chen Y, Zuo F, Mamdani M, Chan C, Loong D, Isaranuwatchai W, Ratjen F, Cohen E. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr 2020; 174:332-340. [PMID: 32011642 PMCID: PMC7042898 DOI: 10.1001/jamapediatrics.2019.5863] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Clinical guidelines recommend that children with pleural empyema be treated with chest tube insertion and intrapleural fibrinolytics. The addition of dornase alfa (DNase) has been reported to improve outcomes in adults but remains unproven in children. OBJECTIVE To determine if intrapleural tissue plasminogen activator (tPA) and DNase is more effective than tPA and placebo at reducing hospital length of stay in children with pleural empyema. DESIGN, SETTING, AND PARTICIPANTS This multicenter, parallel-group, placebo-controlled, superiority randomized clinical trial included children diagnosed as having pleural empyema requiring drainage aged 6 months to 18 years treated at 6 tertiary Canadian children's hospitals. A total of 379 children were assessed for eligibility; 281 were excluded and 98 were randomized. One child was excluded after randomization for not meeting the inclusion criteria. Data were collected from March 4, 2013, to December 13, 2017. INTERVENTIONS Participants underwent chest tube insertion and 3 daily administrations of intrapleural tPA, 4 mg, followed by DNase, 5 mg (intervention group), or 5 mL of normal saline (placebo; control group). Participants, families, clinical staff, and members of the study team were blinded to allocation. MAIN OUTCOMES AND MEASURES The primary outcome was hospital length of stay from chest tube insertion to discharge. Secondary outcomes included time to meeting discharge criteria, time to chest tube removal, mean fever duration, additional pleural drainage procedures, hospital readmissions, and total health care cost. RESULTS Of the 97 analyzed children with pleural empyema, 52 (54%) were male, and the mean (SD) age was 5.1 (3.6) years. A total of 49 children were randomized to tPA and DNase and 48 were randomized to tPA and placebo. Treatment with tPA and DNase was not associated with decreased hospital length of stay compared with tPA and placebo (mean [SD] length of stay, 9.0 [4.9] vs 9.1 [5.3] days; mean difference, -0.1 days; 95% CI, -2.0 to 2.1; P = .96). Similarly, no significant differences were observed for any of the secondary outcomes. Of the 14 adverse events in the tPA and DNase group, 6 (43%) were serious; of the 21 adverse events in the tPA and placebo group, 8 (38%) were serious. There were no deaths. CONCLUSIONS AND RELEVANCE The addition of DNase to intrapleural tPA for children with pleural empyema had no effect on hospital length of stay or other outcomes compared with tPA with placebo. Clinical practice guidelines should continue to support the use of chest tube insertion and intrapleural fibrinolytics alone as first-line treatment for pediatric empyema. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01717742.
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Affiliation(s)
- Michael H. Livingston
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada,Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, New York
| | - Sanjay Mahant
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bairbre Connolly
- Image-Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ian MacLusky
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Sophie Laberge
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Lucia Giglia
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Connie Yang
- British Columbia’s Children’s Hospital, Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- British Columbia’s Children’s Hospital, Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Shawyer
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Mary Brindle
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Simon Parsons
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Cristina Stoian
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - J. Mark Walton
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yang Chen
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carol Chan
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, St Michael’s Hospital, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, St Michael’s Hospital, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Felix Ratjen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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He F, Lu T, Fang X, Li Y, Zuo F, Deng X, Ye J. Effects of strontium amount on the mechanical strength and cell-biological performance of magnesium-strontium phosphate bioceramics for bone regeneration. Mater Sci Eng C Mater Biol Appl 2020; 112:110892. [PMID: 32409050 DOI: 10.1016/j.msec.2020.110892] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/20/2020] [Accepted: 03/20/2020] [Indexed: 12/23/2022]
Abstract
Magnesium and strontium are able to enhance osteogenesis and suppress osteoclastic activities simultaneously, and they were nontoxic in wide concentration ranges; these make the magnesium-strontium phosphate bioceramics suitable for treating osteoporotic bone defects. The aim of this study was to investigate the effects of strontium amount on the mechanical strength and cell-biological performance of magnesium-strontium phosphate [MgxSr3-x(PO4)2; 3-x = 0, 0.1, 0.25, 0.5, 0.75, 1] bioceramics, which were sintered at 1100 °C. The results indicated that the magnesium-strontium phosphate bioceramics except Mg2.9Sr0.1(PO4)2 and Mg2.25Sr0.75(PO4)2 bioceramics had considerable compressive strength. The variation in magnesium and strontium contents did not regularly affect the in vitro osteogenic differentiation and osteoclastic activities. The Mg2.75Sr0.25(PO4)2 bioceramic had the most desirable overall performance, as reflected by considerably high compressive strength, enhanced in vitro osteogenesis and inhibited osteoclastic activities. Therefore, the Mg2.75Sr0.25(PO4)2 bioceramic is considered a promising biomaterial for osteoporotic bone regeneration.
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Affiliation(s)
- Fupo He
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China; Jihua Laboratory, Foshan 528200, People's Republic of China.
| | - Teliang Lu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China
| | - Xibo Fang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Yanhui Li
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Fei Zuo
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Xin Deng
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China; Jihua Laboratory, Foshan 528200, People's Republic of China
| | - Jiandong Ye
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China.
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23
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Opingari E, Verma S, Connelly KA, Mazer CD, Teoh H, Quan A, Zuo F, Pan Y, Bhatt DL, Zinman B, Leiter LA, Yan AT, Cherney DZI, Gilbert RE. The impact of empagliflozin on kidney injury molecule-1: a subanalysis of the Effects of Empagliflozin on Cardiac Structure, Function, and Circulating Biomarkers in Patients with Type 2 Diabetes CardioLink-6 trial. Nephrol Dial Transplant 2020; 35:895-897. [DOI: 10.1093/ndt/gfz294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erika Opingari
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kim A Connelly
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Cyril David Mazer
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Yi Pan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Bernard Zinman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lawrence A Leiter
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Z I Cherney
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Richard E Gilbert
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
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24
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Mazer CD, Hare GMT, Connelly PW, Gilbert RE, Shehata N, Quan A, Teoh H, Leiter LA, Zinman B, Jüni P, Zuo F, Mistry N, Thorpe KE, Goldenberg RM, Yan AT, Connelly KA, Verma S. Effect of Empagliflozin on Erythropoietin Levels, Iron Stores, and Red Blood Cell Morphology in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease. Circulation 2019; 141:704-707. [PMID: 31707794 DOI: 10.1161/circulationaha.119.044235] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C David Mazer
- Department of Anesthesia (C.D.M., G.M.T.H., N.M.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Anesthesia (C.D.M., G.M.T.H.), University of Toronto, Ontario, Canada.,Department of Physiology (C.D.M., G.M.T.H., K.A.C.), University of Toronto, Ontario, Canada
| | - Gregory M T Hare
- Department of Anesthesia (C.D.M., G.M.T.H., N.M.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Anesthesia (C.D.M., G.M.T.H.), University of Toronto, Ontario, Canada.,Department of Physiology (C.D.M., G.M.T.H., K.A.C.), University of Toronto, Ontario, Canada
| | - Philip W Connelly
- Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology (P.W.C., N.S.), University of Toronto, Ontario, Canada
| | - Richard E Gilbert
- Division of Endocrinology and Metabolism (R.E.G., H.T., L.A.L.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada
| | - Nadine Shehata
- Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology (P.W.C., N.S.), University of Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (N.S., P.J.), University of Toronto, Ontario, Canada.,Division of Hematology (N.S.), Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (A.Q., H.T., S.V.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Endocrinology and Metabolism (R.E.G., H.T., L.A.L.), Unity Health Toronto, Ontario, Canada.,Division of Cardiac Surgery (A.Q., H.T., S.V.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism (R.E.G., H.T., L.A.L.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada.,Department of Nutritional Sciences (L.A.L.), University of Toronto, Ontario, Canada
| | - Bernard Zinman
- Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital (B.Z.), Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre (P.J., F.Z., K.E.T.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (N.S., P.J.), University of Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre (P.J., F.Z., K.E.T.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada
| | - Nikhil Mistry
- Department of Anesthesia (C.D.M., G.M.T.H., N.M.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre (P.J., F.Z., K.E.T.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Ontario, Canada
| | | | - Andrew T Yan
- Division of Cardiology (A.T.Y., K.A.C.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology (A.T.Y., K.A.C.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Physiology (C.D.M., G.M.T.H., K.A.C.), University of Toronto, Ontario, Canada.,Department of Medicine (P.W.C., R.E.G., N.S., L.A.L., B.Z., P.J., A.T.Y., K.A.C.), University of Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery (A.Q., H.T., S.V.), Unity Health Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science (C.D.M., G.M.T.H., P.W.C., R.E.G., A.Q., H.T., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute of St Michael's Hospital (C.D.M., G.M.T.H., R.E.G., A.Q., H.T., L.A.L., P.J., F.Z., N.M., K.E.T., A.T.Y., K.A.C., S.V.), Unity Health Toronto, Ontario, Canada.,Department of Surgery (S.V.), University of Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V.), University of Toronto, Ontario, Canada
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25
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Kerr K, Morse G, Graves D, Zuo F, Lipowicz A, Carpenter DO. A Detoxification Intervention for Gulf War Illness: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health 2019; 16:E4143. [PMID: 31661809 PMCID: PMC6862571 DOI: 10.3390/ijerph16214143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Abstract
Approximately 30% of the 700,000 US veterans of the 1990-1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (n = 32) were randomly assigned to the intervention (n = 22) or a four-week waitlist control (n = 10). The daily 4-6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran's Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; -0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.
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Affiliation(s)
- Kathleen Kerr
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada.
| | - Gayle Morse
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
| | - Donald Graves
- Department of Psychology, The Sage Colleges, Troy, NY 12180, USA.
| | - Fei Zuo
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON M5G 1B1, Canada.
| | - Alain Lipowicz
- Trillium Gift of Life Network, Ministry of Health and Long-Term Care, Toronto, ON M5G 2C9, Canada.
| | - David O Carpenter
- Institute for Health and the Environment, University at Albany, Albany, NY 12144, USA.
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26
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Garg V, Verma S, Peterson MD, Chu MWA, Quan A, Zuo F, Teoh H, Mazer CD, Smith EE. P5602Comparison of innominate vs axillary artery cannulation for cerebral protection on neurocognitive outcomes in aortic surgery: a pre-specified analysis of the ACE CardioLink-3 randomised trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Success after aortic surgery depends on avoidance of neurocognitive dysfunction, thus novel adjuncts to proximal aortic surgery must be evaluated for efficacy of cerebral protection during circulatory arrest. We report the primary neurocognitive results from the ACE CardioLink-3 randomised controlled trial comparing innominate to axillary artery cannulation for cerebral protection (NCT02554032).
Methods
The primary safety endpoint was the proportion of patients with new radiologically severe ischaemic cerebral lesions found on post-operative versus pre-operative diffusion weighted magnetic resonance imaging (DW-MRI). Neurocognitive outcomes were assessed using the Mini-Mental State Exam (MMSE), and the Montreal Cognitive Assessment (MoCA). Continuous and binary outcomes were analysed using ANCOVA (controlling for baseline score) and chi-square/Fisher's exact tests.
Results
Of the 111 patients randomised, 102 patients were included in the primary safety per-protocol analysis. The primary safety outcome (significant new ischaemic lesions on DW-MRI) occurred in 34% in the innominate group and 38.8% in the axillary group (OR 0.81; 0.41 to 1.60; P=0.0009 for non-inferiority). Rates of post-operative stroke/transient ischaemic attack, seizure, delirium, and encephalopathy were similar between groups. The rate of patients with a post-operative MoCA score less than 26 was 44.9% and 39.1% in the innominate and axillary groups respectively (P=0.807). A post-operative MMSE score of less than 24 was observed in 2% vs. 6.5% of the patients in the innominate and axillary groups respectively (P=0.866). A >1-point decrease in the MoCA score from pre-operatively to post-operatively was seen in 32.7% and 34.8% in the innominate and axillary groups respectively (P=0.962). A >1-point decrease in the MMSE score from pre-to post-operative was observed in 20.4% in the innominate artery group compared with 30.4% in the axillary group (P=0.346).
Conclusion
Post-operative neurocognitive dysfunction and DW-MRI incidence of severe ischaemic lesions did not differ in patients randomised to innominate artery cannulation vs, conventional axillary artery cannulation, though the burden of new severe ischaemic lesions is high in both groups.
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Affiliation(s)
- V Garg
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - M D Peterson
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - M W A Chu
- University of Western Ontario, Cardiac Surgery, London, Canada
| | - A Quan
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - F Zuo
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - H Teoh
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - C D Mazer
- St. Michael's Hospital, Anesthesia, Toronto, Canada
| | - E E Smith
- University of Calgary, Clinical Neurosciences, Calgary, Canada
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27
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Garg V, Verma S, Connelly KA, Yan AT, Sikand A, Garg A, Dorian P, Zuo F, Leiter LA, Zinman B, Juni P, Verma A, Quan A, Mazer CD, Ha ACT. P3753Does empagliflozin modulate the autonomic system among patients with type 2 diabetes and coronary artery disease? Insights from the Holter sub-study of the EMPA-Heart CardioLink-6 Randomised Trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The mechanism behind how empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, reduces all-cause and cardiovascular mortality among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) is unknown. Autonomic tone, as reflected by changes in heart rate variability (HRV), is an established prognosticator in patients with CAD and/or heart failure.
Purpose
To assess if empagliflozin treatment changes HRV in subjects with T2DM and CAD.
Methods
In the double-blind EMPA-Heart trial, 97 subjects with T2DM and CAD were randomised to empagliflozin 10 mg/day or placebo for 6 months and underwent 24-hour Holter monitoring at baseline and 6 months. Using automated algorithms, time and frequency HRV domain measures were obtained (standard deviation of NN intervals (SDNN); SD of the average NN intervals for each 5-minute segment (SDANN); root mean square of successive RR interval differences (rMSSD); % interval differences of successive NN intervals >50 ms (pNN50); ratio of low to high frequency (LF/HF)). Changes of these HRV parameters were calculated over 6 months. Between-group differences in HRV parameters were compared using ANCOVA.
Results
Complete Holter data (baseline and 6-month) were available for 68% (n=66) of the cohort. The average heart rate (HR) at baseline/6 months was 69.5±9.8 bpm/72.8±8.1 bpm and 76±10.4 bpm/76.5±10.6 in the placebo group and empagliflozin group, respectively. Both groups had similar changes in average HR over 6 months. Key Holter data are summarised in the table. SDNN and SDANN were higher in the placebo vs. empagliflozin group at 6 months; no significant difference was noted for all other measures.
Empagliflozin 10 mg/day (n=33) Placebo (n=33) Adjusted difference between Empagliflozin and Placebo (ANCOVA) Baseline, Mean (SD) 6-month, Mean (SD) Baseline, Mean (SD) 6-month, Mean (SD) Mean, (95% CI) P-value SDNN (ms) 100.49 (43.74) 98.05 (38.86) 109.35 (30.02) 125.08 (43.83) −18.55 (−34.28, −2.82) 0.022 SDANN (ms) 86.84 (39.34) 83.76 (35.53) 94.70 (28.52) 118.28 (77.41) −20.24 (−37.27, −3.21) 0.021 rMSSD (ms) 27.00 (11.84) 27.22 (13.48) 28.00 (11.58) 27.17 (9.38) −1.23 (−6.02, 3.55) 0.608 pNN50 (%) 7.81 (7.59) 8.32 (9.51) 8.26 (7.8) 6.93 (5.35) 0.51 (−2.61, 3.62) 0.746 LF/HF ratio 1.63 (0.52) 1.65 (0.51) 1.53 (0.43) 1.83 (0.82) −0.08 (−0.38, 0.22) 0.602
Conclusions
Among subjects with T2DM and CAD, changes in HRV over 6 months were similar in the empagliflozin and placebo arms suggesting that the mortality benefit conferred by empagliflozin is not associated with positive modulation of autonomic tone.
Acknowledgement/Funding
This trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.
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Affiliation(s)
- V Garg
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - S Verma
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - K A Connelly
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - A T Yan
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - A Sikand
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - A Garg
- University of Toronto, Medicine, Toronto, Canada
| | - P Dorian
- St. Michael's Hospital, Cardiology, Toronto, Canada
| | - F Zuo
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - L A Leiter
- St. Michael's Hospital, Endocrinology & Metabolism, Toronto, Canada
| | - B Zinman
- Mount Sinai Hospital of the University Health Network, Endocrinology & Metabolism, Toronto, Canada
| | - P Juni
- St. Michael's Hospital, Applied Health Research Centre, Toronto, Canada
| | - A Verma
- Southlake Regional Health Centre, Cardiology, Toronto, Canada
| | - A Quan
- St. Michael's Hospital, Cardiac Surgery, Toronto, Canada
| | - C D Mazer
- St. Michael's Hospital, Anesthesia, Toronto, Canada
| | - A C T Ha
- UHN - University of Toronto, Peter Munk Cardiac Centre, Toronto, Canada
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28
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Lin DT, Yuan LJ, Zhang PJ, Zuo F, Plucknett K, Grasso S, Wang HJ, Lin HT. Densification and Phase Transformation in Multi-Layered Graded Si 3N 4-TiN Components Produced by Field-Assisted Sintering. Materials (Basel) 2019; 12:ma12182900. [PMID: 31500363 PMCID: PMC6766241 DOI: 10.3390/ma12182900] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/23/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022]
Abstract
The structural and/or functional design of multiphase ceramics, along with their processing, are timely research topics in the area of field-assisted sintering techniques, such as spark plasma sintering, especially for systems containing both electrically insulating and conductive phases. In the present study, spark plasma sintering of Si3N4-TiN composites was investigated by changing the TiN particle size and electrical current waveform. Their combined effects on both the densification behavior and α-to-β phase conversion of the Si3N4 matrix was studied and compared by means of a thermodynamic approach and dilatometric measurements. Through the control of TiN phase characteristics and heating mode, double-layered Si3N4-based components were also prepared using a one-step spark plasma sintering process, which was compared with conventional hot-pressing. It was shown that the size of the conductive TiN phase has a significant influence on the particle rearrangement, with the formation of a liquid phase, and the solution-diffusion-precipitation process, through the field-induced local heating and electrowetting mechanisms. Moreover, the contribution of current pulsing to the densification and α-to-β conversion of the layered Si3N4-based components was mostly dependent upon the particle size distribution and content of the TiN phase, indicating that the electric-field effect is dependent upon current path.
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Affiliation(s)
- Dong-Tao Lin
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
| | - Li-Juan Yuan
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
| | - Peng-Jie Zhang
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
| | - Fei Zuo
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
| | - Kevin Plucknett
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
- Department of Mechanical Engineering, Dalhousie University, Halifax, NS B3H4R2, Canada.
| | - Salvatore Grasso
- Key Laboratory of Advanced Technologies of Materials, Southwest Jiaotong University, Chengdu 610031, China.
| | - Hong-Jian Wang
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
| | - Hua-Tay Lin
- Affiliation a School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, China.
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29
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Wu Y, Zhang WX, Zuo F, Zhang GW. Comparison of mRNA expression from Y-chromosome X-degenerate region genes in taurine cattle, yaks and interspecific hybrid bulls. Anim Genet 2019; 50:740-743. [PMID: 31475374 DOI: 10.1111/age.12841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
The yattle (dzo) is an interspecific hybrid of the taurine cattle (Bos taurus) and the domestic yak (Bos grunniens). F1 hybrid yattle bulls are sterile due to spermatogenic arrest and have misregulation of spermatogenesis genes in the testes. However, the expression pattern of Y chromosome-linked genes in cattle, yaks and yattle testes is still unknown. In this study, we analyzed the mRNA expression pattern of 10 genes known to be present as single copies in the X-degenerate region of the bovine male-specific region of the Y chromosome. Using male-specific primers and reverse transcription quantitative PCR, the ubiquitously transcribed tetratricopeptide repeat gene, Y-linked (UTY), oral-facial-digital syndrome 1, Y-linked (OFD1Y) and ubiquitin specific peptidase 9, Y-linked (USP9Y) genes were ubiquitously expressed and significantly more highly expressed in yattle than in cattle and yaks testes (P < 0.001). RNA binding motif protein, Y-linked (RBMY) had testes-specific expression, and eukaryotic translation initiation factor 1A, Y-linked (EIF1AY) was expressed mainly in testis, whereas yattle and cattle did not show significant differences with respect to the expression of RBMY and EIF1AY. Thus, based on the model of yattle bull sterility, the high expression of UTY, OFD1Y and USP9Y may be associated with yattle infertility.
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Affiliation(s)
- Y Wu
- College of Animal Science, Southwest University, Rongchang, Chongqing, 402460, China.,Beef Cattle Engineering and Technology Research Center of Chongqing, Southwest University, Rongchang, Chongqing, 402460, China
| | - W-X Zhang
- Animal Husbandry and Veterinary Bureau of Rongchang, Rongchang, Chongqing, 402460, China
| | - F Zuo
- College of Animal Science, Southwest University, Rongchang, Chongqing, 402460, China.,Beef Cattle Engineering and Technology Research Center of Chongqing, Southwest University, Rongchang, Chongqing, 402460, China
| | - G-W Zhang
- College of Animal Science, Southwest University, Rongchang, Chongqing, 402460, China.,Beef Cattle Engineering and Technology Research Center of Chongqing, Southwest University, Rongchang, Chongqing, 402460, China
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30
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Verma S, Mazer CD, Yan AT, Mason T, Garg V, Teoh H, Zuo F, Quan A, Farkouh ME, Fitchett DH, Goodman SG, Goldenberg RM, Al-Omran M, Gilbert RE, Bhatt DL, Leiter LA, Jüni P, Zinman B, Connelly KA. Effect of Empagliflozin on Left Ventricular Mass in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The EMPA-HEART CardioLink-6 Randomized Clinical Trial. Circulation 2019; 140:1693-1702. [PMID: 31434508 DOI: 10.1161/circulationaha.119.042375] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [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] [Indexed: 01/14/2023]
Abstract
BACKGROUND SGLT2 (sodium-glucose cotransporter 2) inhibitors lower cardiovascular events in type 2 diabetes mellitus but whether they promote direct cardiac effects remains unknown. We sought to determine if empagliflozin causes a decrease in left ventricular (LV) mass in people with type 2 diabetes mellitus and coronary artery disease. METHODS Between November 2016 and April 2018, we recruited 97 individuals ≥40 and ≤80 years old with glycated hemoglobin 6.5% to 10.0%, known coronary artery disease, and estimated glomerular filtration rate ≥60mL/min/1.73m2. The participants were randomized to empagliflozin (10 mg/day, n=49) or placebo (n=48) for 6 months, in addition to standard of care. The primary outcome was the 6-month change in LV mass indexed to body surface area from baseline as measured by cardiac magnetic resonance imaging. Other measures included 6-month changes in LV end-diastolic and -systolic volumes indexed to body surface area, ejection fraction, 24-hour ambulatory blood pressure, hematocrit, and NT-proBNP (N-terminal pro b-type natriuretic peptide). RESULTS Among the 97 participants (90 men [93%], mean [standard deviation] age 62.8 [9.0] years, type 2 diabetes mellitus duration 11.0 [8.2] years, estimated glomerular filtration rate 88.4 [16.9] mL/min/1.73m2, LV mass indexed to body surface area 60.7 [11.9] g/m2), 90 had evaluable imaging at follow-up. Mean LV mass indexed to body surface area regression over 6 months was 2.6 g/m2 and 0.01 g/m2 for those assigned empagliflozin and placebo, respectively (adjusted difference -3.35 g/m2; 95% CI, -5.9 to -0.81g/m2, P=0.01). In the empagliflozin-allocated group, there was significant lowering of overall ambulatory systolic blood pressure (adjusted difference -6.8mmHg, 95% CI -11.2 to -2.3mmHg, P=0.003), diastolic blood pressure (adjusted difference -3.2mmHg; 95% CI, -5.8 to -0.6mmHg, P=0.02) and elevation of hematocrit (P=0.0003). CONCLUSIONS Among people with type 2 diabetes mellitus and coronary artery disease, SGLT2 inhibition with empagliflozin was associated with significant reduction in LV mass indexed to body surface area after 6 months, which may account in part for the beneficial cardiovascular outcomes observed in the EMPA-REG OUTCOME (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02998970.
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Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery (S.V., M.A.O.), University of Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesia (C.D.M.), University of Toronto, Ontario, Canada.,Department of Physiology (C.D.M., K.A.C.), University of Toronto, Ontario, Canada
| | - Andrew T Yan
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
| | - Tamique Mason
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada
| | - Vinay Garg
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (S.V., T.M, V.G., H.T., A.Q.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital/Mount Sinai Hospital, Ontario, Canada (M.E.F.)
| | - David H Fitchett
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Shaun G Goodman
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Canadian Heart Research Centre, Toronto, Ontario (S.G.G.).,Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research Centre, University of Alberta, Edmonton (S.G.G.)
| | | | - Mohammed Al-Omran
- Division of Vascular Surgery (M.A.O.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery (S.V., M.A.O.), University of Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology (S.V., T.M., V.G., M.A.O.), University of Toronto, Ontario, Canada
| | - Richard E Gilbert
- Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism (H.T., R.E.G., L.A.L.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Department of Nutritional Sciences (L.A.L.), University of Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation (P.J.), University of Toronto, Ontario, Canada
| | - Bernard Zinman
- Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (B.Z.)
| | - Kim A Connelly
- Division of Cardiology (A.T.Y., D.H.F., S.G.G., K.A.C.), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physiology (C.D.M., K.A.C.), University of Toronto, Ontario, Canada.,Department of Medicine (A.T.Y., V.G., M.E.F., D.H.F., S.G.G., R.E.G., L.A.L., P.J., B.Z., K.A.C.), University of Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre (S.V., A.T.Y., M.E.F., K.A.C.), University of Toronto, Ontario, Canada
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He F, Lu T, Fang X, Tian Y, Li Y, Zuo F, Ye J. Modification of honeycomb bioceramic scaffolds for bone regeneration under the condition of excessive bone resorption. J Biomed Mater Res A 2019; 107:1314-1323. [PMID: 30707498 DOI: 10.1002/jbm.a.36644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/02/2019] [Accepted: 01/28/2019] [Indexed: 01/07/2023]
Abstract
Gallium (Ga) ions have been clinically approved for treating the diseases caused by the excessive bone resorption through the systemic administration. Nevertheless, little attention has been given to the Ga-containing biomaterials for repairing bone defects under the pathological condition of excessive bone resorption. In the current study, for the first time the Ga-containing phosphate glasses (GPGs) were introduced to modify the honeycomb β-tricalcium phosphate (β-TCP) bioceramic scaffolds, which were prepared by an extrusion method. The results indicated that the scaffolds were characterized by uniform pore structure and channel-like macropores. The addition of GPGs promoted densification of strut of scaffolds by achieving liquid-sintering of β-TCP, thereby tremendously increasing the compressive strength. The ions released from scaffolds pronouncedly inhibited osteoclastogenesis-related gene expressions and multinuclearity of RAW264.7 murine monocyte cells, as well as expressions of early osteogenic makers of mouse bone mesenchymal stem cells (mBMSCs). However, the scaffolds with lower amount of Ga increased cell proliferation and upregulated expression of late osteogenic maker of mBMSCs. This study offers a novel approach to modify the bioceramic scaffolds for bone regeneration under the condition of accelerated bone resorption. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1314-1323, 2019.
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Affiliation(s)
- Fupo He
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Teliang Lu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, People's Republic of China
| | - Xibo Fang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Ye Tian
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Yanhui Li
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Fei Zuo
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, 510006, People's Republic of China
| | - Jiandong Ye
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, People's Republic of China
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He F, Lu T, Fang X, Qiu C, Tian Y, Li Y, Zuo F, Ye J. Study on Mg xSr 3-x(PO 4) 2 bioceramics as potential bone grafts. Colloids Surf B Biointerfaces 2018; 175:158-165. [PMID: 30530001 DOI: 10.1016/j.colsurfb.2018.11.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Magnesium (Mg) and strontium (Sr), which are essential nutrient elements in the natural bone, positively affect the osteogenic activity even in wide ranges of ion concentrations. However, it remains unknown whether magnesium-strontium phosphates [MgxSr3-x(PO4)2] are potential bone grafts for accelerating bone regeneration. Herein, a serial of MgxSr3-x(PO4)2, including Mg3(PO4)2, Mg2Sr(PO4)2, Mg1.5Sr1.5(PO4)2, MgSr2(PO4)2 and Sr3(PO4)2, were synthesized using a solid-state reaction approach. The physicochemical properties and cell behaviors of MgxSr3-x(PO4)2 bioceramics were characterized and compared with the common bone graft β-tricalcium phosphate (β-TCP). The results indicated that various MgxSr3-x(PO4)2 bioceramics differed in compressive strength and in vitro degradation rate. All the MgxSr3-x(PO4)2 bioceramics had excellent biocompatibility. In contrast to β-TCP, the MgxSr3-x(PO4)2 enhanced alkaline phosphatase activity of mouse bone mesenchymal stem cells (mBMSCs), and inhibited osteoclastogenesis-related gene expression of RAW264.7 cells, but did not enhance osteogenesis-related gene expression of mBMSCs which were treated with osteogenesis induction supplements. However, Mg3(PO4)2 stimulated osteogenesis-related gene expression of mBMSCs without the treatment of osteogenesis induction supplements. This work contributes to the design of bone graft and may open a new avenue for the bone regeneration field.
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Affiliation(s)
- Fupo He
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Teliang Lu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China
| | - Xibo Fang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Chao Qiu
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Ye Tian
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Yanhui Li
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Fei Zuo
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou 510006, People's Republic of China
| | - Jiandong Ye
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, People's Republic of China.
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Hobin E, Vallance K, Zuo F, Stockwell T, Rosella L, Simniceanu A, White C, Hammond D. Testing the Efficacy of Alcohol Labels with Standard Drink Information and National Drinking Guidelines on Consumers' Ability to Estimate Alcohol Consumption. Alcohol Alcohol 2018; 53:3-11. [PMID: 29016708 DOI: 10.1093/alcalc/agx052] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/20/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Despite the introduction of national drinking guidelines in Canada, there is limited public knowledge of them and low understanding of 'standard drinks (SDs)' which limits the likelihood of guidelines affecting drinking behaviour. This study tests the efficacy of alcohol labels with SD information and Canada's Low-Risk Drinking Guidelines (LRDGs) as compared to %ABV labels on consumers' ability to estimate alcohol intake. It also examines the label size and format that best supports adults' ability to make informed drinking choices. Methods This research consisted of a between-groups experiment (n = 2016) in which participants each viewed one of six labels. Using an online survey, participants viewed an alcohol label and were asked to estimate: (a) the amount in a SD; (b) the number of SDs in an alcohol container and (c) the number of SDs to consume to reach the recommended daily limit in Canada's LRDG. Results Results indicated that labels with SD and LRDG information facilitated more accurate estimates of alcohol consumption and awareness of safer drinking limits across different beverage types (12.6% to 58.9% increase in accuracy), and labels were strongly supported among the majority (66.2%) of participants. Conclusion Labels with SD and LRDG information constitute a more efficacious means of supporting accurate estimates of alcohol consumption than %ABV labels, and provide evidence to inform potential changes to alcohol labelling regulations. Further research testing labels in real-world settings is needed. Short summary Results indicate that the introduction of enhanced alcohol labels combining standard drink information and national drinking guidelines may be an effective way to improve drinkers' ability to accurately assess alcohol consumption and monitor intake relative to guidelines. Overall support for enhanced labels suggests probable acceptability of introduction at a population level.
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Affiliation(s)
- Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Ave., Suite 300, Toronto, ON, Canada M5G 1V2
| | - Kate Vallance
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8Y 2E4
| | - Fei Zuo
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Ave., Suite 300, Toronto, ON, Canada M5G 1V2
| | - Tim Stockwell
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8Y 2E4
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
| | - Alice Simniceanu
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 480 University Ave., Suite 300, Toronto, ON, Canada M5G 1V2
| | - Christine White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada N2L 3G1
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada N2L 3G1
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Chen X, Liu L, He J, Zuo F, Guo Z. Fabrication of a Metal Micro Mold by Using Pulse Micro Electroforming. Micromachines (Basel) 2018; 9:E203. [PMID: 30424136 PMCID: PMC6187575 DOI: 10.3390/mi9050203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 12/01/2022]
Abstract
Microfluidic devices have been widely used for biomedical and biochemical applications. Due to its unique characteristics, polymethyl methacrylate (PMMA) show great potential in fabricating microfluidic devices. Hot embossing technology has established itself as a popular method of preparing polymer microfluidic devices in both academia and industry. However, the fabrication of the mold used in hot embossing is time-consuming in general and often impractical for economically efficient prototyping. This paper proposes a modified technology for preparing metal micro molds by using pulse micro electroforming directly on metallic substrate, which could save time and reduce costs. In this method, an additive was used to avoid surface defect on deposited nickel. A chemical etching process was performed on the metallic substrate before the electroforming process in order to improve the bonding strength between the deposited structure and substrate. Finally, with the aim of obtaining a metal micro mold with high surface quality (low surface roughness), an orthogonal experiment was designed and conducted to optimize the electroforming parameters. Additionally, metal micro molds with different structures were well prepared by using the optimized parameters.
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Affiliation(s)
- Xiaolei Chen
- School of Electro-mechanical Engineering, Guangdong University of Technology, Guangzhou 510016, China.
- Guangzhou Key Laboratory of Nontraditional Machining and Equipment, Guangzhou 510006, China.
| | - Li Liu
- School of Electro-mechanical Engineering, Guangdong University of Technology, Guangzhou 510016, China.
| | - Junfeng He
- School of Electro-mechanical Engineering, Guangdong University of Technology, Guangzhou 510016, China.
| | - Fei Zuo
- School of Electro-mechanical Engineering, Guangdong University of Technology, Guangzhou 510016, China.
| | - Zhongning Guo
- School of Electro-mechanical Engineering, Guangdong University of Technology, Guangzhou 510016, China.
- Guangzhou Key Laboratory of Nontraditional Machining and Equipment, Guangzhou 510006, China.
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Haines DE, Wright M, Harks E, Deladi S, Fokkenrood S, Brink R, Belt H, Kolen AF, Mihajlovic N, Zuo F, Rankin D, Stoffregen W, Cockayne D, Cefalu J. Near-Field Ultrasound Imaging During Radiofrequency Catheter Ablation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005295. [DOI: 10.1161/circep.117.005295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
- David E. Haines
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Matthew Wright
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Erik Harks
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Szabolcs Deladi
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Steven Fokkenrood
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Rob Brink
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Harm Belt
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Alexander F. Kolen
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Nenad Mihajlovic
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Fei Zuo
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Darrell Rankin
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - William Stoffregen
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Debra Cockayne
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Joseph Cefalu
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
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Hobin E, Bollinger B, Sacco J, Liebman E, Vanderlee L, Zuo F, Rosella L, L'abbe M, Manson H, Hammond D. Consumers' Response to an On-Shelf Nutrition Labelling System in Supermarkets: Evidence to Inform Policy and Practice. Milbank Q 2017; 95:494-534. [PMID: 28895220 DOI: 10.1111/1468-0009.12277] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Policy Points: On-shelf nutrition labelling systems in supermarkets, such as the Guiding Stars system, are intended to provide consumers with simple, standardized nutrition information to support more informed and healthier food choices. Policies that support the provision of simplified nutrition labelling systems may encourage consumers to make positive shifts in food-purchasing behaviors. The shifts in consumer food-purchasing patterns observed in our study after the introduction of the Guiding Stars system in supermarkets translated into measurable nutritional benefits, including more items purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. This study is one of the first to report the positive impact of an on-shelf nutrition labelling system on supermarket sales and revenues-key information that was specifically requested by the US National Academies, as such labelling interventions may be more sustainable if they lead to higher revenues. CONTEXT Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. METHODS Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or "chains") in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. FINDINGS Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. CONCLUSIONS This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes.
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Affiliation(s)
- Erin Hobin
- Public Health Ontario.,These authors contributed equally to this work
| | - Bryan Bollinger
- Public Health Ontario.,These authors contributed equally to this work
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Pourtaherian A, Scholten HJ, Kusters L, Zinger S, Mihajlovic N, Kolen AF, Zuo F, Ng GC, Korsten HHM, de With PHN. Medical Instrument Detection in 3-Dimensional Ultrasound Data Volumes. IEEE Trans Med Imaging 2017; 36:1664-1675. [PMID: 28410101 DOI: 10.1109/tmi.2017.2692302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ultrasound-guided medical interventions are broadly applied in diagnostics and therapy, e.g., regional anesthesia or ablation. A guided intervention using 2-D ultrasound is challenging due to the poor instrument visibility, limited field of view, and the multi-fold coordination of the medical instrument and ultrasound plane. Recent 3-D ultrasound transducers can improve the quality of the image-guided intervention if an automated detection of the needle is used. In this paper, we present a novel method for detecting medical instruments in 3-D ultrasound data that is solely based on image processing techniques and validated on various ex vivo and in vivo data sets. In the proposed procedure, the physician is placing the 3-D transducer at the desired position, and the image processing will automatically detect the best instrument view, so that the physician can entirely focus on the intervention. Our method is based on the classification of instrument voxels using volumetric structure directions and robust approximation of the primary tool axis. A novel normalization method is proposed for the shape and intensity consistency of instruments to improve the detection. Moreover, a novel 3-D Gabor wavelet transformation is introduced and optimally designed for revealing the instrument voxels in the volume, while remaining generic to several medical instruments and transducer types. Experiments on diverse data sets, including in vivo data from patients, show that for a given transducer and an instrument type, high detection accuracies are achieved with position errors smaller than the instrument diameter in the 0.5-1.5-mm range on average.
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Hobin E, Erickson T, Comte M, Zuo F, Pasha S, Murnaghan D, Manske S, Casey C, Griffith J, McGavock J. Examining the impact of a province-wide physical education policy on secondary students' physical activity as a natural experiment. Int J Behav Nutr Phys Act 2017; 14:98. [PMID: 28724390 PMCID: PMC5518116 DOI: 10.1186/s12966-017-0550-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 07/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this paper is to examine the impact of a province-wide physical education (PE) policy on secondary school students’ moderate to vigorous physical activity (MVPA). Methods Policy: In fall 2008, Manitoba expanded a policy requiring a PE credit for students in grades 11 and 12 for the first time in Canada. The PE curriculum requires grades 11 and 12 students to complete a minimum of 55 h (50% of course hours) of MVPA (e.g., ≥30 min/day of MVPA on ≥5 days a week) during a 5-month semester to achieve the course credit. Study Designs: A natural experimental study was designed using two sub-studies: 1) quasi-experimental controlled pre-post analysis of self-reported MVPA data obtained from census data in intervention and comparison [Prince Edward Island (PEI)] provinces in 2008 (n = 33,619 in Manitoba and n = 2258 in PEI) and 2012 (n = 41,169 in Manitoba and n = 4942 in PEI); and, 2) annual objectively measured MVPA in cohorts of secondary students in intervention (n = 447) and comparison (Alberta; n = 224) provinces over 4 years (2008 to 2012). Analysis: In Study 1, two logistic regressions were conducted to model the odds that students accumulated: i) ≥30 min/day of MVPA, and ii) met Canada's national recommendation of ≥60 min/day of MVPA, in Manitoba versus PEI after adjusting for grade, sex, and BMI. In Study 2, a mixed effects model was used to assess students’ minutes of MVPA per day per semester in Manitoba and Alberta, adjusting for age, sex, BMI, school location and school SES. Results In Study 1, no significant differences were observed in students achieving ≥30 (OR:1.13, 95% CI:0.92, 1.39) or ≥60 min/day of MVPA (OR:0.92, 95% CI: 0.78, 1.07) from baseline to follow-up between Manitoba and PEI. In Study 2, no significant policy effect on students’ MVPA trajectories from baseline to last follow-up were observed between Manitoba and Alberta overall (−1.52, 95% CI:-3.47, 0.42), or by covariates. Conclusions The Manitoba policy mandating PE in grades 11 and 12 had no effect on student MVPA overall or by key student or school characteristics. However, the effect of the PE policy may be underestimated due to the use of a nonrandomized research design and lack of data assessing the extent of policy implementation across schools. Nevertheless, findings can provide evidence about policy features that may improve the PE policy in Manitoba and inform future PE policies in other jurisdictions.
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Affiliation(s)
- Erin Hobin
- Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON, M5R 1V2, Canada. .,University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A2, Canada.
| | - Tannis Erickson
- Children's Hospital Research Institute of Manitoba, 513-715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada
| | - Melisa Comte
- Children's Hospital Research Institute of Manitoba, 513-715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada.,University of Manitoba, 66 Chancellors Circle, Winnipeg, MB, R3T 2N2, Canada
| | - Fei Zuo
- Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON, M5R 1V2, Canada
| | - Saamir Pasha
- Peel Public Health Unit, 150 Central Park Dr, Brampton, ON, L6T 2T9, Canada
| | - Donna Murnaghan
- Thompson Rivers University, 900 McGill Rd, Kamloops, BC, V2C 0C8, Canada
| | - Steve Manske
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.,Propel Centre for Population Health Impact, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Catherine Casey
- University of Manitoba, 66 Chancellors Circle, Winnipeg, MB, R3T 2N2, Canada
| | - Jane Griffith
- Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, 513-715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada.,University of Manitoba, 66 Chancellors Circle, Winnipeg, MB, R3T 2N2, Canada
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Jiang B, He Y, Zuo F, Wu L, Liu QH, Zhang L, Zhou CX, Cheng JJ, Chan Sc ZS, Lam DQ. [Effectiveness of bupropion and counseling for smoking cessation]. Zhonghua Yu Fang Yi Xue Za Zhi 2016; 50:640-644. [PMID: 27412843 DOI: 10.3760/cma.j.issn.0253-9624.2016.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of bupropion for smoking cessation among Chinese smokers at a smoking cessation clinic. METHODS A prospective observational study was conducted in a hospital located in Beijing during 2008 and from 28 to 31 October 2014. A total of 287 smokers (265 men and 22 women) were assessed using data from structured questionnaires at baseline and were followed up at 1 and 6 months. Trained physician counselors provided free brief education and individual counseling sessions for all participants at the first visit. A total 131 participants were prescribed bupropion in addition to counseling. The counseling plus bupropion group was compared with the group who underwent counseling without bupropion. Outcomes were self-reported 7-day point prevalence abstinence rates at 1- and 6-month follow-up and continuous abstinence rates at 6-month follow-up. Smoking reduction rates at 1 and 6 months were also measured. RESULTS By intention-to-treat analysis, the 7-day point prevalence abstinence rate of the bupropion group at 1 and 6 months was higher than for the counseling-only group: at 1-month follow-up, 26.0% (34/131) vs. 15.4% (24/156), with OR (95% CI) 1.93(1.07-3.46); these rates at 6-month follow-up were 27.8% (35/131) vs. 15.4% (24/156), with OR (95% CI) 2.01(1.12-3.59). The 1-month continuous abstinence rate at 6 months was higher in the bupropion group: 26.0% (34/131) vs. 14.7% (23/156), with OR (95%CI) 2.03(1.12-3.66). Participants in the bupropion group also had a higher smoking reduction rate at 1 month than those in the counseling-only group: 55.0% (72/131) vs. 38.5% (60/156), with OR (95%CI) 1.95 (1.22-3.13). CONCLUSION Prescription of bupropion at this smoking cessation clinic was effective in doubling the quitting rates and smoking reduction rates among Chinese smokers.
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Affiliation(s)
- B Jiang
- Department of Traditional Chinese Medicine and Acupuncture, Nanlou Faculty of Clinical Medicine, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Zuo F, Comte M, So J, Rosella L, McGavock J, Hobin E. Trajectories of objectively measured sedentary time among secondary students in Manitoba, Canada in the context of a province-wide physical education policy: A longitudinal analysis. Can J Public Health 2016; 107:e23-e29. [PMID: 27348105 DOI: 10.17269/cjph.107.5238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/13/2016] [Accepted: 10/18/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Canadian adolescents' sedentary behaviour (SB) is poorly understood and greatly understudied compared to physical activity (PA). Accumulating evidence suggests that SB poses long-term health risks regardless of PA levels. To design effective interventions that target SB, it is critical to first understand adolescents' sedentary time (ST) trajectories in a Canadian context. Therefore, we examined longitudinal trajectories of Manitoba students' ST from 2008 to 2011 and identified associated factors in the context of a province-wide physical education (PE) policy. METHODS Secondary schools offering grades 9 through 12 were randomly selected in blocks to represent the urban and rural geography of Manitoba. In each selected school (n = 31), a convenience sample of grade 9 or 10 PE classes was recruited, leading to a final sample of 447 students. To assess ST, participants wore accelerometers on 7 consecutive days at baseline (2008) and during at least one follow-up period (2009, 2010 and 2011). RESULTS At baseline, students accumulated an average of 540 minutes/day of ST. Over the course of secondary school, students' ST trajectories remained stable. Females compared to males had a slightly higher rate of decline in ST (p = 0.035), adjusting for socio-demographic variables. ST trajectories were not associated with baseline PA, body mass index and school neighbourhood socio-economic status. CONCLUSION Adolescent ST remained high throughout secondary school. SB may be well established by early adolescence and track through late adolescence. Our findings suggest the potential need for additional interventions to reduce SB before and over the course of secondary school.
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Affiliation(s)
- Fei Zuo
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Melisa Comte
- Manitoba Institute of Child Health, Department of Paediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jannice So
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan McGavock
- Manitoba Institute of Child Health, Department of Paediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Erin Hobin
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
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Hobin E, Sacco J, Vanderlee L, White CM, Zuo F, Sheeshka J, McVey G, Fodor O'Brien M, Hammond D. A randomized trial testing the efficacy of modifications to the nutrition facts table on comprehension and use of nutrition information by adolescents and young adults in Canada. Health Promot Chronic Dis Prev Can 2015; 35:173-83. [PMID: 26674187 DOI: 10.24095/hpcdp.35.10.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Given the proposed changes to nutrition labelling in Canada and the dearth of research examining comprehension and use of nutrition facts tables (NFts) by adolescents and young adults, our objective was to experimentally test the efficacy of modifications to NFts on young Canadians' ability to interpret, compare and mathematically manipulate nutrition information in NFts on prepackaged food. METHODS An online survey was conducted among 2010 Canadians aged 16 to 24 years drawn from a consumer sample. Participants were randomized to view two NFts according to one of six experimental conditions, using a between-groups 2 x 3 factorial design: serving size (current NFt vs. standardized serving-sizes across similar products) x percent daily value (% DV) (current NFt vs. "low/med/high" descriptors vs. colour coding). The survey included seven performance tasks requiring participants to interpret, compare and mathematically manipulate nutrition information on NFts. Separate modified Poisson regression models were conducted for each of the three outcomes. RESULTS The ability to compare two similar products was significantly enhanced in NFt conditions that included standardized serving-sizes (p ≤ .001 for all). Adding descriptors or colour coding of % DV next to calories and nutrients on NFts significantly improved participants' ability to correctly interpret % DV information (p ≤ .001 for all). Providing both standardized serving-sizes and descriptors of % DV had a modest effect on participants' ability to mathematically manipulate nutrition information to calculate the nutrient content of multiple servings of a product (relative ratio = 1.19; 95% confidence limit: 1.04-1.37). CONCLUSION Standardizing serving-sizes and adding interpretive % DV information on NFts improved young Canadians' comprehension and use of nutrition information. Some caution should be exercised in generalizing these findings to all Canadian youth due to the sampling issues associated with the study population. Further research is needed to replicate this study in a more heterogeneous sample in Canada and across a range of food products and categories.
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Affiliation(s)
- E Hobin
- Public Health Ontario, Toronto, Ontario, Canada
| | - J Sacco
- Public Health Ontario, Toronto, Ontario, Canada
| | - L Vanderlee
- University of Waterloo, Waterloo, Ontario, Canada
| | - C M White
- University of Waterloo, Waterloo, Ontario, Canada
| | - F Zuo
- Public Health Ontario, Toronto, Ontario, Canada
| | - J Sheeshka
- Victoria University, Melbourne, Australia
| | - G McVey
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - D Hammond
- University of Waterloo, Waterloo, Ontario, Canada
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Zuo F, Han J, Yan P, van Assen H, Suzuki K. Guest Editorial: Special issue on advanced computing for image-guided intervention. Neurocomputing 2014. [DOI: 10.1016/j.neucom.2014.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Delle Sedie A, Riente L, Bandinelli F, Bi Y, Xu Q, Cao Y, Yuan Y, Zuo F, Gao Y, Matucci Cerinic M, Bombardieri S, Xiao C. AB0679 Comparison of Two Different Ethnic Groups of as Patients: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3657] [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: 11/04/2022]
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Chen H, Duan J, Zuo F. Mechanism of the reversal effect of mifepristone on drug resistance of the human cervical cancer cell line HeLa/MMC. Genet Mol Res 2014; 13:1288-95. [PMID: 24634186 DOI: 10.4238/2014.february.27.14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We examined the ability of mifepristone to reverse the in vitro drug resistance of human cervical cancer cells resistant to mitomycin-C (HeLa/MMC) cells and investigated the mechanism of this effect. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed to detect the drug resistance of HeLa/MMC cells and the reversed drug resistance in vitro. Expression levels of B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and glucosylceramide synthase (GCS) were measured in HeLa and HeLa/MMC cells. The resistance index of HeLa/MMC cells on MMC was reduced from 5.02 to 1.46 after 10 mg/mL mifepristone exposure. A combination of mifepristone upregulated the Bax/Bcl-2 protein expression ratio and apoptosis in HeLa/MMC cells. GCS expression was significantly higher in HeLa/MMC cells than in HeLa cells (P < 0.01), but distinctly declined in both cell lines after mifepristone application (P < 0.01). Mifepristone reversed the resistance of HeLa/MMC cells to MMC in vitro; the overexpression of the GCS gene and the increased expression of apoptosis-related protein Bcl-2 may play important roles in the formation of multidrug resistance in cervical cancer.
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Affiliation(s)
- H Chen
- Department of Gynecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - J Duan
- Department of Gynecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - F Zuo
- Department of Gynecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China
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Zuo F, Li Y, Johnson S, Johnson J, Varughese S, Copes R, Liu F, Wu HJ, Hou R, Chen H. Temporal and spatial variability of traffic-related noise in the City of Toronto, Canada. Sci Total Environ 2014; 472:1100-1107. [PMID: 24361745 DOI: 10.1016/j.scitotenv.2013.11.138] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/29/2013] [Indexed: 06/03/2023]
Abstract
The majority of studies that assessed population-level exposure to traffic-related noise were conducted in European countries and less is known about the exposure to traffic noise in North America, particularly in Canadian cities. This study explored the temporal and spatial variability of traffic noise in the City of Toronto, the largest city in Canada. We conducted two cycles of intensive field measurement campaign to collect real-time measurements of traffic noise at 554 locations across Toronto between June 2012 and January 2013. At each site, we collected measurements for a period of 30 min during daytime. Repeated measurements were made in cycle two at 62 locations randomly selected from cycle one, which exhibited high correlation (Pearson's correlation coefficient (r): 0.79). In addition, continuous measurements of noise were recorded for seven days at ten sites. We observed that noise variability was predominantly spatial in nature, rather than temporal: spatial variability accounted for 60% of the total observed variations in traffic noise. Traffic volume, length of arterial road, and industrial area were three most important variables, explaining the majority of the spatial variability of noise (R(2)=0.68 to 0.74, depending on the cycle). In comparison to the 16-h equivalent sound level guideline for outdoor locations set out by the Ministry of the Environment of the Province of Ontario, 80% of our sampled locations exceeded this guideline (i.e. 55 dBA,16 h). These findings suggested ubiquitous traffic noise exposure across Toronto and that noise variability was explained mostly by spatial characteristics.
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Affiliation(s)
- Fei Zuo
- Public Health Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ye Li
- Public Health Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | - Ray Copes
- Public Health Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Fuan Liu
- McGill University, Montreal, Canada
| | | | - Rebecca Hou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
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Colangelo P, Giannuzzi F, Nicotri S, Zuo F. Temperature and chemical potential dependence of the gluon condensate: A holographic study. Int J Clin Exp Med 2013. [DOI: 10.1103/physrevd.88.115011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Morrison RJ, Zhang J, Urban ER, Hall J, Ittekkot V, Avril B, Hu L, Hong GH, Kidwai S, Lange CB, Lobanov V, Machiwa J, San Diego-McGlone ML, Oguz T, Plumley FG, Yeemin T, Zhu W, Zuo F. Developing human capital for successful implementation of international marine scientific research projects. Mar Pollut Bull 2013; 77:11-22. [PMID: 24055460 DOI: 10.1016/j.marpolbul.2013.09.001] [Citation(s) in RCA: 5] [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] [Received: 08/27/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
The oceans play a crucial role in the global environment and the sustainability of human populations, because of their involvement in climate regulation and provision of living and non-living resources to humans. Maintenance of healthy oceans in an era of increasing human pressure requires a high-level understanding of the processes occurring in the marine environment and the impacts of anthropogenic activities. Effective protection and sustainable resource management must be based, in part, on knowledge derived from successful research. Current marine research activities are being limited by a need for high-quality researchers capable of addressing critical issues in broad multidisciplinary research activities. This is particularly true for developing countries which will require the building of capacity for marine scientific research. This paper reviews the current activities aimed at increasing marine research capacity in developing and emerging countries and analyses the challenges faced, including: appropriate alignment of the research goals and societal and policy-relevant needs; training in multidisciplinary research; increasing capacity for overall synthesis of scientific data; building the capacity of technical staff; keeping highly qualified personnel in marine scientific research roles; cross-cultural issues in training; minimising duplication in training activities; improving linkages among human capital, project resources and infrastructure. Potential solutions to these challenges are provided, along with some priorities for action aimed at improving the overall research effort.
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Affiliation(s)
- R J Morrison
- University of Wollongong, Wollongong, NSW 2522, Australia.
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Wright M, Harks E, Deladi S, Suijver F, Barley M, van Dusschoten A, Fokkenrood S, Zuo F, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Real-time lesion assessment using a novel combined ultrasound and radiofrequency ablation catheter. Heart Rhythm 2011; 8:304-12. [PMID: 21044698 DOI: 10.1016/j.hrthm.2010.10.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/27/2010] [Indexed: 11/27/2022]
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