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Réglade U, Bocquet A, Gautier R, Cohen J, Marquet A, Albertinale E, Pankratova N, Hallén M, Rautschke F, Sellem LA, Rouchon P, Sarlette A, Mirrahimi M, Campagne-Ibarcq P, Lescanne R, Jezouin S, Leghtas Z. Author Correction: Quantum control of a cat qubit with bit-flip times exceeding ten seconds. Nature 2024:10.1038/s41586-024-07565-z. [PMID: 38760464 DOI: 10.1038/s41586-024-07565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Affiliation(s)
- U Réglade
- Alice & Bob, Paris, France
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - A Bocquet
- Alice & Bob, Paris, France
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - R Gautier
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | | | - A Marquet
- Alice & Bob, Paris, France
- Ecole Normale Supérieure de Lyon, CNRS, Laboratoire de Physique, Lyon, France
| | | | | | | | | | - L-A Sellem
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - P Rouchon
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - A Sarlette
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - M Mirrahimi
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - P Campagne-Ibarcq
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | | | | | - Z Leghtas
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France.
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Réglade U, Bocquet A, Gautier R, Cohen J, Marquet A, Albertinale E, Pankratova N, Hallén M, Rautschke F, Sellem LA, Rouchon P, Sarlette A, Mirrahimi M, Campagne-Ibarcq P, Lescanne R, Jezouin S, Leghtas Z. Quantum control of a cat qubit with bit-flip times exceeding ten seconds. Nature 2024:10.1038/s41586-024-07294-3. [PMID: 38710932 DOI: 10.1038/s41586-024-07294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Quantum bits (qubits) are prone to several types of error as the result of uncontrolled interactions with their environment. Common strategies to correct these errors are based on architectures of qubits involving daunting hardware overheads1. One possible solution is to build qubits that are inherently protected against certain types of error, so the overhead required to correct the remaining errors is greatly reduced2-7. However, this strategy relies on one condition: any quantum manipulations of the qubit must not break the protection that has been so carefully engineered5,8. A type of qubit known as a cat qubit is encoded in the manifold of metastable states of a quantum dynamical system, and thereby acquires continuous and autonomous protection against bit-flips. Here, in a superconducting-circuit experiment, we implemented a cat qubit with bit-flip times exceeding 10 s. This is an improvement of four orders of magnitude over previously published cat-qubit implementations. We prepared and imaged quantum superposition states, and measured phase-flip times greater than 490 ns. Most importantly, we controlled the phase of these quantum superpositions without breaking the bit-flip protection. This experiment demonstrates the compatibility of quantum control and inherent bit-flip protection at an unprecedented level, showing the viability of these dynamical qubits for future quantum technologies.
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Affiliation(s)
- U Réglade
- Alice & Bob, Paris, France
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - A Bocquet
- Alice & Bob, Paris, France
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - R Gautier
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | | | - A Marquet
- Alice & Bob, Paris, France
- Ecole Normale Supérieure de Lyon, CNRS, Laboratoire de Physique, Lyon, France
| | | | | | | | | | - L-A Sellem
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - P Rouchon
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - A Sarlette
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - M Mirrahimi
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | - P Campagne-Ibarcq
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France
| | | | | | - Z Leghtas
- Laboratoire de Physique de l'Ecole Normale Supérieure, ENS-PSL, CNRS, Sorbonne Université, Université Paris Cité, Centre Automatique et Systèmes, Mines Paris, Université PSL, Inria, Paris, France.
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Noy R, Bassal R, Ostrovsky D, Cohen J, Ishai R, Cohen-Vaizer M, Vaisbuch Y. Surgical Approaches to Petrous Apex Cholesterol Granulomas: A Systematic Review and Network Meta-analysis. Laryngoscope 2024; 134:1540-1550. [PMID: 37812326 DOI: 10.1002/lary.31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To compare the outcomes of different surgical approaches to petrous apex cholesterol granulomas (PACG). DATA SOURCES PubMed, Embase, Google Scholar, Cochrane, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analyses guidelines, databases were searched from inception to November 31, 2022. Studies comparing two or more approaches were included. Reviews and population studies were excluded. The main outcome measures were the resolution of symptoms, serviceable hearing, complication, and revision rates. RESULTS The search yielded 2132 studies. After applying inclusion and exclusion criteria, 15 studies remained, consisting of 214 patients treated with lateral approaches (n = 182) or anterior endonasal approaches (n = 32). The efficacy of lateral and anterior endonasal approaches in achieving symptom resolution was comparable (73% vs. 68%, p = 0.5). Both exhibited similar rates of complications (33% vs. 37%, p = 0.3), albeit with distinct profiles. Lateral approaches were associated with higher rates of facial palsy and sensorineural hearing loss (44% vs. 18%, p = 0.03). Anterior endonasal approaches demonstrated higher rates of epistaxis and cerebrospinal fluid leak (15% vs. 1%, p = 0.001). Anterior endonasal approaches exhibited lower revision rates (OR: 0.35, 95% CI: 0.14-0.88). The placement of a stent in both approaches was associated with higher symptom resolution (OR: 5.12, 95% CI: 1.05-9.97) and lower revision rates (OR: 0.71, 95% CI: 0.33-0.92). CONCLUSIONS Anterior endonasal approaches yield lower revision rates compared to lateral approaches for PACG. Both approaches demonstrate similar effectiveness in symptom resolution and comparable rates of complications, with distinct profiles. Facial nerve and hearing status are important factors that should be addressed when selecting the approach. Stenting is beneficial. LEVEL OF EVIDENCE NA Laryngoscope, 134:1540-1550, 2024.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Raghad Bassal
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dmitry Ostrovsky
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Reuven Ishai
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mauricio Cohen-Vaizer
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Noy R, Habashi N, Akrish S, Cohen J, Shkedy Y. Preoperative tracheostomy is associated with thyroid gland invasion and poorer prognosis in laryngectomized patients. Eur Arch Otorhinolaryngol 2024; 281:935-943. [PMID: 37880425 DOI: 10.1007/s00405-023-08302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. METHODS All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator. RESULTS A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03). CONCLUSION Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Solis-Pazmino P, Figueroa L, La K, Termeie O, Oka K, Schleicher M, Cohen J, Barnajian M, Nasseri Y. Liposomal bupivacaine versus conventional anesthetic or placebo for hemorrhoidectomy: a systematic review and meta-analysis. Tech Coloproctol 2024; 28:29. [PMID: 38294561 PMCID: PMC10830612 DOI: 10.1007/s10151-023-02881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/11/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Liposome bupivacaine (LB) is a long-acting anesthetic to enhance postoperative analgesia. Studies evaluating the efficacy of the LB against an active comparator (bupivacaine or placebo) on acute postoperative pain control in hemorrhoidectomy procedures are few and heterogeneous. Therefore, we performed a systematic review and meta-analysis comparing LB's analgesic efficacy and side effects to conventional/placebo anesthetic in hemorrhoidectomy patients. METHODS We performed a systematic review and meta-analysis of randomised controlled trials investigating the use of LB after haemorrhoidectomy. We searched the literature published from the time of inception of the datasets to August 19, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. RESULTS A total of 338 patients who underwent a hemorrhoidectomy procedure enrolled in three randomized clinical trials were included. The overall mean age was 45.84 years (SD ± 11.43), and there was a male predominance (53.55% male). In total 194 patients (52.2%) received LB and 144 (47.8%) received either bupivacaine or placebo. Pain scores at 72 h in the LB (199, 266, and 300 mg) were significantly lower than in the bupivacaine HCl group (p = 0.002). Compared to the bupivacaine/placebo group, the time to first use of opioids in the LB group was significantly longer at LB 199 mg (11 h vs. 9 h), LB 266 mg (19 h vs. 9 h), and LB 300 mg (19 h vs. 8 h) (p < 0.05). Moreover, compared to the bupivacaine/epinephrine group, it was significantly lower in the LB 266 mg group (3.7 vs. 10.2 mg) and at LB 300 mg (13 vs. 33 mg) (p < 0.05). Finally, regarding adverse effects, the conventional anesthetic/placebo group reported more pain in bowel movement than LB groups (OR 2.60, 95% CI 1.31-5.16). CONCLUSIONS Comparing LB to conventional anesthetic/placebo anesthetic for hemorrhoidectomy, we found a statistically significant reduction in pain through 72 h, decreased opioid requirements, and delayed time to first opioid use. Moreover, the conventional anesthetic/placebo group reported more pain in bowel movement than LB groups.
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Affiliation(s)
- P Solis-Pazmino
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- CaTaLiNA-Cancer de Tiroides en Latino América, Quito, Ecuador
| | - L Figueroa
- CaTaLiNA-Cancer de Tiroides en Latino América, Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - K La
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - O Termeie
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - K Oka
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - J Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - M Barnajian
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - Y Nasseri
- Surgery Group Los Angeles, Los Angeles, CA, USA.
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Noy R, Shkedy Y, Habashi N, Billan S, Cohen J. Oncological outcomes and failure patterns of laser cordectomy in recurrent glottic cancer. Am J Otolaryngol 2024; 45:104109. [PMID: 37948822 DOI: 10.1016/j.amjoto.2023.104109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival. RESULTS A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9). CONCLUSIONS Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Oncology Radiation Division, Rambam Health Care Campus, Haifa, Israel.
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Barris DM, Mikhno M, Kornblit M, Wang K, Duong S, Cohen J, Paul E, Stern K, Ezon D, Geiger M. Clinical utility of repeat fetal echocardiography in congenital heart disease. Ultrasound Obstet Gynecol 2023; 62:695-700. [PMID: 37128164 DOI: 10.1002/uog.26240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To investigate the utility of repeat fetal echocardiography (FE) following a diagnosis of structural congenital heart disease (CHD) on the initial FE. We evaluated how often changes in management and counseling occurred based on subsequent FE findings and sought to determine which types of CHD were more likely to have changes in management and/or counseling based on repeat FE. METHODS This was a retrospective review of all patients who presented to our center between January 2012 and January 2019 and who had more than one FE performed for structural CHD. We reviewed consultation notes to determine whether management or counseling had changed based on FE findings at follow-up visits. Management variables included a change in location or mode of delivery, plan for atrial septostomy, initiation of prostaglandin infusion, umbilical line placement and planned admission location (nursery vs neonatal intensive care unit). We defined a counseling change as any of the above changes in management as well as any meaningful refinements in the cardiac diagnosis that led to a change in the overall prognosis or future management. Initial diagnoses were grouped into anatomically/hemodynamically relevant subgroups. Fisher's exact test was used to assess the relationship between the initial diagnosis and changes in management. Post-hoc pairwise comparisons were performed using Dunnett's test. RESULTS Between January 2012 and January 2019, 267 patients underwent 534 follow-up FE assessments performed for structural CHD. Management change based on repeat FE occurred in 41/267 (15.4%) cases. A change in management was associated with the diagnosis made at the initial visit (P < 0.001). The proportion of cases with a management change was highest among those with an initial diagnosis of pulmonary valve abnormality/non-critical pulmonary stenosis (4/11 (36.4%)), followed by balanced atrioventricular canal (AVC) defect (5/17 (29.4%)) and left ventricular outflow tract obstruction/aortic valve abnormality or coarctation/interrupted aortic arch (19/68 (27.9%)). No management change occurred in fetuses diagnosed with isolated ventricular septal defect (VSD), truncus arteriosus, pulmonary vein anomaly or isolated arch sidedness/branching abnormality. Compared to those with a VSD, management was significantly more likely to be changed in fetuses with a balanced AVC defect (P = 0.025) and left heart lesions (P = 0.002). Right heart lesions showed a trend towards an increased incidence of management change (P = 0.05). A counseling change based on repeat FE occurred in 108/267 (40.4%) cases. The proportion of cases with a counseling change was highest among those with an initial diagnosis of pulmonary valve abnormality/non-critical pulmonary stenosis (8/11 (72.7%)) and hypoplastic left heart syndrome/critical aortic stenosis (5/9 (55.6%)). CONCLUSIONS The clinical utility of follow-up FE is associated with the type of CHD diagnosed. Follow-up FE led to changes in management in several types of CHD, most commonly in cases with an initial diagnosis of right and left outflow obstructive lesions and balanced AVC defect. When developing programmatic protocols for the frequency of FE assessments, the type of CHD should be a major determinant, but additional studies are required to reach a consensus on how often serial FE should be performed for each type of CHD. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D M Barris
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - M Mikhno
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - M Kornblit
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - K Wang
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S Duong
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - J Cohen
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - E Paul
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - K Stern
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - D Ezon
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - M Geiger
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
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Levy M, Zurawel M, d’Hardemare V, Moran A, Andelman F, Manor Y, Cohen J, Meshulam M, Balash Y, Gurevich T, Fried I, Bergman H. Subthalamic nucleus physiology is correlated with deep brain stimulation motor and non-motor outcomes. Brain Commun 2023; 5:fcad268. [PMID: 38025270 PMCID: PMC10664412 DOI: 10.1093/braincomms/fcad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/24/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Subthalamic nucleus deep brain stimulation is commonly indicated for symptomatic relief of idiopathic Parkinson's disease. Despite the known improvement in motor scores, affective, cognitive, voice and speech functions might deteriorate following this procedure. Recent studies have correlated motor outcomes with intraoperative microelectrode recordings. However, there are no microelectrode recording-based tools with predictive values relating to long-term outcomes of integrative motor and non-motor symptoms. We conducted a retrospective analysis of the outcomes of patients with idiopathic Parkinson's disease who had subthalamic nucleus deep brain stimulation at Tel Aviv Sourasky Medical Centre (Tel Aviv, Israel) during 2015-2016. Forty-eight patients (19 women, 29 men; mean age, 58 ± 8 years) who were implanted with a subthalamic nucleus deep brain stimulation device underwent pre- and postsurgical assessments of motor, neuropsychological, voice and speech symptoms. Significant improvements in all motor symptoms (except axial signs) and levodopa equivalent daily dose were noted in all patients. Mild improvements were observed in more posterior-related neuropsychological functions (verbal memory, visual memory and organization) while mild deterioration was observed in frontal functions (personality changes, executive functioning and verbal fluency). The concomitant decline in speech intelligibility was mild and only partial, probably in accordance with the neuropsychological verbal fluency results. Acoustic characteristics were the least affected and remained within normal values. Dimensionality reduction of motor, neuropsychological and voice scores rendered six principal components that reflect the main clinical aspects: the tremor-dominant versus the rigidity-bradykinesia-dominant motor symptoms, frontal versus posterior neuropsychological deficits and acoustic characteristics versus speech intelligibility abnormalities. Microelectrode recordings of subthalamic nucleus spiking activity were analysed off-line and correlated with the original scores and with the principal component results. Based on 198 microelectrode recording trajectories, we suggest an intraoperative subthalamic nucleus deep brain stimulation score, which is a simple sum of three microelectrode recording properties: normalized neuronal activity, the subthalamic nucleus width and the relative proportion of the subthalamic nucleus dorsolateral oscillatory region. A threshold subthalamic nucleus deep brain stimulation score >2.5 (preferentially composed of normalized root mean square >1.5, subthalamic nucleus width >3 mm and a dorsolateral oscillatory region/subthalamic nucleus width ratio >1/3) predicts better motor and non-motor long-term outcomes. The algorithm presented here optimizes intraoperative decision-making of deep brain stimulation contact localization based on microelectrode recording with the aim of improving long-term (>1 year) motor, neuropsychological and voice symptoms.
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Affiliation(s)
- Mikael Levy
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Mika Zurawel
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Vincent d’Hardemare
- Department of Neurosurgery, Hospital Foundation Rothschild, Paris 75019, France
| | - Anan Moran
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- School of Neurobiology, Biochemistry & Biophysics, George S. Wise Faculty of Life Science, Tel-Aviv University, Tel Aviv 6423906, Israel
| | - Fani Andelman
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Manor
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jacob Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
| | - Moshe Meshulam
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yacov Balash
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itzhak Fried
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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Rodriguez JAP, Wilhelm MB, Travis B, Kargel JS, Zarroca M, Berman DC, Cohen J, Baker V, Lopez A, Buckner D. Exploring the evidence of Middle Amazonian aquifer sedimentary outburst residues in a Martian chaotic terrain. Sci Rep 2023; 13:17524. [PMID: 37853014 PMCID: PMC10584912 DOI: 10.1038/s41598-023-39060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
The quest for past Martian life hinges on locating surface formations linked to ancient habitability. While Mars' surface is considered to have become cryogenic ~3.7 Ga, stable subsurface aquifers persisted long after this transition. Their extensive collapse triggered megafloods ~3.4 Ga, and the resulting outflow channel excavation generated voluminous sediment eroded from the highlands. These materials are considered to have extensively covered the northern lowlands. Here, we show evidence that a lacustrine sedimentary residue within Hydraotes Chaos formed due to regional aquifer upwelling and ponding into an interior basin. Unlike the northern lowland counterparts, its sedimentary makeup likely consists of aquifer-expelled materials, offering a potential window into the nature of Mars' subsurface habitability. Furthermore, the lake's residue's estimated age is ~1.1 Ga (~3.2 Ga post-peak aquifer drainage during the Late Hesperian), enhancing the prospects for organic matter preservation. This deposit's inferred fine-grained composition, coupled with the presence of coexisting mud volcanoes and diapirs, suggest that its source aquifer existed within abundant subsurface mudstones, water ice, and evaporites, forming part of the region's extremely ancient (~ 4 Ga) highland stratigraphy. Our numerical models suggest that magmatically induced phase segregation within these materials generated enormous water-filled chambers. The meltwater, originating from varying thermally affected mudstone depths, could have potentially harbored diverse biosignatures, which could have become concentrated within the lake's sedimentary residue. Thus, we propose that Hydraotes Chaos merits priority consideration in future missions aiming to detect Martian biosignatures.
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Affiliation(s)
- J Alexis P Rodriguez
- Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ, 85719-2395, USA.
- External Geodynamics and Hydrogeology Group, Department of Geology, Autonomous University of Barcelona, Bellaterra, 08193, Barcelona, Spain.
| | | | - Bryan Travis
- Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ, 85719-2395, USA
| | - Jeffrey S Kargel
- Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ, 85719-2395, USA
| | - Mario Zarroca
- External Geodynamics and Hydrogeology Group, Department of Geology, Autonomous University of Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Daniel C Berman
- Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ, 85719-2395, USA
| | - Jacob Cohen
- NASA Ames Research Center, Moffett Field, CA, 94035, USA
| | - Victor Baker
- Department of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Anthony Lopez
- Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ, 85719-2395, USA
| | - Denise Buckner
- Blue Marble Space Institute of Science, Seattle, WA, 98104, USA
- University of Florida, Gainesville, FL, 32611, USA
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Onukwugha F, Dyson J, Howlett H, Combe K, Catterick M, Cohen J, Smith L. Reflections of maternity service users and midwives' on the co-creation of interventions to support midwives addressing alcohol during antenatal care. Patient Educ Couns 2023; 115:107896. [PMID: 37527593 DOI: 10.1016/j.pec.2023.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND There are divergent perspectives between midwives and pregnant women on how alcohol consumption during pregnancy could be addressed. Co-creation is an approach where lay people and professionals work together as equal partners, offering the opportunity to bridge the gap. OBJECTIVES Our aim was to evaluate how well we carried out authentic co-creation of an intervention to support midwives have a dialogue about alcohol consumption with pregnant women. PATIENT INVOLVEMENT Recent maternity service users including women with experience of harm due to alcohol during pregnancy provided feedback on the design, conduct and dissemination of the study. METHODS An iterative co-creation approach rooted in participatory research methods was used. Five online workshops were carried out with thirteen midwives and six maternity service users via Zoom July-August 2021. Data were analysed using the core values of co-create as a framework: equality, inclusivity, holistic, resource, positivity, transparency, iterative, and sustainability. RESULTS The co-creation process was productive and rewarding to midwives and maternity service users. There were positive experiences across the co-creation framework with some unintended positive consequences for maternity-service users. DISCUSSION This evaluation provides new knowledge on how well the co-creation process worked in relation to research involving a sensitive topic that can invite stigma. Co-creation projects require generous time and financial resources to ensure a high-quality process and robust outcome for all. PRACTICAL VALUE Co-creation of strategies involving both service providers and service users have potential to facilitate evidence-based practice. FUNDING This research is funded by the National Institute for Health Research (Reference: NIHR201128).
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Affiliation(s)
- F Onukwugha
- Institute for Clinical and Applied Health Research, University of Hull, Cottingham Road, Hull HU6 7X, UK
| | - J Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - H Howlett
- NHS North East and North Cumbria, Parkhouse Building, Baron Way, Kingmoor Park, Carlisle, Cumbria, CA6 4SJ, UK
| | - K Combe
- Faculty of Health Sciences, University of Hull, Cottingham Road, Hull HU6 7RX, UK
| | - M Catterick
- FASD Network, Newtown Community Resource Centre, Stockton-on-Tees, UK
| | - J Cohen
- HYMS, University of Hull, Cottingham Road, Hull HU6 7X, UK
| | - L Smith
- Institute for Clinical and Applied Health Research, University of Hull, Cottingham Road, Hull HU6 7X, UK.
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11
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Keller SB, Cohen J, Moon-Grady A, Cuneo B, Paul E, Coll AC, Campbell M, Srivastava S. Patterns of endocardial fibroelastosis without atrioventricular block in fetuses exposed to anti-Ro/SSA antibodies. Ultrasound Obstet Gynecol 2023; 62:148-151. [PMID: 36806323 DOI: 10.1002/uog.26181] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/24/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Anti-Ro/SSA-antibody-mediated endocardial fibroelastosis (EFE) without atrioventricular (AV) block at presentation is a rare cardiac phenotype. We report on 11 fetuses with this rare type of anti-Ro/SSA-antibody-mediated cardiac involvement, presenting with a distinctive echocardiographic pattern of EFE. Eleven fetuses with isolated EFE at presentation were included from four cardiac centers, and experienced fetal cardiologists reached a consensus regarding EFE location on echocardiography at presentation. Interval changes to subsequent fetal and postnatal echocardiograms were assessed to evaluate response to therapy. Echocardiographic markers of cardiac performance, including diastolic function and AV conduction, were reviewed. Ten fetuses were found to have EFE of the aortic root, proximal aorta and/or left ventricular outflow tract. In the same 10 cases, EFE of the pulmonary root, pulmonary artery and/or right ventricular outflow tract was identified. Six cases had atrial EFE and six had EFE of the crux. Four cases were known to be positive for anti-Ro/SSA antibodies prior to diagnosis, whereas, in the remaining seven, echocardiographic findings prompted testing, which was positive in all cases. The AV interval at presentation was normal in all cases, but one fetus subsequently developed AV block. Nine patients were treated with transplacental dexamethasone, five of which also received intravenous immunoglobulin (IVIG), and one received IVIG only. Of the 10 treated cases, six had improvement in EFE as shown by serial imaging and, in four cases, the severity was unchanged. All patients were liveborn. In our cohort, EFE of the aortic and pulmonary arteries and outflow tracts was nearly universal, and involvement of the atria and the crux of the heart was also common. The high survival rate and low burden of AV block are also suggestive of a distinct phenotype of anti-Ro/SSA-antibody-mediated cardiac disease with a favorable prognosis. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S B Keller
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - J Cohen
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Hospital, New York, NY, USA
| | - A Moon-Grady
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - B Cuneo
- Department of Pediatrics, Division of Cardiology, University of Colorado, Denver, CO, USA
| | - E Paul
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Hospital, New York, NY, USA
| | - A C Coll
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - M Campbell
- Department of Pediatric Cardiology, Nemours Children's Hospital, Wilmington, DE, USA
| | - S Srivastava
- Department of Pediatric Cardiology, Nemours Children's Hospital, Wilmington, DE, USA
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12
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Tandron M, Cohen L, Cohen J, Allegra P, Munoz J, Kaplan L, Baraga M. The fifty most-cited articles regarding midshaft clavicle fractures. J Orthop 2023; 39:50-58. [PMID: 37125014 PMCID: PMC10130696 DOI: 10.1016/j.jor.2023.03.014] [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] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The clavicle is the most frequently fractured bone in the human body, and up to 80% of clavicle fractures occur in the middle third diaphyseal region of the clavicle (midshaft). We conducted a bibliometric analysis to identify and evaluate the 50 most-cited publications pertaining to midshaft clavicle fractures (MCF). Materials and methods Two independent reviewers conducted separate queries on Web of Science in December 2021 for "midshaft clavicle fractures". The publications yielded were organized from highest to lowest number of citations. We included articles, review articles, and editorial materials and excluded other document types. Both reviewers independently reviewed all abstracts until 50 studies pertaining to MCF were included. Theory We hypothesized that most articles would be published between 2000 and 2019, pertain to outcomes, and those with a greater (lower numeric) level of evidence would correlate with number of citations. Results The most prolific decade was from 2010 to 2019, with 50% (25/50) of articles published. Average citation density was 6.3 ± 5.5 (range, 1.3-33.1), defined as the average number of citations per year since publication. The median level of evidence (LOE) was 3.5 (IQR: 3). One-way ANOVA tests were used to compare the effects of LOE on total citations and citation density. There were statistically significant differences in total citations (F value = 12.07, p = 0.001) and citation density (F value = 21.14, p < 0.001) between LOE groups. The median number of total citations, grouped by LOE of 1 through 5, were as follows: 110, 66, 66, 51, 52. Conclusions This review provides an overview of the 50 most cited papers regarding MCF. This should be used as a reference for physicians and other providers who treat patients with MCF for treatment guidance and for those in teaching roles as a student and resident/fellow educational resource.
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Affiliation(s)
- Marissa Tandron
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lara Cohen
- Harvard Combined Orthopaedic Residency Program, Boston, MA, 02114, USA
| | - Jacob Cohen
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Paul Allegra
- Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY, 10075, USA
| | - Julianne Munoz
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Lee Kaplan
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Michael Baraga
- University of Miami, Department of Orthopaedic Surgery, Miami, FL, 33136, USA
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13
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Arnon J, Kein S, Cohen J, Zick A, Zarbiv Y, Avner M, Halutsi Y, Stepensky P, Avni B, Grisariu S, Elia A, Popovtzer A, Cohen C, Lotem M. 11P Successful transfer and prolonged persistence of engineered lymphocytes with T-cell receptor targeting NY-ESO-1. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100977] [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: 04/05/2023] Open
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14
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Hyde Z, Roura R, Signer D, Patel A, Cohen J, Saheed M, Brinkley S, Irvin R, Sulkowski MS, Thomas DL, Rothman RE, Hsieh YH. Evaluation of a pilot emergency department linkage to care program for patients previously diagnosed with Hepatitis C. J Viral Hepat 2023; 30:129-137. [PMID: 36441638 PMCID: PMC9852079 DOI: 10.1111/jvh.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
There is a significant number of Emergency Department (ED) patients with known chronic hepatitis C virus (HCV) infection who have not been treated with directly acting antivirals. We implemented a pilot ED-based linkage-to-care program to address this need and evaluated the impact of the program using the HCV Care Continuum metrics. Between March 2015 and May 2016, dedicated patient care navigators identified HCV RNA-positive patients in an urban ED and offered expedited appointments with the on-site viral hepatitis clinic. Patient demographics and care continuum outcomes were abstracted from the EMR and analysed to determine significant factors influencing linkage-to-care (LTC) and treatment initiation rates. The ED linkage-to-care program achieved a 43% linkage-to-care rate (165/384), 22% treatment rate (84/384) and 16% sustained virologic response rate (63/384). Significant associations were found between linkage-to-care and increasing age (OR = 1.03), Medicare insurance (OR = 2.21) and having a primary care physician (PCP) (OR = 4.03). For patients who were linked, the odds of initiating treatment were also positively significantly associated with increasing age (OR = 1.04) and having a PCP (OR = 2.77). For patients who initiated treatment, the odds of sustained virologic response were marginally associated with having a PCP (OR = 4.92).Our ED linkage-to-care program utilized care coordination to successfully link nearly half of approached HCV RNA-positive patients to care. This design can be feasibly replicated by other EDs given limited non-clinical training required for linkage-to-care staff. Adoption of similar programs in other EDs may improve the rates of LTC and treatment initiation for previously diagnosed HCV patients.
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Affiliation(s)
- Zak Hyde
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danielle Signer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anuj Patel
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob Cohen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherilyn Brinkley
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Risha Irvin
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark S. Sulkowski
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L. Thomas
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Derridj N, Ghanchi A, Bonnet D, Adnot P, Rahshenas M, Salomon L, Cohen J, Khoshnood B. Early mortality in infants born with severe neonatal-operated congenital heart defects and low or very low birthweight: Systematic review and meta-analysis. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.277] [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: 01/01/2023]
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16
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Rodriguez JAP, Robertson DK, Kargel JS, Baker VR, Berman DC, Cohen J, Costard F, Komatsu G, Lopez A, Miyamoto H, Zarroca M. Evidence of an oceanic impact and megatsunami sedimentation in Chryse Planitia, Mars. Sci Rep 2022; 12:19589. [PMID: 36456647 PMCID: PMC9715952 DOI: 10.1038/s41598-022-18082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/04/2022] [Indexed: 12/05/2022] Open
Abstract
In 1976, NASA's Viking 1 Lander (V1L) was the first spacecraft to operate successfully on the Martian surface. The V1L landed near the terminus of an enormous catastrophic flood channel, Maja Valles. However, instead of the expected megaflood record, its cameras imaged a boulder-strewn surface of elusive origin. We identified a 110-km-diameter impact crater (Pohl) ~ 900 km northeast of the landing site, stratigraphically positioned (a) above catastrophic flood-eroded surfaces formed ~ 3.4 Ga during a period of northern plains oceanic inundation and (b) below the younger of two previously hypothesized megatsunami deposits. These stratigraphic relationships suggest that a marine impact likely formed the crater. Our simulated impact-generated megatsunami run-ups closely match the mapped older megatsunami deposit's margins and predict fronts reaching the V1L site. The site's location along a highland-facing lobe aligned to erosional grooves supports a megatsunami origin. Our mapping also shows that Pohl's knobby rim regionally represents a broader history of megatsunami modification involving circum-oceanic glaciation and sedimentary extrusions extending beyond the recorded megatsunami emplacement in Chryse Planitia. Our findings allow that rocks and soil salts at the landing site are of marine origin, inviting the scientific reconsideration of information gathered from the first in-situ measurements on Mars.
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Affiliation(s)
- J. Alexis P. Rodriguez
- grid.423138.f0000 0004 0637 3991Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ 85719-2395 USA
| | - Darrel K. Robertson
- grid.419075.e0000 0001 1955 7990NASA Ames Research Center, Moffett Field, CA 94035 USA
| | - Jeffrey S. Kargel
- grid.423138.f0000 0004 0637 3991Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ 85719-2395 USA
| | - Victor R. Baker
- grid.134563.60000 0001 2168 186XDepartment of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ 85721 USA
| | - Daniel C. Berman
- grid.423138.f0000 0004 0637 3991Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ 85719-2395 USA
| | - Jacob Cohen
- grid.419075.e0000 0001 1955 7990NASA Ames Research Center, Moffett Field, CA 94035 USA
| | - Francois Costard
- grid.503243.3GEOPS-Géosciences Paris Sud, Université Paris-Sud, CNRS, Université Paris-Saclay, 91405 Orsay, France
| | - Goro Komatsu
- grid.412451.70000 0001 2181 4941International Research School of Planetary Sciences, Università D’Annunzio, Viale Pindaro 42, 65127 Pescara, Italy
| | - Anthony Lopez
- grid.423138.f0000 0004 0637 3991Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ 85719-2395 USA
| | - Hideaki Miyamoto
- grid.26999.3d0000 0001 2151 536XDepartment of Systems Innovation, University of Tokyo, Tokyo, 113-8656 Japan
| | - Mario Zarroca
- grid.7080.f0000 0001 2296 0625External Geodynamics and Hydrogeology Group, Department of Geology, Autonomous University of Barcelona, 08193 Bellaterra, Barcelona, Spain
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Panovska-Griffiths J, Swallow B, Hinch R, Cohen J, Rosenfeld K, Stuart RM, Ferretti L, Di Lauro F, Wymant C, Izzo A, Waites W, Viner R, Bonell C, Fraser C, Klein D, Kerr CC. Statistical and agent-based modelling of the transmissibility of different SARS-CoV-2 variants in England and impact of different interventions. Philos Trans A Math Phys Eng Sci 2022. [PMID: 35965458 DOI: 10.6084/m9.figshare.c.6070427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- J Panovska-Griffiths
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
- The Queen's College, University of Oxford, Oxford
| | - B Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - R Hinch
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - J Cohen
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - K Rosenfeld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - R M Stuart
- University of Copenhagen, Copenhagen, Denmark
| | - L Ferretti
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - F Di Lauro
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - C Wymant
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - A Izzo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - W Waites
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH Glasgow, UK
| | - R Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - C Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - C Fraser
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - D Klein
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - C C Kerr
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
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Panovska-Griffiths J, Swallow B, Hinch R, Cohen J, Rosenfeld K, Stuart RM, Ferretti L, Di Lauro F, Wymant C, Izzo A, Waites W, Viner R, Bonell C, Fraser C, Klein D, Kerr CC. Statistical and agent-based modelling of the transmissibility of different SARS-CoV-2 variants in England and impact of different interventions. Philos Trans A Math Phys Eng Sci 2022; 380:20210315. [PMID: 35965458 PMCID: PMC9376711 DOI: 10.1098/rsta.2021.0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/09/2022] [Indexed: 05/21/2023]
Abstract
The English SARS-CoV-2 epidemic has been affected by the emergence of new viral variants such as B.1.177, Alpha and Delta, and changing restrictions. We used statistical models and the agent-based model Covasim, in June 2021, to estimate B.1.177 to be 20% more transmissible than the wild type, Alpha to be 50-80% more transmissible than B.1.177 and Delta to be 65-90% more transmissible than Alpha. Using these estimates in Covasim (calibrated 1 September 2020 to 20 June 2021), in June 2021, we found that due to the high transmissibility of Delta, resurgence in infections driven by the Delta variant would not be prevented, but would be strongly reduced by delaying the relaxation of restrictions by one month and with continued vaccination. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.
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Affiliation(s)
- J. Panovska-Griffiths
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Queen's College, University of Oxford, Oxford, UK
| | - B. Swallow
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - R. Hinch
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J. Cohen
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - K. Rosenfeld
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - L. Ferretti
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - F. Di Lauro
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C. Wymant
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - A. Izzo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - W. Waites
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH Glasgow, UK
| | - R. Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - C. Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - C. Fraser
- The Big Data Institute and the Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - D. Klein
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - C. C. Kerr
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA
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Tie J, Cohen J, Lahouel K, Lo S, Wang Y, Wong R, Shapiro J, Harris S, Khattak A, Burge M, Horvath L, Karapetis C, Shannon J, Singh M, Yip D, Papadopoulos N, Tomasetti C, Kinzler K, Vogelstein B, Gibbs P. 318MO Circulating tumour DNA (ctDNA) dynamics, CEA and sites of recurrence for the randomised DYNAMIC study: Adjuvant chemotherapy (ACT) guided by ctDNA analysis in stage II colon cancer (CC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cohen J, Natale C, Lin J, Lorusso P, Mita A, Mita M, Muller C, Orloff M, Papadopoulos K, Rodon J, Garyantes T. 85P A circulating, surrogate-systemic biomarker correlates with anti-tumor benefit on LNS8801 therapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.117] [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: 11/01/2022] Open
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Cohen J, Moreau J, Gouirand V, Macon C, Boothby I, Gratz I, Stoecklinger A, Weaver C, Sharpe A, Ricardo-Gonzalez R, Rosenblum M. 012 Tissue-specific manipulation of regulatory T cells reveals the skin to be a site of immune tolerance. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chavez-Badiola A, Flores-Saiffe Farias A, Sanchez D, Mendizabal-Ruiz G, Valencia-Murillo R, Drakeley A, Cohen J. P-249 The location of fragments and degraded zones in blastocysts is associated with ploidy: moving towards explaining an AI-based morphology tool trained on euploidy outcomes. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the location of degraded areas or fragments an indication of ploidy in blastocyst images?
Summary answer
Degradation traces observed in a blastocyst’s inner cell mass correlates with aneuploidy when confirmed by trophectoderm biopsy.
What is known already
The interaction between humans and Artificial Intelligence (AI) augmented intelligence, (AuI) is dependent on the AI’s ability to be self-explainable and interpretable. This is a highly desired feature of AI’s in healthcare, given that blindly trusting it to make a decision has serious ethical considerations and potential consequences. Currently, most available AI’s provide “black-box” advice that might cause difficult interaction with their human counterparts. ERICA (IVF2.0 Limited, UK), was designed to rank blastocysts using euploid status as ground truth, and although initially a “black-box,” we describe results from an initial attempt towards making it explainable.
Study design, size, duration
This study was designed as a proof-of-concept on retrospectively collected images. De-identified images (n = 329) with known ploidy status (euploid or aneuploid) were retrieved (November 2021) from ERICA. The images were processed from December 2021 to January 2022.
Participants/materials, setting, methods
A senior embryologist identified visual degenerative traces from blastocyst images for areas of cell degradation and cell fragments. Ploidy status was blinded to the embryologist. Images were segmented for trophectoderm (TE), blastocoele (BC), and inner cell mass (ICM) using the automated tool of ERICA’s algorithm. The distance between the centre of each degenerative trace and the ICM was measured. The Dice Similarity Coefficient (DSC) and the proportion of degenerative traces in each zone were computed.
Main results and the role of chance
We identified some level of degradation in 60% of the blastocysts, particularly in BC:44%, ICM:38%, TE:26%, and ICM+BC:55%, and the presence of fragments in 103, particularly in BC:21%, ICM:10%, and TE:24%. Our database contained 52% euploid blastocyst images.
We found that when DSC between degradation and ICM is more than 10% (44/78 aneuploids) the chances of aneuploidy increase by 25% (Z=-1.76, p < 0.05).
We also found a 13% increased chance of an embryo being aneuploid (92/157 aneuploidy) if the area of ICM+BC has any presence of degradation (Z=-1.14, p = 0.13), and an increased risk of aneuploidy if DSC (U = 12401, p = 0.09), and also if the proportion of degradation was found in ICM+BC (U = 12397, p = 0.09).
Our data also suggests that aneuploid embryos have closer fragments (mean=51um, 95% CI: 42.2-59.9) than euploids (mean=63.4um 95% CI:51.1-75.7) (U = 988,=0.19).
Mann-Whitney U test and Z-test for proportions were used accordingly, both under the hypothesis that increased degenerative traces means a higher probability of being aneuploid (one-tailed test).
Limitations, reasons for caution
Analyzing degenerative traces using a single image from a single focal plane might be limiting. Identifying fragments and degradation might not be a replicable process inter- or intra- embryologist. More annotators are needed to reduce this bias.
Wider implications of the findings
Correlation between aneuploidy and cell degradation was stronger in the ICM than TE, although ploidy status is obtained via TE biopsy. Our data suggest that fragments that are closer to the ICM might increase the chances of aneuploidy. A larger prospective multicentre study should be conducted to confirm these findings.
Trial registration number
not applicable
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Affiliation(s)
- A Chavez-Badiola
- IVF 2.0 Ltd, Research and development , Maghull, United Kingdom
- University of Kent, School of Bioscience , Canterbury, United Kingdom
| | | | - D Sanchez
- New Hope Fertility Center, Embryology , Mexico City, Mexico
| | - G Mendizabal-Ruiz
- IVF 2.0 Ltd, Research and development , Maghull, United Kingdom
- Universidad de Guadalajara, Department of Computational Sciences , Guadalajara, Mexico
| | | | - A Drakeley
- Hewitt Fertility Centre- Liverpool Women's Hospital, University of Liverpool , Liverpool, United Kingdom
| | - J Cohen
- IVFqc, Research & Development , New York, U.S.A
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Chavez Badiola A, Flores-Saiffe A, Valencia R, Mendizabal-Ruiz G, Villavicencio J, Gonzalez D, Griffin D, Drakeley A, Cohen J. P-241 ‘Augmented intelligence’ to possibly shorten euploid identification time: A human-machine interaction study for euploid identification using ERICA, an Artificial Intelligence software to assist embryo ranking. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What is the mean number of transfers needed to achieve a euploid transfer selected by embryologists plus ERICA’s assistance?
Summary answer
Augmented intelligence (ERICA plus human collaboration) outperforms both the embryologists and artificial intelligence's individual performance alone.
What is known already
Euploid embryos are more likely to implant successfully. Artificial intelligence (AI) could improve embryo selection over current techniques, but scepticism exists. Augmented intelligence (AuI) combines both the mathematical reproducibility of machine learning and the knowledge and experience of humans. This approach employs AI tools as an assistant, where the user shall learn to interpret the AI. A recent study suggested that embryologists assisted by AI improved the embryo selection of euploid transfers. ERICA (IVF2.0 Limited, UK) was designed to rank blastocysts according to their probability of euploidy.
Study design, size, duration
We prospectively studied embryo selection for ERICA alone, embryologists only and when interacting (embryologists and ERICA) in 150 synthetically generated (reconstructed on real-data) embryo transfer cycles. Embryos were ranked in order, and performance was assessed by time to identify a euploid embryo within each cycle cohort correctly. Embryologists were allowed to rank a maximum of 10 cycles per day for three weeks starting in January 2022, using a mobile phone application designed for this purpose.
Participants/materials, setting, methods
Using real-life cycle distributions of euploid/aneuploid blastocysts and the number of embryos in a cycle (according to ERICA’s database), we created 150 synthetic cycles, 30 for each age bracket (< 35, 35-37, 38-40, 41-42, and >42). These were randomly populated with blastocyst images preserving their actual ploidy status correspondingly. Each synthetic cycle contained between 2 to 6 authentic embryo images with at least one euploid and one aneuploid.
Main results and the role of chance
The total database had a euploid rate of 37.4% (n = 513), and by age brackets from 1 to 5 were 45.7% (n = 116), 43.8% (n = 105), 35.9% (n = 92), 31.2% (n = 96), and 28.8% (n = 104) respectively.
The mean number of cycles analysed by each participant was 113.5 (CI: 100.8-126.2). The mean time-to-euploid transfer for embryologists alone was 2.07 (CI:2.00-2.13); for the ERICA alone was 1.86 (CI:1.82-1.91); and for embryologists assisted by ERICA was 1.62 (CI:1.55-1.68). All study groups compared to each other were statistically significant using a paired two-tailed student’s t-test (p < 0.001).
The proportion of euploid transfer at the first try for embryologists alone was 0.40 (CI:0.37-0.43), for ERICA alone was 0.54 (CI:0.53-0.54), and for embryologists assisted by ERICA was 0.47 (CI:0.44-0.50). All study groups compared with each other were statistically significant with a paired two-tailed student’s t-test (p < 0.01).
Limitations, reasons for caution
Although our findings suggest that Aul outperforms both AI and humans alone, this study needs to be replicated with a larger cohort of embryologists with different experience levels in different countries to confirm these results.
Wider implications of the findings
Combining machine-human interaction through a well-designed process could improve embryo selection and reduce inter-operator variability amongst staff with different experience levels. It could also set a frame for adequate agency and accountability, and enhance trust and adoption.
Trial registration number
NA
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Affiliation(s)
- A Chavez Badiola
- IVF 2.0 ltd, Research and Development , London, United Kingdom
- University of Kent, School of Biosciences , Canterbury, United Kingdom
- New Hope Fertility Center, Clinical Research , Mexico City, Mexico
| | - A Flores-Saiffe
- IVF 2.0 ltd, Research and Development , London, United Kingdom
| | - R Valencia
- IVF 2.0 ltd, MLOps , London, United Kingdom
| | | | | | - D Gonzalez
- IVF 2.0 ltd, MLOps , Guadalajara, Mexico
| | - D Griffin
- University of Kent, School of Biosciences , Canterbury, United Kingdom
| | - A Drakeley
- Liverpool Women's Hospital, Hewitt Centre for Reproductive Medicine , Liverpool, United Kingdom
- University of Liverpool, Clinical , Liverpool, United Kingdom
| | - J Cohen
- IVFqc, Research and Development , New York City, U.S.A
- IVF 2.0 ltd, Embryology , New York City, U.S.A
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Chávez-Badiola A, Flores-Saiffe Farías A, Mendizabal G, Valencia-Murillo R, Sakkas D, Ocali O, Mazur P, Viñals Gonzalez X, Hernandez Leon M, Valadez Aguilar A, Griffin D, Drakeley A, Cohen J. P-085 Use of an artificial intelligence tool to assess single-sperm motility variables related to bias preference of ICSI sperm selection practice, normal fertilization, and blastocyst formation. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Which single-sperm WHO motility variables are associated with ICSI sperm selection preference, normal fertilization, and blastocyst formation when assessed by an artificial intelligence platform?
Summary answer
Injected sperm had higher VSL, VAP, and LIN compared with non-injected. Higher STR was associated with fertilization and higher WOB and less HMP with blastulation.
What is known already
Sperm selection for intracytoplasmic sperm injection (ICSI) is key to its success. Currently, the procedure may be subjective although the embryologist selects rapidly from a small population of sperm. There is no consensus on specific motility variables for single-sperm selection.
SiD (IVF 2.0 Limited, UK) software is able to assess all sperm in a visual field and accurately compute the motility variables for each sperm in real-time. SiDTM could help to understand the association between motility variables related to ICSI success and to assess the differences in sperm selection practice between different clinics and operators.
Study design, size, duration
473 ICSI videos and their corresponding outcome were retrospectively analyzed using SiD software and assessed against normal fertilization (2PN), and blastocyst formation (BF), from four fertility clinics in different countries between July 2021 to December 2021. Ethical approval was obtained. This study was non-interventional. The study parameters were defined as sperm that were selected or non-selected, 2PN, and BF.
Participants/materials, setting, methods
Motility variables were computed from ICSI videos for VSL, VCL, LIN, VAP, ALH, WOB, STR as defined by the WHO manual for the examination and processing of human semen; and HMP, a metric associated with sperm-head movements. Injected sperm were manually identified and the injection was visually verified by a senior embryologist. Extracted motility variables were standardized according to each clinic and PVP concentration. Study groups were tested with a two-sided Mann-Whitney U test.
Main results and the role of chance
Video analysis identified 304 selected and 9543 non-selected sperm. 2PN and BF status was known for 302 and 301 injected oocytes respectively (2PN rate: 79%, BF rate: 53%).
Embryologists used VSL, VAP, and LIN as the preferred motility criteria to select sperm (p < 0.001). Using data from all clinics, we found a tendency for STR (p = 0.12) and LIN (p = 0.14) for 2PN and WOB (p = 0.11) and VAP (p = 0.18) for BF.
There was partial consistency on sperm selection criteria amongst clinics: Clinic1 selected VSL, VAP, and LIN as the main variables to select sperm; Clinic2 VSL, WOB, and LIN; Clinic3 VSL, VAP, and VCL; and Clinic4 ALH, VCL, and VAP (p < 0.001).
For Clinic1 higher HMP showed a correlation (p = 0.06, n = 21) to 2PN, while higher WOB (p = 0.12, n = 21) did for BF. Clinic2 showed a limited association to higher STR and 2PN (p = 0.12, n = 120), and a significant association between higher WOB and BF (p < 0.05, n = 120). Clinic3’s data suggested that higher STR was associated with 2PN (p < 0.05, n = 97) and low HMP with BF (p < 0.05, n = 97).
Limitations, reasons for caution
This retrospective study needs to be repeated prospectively with larger numbers in more locations using embryologists with different levels of ICSI experience. Clinical outcome data such as clinical pregnancy, miscarriage, and live birth impact is still required.
Wider implications of the findings
SiD was able to track and extract motility features from single sperm. SiDTM could assist embryologists in real-time to select sperm during ICSI and could be used as a training tool to reduce variability among embryologists.
Trial registration number
RPA-2021-03
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Affiliation(s)
- A Chávez-Badiola
- IVF 2.0 Limited, Research & Development , Guadalajara, Mexico
- University of Kent, School of Bioscience , Canterbury, United Kingdom
| | | | - G Mendizabal
- IVF 2.0 Limited, Research & Development , Guadalajara, Mexico
- Universidad de Guadalajara, Departamento de Bioingeniería Traslacional , Guadalajara, Mexico
| | | | - D Sakkas
- Boston IVF, Scientific Director , Waltham MA, U.S.A
| | - O Ocali
- Boston IVF, Embryology research department , Waltham MA, U.S.A
| | - P Mazur
- Nadiya Clinic, Embryology department , Kyiv, Ukraine
| | | | | | | | - D Griffin
- University of Kent, School of Bioscience , Canterbury, United Kingdom
| | - A Drakeley
- Hewitt Fertility Centre- Liverpool Women's Hospital, University of Liverpool , Liverpool, United Kingdom
| | - J Cohen
- IVFqc, Research & Development , New York, U.S.A
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Patel U, Dorkhom N, Abair T, Cameron DR, Cohen J. Breast cancer: Online education’s effect on clinician ability to assess risk of recurrence and understanding the latest data. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12509 Background: Hormone receptor positive breast cancer (HR+ BC) is often diagnosed in the early, curable, stage. Emerging treatment options make it important to educate clinicians on how to identify patients eligible for these options and increase their understanding of the clinical data associated with therapies in HR+/HER2- early breast cancer (EBC). The study objective was to assess the impact of 2 educational activities on HR+/HER2- EBC on oncologists’ knowledge, competence, and confidence related to risk of recurrence and clinical data. Methods: Two online continuing medical education activities were launched in 2021 covering a range of topics focused on identification of patients at high risk of recurrence and the latest clinical trial data for CDK4/6 inhibitors (CDK4/6i) in HR+/HER2- EBC. Educational impact was assessed using a repeated pair design, with knowledge/competence and confidence questions pre- and post-education. Confidence was assessed on a Likert-type scale ranging from not confident to very confident. Questions were designed to assess if certain learning objectives (LOs), covering identified educational gaps, were met. Data was collected from 06/14/2021 to 01/31/2022. Statistical significance was assessed using McNemar’s test ( P < .05 level). Results: 5,544 learners participated in these 2 activities, including 727 oncologists. The LOs were grouped in 3 themes that assessed oncologists’ knowledge/competence and confidence related to identifying patients with HR+/HER2- EBC at high risk of recurrence and understanding the clinical trial data investigating CDK4/6i in this setting. Two themes showed a significant improvement. The number of oncologist learners assessed per theme differed from 228 to 260. Conclusions: Participation in text- and video-based activities resulted in a significant improvement of oncologists’ knowledge, competence, and confidence related to CDK4/6i clinical data and treatment eligibility for patients with HR+/HER2- EBC. Baseline knowledge regarding the identification of high risk of recurrence in HR+/HER2-EBC was high (89% correct responses pre-education) in comparison that of clinical trial data and confidence in identification of patients eligible for adjuvant therapy (54% and 21% respectively). This finding could be reflective of clinicians having a high-level knowledge and competence related to risk stratification prior to the developments that occurred secondary to the approval of CDK4/6i in the adjuvant setting. With these new developments additional education around this topic will be required.[Table: see text]
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Worst MA, Caracio R, Whitney M, Cohen J, Yao JC. The effect of a series of online CME activities on the multidisciplinary management of patients with GEP-NETs. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e23004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23004 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare, heterogenous neoplasms characterized by a wide spectrum of clinical manifestations. Management strategies are varied and include surgery, radiological intervention, cytotoxic chemotherapies, somatostatin analogs, TKIs, and novel peptide receptor radionuclide therapy (PRRT). Due to their clinical complexity, the diagnosis and treatment of GEP-NETS should involve collaboration between specialists in multiple disciplines. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists, gastroenterologists, and pathologists with respect to the use of novel systemic therapies for the multidisciplinary management of patients with GEP-NETs. Methods: The educational series consisted of 3 online, CME-certified activities. Educational impact was assessed with repeated pre-/post-education including multiple choice knowledge/competence questions and 5-point Likert scale confidence questions. Data from all oncologists, gastroenterologists, and pathologists who completed pre- and/or post-education assessments were aggregated across activities and stratified by learning theme. Relative changes in percentage of correct responses and clinicians who were confident (value of 4 or 5) were used to measure improvement in knowledge, competence, and confidence. A McNemar’s test assessed significant levels of changes reported with P values < .05 considered statistically significant. The first activity in the series launched December 2020 and the last launched February 2021; data were collected until February 2022. Results: The educational series resulted in overall statistically significant improvements in oncologists’, gastroenterologists’, and pathologists’ knowledge, competence, and confidence after education (N = 125 to 455, P < .05). Conclusions: This analysis demonstrates that oncologists’, gastroenterologists’, and pathologists’ knowledge, competence, and confidence regarding the use of novel systemic therapies in the multidisciplinary management of patients with GEP-NETs improved after education. Despite these improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.[Table: see text]
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Affiliation(s)
| | | | | | | | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
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Cohen J, Benstead K. PO-1862 E-leaning module effect on knowledge and confidence of clerical staff regarding radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shlomi D, Cohen J, Alon A, Oberman B, Katz I. Duplicate Prescription Rates of Long-Acting Bronchodilator Inhalers. J Aerosol Med Pulm Drug Deliv 2022; 35:252-258. [PMID: 35384737 DOI: 10.1089/jamp.2021.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Long-acting bronchodilator inhalers are widely used with or without inhaled corticosteroids (ICs) by patients with lung diseases. In Israel alone, there are 21 inhalers containing long-acting β2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs). Some patients are treated incorrectly with several inhalers of the same pharmacologic group. Methods: Electronic data of LABA and/or LAMA inhalers purchased during a period of 1 year were extracted in one district of Clalit Health Services in Israel. Patients who were treated with two or more inhalers from the same pharmacologic group were compared with patients without duplicate treatment. Inhaler purchases during the 12 months before and after the first duplicate purchase were compared with the purchases by patients without duplication of treatment. New diagnoses were compared to identify possible side effects. Results: Of the 13,528 patients who were treated with LABA and/or LAMA inhalers, 244 (1.8%) purchased at least two different inhalers from the same pharmacologic group. Inhaler purchases were 3.8 times higher in the duplication group during the 12 months before the first duplication. Inhaler purchase increased by 28% in the duplication group compared with a 4.5% increase in the nonduplication group (p < 0.001) during the following year. The risk for duplicated consumption was significantly higher in patients with a chronic obstructive pulmonary disease (COPD) diagnosis, males, and persons aged between 61 and 80 years. Conclusions: Nearly 2% of the patients treated with long-acting bronchodilators consumed different medications of the same pharmacologic group even when adherence was satisfactory. COPD patients are at higher risk for inhaler duplication. Clinical Trial Registration Number: 0151-20-COM1.
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Affiliation(s)
- Dekel Shlomi
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Clalit Health Services, Petah Tiqwa, Israel
| | | | - Adi Alon
- Clalit Health Services, Petah Tiqwa, Israel
| | - Bernice Oberman
- The Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Ramat Gan, Israel
| | - Irit Katz
- Clalit Health Services, Petah Tiqwa, Israel
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Cohen J, Wang L, Marques S, Ialy-Radio C, Barbaux S, Lefèvre B, Gourier C, Ziyyat A. Oocyte ERM and EWI Proteins Are Involved in Mouse Fertilization. Front Cell Dev Biol 2022; 10:863729. [PMID: 35359433 PMCID: PMC8963852 DOI: 10.3389/fcell.2022.863729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
In mammalian fertilization, the link between the oocyte plasma membrane and underneath cytoskeleton has often been associated to key elements of successful gamete fusion, like microvilli shaping or CD9 function, but its effective role has poorly been studied. EWI-2 and EWI-F as cis partners of CD9, and ERM proteins (Ezrin, Radixin and Moesin) that both attach to the actin cytoskeleton and to the EWI are part of the molecules that make the link between the oocyte membrane and its cytoskeleton. This study aims to assay through siRNA inhibition, the involvement of these ERM and EWI molecules in mouse fertilization, their role in the microvilli morphology of the egg but also their possible contribution to the cortical tension, a parameter that reflects the mechanical behavior of the oocyte cortex. Whereas inhibiting separately the expression of each protein had no effect on fertilization, the combined inhibition of either EWI-2/EWI-F or the three ERM triggered a significant decrease of the fertilization index. This inhibition seems to correlate with an increase in the radius of curvature of the oocyte microvilli. It also causes a decrease of the oocyte cortical tension. These results show the importance of EWI-2 and EWI–F and ERM proteins in the smooth running of a fertilization event and support their involvement in the microvilli architecture of the oocyte and in its mechanical properties.
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Affiliation(s)
- J Cohen
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
| | - L Wang
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
- Ecole Normale Supérieure (ENS), Université Paris Sciences et Lettres (PSL), CNRS, Sorbonne Université, Université de Paris, Paris, France
- Department of Histo-embryology, Genetics and Developmental Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S Marques
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
| | - C Ialy-Radio
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
| | - S Barbaux
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
| | - B Lefèvre
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
| | - C Gourier
- Ecole Normale Supérieure (ENS), Université Paris Sciences et Lettres (PSL), CNRS, Sorbonne Université, Université de Paris, Paris, France
| | - A Ziyyat
- Institut Cochin, INSERM, CNRS, Université de Paris, Paris, France
- Service d’histologie, d’embryologie, Biologie de la Reproduction, AP-HP, Hôpital Cochin, Paris, France
- *Correspondence: A Ziyyat,
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Taylor B, Cohen J, Tejeda J, Wang T. Belumosudil for chronic graft-versus-host disease. Drugs Today (Barc) 2022; 58:203-212. [DOI: 10.1358/dot.2022.58.5.3400705] [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: 11/03/2022]
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Cimenser A, Konisky A, Shukla M, Mrozak H, Cohen J, Kolin K, Martin K, Boasso A, Hempel E, Malchano Z, Hajos M. Effects of gamma sensory stimulation on cognitive function in Alzheimer’s disease patients. Alzheimers Dement 2021. [DOI: 10.1002/alz.056695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mihaly Hajos
- Cognito Therapeutics Cambridge MA USA
- Translational Neuropharmacology, Department of Comparative Medicine, Yale University School of Medicine New Haven CT USA
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Lee C, Patel N, Panepinto L, Byers M, Ambrosino M, Adusumalli S, Denduluri S, Cohen J, Scherrer-Crosbie M. The role of premorbid transthoracic echocardiogram in identifying adverse clinical outcomes in patients admitted with COVID-19. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The novel coronavirus disease (COVID-19) inpatient mortality rate is approximately 20% in the United States. Reports have described a wide pattern of abnormalities in echocardiograms performed in patients admitted with COVID-19. The role of premorbid transthoracic echocardiogram (TTE) in the prediction of COVID-19 severity and mortality is yet to be fully assessed.
Purpose
To assess whether a pre-COVID TTE can identify patients at high risk of adverse outcomes who are admitted with COVID-19.
Methods
All patients who underwent a TTE from one year to one month prior to an index inpatient admission for COVID-19 were retrospectively enrolled across five clinical sites. Demographic information, medical history, and laboratory data were included for analysis. Echocardiograms were analyzed by an observer blinded to clinical data. Linear and logistic regressions were performed to detect the association of variables with death, invasive mechanical ventilation, initiation of dialysis, and a composite of these endpoints during the COVID-19 admission. Outcomes were then adjusted for a risk score using inverse propensity weighting incorporating age, sex, diabetes, hypertension, obstructive sleep apnea, history of atherosclerotic cardiovascular disease, atrial fibrillation, diuretic use, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use.
Results
There were 104 patients (68±15 years old, 49% male, BMI 31.4±9.1kg/m2) who met inclusion criteria (baseline characteristics in Table 1). Mean time from TTE to positive SARS-CoV-2 PCR test was 139±91 days. Twenty-nine (28%) participants died during the index COVID-19 admission. There was no association of pre-COVID echocardiographic measures of systolic ventricular function with any endpoint. Diastolic function, as assessed by LV e', was associated with mortality (Table 2). There were 25 patients (24%) with a normal lateral e' (≥10cm/s); none died. There were 35 (34%) patients with LV e' lateral velocity <8 cm/s, of whom 15 (43%) died. LV e' lateral velocity <8 cm/s was associated with an unadjusted odds ratio of 7.69 (95% confidence interval [CI] 2.26–26.19) for death and 3.25 (95% CI 1.11–9.54) for the composite outcome. The odds ratio for death was 4.76 (95% CI 1.10–20.61) and 3.78 (95% CI 0.98–14.6) for the composite outcome after adjustment for clinical risk factors (Table 2).
Conclusion
In patients with an echocardiogram prior to COVID-19, impaired diastolic function as represented by an abnormal LV e' lateral velocity was associated with both inpatient COVID-19 mortality and a composite outcome of death, mechanical ventilation, and initiation of dialysis, even after adjustment for multiple co-morbidities and medication use. Knowledge of the pre-COVID TTE results may help clinicians identify patients at higher risk of adverse outcomes during an admission for COVID-19.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Lee
- University of Pennsylvania, Philadelphia, United States of America
| | - N Patel
- University of Pennsylvania, Philadelphia, United States of America
| | - L Panepinto
- University of Pennsylvania, Philadelphia, United States of America
| | - M Byers
- University of Pennsylvania, Philadelphia, United States of America
| | - M Ambrosino
- University of Pennsylvania, Philadelphia, United States of America
| | - S Adusumalli
- University of Pennsylvania, Philadelphia, United States of America
| | - S Denduluri
- University of Pennsylvania, Philadelphia, United States of America
| | - J Cohen
- University of Pennsylvania, Philadelphia, United States of America
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Glorion M, De Wolf J, Zuber B, Cassiano F, Preau S, Brun AL, Cohen J, Tachon G, Neuville M, Brugière O, Picard C, Beaumont-Azuar L, Fessler J, Jacqmin S, Pricopi C, Chapelier A, Cuquemelle E, Parquin F, Magnan A, Roux A, Le Guen M, Sage E, Cerf C. Lung transplantation for COVID-19-associated acute respiratory distress syndrome: The first French patient. Respir Med Res 2021; 80:100851. [PMID: 34433119 PMCID: PMC8349363 DOI: 10.1016/j.resmer.2021.100851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/01/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Affiliation(s)
- M Glorion
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - J De Wolf
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - B Zuber
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - F Cassiano
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - S Preau
- Department of Intensive Care, Salengro Hospital Lille CHU Avenue du Professeur Emile Laine, 59037 Lille, France
| | - A L Brun
- Department of radiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - J Cohen
- Department of Pathology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - G Tachon
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - M Neuville
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - O Brugière
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Picard
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - L Beaumont-Azuar
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - J Fessler
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - S Jacqmin
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Pricopi
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Chapelier
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - E Cuquemelle
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - F Parquin
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Magnan
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Roux
- Department of Pathology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - M Le Guen
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - E Sage
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Cerf
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
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Chave. Badiola A, Flores-Saiffe A, Valencia-Murillo R, Mendizabal-Ruiz G, Santibañez-Morales A, Drakeley A, Cohen J. P–243 Improving ERICA’s (Embryo Ranking Intelligent Classification Assistant) performance. Should we train an AI to remain static or dynamic, adapting to specific conditions? Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can ERICA’s deep-learning capabilities allow it to learn specifics from individual clinics, and improve its performance through a quality assurance and fine-tuning process?
Summary answer
Quality assurance and fine-tuning allowed ERICA to adapt to unique specifications of individual clinics, resulting in an improved performance at each clinic.
What is known already
Machine learning (ML) solutions to real-life problems have shown that generalizability (applicability of a model to different scenarios) of a single model is fundamentally a suboptimal approach, due to the risk of underspecification. Under-specification becomes relevant in environments where there is a myriad of protocols and approaches, like during IVF treatments. It is naïve to assume that different features extracted from embryos to predict treatment success weigh the same along the overall heterogeneity of protocols. This underspecification problem takes special relevance when deploying an ML-based product, like ERICA, in a clinical setting.
Study design, size, duration
Retrospective analysis of results from the quality assurance (QA) and fine-tuning (adaptation) process performed for a deep learning algorithm named ERICA (Embryo Ranking Intelligent Classification Assistant) at five clinics (1879 embryos) between August and September 2020.
Participants/materials, setting, methods
QA and fine-tuning consist of a transfer-learning approach (of the ERICA Core model) and re-training using embryos of each clinic exclusively. Results are assessed by a 10-fold cross validation approach, which splits the database in 10 and iteratively validates on each by training on the rest. Performance of ERICA is assessed both before and after the fine-tuning process and results are presented as averages per clinic. Embryos considered for QA and fine-tuning had known outcome.
Main results and the role of chance
After the fine-tuning, ERICA showed an average improvement of 13% in accuracy (from 50.2% to 63.2%); 36.6% in specificity (from 22.4% to 59%); 11% for Positive Predictive Value (from 51% to 62); 19.6% for Negative Predictive Value (from 44.6% to 64.2%), and 3.4% for F1 score (from 60% to 63.4%). Sensitivity decreased from 78% to 65.4%.
Our results suggest ERICA’s Core is robust lending itself to be fine-tuned. It learns from individual laboratory specifics, and in this way adapts to new clinics. The results demonstrate that the Core model tends to classify embryos from new clinics as having a good prognosis, since it showed a high sensitivity and low specificity, both showing an improved balance following the fine-tune process. Additionally, the probability of finding a good prognosis embryo in the different labels, behaved as expected, decreasing its probability from Optimal (65.8%) to Poor prognosis (37.4%).
Limitations, reasons for caution
underspecification is a challenge to Artificial Intelligence (AI) based solutions pursuing a general model. For this study, our approach of QA followed by a fine-tuning process to overcome underspecification, was successful. However, it was only applied to 5 clinics, and the findings remain to be proven on a larger scale.
Wider implications of the findings: Performance of QA should be considered standard before clinical implementation of any AI based solution. Our results should be interpreted as the theoretical/expected future performance of ERICA for each clinic. Regular assessments on performance for all models generated after fine-tuning are encouraged.
Trial registration number
Not applicable
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Affiliation(s)
- A Chave. Badiola
- New Hope Fertility Center, Reproductive Medicine, guadalajara, Mexico
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
- University of Kent, School of Biosciences, Kent, United Kingdom
| | - A Flores-Saiffe
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
| | | | | | | | - A Drakeley
- Hewitt Centre for Reproductive Medicine, Reproductive Medicine, Liverpool, United Kingdom
| | - J Cohen
- ART Institute of Washington, Reproductive Medicine, Bethesda, USA
- IVF 2.0 Ltd, Embryology Director, Maghull, United Kingdom
- IVFqc, Chief Executive Officer, New York, USA
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Chavez-Badiola A, Farias AFS, Mendizabal-Ruiz G, Griffin D, Valencia-Murillo R, Reyes-Gonzalez D, Drakeley AJ, Cohen J. O-235 ERICA (Embryo Ranking Intelligent Classification Assistant) AI predicts miscarriage in poorly ranked embryos from one static, non-invasive embryo image assessment. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.059] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does ERICA’s prognosis ranking based on ploidy, predict early miscarriage following positive biochemical pregnancy test?
Summary answer
The lower ERICA grades embryos, the higher the likelihood of early miscarriage, irrespective of age group.
What is known already
The vast majority of early miscarriages are due to aneuploidy, but preimplantation genetic testing for aneuploidy (PGTA) is potentially invasive, expensive, time-consuming and usually necessitates cryopreservation. Current methods for embryo selection based on morphology and morphokinetics are poorly correlated with ploidy. ERICA is a deep-learning non-invasive tool for embryo ranking, trained to identify ploidy, and has previously been shown to be similar or better than experienced embryologists in assessing implantation potential. AI-based tools capable of embryo ranking and assessment could help save laboratory time and costs, avoiding risk to embryos from invasive techniques.
Study design, size, duration
Retrospective analysis of 599 blastocysts transferred over 12 months in which ERICA was used to assist embryologists during the embryo selection process. ERICA’s prognosis based on ploidy potential is presented as groups labelled as “optimal”, “good”, “fair”, or “poor”. Embryo transfers (ET) reaching biochemical pregnancy (beta-hCG ≥ 20iu) were considered for the study. Early pregnancy loss (EPL) was defined as a biochemical pregnancy failing to develop a gestational sac and/or failure to show heartbeat (FHR).
Participants/materials, setting, methods
ETs resulting in biochemical pregnancies at two IVF clinics were followed-up to FHR till 8 weeks gestation. EPLs were divided into groups according to the presence or absence of a pregnancy sac. ERICA’s suggested prognosis during the embryo selection process was tested against pregnancy outcomes. Further analysis of pregnancy outcomes and their relation to ERICA’s labels was also performed based on age groups. Z-test for two proportions was used to assess statistical significance.
Main results and the role of chance
506 ETs were performed for 599 embryos (mean 1.2 embryos), from which 285 resulted in positive pregnancy tests (56.3%). Thirty-one (10.9%) EPLs happened before the identification of a gestational sac (GS). Ten pregnancies failed to develop FHR after initial GS identification (3.9%), for an overall EPL of 14.4%. The average age in this group was 35.4 years. When evaluated using ERICA’s labels “optimal”, “good”, “fair, and “poor”, chances of miscarriage before GS were 8.9% (8/89); 14.1% (11/78); 18.5% (5/27); and 18.7% (9/48) respectively, where denominator represents total number within a label (i.e. EPL/n). When including all EPLs, chances of miscarriage according to the same labels were 11.2%; 17.9%; 22.2%; and 22.9% respectively.
ERICA’s performance to anticipate the risk of EPL showed statistical significance when the optimal label was compared against all other labels (Z -1.786, p < 0.05), and against the poor prognosis label (Z=-1.653, p < 0.05). After stratifying the dataset according to age groups, increasing miscarriage rates were maintained as ERICA’s prognosis for an embryo worsened, regardless of age groups. The most notable performance was for ≤35-year-olds, where embryos ranked as optimal had an EPL rate of 14.3% in contrast to lowest ranked embryos having a 33.3% EPL rate.
Limitations, reasons for caution
The retrospective nature of this study along with its sample-size might limit the reach of our conclusions, in particular for older patients. The results we present must still be confirmed prospectively, and on a larger dataset.
Wider implications of the findings
Most EPLs are attributed to genetic factors, hence ERICA’s training for embryo ranking was based on ploidy. We conclude that ERICA’s AI is able to identify embryos at a higher risk of EPL non-invasively. Cytogenetic studies from products of miscarriage would help to confirm the hypothesis.
Trial registration number
Not applicable
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Affiliation(s)
- A Chavez-Badiola
- IVF 2.0 Ltd, Chief Executive Officer, Maghull, United Kingdom
- University of Kent, School of biosciences, Kent, United Kingdom
- New Hope Fertility Center, Reproductive Medicine, Guadalajara, Mexico
| | | | - G Mendizabal-Ruiz
- IVF 2.0 Ltd, Research and development, Maghull, United Kingdom
- Universidad de Guadalajara, Computational Sciences, Guadalajara, Mexico
| | - D Griffin
- University of Kent, School of biosciences, Kent, United Kingdom
| | | | | | - A J Drakeley
- IVF 2.0 Ltd, Research and development, Maghull, United Kingdom
- Hewitt Centre for Reproductive Medicine, Reproductive medicine, Liverpool, United Kingdom
| | - J Cohen
- ART Institute of Washington, Reproductive medicine, Bethesda, U.S.A
- IVFqc, Chief Executive Officer, New York, U.S.A
- IVF 2.0 Ltd, Embryology director, Maghull, United Kingdom
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Drakeley A, Flores-Saiffe A, Chavez-Badiola A, Mendizabal-Ruiz G, Reyes-González D, Valencia R, Cohen J. P–244 ERICA’s (Embryo Ranking Intelligent Classification Assistant) ranking, based on ploidy prediction, is strongly correlated with pregnancy outcomes. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
How does ERICA perform when ranking the most suitable embryos for transfer in terms of clinical pregnancy, and the presence of a fetal heartbeat (FHB)?
Summary answer
ERICA’s Artificial Intelligence ranking system was positively correlated with outcomes defined as implantation and presence of FHB. Best-ranking embryos outperformed lower-ranking embryos by statistical significance.
What is known already
ERICA, the Embryo Ranking Intelligent Classification Assistant, is a deep learning AI system trained to rank embryos based on their ploidy status, which is highly correlated with successful treatments.
ERICA ranks the embryos according to their prognosis predictions and labels them into four quality categories: optimal, good, fair, and poor. ERICA’s performance in the clinic remains to be tested.
Study design, size, duration
Retrospective analysis on ERICA’s performance over 4 consecutive months after quality assurance and fine-tuning processes. We compared both the ranking and prognosis of the AI algorithm against clinical outcomes in IVF cycles and subsequent embryo transfers. For this study, all cycles where ERICA was used to assist embryologists during the embryo selection process were included. Double embryo transfers with a single FHB where excluded.
Participants/materials, setting, methods
Total 77 cycles with 81 transfers of 98 embryos (17 cases underwent a double embryo transfer) from two IVF clinics. Evaluated clinical outcomes included biochemical pregnancy test (defined as beta human chorionic gonadotropin >20 mUI/ml), and presence/absence of FHB. We compared the ERICA rankings and predictions against outcome and a sub-analysis was performed on transferred embryos with known ploidy status (14 embryos).
Main results and the role of chance
The distribution of embryos within the ERICA categories are 42% for optimal, 38% for good, 19% for fair, and 6% for poor. The observed biochemical pregnancy rate was 51%, 25%, 47% and 33% respectively, and 39%, 22%, 42%, 17% for FHB. We found statistical significance (Z = 1.78; p = 0.0378) for the proportion of biochemical pregnancy between transfers labelled by ERICA as optimal (51%) and all lower rankings (33%). The proportion of transfers with presence of FHB within the optimal group was 39%, compared with 29% for the rest of the embryos. This did not show statistical significance (Z = 1.141; p = 0.127). Additionally, we observed that the proportion of biochemical pregnancy and presence of FHB in the group of transfers with known ploidy (n = 14) was 50% and 36% respectively, and the transfers with unknown ploidy and labelled as optimal by ERICA (n = 35) was 54% and 43% respectively.
Limitations, reasons for caution
This is the first report on ERICA’s performance on real clinical data, and despite being a relatively small dataset, we observed statistical significance of the embryos labelled by ERICA as having optimal quality. Further studies should be conducted with larger datasets and more clinics included to strengthen the evidence.
Wider implications of the findings: This is the first report on ERICA’s performance on real clinical data, and despite being a relatively small dataset, we observed statistical significance of the embryos labelled by ERICA as having optimal quality. Further studies should be conducted with larger datasets and more clinics included to strengthen the evidence.
Trial registration number
Not applicable
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Affiliation(s)
- A Drakeley
- Hewitt Fertility Centre- Liverpool Women’s Hospital, Reproductive Medicine, Liverpool, United Kingdom
| | - A Flores-Saiffe
- Universidad de Guadalajara, Department of Computational Sciences-, Guadalajara, Mexico
| | - A Chavez-Badiola
- University of Kent, School of Bioscience, Canterbury, United Kingdom
| | - G Mendizabal-Ruiz
- Universidad de Guadalajara, Department of Computational Sciences-, Guadalajara, Mexico
| | | | - R Valencia
- IVF 2.0 Limited, Research & Development, Guadalajara, Mexico
| | - J Cohen
- IVFqc, Research & Development, New York, USA
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Badiola AC, Mendizabal G, Cohen J, Flores-Saiffe A, Roberto VM, Drakeley A. P–096 Real-time ranking of single spermatozoa using artificial vision analysis of complex motility patterns during ICSI aimed at improving fertilization and blastocyst development. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.095] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Can real-time artificial vision identify beneficial movement patterns of single spermatozoa in a cohort visualized in PVP during ICSI possibly enhancing fertilization and embryo development?
Summary answer
Artificial vision seems able to identify advantageous movement patterns of individual spermatozoa having a significant impact on both normal fertilization and blastocyst formation.
What is known already
Spermatozoa isolated from poor semen may reduce the quality of embryo development and blastocyst formation. Normal motility is dependent on general sperm morphology and characteristic movement of the flagellum enabling forward mobility. Spermatozoa roll as they swim. It is known that this rotational motion around their longitudinal axis promotes rheotaxis, which is a mechanism that allows the sperm to navigate to the site of fertilization. Therefore, it is possible that the characteristics of the rotational movement are related to sperm quality.
Study design, size, duration
Non-intervention study based on a cohort of 132 videos of in-vitro fertilization treatments with ICSI during which the sperm selection process was recorded up to sperm injection. The study was performed at one IVF center within a 6-month period. Injected spermatozoa and their corresponding oocytes were individually assessed from fertilization to blastocyst formation. Videos, where spermatozoa selected for injection could not be identified, were excluded. Relevant outcomes included normal fertilization (2PN), and blastocyst formation.
Participants/materials, setting, methods
Using a digitizer attached to an optical microscope (640 x 480 pixels), videos were recorded to include the sperm selection process, immobilization, and subsequent injection following standard ICSI protocols. Individual spermatozoa motility features were extracted using a proprietary computer-vision algorithm (SID, IVF 2.0 LTD). The rotational movements of spermatozoa were inferred by computing the variations of the mean intensity of the sperm in the video-sequence across time (MI).
Main results and the role of chance
Based on SID’s analysis, we found statistically significant differences between the median prominences of the MI of those injected spermatozoa that resulted in successful fertilization in comparison to those with failed fertilization (p-value=0.029, 28 negative fertilization, and 71 positive fertilization) using a one-tailed t-Student test with a significance level of 5%. We also found statistically significant differences between the median prominences of the MI of those spermatozoa that resulted in blastocysts in comparison with the spermatozoa-oocyte cohorts which didn’t reach the blastocyst stage (p-value 0.004, 51 with negative blastocyst formation and 48 with blastocyst formation).
Limitations, reasons for caution
The size of this database is modest, therefore a larger study with multiple clinics will be necessary to confirm the findings. Large prominence does not necessarily assurance successful fertilization or blastocyst formation since there may be other factors such as oocyte quality or the ICSI technique.
Wider implications of the findings: Objective assessment of sperm rotational movement is difficult to quantify and to be objectively assessed during standard sperm selection. Real-time artificial vision tools such as SID could assist embryologists during the sperm selection process for ICSI.
Trial registration number
NA
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Affiliation(s)
- A Chave Badiola
- New Hope Fertility Center, Reproductive Medicine, Guadalajara, Mexico
- University of Kent, School of Biosciences, Kent, United Kingdom
- IVF 2.0 Ltd, Chief Executive Officer, Maghull, United Kingdom
| | - G Mendizabal
- Universidad de Guadalajara, Departamento de Ciencias Computacionales, Guadalajara, Mexico
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
| | - J Cohen
- ART Institute of Washington, Reproductive Medicine, Bethesda, USA
- IVFqc, Chief Executive Officer, New York, USA
- IVF 2.0 Ltd, Embryology Director, Maghull, United Kingdom
| | - A Flores-Saiffe
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
| | - V M Roberto
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
| | - A Drakeley
- IVF 2.0 Ltd, Research and Development, Maghull, United Kingdom
- Hewitt Centre for Reproductive Medicine, Reproductive Medicine, Liverpool, United Kingdom
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Karmali R, Donovan A, Wagner‐Johntson N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Lansigan F, Kaplan JB, Caimi PB, Rajguru S, Evens A, Klein A, Umyarova E, Amengual JE, Lue JK, Diefenbach C, Epperla N, Barta SK, Hernandez‐Ilizaliturri FJ, Handorf E, Villa D, Gerrie AS, Li S, Mederios J, Wang M, Cohen J, Calzada O, Churnetski M, Hill B, Sawalha Y, Gerson JN, Kothari S, Vose JM, Bast M, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B. SURVIVAL FOLLOWING FIRST RELAPSE IN YOUNGER PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.60_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - A. Donovan
- Dartmouth Hitchcock, Hem Onc Lebanon USA
| | | | - M. Messmer
- Johns Hopkins University, Hem Onc Baltimore USA
| | - A. Mehta
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - J. K. Anderson
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - N. Reddy
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - A. E. Kovach
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - D. J. Landsburg
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | - M. Glenn
- Huntsman Cancer Institute, Hem Onc Salt Lake City USA
| | | | | | | | | | - P. B. Caimi
- Case Western Reserve University, Hem Onc Cleveland USA
| | - S. Rajguru
- University of Wisconsin, Hem Onc Madison USA
| | - A. Evens
- Rutgers, Hem Onc New Brunswick USA
| | | | - E. Umyarova
- University of Vermont, Hem Onc Burlington USA
| | | | | | | | - N. Epperla
- Ohio State University, Hem Onc Columbus USA
| | - S. K. Barta
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - E. Handorf
- Fox Chase Cancer Center, Hematology Oncology Philadelphia USA
| | - D. Villa
- BC Cancer, Hem Onc Vancouver Canada
| | | | - S. Li
- MD Anderson, Hem Onc Houstin USA
| | | | - M. Wang
- MD Anderson, Hem Onc Houstin USA
| | | | | | | | | | | | - J. N. Gerson
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - J. M. Vose
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - M. Bast
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - T. S. Fenske
- Medical College of Wisconsin, Hem Onc Milwaukee USA
| | | | | | - D. Bond
- Ohio State University, Hem Onc Columbus USA
| | - V. Bachanova
- University of Minnesota , Hem Onc Minneapolis USA
| | - B. Kolla
- University of Minnesota , Hem Onc Minneapolis USA
| | - J. Chavez
- Moffitt Cancer Center, Hem Onc Tampa USA
| | - B. Shah
- Moffitt Cancer Center, Hem Onc Tampa USA
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Worst MA, Cain B, Nelson T, Cohen J, Drilon AE. Oncologist management of NTRK fusion-positive NSCLC improves after virtual patient simulation participation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e23008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23008 Background: Although relatively rare, neurotrophic receptor tyrosine kinase (NTRK) fusions, represent a clinically relevant subgroup of NSCLC that can derive benefit from targeted therapies. Relatively quick and durable responses have been achieved with these targeted therapies in advanced NSCLC and intracranial activity has also been observed. The objective of this study was to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention improved performance of oncologists in using appropriate strategies to diagnose and manage patients with NTRK fusion-positive advanced NSCLC. Methods: The CME intervention consisted of two patient cases presented in a VPS platform that allowed learners to order lab tests, diagnoses and treatments in a manner matching the scope and depth of actual practice. Clinical decisions made by the learners using open field entries within an EHR interface were analyzed and, after each decision, tailored clinical guidance (CG) was provided based on current evidence and expert recommendation. Learner decisions were collected post-CG and compared with each user’s baseline (pre-CG) data using a McNemar’s test to determine P values. Results were then aggregated for the two cases based on clinical decisions and stratified by practice setting. The activity posted July 31, 2020; data were collected through December 1, 2020. Results: Overall significant improvements were seen after CG in clinical decisions made by oncologists in both the community and academic settings [reported as % absolute improvement (% correct pre-CG vs % correct post-CG); P value]. Conclusions: This analysis demonstrated that VPS that immerses and engages oncologists in an authentic and practical learning experience can significantly improve evidence-based clinical decisions related to the diagnosis and management of patients with NTRK fusion-positive advanced NSCLC. Despite the improvements, additional educational activities are needed to address any residual gaps and further increase oncologists’ ability in this clinical setting.[Table: see text]
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Affiliation(s)
| | | | | | | | - Alexander E. Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Worst MA, Caracio R, Lucero K, Cohen J. CME curriculum improves clinician knowledge, competence, and confidence in managing patients with NF1-related tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23009 Background: Neurofibromatosis type 1 (NF1) is an uncommon complex autosomal dominant disorder caused by germline mutations in the NF1 tumor suppressor gene. Therapeutic options have historically been limited with surgical debulking being the preferred treatment modality. However, recent clinical data have shown improved outcomes with the use of MEK inhibitors. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of physician learners with respect to the treatment of NF1-related tumors. Methods: The educational series consisted of four online, CME-certified activities. For each activity, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities, stratified by learning theme, and evaluated by target specialty. A repeated pairs pre-/post-assessment study design was used and McNemar’s test or paired samples t-test (P < .05) assessed educational effect. The first activity in the series launched Dec. 2019 and the last launched June 2020; data were collected until Dec. 2020. Results: Overall significant improvements were seen after education for oncologists (N = 258, P < .001), neurologists (N = 474, P < .001), surgeons (N = 427, P < .001), neurosurgeons (N = 93, P < .05), and pediatricians (N = 56, P < .001), regardless of practice setting. A sub-analysis of community specialists also showed significant improvements after education: oncologists (N = 117, P < .01), neurologists (N = 188, P < .001), and surgeons (N = 206, P < .001). Outcomes assessed by learning themes and specialty showed relative percent increases, with the majority being statistically significant. Conclusions: This analysis demonstrates that oncologists’ and other specialists’ knowledge, competence, and confidence regarding the treatment of NF1-related tumors improved after education, as measured through a comprehensive analysis of CME outcomes data from a variety of activities designed to achieve these ends. These results have the ability to translate to improvements in clinical care. Despite the improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.
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Rubinstein L, Paul AM, Houseman C, Abegaz M, Tabares Ruiz S, O’Neil N, Kunis G, Ofir R, Cohen J, Ronca AE, Globus RK, Tahimic CGT. Placenta-Expanded Stromal Cell Therapy in a Rodent Model of Simulated Weightlessness. Cells 2021; 10:940. [PMID: 33921854 PMCID: PMC8073415 DOI: 10.3390/cells10040940] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
Long duration spaceflight poses potential health risks to astronauts during flight and re-adaptation after return to Earth. There is an emerging need for NASA to provide successful and reliable therapeutics for long duration missions when capability for medical intervention will be limited. Clinically relevant, human placenta-derived therapeutic stromal cells (PLX-PAD) are a promising therapeutic alternative. We found that treatment of adult female mice with PLX-PAD near the onset of simulated weightlessness by hindlimb unloading (HU, 30 d) was well-tolerated and partially mitigated decrements caused by HU. Specifically, PLX-PAD treatment rescued HU-induced thymic atrophy, and mitigated HU-induced changes in percentages of circulating neutrophils, but did not rescue changes in the percentages of lymphocytes, monocytes, natural killer (NK) cells, T-cells and splenic atrophy. Further, PLX-PAD partially mitigated HU effects on the expression of select cytokines in the hippocampus. In contrast, PLX-PAD failed to protect bone and muscle from HU-induced effects, suggesting that the mechanisms which regulate the structure of these mechanosensitive tissues in response to disuse are discrete from those that regulate the immune- and central nervous system (CNS). These findings support the therapeutic potential of placenta-derived stromal cells for select physiological deficits during simulated spaceflight. Multiple countermeasures are likely needed for comprehensive protection from the deleterious effects of prolonged spaceflight.
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Affiliation(s)
- Linda Rubinstein
- Universities Space Research Association, Columbia, MD 21046, USA; (L.R.); (A.M.P.)
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
| | - Amber M. Paul
- Universities Space Research Association, Columbia, MD 21046, USA; (L.R.); (A.M.P.)
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL 32114, USA
| | - Charles Houseman
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Blue Marble Space Institute of Science, Seattle, WA 98154, USA
| | - Metadel Abegaz
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Blue Marble Space Institute of Science, Seattle, WA 98154, USA
| | - Steffy Tabares Ruiz
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Blue Marble Space Institute of Science, Seattle, WA 98154, USA
| | - Nathan O’Neil
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Blue Marble Space Institute of Science, Seattle, WA 98154, USA
| | - Gilad Kunis
- Pluristem Ltd., Haifa 31905, Israel; (G.K.); (R.O.)
| | - Racheli Ofir
- Pluristem Ltd., Haifa 31905, Israel; (G.K.); (R.O.)
| | - Jacob Cohen
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
| | - April E. Ronca
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- Wake Forest Medical School, Winston-Salem, NC 27101, USA
| | - Ruth K. Globus
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
| | - Candice G. T. Tahimic
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94035, USA; (C.H.); (M.A.); (S.T.R.); (N.O.); (J.C.); (A.E.R.); (R.K.G.)
- KBR, Houston, TX 77002, USA
- Department of Biology, University of North Florida, Jacksonville, FL 32224, USA
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Parikh K, Topping DL, Dhoble S, Cohen J, Kadkhoda H, Kugel P, Van Laar ES. Patient-centric care in bladder cancer: Virtual simulation to benefit clinical decision-making of oncologists. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
492 Background: Immunotherapy (IO) utility in bladder cancer (UC) has expanded into multiple stages of disease. Employing IO optimally requires mastery of clinical trial data, patient eligibility criteria, and interpretation of biomarkers and determination of treatment sequencing. Given the nuanced therapeutic decision-making, education was developed in partnership between Medscape Oncology and Society for Immunotherapy of Cancer (SITC) to assist oncologists in improving their performance surrounding the management of patients with advanced UC. Methods: A virtual patient simulation (VPS) continuing medical education (CME)-certified activity depicting 2 advanced UC cases was made available to oncologist members of Medscape. The cases depicted 1) a patient with newly diagnosed metastatic UC with comorbidities and PDL1+ disease and 2) a patient with advanced UC progressing on platinum therapy with no actionable mutations. The VPS platform captures real-life decision making process of oncologists in an EHR-like format supported by an extensive database of diagnostic and treatment possibilities. Learners were able to interact with patients via video, order lab tests, assess patients, make diagnoses, and order treatments matching the scope and depth of actual practice. Tailored clinical guidance (CG) employing up-to-date evidence-based and faculty recommendations was provided after each decision point. Decisions were collected pre- and post-CG and analyzed using McNemar’s test to determine p-values. Data were collected from 4/28/20 to 7/13/20. Results: Analyses from oncologists (n = 51-66) found significant improvement in performance measured pre- to-post CG: Case 1: Ordering appropriate testing to determine patient eligibility for therapy (39% pre; 65% post; p < .001) Prescribing appropriate therapy based on patient- and disease-specific factors (38% pre; 77% post; p < .001) Providing appropriate counseling and follow-up for a patient receiving treatment (65% pre; 80% post; p < .01) Case 2: Ordering appropriate testing to determine patient eligibility for therapy (39% pre; 57% post; p < .01) Prescribing appropriate therapy based on patient- and disease-specific factors (25% pre; 41% post; p < .01) Providing appropriate counseling and follow-up for a patient receiving treatment (71% pre; 82% post; p < .05). Conclusions: This activity demonstrates the value of providing oncologists a simulation platform to practice and master clinical decision-making of the limitless possible diagnostic and therapeutic options in the management of advanced UC. Insights from rationales for each clinical decision point uncover continued gaps for oncologists on guideline recommendations, efficacy outcomes, or molecular implications. They also highlight barriers including limited experience or confidence with IO.
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Mestres E, García-Jiménez M, Casals A, Cohen J, Acacio M, Villamar A, Matia-Algué Q, Calderón G, Costa-Borges N. Factors of the human embryo culture system that may affect media evaporation and osmolality. Hum Reprod 2021; 36:605-613. [PMID: 33458748 DOI: 10.1093/humrep/deaa370] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Which lab-related factors impact the culture system's capacity to maintain a stable osmolality during human embryo culture? SUMMARY ANSWER Incubator humidity, the volume of mineral oil, the type of culture media and the design of time-lapse dishes have been identified as important parameters that can cause an impact on media evaporation and consequently osmolality during culture. WHAT IS KNOWN ALREADY Culture medium is a critical component in human embryo culture. Minimizing its evaporation during culture is an adequate strategy to stabilize osmolality and, as a result, improving culture conditions and clinical outcomes. STUDY DESIGN, SIZE, DURATION The studied variables included media composition and supplementation; volume of mineral oil; incubator humidification; and the type of dish and incubator used. Additionally, six time-lapse dish models were compared in their ability to prevent evaporation. PARTICIPANTS/MATERIALS, SETTING, METHODS Dishes were incubated in parallel to analyze osmolality during culture between groups: synthetic oviductal medium enriched with potassium versus human tubal fluid medium; protein versus no protein supplementation; dry versus humid atmosphere; high versus low volume of mineral oil. Additionally, media evaporation was compared between six models of time-lapse dishes with distinct designs, cultured in a joint incubator. Two of them were retested in their corresponding incubator to analyze the dish-incubator fit. Daily osmolality measurements were compared between groups. Linear regression was performed to analyze evaporation rates. MAIN RESULTS AND THE ROLE OF CHANCE Protein supplementation did not significantly affect evaporation. Contrarily, humidity levels inside the incubators, the volume of mineral oil and the type of culture media, played an important role in osmolality stabilization. The design of time-lapse dishes and their recommended preparation protocol heavily influenced their evaporation rates, which were further altered by each incubator's characteristics. Media with initially high osmolalities had a bigger risk of reaching hypertonic levels during culture. LIMITATIONS, REASONS FOR CAUTION While numerous, the studied variables are limited and therefore other factors could play a role in osmolality dynamics, as well. Incontrollable atmospheric factors could also result in some variation in the observed results between different centers and laboratories. WIDER IMPLICATIONS OF THE FINDINGS Published literature has extensively described how hypertonic media may impair embryo development and negatively affect clinical outcomes; therefore, maintaining a stable osmolality during culture should be considered essential. This work is of interest both for embryologists when analyzing their culture system and methodologies, as well as manufacturers in charge of designing IVF consumables. STUDY FUNDING/COMPETING INTEREST(S) This study was privately funded. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E Mestres
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - M García-Jiménez
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - A Casals
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - J Cohen
- ART Institute of Washington, Hudson, NY, USA
| | - M Acacio
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - A Villamar
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - Q Matia-Algué
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - G Calderón
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
| | - N Costa-Borges
- Embryotools R&D Center, Parc Científic de Barcelona, Barcelona, Spain
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Abstract
Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.
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Affiliation(s)
- M Siebert
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France; Department of general surgery and emergency surgery, CHU de Grenoble, Grenoble, France.
| | - A Le Fouler
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - N Sitbon
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - J Cohen
- Multipurpose intensive care unit, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - J Abba
- Department of general surgery and emergency surgery, CHU de Grenoble, Grenoble, France
| | - E Poupardin
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
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Clinton J, Cohen J, Lapinski J, Trussler M. Partisan pandemic: How partisanship and public health concerns affect individuals' social mobility during COVID-19. Sci Adv 2021; 7:eabd7204. [PMID: 33310734 PMCID: PMC7787499 DOI: 10.1126/sciadv.abd7204] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 05/21/2023]
Abstract
Rampant partisanship in the United States may be the largest obstacle to the reduced social mobility most experts see as critical to limiting the spread of the COVID-19 pandemic. Analyzing a total of just over 1.1 million responses collected daily between 4 April and 10 September reveals not only that partisanship is more important than public health concerns for explaining individuals' willingness to stay at home and reduce social mobility but also that the effect of partisanship has grown over time-especially among Republicans. All else equal, the relative importance of partisanship for the increasing (un)willingness of Republicans to stay at home highlights the challenge that politics poses for public health.
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Affiliation(s)
- J Clinton
- Department of Political Science, Vanderbilt University, Nashville, TN, USA.
| | - J Cohen
- Survey Monkey, Menlo Park, CA
| | - J Lapinski
- Department of Political Science, University of Pennsylvania, Philadelphia, PA, USA
| | - M Trussler
- Penn Program on Opinion Research and Election Studies, University of Pennsylvania, Philadelphia, PA, USA
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Mehta N, Armagan A, Chatterjee-Shin P, Cohen J. P222 SEVERE ASTHMA: VIRTUAL PATIENT SIMULATION IMPROVES CLINICAL DECISIONS OF ALLERGISTS AND PULMONOLOGISTS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lucero KS, Spyropoulos J, Blevins D, Warters M, Norton A, Cohen J. Virtual Patient Simulation in Continuing Education: Improving the Use of Guideline-Directed Care in Venous Thromboembolism Treatment. J Eur CME 2020; 9:1836865. [PMID: 33178492 PMCID: PMC7594728 DOI: 10.1080/21614083.2020.1836865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Results of a CME-certified activity completed by a total of 986 cardiologists and 783 haematologists-oncologists (haem-oncs) from around the world were examined to determine whether virtual patient simulation could improve decision-making and performance within the simulation related to patient evaluation, tailoring anticoagulant therapy, and patient management to improve adherence using patient-centred care strategies. Results showed a significant overall impact of education from pre- to post-clinical guidance (CG) on correct decisions made in both cases for cardiologists, with a relative improvement of 22% for Case 1 (45% pre- to 55% post-CG, n = 475, t(474) = 14.12, P<.001, Cohen’s d =.46) and 19% for Case 2 (62% pre- to 74% post-CG, n = 245, t(244) = 11.95, P<.001, Cohen’s d =.59). Impact also was seen for haem-oncs, with a relative improvement of 27% for Case 1 (45% pre- to 57% post-CG, n = 280, t(279) = 11.91, P <.001, Cohen’s d =.60) and 19% for Case 2 (63% pre- to 75% post-CG, n = 147, t(146) = 9.52, P <.001, Cohen’s d =.58). Virtual patient simulation improved cardiologists’ and haem-oncs management of patients with pulmonary embolism in a simulated environment.
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Affiliation(s)
| | | | | | - Martin Warters
- Learner Experience and Instructional Design, Medscape, LLC, New York, NY, USA
| | | | - Jacob Cohen
- Outcomes and Insights Manager, Medscape, LLC, New York, NY, USA
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Wilhite A, Cohen J, Duppenthaler M, Wicklund T, Thompson R, Nelson K, Ghebre R. Assessing barriers to genetic screening for hereditary breast, ovarian, and colon cancer in high-risk populations. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cohen J. Future mechanisms for funding research on unhealthy commodities – criteria for industry-supported research funding programs. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Research funding is scarce and some argue that commercial enterprises not only can, but should, fund extramural research. Others are concerned by the evidence that commercial funding of research is used by these commercial interests to subvert the scientific process, to gain credibility and to advance their own financial interests, without regard to broader societal values and needs. A key question is whether there might be a funding model whereby industry-supported research funding programs are acceptable to the public health community and that support broader societal goals. We developed eight criteria for evaluating research funding programs that include support from the tobacco industry: (1) transparency and independence; (2) competitive funding process; (3) ownership of data and freedom to publish; (4) independent research agenda; (5) governance; (6) protection against conflict of interest; (7) industry public relations gains that counteract public health; and, (8) feasibility. We will discuss the applicability of similar programs for funding research on other unhealthy commodities, and on the practices of other harmful industries such as the fossil fuels industry.
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Affiliation(s)
- J Cohen
- Institute for Global Tobacco Control, Johns Hopkins University, Baltimore, USA
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Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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