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Zhu A, Tang R, Rajendran S, Hajian H, Aitken SJ. Prescriber decision-making on antithrombotic therapy after endovascular intervention for peripheral artery disease: a protocol for a discrete choice experiment. BMJ Open 2024; 14:e079668. [PMID: 38508643 PMCID: PMC10961582 DOI: 10.1136/bmjopen-2023-079668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a major risk factor for cardiovascular morbidity and mortality, despite surgical and endovascular treatments. Emerging evidence supports the use of immediate antithrombotic medications after endovascular intervention for PAD, however, there is a lack of consensus regarding choice and duration of antithrombotic therapy. Prescriber decision-making is a complex process, with prior studies demonstrating patient factors can influence variability in antithrombotic therapy for PAD. However, it remains unclear the relative contribution of these factors. This paper describes a planned study that aims to (1) determine the influence of patient factors on clinician preference for antithrombotic therapy following endovascular intervention and (2) compare differences in prescribing preferences between consultant vascular surgeons and trainees. METHODS AND ANALYSIS This cross-sectional survey will evaluate antithrombotic prescribing choices using a discrete choice experiment (DCE) that has been developed and piloted for this study. A list of attributes and levels was generated using a mixed-methods approach. This included an extensive literature review and semistructured interviews with prescribing clinicians. Following final selection of included attributes, specialised software was used to construct a D-efficient design for the DCE questionnaire. The electronic questionnaire will be administered to vascular trainees and consultant surgeons across Australia. These data will be analysed using multinomial logistic regression, treating the decision to prescribe antithrombotic therapy as a function of both the attributes of the two alternatives, as well as characteristics of the respondent. Latent class analysis will be used to explore heterogeneity of responses. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Sydney Human Ethics committee (2023/474). The results of this study will be published in peer-reviewed journals and presented at national vascular surgical conferences. These results will be used to improve understanding how clinicians make prescribing decisions and to inform future strategy to enhance guideline-directed prescribing.
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Affiliation(s)
- Alison Zhu
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Robert Tang
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Saissan Rajendran
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hamid Hajian
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Vascular Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Cutmore C, Hajian H, Aitken S. Is it time for integrated academic pathways in SET training? ANZ J Surg 2023; 93:1130-1131. [PMID: 36912281 DOI: 10.1111/ans.18380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Carina Cutmore
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hamid Hajian
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Vascular Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Sarah Aitken
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Chen O, Hajian H, Varcoe RL, Thomas SD. Infective thrombophlebitis after great saphenous vein cyanoacrylate embolization. J Vasc Surg Cases Innov Tech 2021; 7:577-580. [PMID: 34485781 PMCID: PMC8408552 DOI: 10.1016/j.jvscit.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022]
Abstract
The use of cyanoacrylate embolization has increased in interest as a safe, effective, and minimally invasive method to treat symptomatic saphenous reflux. The procedure is generally well tolerated by patients, and complications such as phlebitis are minor and usually self-limiting. Postprocedural infections have been described but occur infrequently and usually in the early postoperative course. In the present case report, we have described a late-onset infective thrombophlebitis of the great saphenous vein after cyanoacrylate embolization, requiring surgical excision of the treated vein.
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Affiliation(s)
- Oliver Chen
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hamid Hajian
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shannon D Thomas
- Department of Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Yu Y, Wise SG, Michael PL, Bax DV, Yuen GSC, Hiob MA, Yeo GC, Filipe EC, Dunn LL, Chan KH, Hajian H, Celermajer DS, Weiss AS, Ng MKC. Characterization of Endothelial Progenitor Cell Interactions with Human Tropoelastin. PLoS One 2015; 10:e0131101. [PMID: 26115013 PMCID: PMC4482626 DOI: 10.1371/journal.pone.0131101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/28/2015] [Indexed: 01/23/2023] Open
Abstract
The deployment of endovascular implants such as stents in the treatment of cardiovascular disease damages the vascular endothelium, increasing the risk of thrombosis and promoting neointimal hyperplasia. The rapid restoration of a functional endothelium is known to reduce these complications. Circulating endothelial progenitor cells (EPCs) are increasingly recognized as important contributors to device re-endothelialization. Extracellular matrix proteins prominent in the vessel wall may enhance EPC-directed re-endothelialization. We examined attachment, spreading and proliferation on recombinant human tropoelastin (rhTE) and investigated the mechanism and site of interaction. EPCs attached and spread on rhTE in a dose dependent manner, reaching a maximal level of 56±3% and 54±3%, respectively. EPC proliferation on rhTE was comparable to vitronectin, fibronectin and collagen. EDTA, but not heparan sulfate or lactose, reduced EPC attachment by 81±3%, while full attachment was recovered after add-back of manganese, inferring a classical integrin-mediated interaction. Integrin αVβ3 blocking antibodies decreased EPC adhesion and spreading on rhTE by 39±3% and 56±10% respectively, demonstrating a large contribution from this specific integrin. Attachment of EPCs on N-terminal rhTE constructs N25 and N18 accounted for most of this interaction, accompanied by comparable spreading. In contrast, attachment and spreading on N10 was negligible. αVβ3 blocking antibodies reduced EPC spreading on both N25 and N18 by 45±4% and 42±14%, respectively. In conclusion, rhTE supports EPC binding via an integrin mechanism involving αVβ3. N25 and N18, but not N10 constructs of rhTE contribute to EPC binding. The regulation of EPC activity by rhTE may have implications for modulation of the vascular biocompatibility of endovascular implants.
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Affiliation(s)
- Young Yu
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Steven G. Wise
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
- School of Molecular Bioscience, University of Sydney, Sydney, NSW, 2006, Australia
- * E-mail:
| | - Praveesuda L. Michael
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Daniel V. Bax
- School of Molecular Bioscience, University of Sydney, Sydney, NSW, 2006, Australia
| | - Gloria S. C. Yuen
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Matti A. Hiob
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
- School of Molecular Bioscience, University of Sydney, Sydney, NSW, 2006, Australia
| | - Giselle C. Yeo
- School of Molecular Bioscience, University of Sydney, Sydney, NSW, 2006, Australia
| | - Elysse C. Filipe
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise L. Dunn
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Kim H. Chan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Hamid Hajian
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - David S. Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anthony S. Weiss
- School of Molecular Bioscience, University of Sydney, Sydney, NSW, 2006, Australia
- Bosch Institute, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Martin K. C. Ng
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
- The Heart Research Institute, Sydney, NSW, 2042, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
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Stone DJ, Rozovsky I, Morgan TE, Anderson CP, Hajian H, Finch CE. Astrocytes and microglia respond to estrogen with increased apoE mRNA in vivo and in vitro. Exp Neurol 1997; 143:313-8. [PMID: 9056393 DOI: 10.1006/exnr.1996.6360] [Citation(s) in RCA: 198] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study examined the regulation of apolipoprotein E (apoE) by 17beta-estradiol (E2) in brain glia, using rats with regular ovulatory cycles as an in vivo model and cultured astrocytes and mixed glia as in vitro models. Two brain regions were examined which had demonstrated transient synaptic remodeling during the estrous cycle. In the hippocampal CA1 region and the hypothalamic arcuate nucleus, apoE mRNA was elevated at proestrus when plasma E2 was high and synaptic density was increasing. Both astrocytes and microglia contributed to this increase in apoE mRNA. In vitro, E2 treatment had no effect on apoE mRNA levels in monotypic cultures of either astrocytes or microglia. In contrast, mixed glial cultures responded to E2 with increased apoE mRNA and protein, suggesting that heterotypic cellular interactions are important in the brain response to estrogens. In situ hybridization in combination with cell-specific markers showed that E2 increased apoE mRNA levels in both astrocytes and microglia. These results, which are the first evidence of apoE mRNA localization to microglia in vivo and the control of apoE expression in brain cells by estrogens, are discussed in terms of the possible protective role of E2 in Alzheimer's disease and prior findings that emphasize the expression of apoE mRNA in astrocytes within the brain.
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Affiliation(s)
- D J Stone
- Department of Biological Sciences, University of Southern California, Los Angeles, CA, 90089, USA
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