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Glass M, Ji Z, Davis R, Pavlisko E, DiBernardo L, Carney J, Fishbein G, Luthringer D, Miller D, Mitchell R, Larsen B, Butt Y, Bois M, Maleszewski J, Halushka M, Seidman M, Lin CY, Buja M, Stone J, Dov D, Carin L, Glass C. A Machine Learning Algorithm Improves the Diagnostic Accuracy of the Histologic Component of Antibody Mediated Rejection (AMR-H) in Cardiac Transplant Endomyocardial Biopsies. Cardiovasc Pathol 2024:107646. [PMID: 38677634 DOI: 10.1016/j.carpath.2024.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Pathologic antibody mediated rejection (pAMR) remains a major driver of graft failure in cardiac transplant patients. The endomyocardial biopsy remains the primary diagnostic tool but presents with challenges, particularly in distinguishing the histologic component (pAMR-H) defined by 1) intravascular macrophage accumulation in capillaries and 2) activated endothelial cells that expand the cytoplasm to narrow or occlude the vascular lumen. Frequently, pAMR-H is difficult to distinguish from acute cellular rejection (ACR) and healing injury. With the advent of digital slide scanning and advances in machine deep learning, artificial intelligence technology is widely under investigation in the areas of oncologic pathology, but in its infancy in transplant pathology. For the first time, we determined if a machine learning algorithm could distinguish pAMR-H from normal myocardium, healing injury and ACR. MATERIALS AND METHODS A total of 4,212 annotations (1,053 regions of normal, 1,053 pAMR-H, 1,053 healing injury and 1,053 ACR) were completed from 300 hematoxylin and eosin slides scanned using a Leica Aperio GT450 digital whole slide scanner at 40X magnification. All regions of pAMR-H were annotated from patients confirmed with a previous diagnosis of pAMR2 (>50% positive C4d immunofluorescence and/or >10% CD68 positive intravascular macrophages). Annotations were imported into a Python 3.7 development environment using the OpenSlide™ package and a convolutional neural network approach utilizing transfer learning was performed. RESULTS The machine learning algorithm showed 98% overall validation accuracy and pAMR-H was correctly distinguished from specific categories with the following accuracies: normal myocardium (99.2%), healing injury (99.5%) and ACR (99.5%). CONCLUSION Our novel deep learning algorithm can reach acceptable, and possibly surpass, performance of current diagnostic standards of identifying pAMR-H. Such a tool may serve as an adjunct diagnostic aid for improving the pathologist's accuracy and reproducibility, especially in difficult cases with high inter-observer variability. This is one of the first studies that provides evidence that an artificial intelligence machine learning algorithm can be trained and validated to diagnose pAMR-H in cardiac transplant patients. Ongoing studies include multi-institutional verification testing to ensure generalizability.
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Affiliation(s)
- Matthew Glass
- Duke Division of Artificial Intelligence and Computational Pathology, Duke University Medical Center, Durham NC, USA; Department of Anesthesiology, Duke University Medical Center, Durham NC, USA
| | - Zhicheng Ji
- Department of Biostatistics and Bioinformatics, Duke School of Medicine, Durham NC, USA
| | - Richard Davis
- Department of Pathology, Duke University Medical Center, Durham NC, USA
| | - Elizabeth Pavlisko
- Duke Division of Artificial Intelligence and Computational Pathology, Duke University Medical Center, Durham NC, USA; Department of Pathology, Duke University Medical Center, Durham NC, USA
| | - Louis DiBernardo
- Department of Pathology, Duke University Medical Center, Durham NC, USA
| | - John Carney
- Department of Pathology, Duke University Medical Center, Durham NC, USA
| | - Gregory Fishbein
- Department of Pathology, University of California at Los Angeles, Los Angeles CA, USA
| | - Daniel Luthringer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - Dylan Miller
- Department of Pathology, Intermountain Healthcare, Salt Lake City UT, USA
| | - Richard Mitchell
- Department of Pathology, Brigham and Women's Hospital, Boston MA, USA
| | - Brandon Larsen
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Phoenix AZ, USA
| | - Yasmeen Butt
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Phoenix AZ, USA
| | - Melanie Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Joseph Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Marc Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Michael Seidman
- Department of Pathology, University Health Network, Toronto Ontario, CA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University, St. Louis MO, USA
| | - Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston TX, USA
| | - James Stone
- Department of Pathology, Massachusetts General Hospital, Boston MA, USA
| | - David Dov
- Duke Division of Artificial Intelligence and Computational Pathology, Duke University Medical Center, Durham NC, USA; Pratt School of Engineering, Department of Electrical and Computer Engineering, Duke University, Durham NC, USA
| | - Lawrence Carin
- Duke Division of Artificial Intelligence and Computational Pathology, Duke University Medical Center, Durham NC, USA; Pratt School of Engineering, Department of Electrical and Computer Engineering, Duke University, Durham NC, USA
| | - Carolyn Glass
- Duke Division of Artificial Intelligence and Computational Pathology, Duke University Medical Center, Durham NC, USA; Department of Pathology, Duke University Medical Center, Durham NC, USA.
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McBride KA, O'Fee A, Hogan S, Stewart E, Madeley C, Wilkes J, Wylie E, White A, Hickey M, Stone J. Co-design of an intervention to optimize mammographic screening participation in women with obesity and/or physical disabilities. Radiography (Lond) 2024; 30:951-963. [PMID: 38657389 DOI: 10.1016/j.radi.2024.04.011] [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: 01/21/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Mammographic breast screening/rescreening rates are suboptimal for women with obesity and/or physical disabilities. This study describes development of an intervention framework targeting obesity- and disability-related barriers to improve participation. METHODS Mixed methods combined a systematic review with first-person perspectives to optimise screening engagement among women with obesity and/or physical disabilities. Phase 1 (systematic review) was conducted following the PRISMA framework. Phase 2 involved in-depth interviews with n = 8 women with lived experience of obesity and/or physical disabilities. An inductive coding approach was applied to the data which was then combined with Phase 1 results to develop the intervention framework. RESULTS Six studies were included in the systematic review. Tailored education based on individual risk increased willingness to undergo mammographic screening. Recommendations to improve the screening experience included partnerships with consumers, targeted messaging, and enhanced professional development for breast screening staff. Participants also identified strategies to improve the uptake of screening and the experience itself. CONCLUSION Development and evaluation of interventions informed by frameworks like the one developed in this study are needed to improve engagement in screening to promote regular participation among women with physical disabilities and/or obesity. IMPLICATIONS FOR PRACTICE Successful implementation of practice interventions co-designed by women with obesity and/or physical disabilities are likely to improve their breast screening participation. Enhanced training of radiographers aimed at upskilling in empathetic communication around required manoeuvring and potentially longer screening times for clients with obesity and/or physical disabilities may encourage more positive client practitioner interactions. Client information aimed at women with obesity should include information on how to prepare for the appointment and explain there may be equipment limitations compromising imaging which may not be completed at an initial appointment.
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Affiliation(s)
- K A McBride
- School of Medicine, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - A O'Fee
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - S Hogan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - E Stewart
- BreastScreen Victoria, Melbourne, VIC, Australia
| | - C Madeley
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia
| | - J Wilkes
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia
| | - E Wylie
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - A White
- Australian Breast Density Consumer Advisory Council, Australia
| | - M Hickey
- University of Melbourne Department of Obstetrics and Gynaecology and the Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - J Stone
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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Williams IA, Morris PG, Forristal K, Stone J, Gillespie DC. Illness representations of people with later-onset functional seizures. Epilepsy Behav 2024; 152:109666. [PMID: 38382188 DOI: 10.1016/j.yebeh.2024.109666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Although functional seizures can start at any age, little is known about the individuals for whom onset occurs after the age of 40. It has been proposed that health-related traumatic events are more relevant causal factors for people with 'later-onset functional seizures' than for those whose functional seizures begin earlier in life, however, the illness representations of people with later-onset functional seizures have not yet been investigated. This study aimed to understand the experiences and illness representations of people with later-onset functional seizures. METHODS This was a mixed-methods study. People with later-onset functional seizures were recruited via a neurologist's caseload and online membership-led organisations. Semi-structured interview transcripts were analysed using Template Analysis according to the Common-Sense Model (CSM). Self-report measures of demographic and clinical details were collected to characterise the sample and verify themes. RESULTS Eight people with later-onset functional seizures participated in the study. Illness representations relating to all domains of the CSM as well as an additional theme of 'Triggers' were identified. Functional seizures were characterised as a mysterious brain disorder analogous to a computer malfunction and involving involuntary movements associated with alterations in consciousness. Perceptions of duration were indefinite, and triggers were unknown or at the extremes of autonomic arousal. Half of the sample identified health-related events/trauma as causal. Opinions were divided on 'cumulative life stress' as a causal factor. Most perceived themselves to have limited or no control but having 'control' over seizures was conceptualised as different to reducing their likelihood, frequency, or impact. Later-onset functional seizures were viewed as being more detrimental for caring and financial responsibilities but to have advantages for acceptance. CONCLUSIONS This is the first study to assess the illness representations of people with later-onset functional seizures. Many themes were similar to those identified in samples including people with earlier-onset functional seizures. Health-related trauma or events were the most strongly endorsed perceived causal factor, but with the exception of 'consequences', all representations were characterised by uncertainty. Clinicians should hold in mind the interaction between life stage and the consequences of later-onset functional seizures.
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Affiliation(s)
- I A Williams
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - P G Morris
- Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - K Forristal
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - D C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
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Fernandes S, Williams E, Finlayson N, Stewart H, Dhaliwal C, Dorward DA, Wallace WA, Akram AR, Stone J, Dhaliwal K, Williams GOS. Fibre-based fluorescence-lifetime imaging microscopy: a real-time biopsy guidance tool for suspected lung cancer. Transl Lung Cancer Res 2024; 13:355-361. [PMID: 38496695 PMCID: PMC10938104 DOI: 10.21037/tlcr-23-638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
Lung cancer is the most common cause of cancer-related deaths worldwide. Early detection improves outcomes, however, existing sampling techniques are associated with suboptimal diagnostic yield and procedure-related complications. Autofluorescence-based fluorescence-lifetime imaging microscopy (FLIM), a technique which measures endogenous fluorophore decay rates, may aid identification of optimal biopsy sites in suspected lung cancer. Our fibre-based fluorescence-lifetime imaging system, utilising 488 nm excitation, which is deliverable via existing diagnostic platforms, enables real-time visualisation and lifetime analysis of distal alveolar lung structure. We evaluated the diagnostic accuracy of the fibre-based fluorescence-lifetime imaging system to detect changes in fluorescence lifetime in freshly resected ex vivo lung cancer and adjacent healthy tissue as a first step towards future translation. The study compares paired non-small cell lung cancer (NSCLC) and non-cancerous tissues with gold standard diagnostic pathology to assess the performance of the technique. Paired NSCLC and non-cancerous lung tissues were obtained from thoracic resection patients (N=21). A clinically compatible 488 nm fluorescence-lifetime endomicroscopy platform was used to acquire simultaneous fluorescence intensity and lifetime images. Fluorescence lifetimes were calculated using a computationally-lightweight, rapid lifetime determination method. Fluorescence lifetime was significantly reduced in ex vivo lung cancer, compared with non-cancerous lung tissue [mean ± standard deviation (SD), 1.79±0.40 vs. 2.15±0.26 ns, P<0.0001], and fluorescence intensity images demonstrated distortion of alveolar elastin autofluorescence structure. Fibre-based fluorescence-lifetime imaging demonstrated good performance characteristics for distinguishing lung cancer, from adjacent non-cancerous tissue, with 81.0% sensitivity and 71.4% specificity. Our novel fibre-based fluorescence-lifetime imaging system, which enables label-free imaging and quantitative lifetime analysis, discriminates ex vivo lung cancer from adjacent healthy tissue. This minimally invasive technique has potential to be translated as a real-time biopsy guidance tool, capable of optimising diagnostic accuracy in lung cancer.
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Affiliation(s)
- Susan Fernandes
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Elvira Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Neil Finlayson
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, Edinburgh, UK
| | - Hazel Stewart
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Catharine Dhaliwal
- Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - David A. Dorward
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Pathology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William A. Wallace
- Department of Pathology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ahsan R. Akram
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Stone
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Centre for Photonics and Photonic Materials, Department of Physics, The University of Bath, Bath, UK
| | - Kevin Dhaliwal
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Department of Respiratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gareth O. S. Williams
- Translational Healthcare Technologies Group, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? Int J Drug Policy 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [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: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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Chalder T, Landau S, Stone J, Carson A, Reuber M, Medford N, Robinson EJ, Goldstein LH. How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial. Psychol Med 2024:1-10. [PMID: 38197148 DOI: 10.1017/s0033291723003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. METHODS We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. RESULTS All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. CONCLUSIONS Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.
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Affiliation(s)
- T Chalder
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Landau
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - A Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, London, UK
- Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - L H Goldstein
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Wuu YR, Gui B, Kokabee M, Stone J, Karten JL, Harshan M, D'Amico R, Vojnic M, Wernicke G. Prioritizing Radiation and Targeted Systemic Therapy in Patients with Resected Brain Metastases from Lung Cancer Primaries with Targetable Mutations: A Report from a Multi-Site Single Institution. Int J Radiat Oncol Biol Phys 2023; 117:e157. [PMID: 37784747 DOI: 10.1016/j.ijrobp.2023.06.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases (BrM) are a common complication of non-small cell lung cancer (NSCLC), present in up to 50% of patients. While treatment of BrM requires a multidisciplinary approach with surgery, radiotherapy (RT), and systemic therapy, advances in sequencing have improved outcomes with targetable alterations in PDL-1, EGFR, ALK, and KRAS mutations. With a push towards molecular characterization of cancers, we sought out to examine outcomes by treatment modalities at our institution with respect to prioritizing RT and targeted therapies. MATERIALS/METHODS After IRB approval, we identified patients treated with a surgical resection of BrM from NSCL primaries between 2011 to 2022 at 5 sites at our institution. Tumor molecular profiles were reviewed and patients with PDL-1, EGFR, ALK, and KRAS mutations were evaluated by a treatment modality: surgery alone or in combination with RT (SRS, WBRT) and/or systemic therapy (TKIs -1st-3rd generations, immunotherapy). The primary endpoints were in-brain freedom from progression (FFP) and overall survival (OS). SAS Studio version 4.4 was used to perform statistical analyses. RESULTS We identified 272 patients with 162/272 (60%) patients with adequate follow-up included in this analysis. The median follow-up was 27.8 months (range, 0.43 - 134.45 months). There were 59.2% females and 40.7% males, with median ages at diagnosis of 67 years for females and 66 for males, respectively. Of the entire cohort, 102/162 (63%) patients received adjuvant combination RT and systemic therapy, and 60/162 (37%) received adjuvant monotherapy (p <0.0001). The use of systemic therapy was associated with 9.89 months median time to progression vs 4.87 months without it (p = 0.077), respectively. Similarly, patients treated with a combination of RT and systemic therapy had a median FFP time of 9.77 months vs 5.28 months (p = 0.064). No significant difference in OS was found with or without systemic therapy. CONCLUSION After resection of BrM from NSCLC with PDL-1, EGFR, ALK, and KRAS mutations, we found that systemic therapy, including TKIs and immunotherapy, may have an increasing role in delaying time to progression. At our institution, as we continue to identify actionable mutations, a statistically significant number of patients continue to be treated with a combination of RT and systemic therapies with a trend toward superior FFP.
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Affiliation(s)
- Y R Wuu
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - B Gui
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - M Kokabee
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Pathology and Laboratory Medicine at Lenox Hill Hospital, New York, NY
| | - J Stone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - J L Karten
- NYIT College Of Osteopathic Medicine, Old Westbury, NY
| | - M Harshan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Pathology and Laboratory Medicine at Lenox Hill Hospital, New York, NY
| | - R D'Amico
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Neurosurgery at Lenox Hill Hospital, New York, NY
| | - M Vojnic
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Medical Oncology, Northwell Health Cancer Institute at MEETH, New York, NY
| | - G Wernicke
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiation Medicine at Lenox Hill Hospital, New York, NY
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Merritt K, McCutcheon RA, Aleman A, Ashley S, Beck K, Block W, Bloemen OJN, Borgan F, Boules C, Bustillo JR, Capizzano AA, Coughlin JM, David A, de la Fuente-Sandoval C, Demjaha A, Dempster K, Do KQ, Du F, Falkai P, Galińska-Skok B, Gallinat J, Gasparovic C, Ginestet CE, Goto N, Graff-Guerrero A, Ho BC, Howes O, Jauhar S, Jeon P, Kato T, Kaufmann CA, Kegeles LS, Keshavan MS, Kim SY, King B, Kunugi H, Lauriello J, León-Ortiz P, Liemburg E, Mcilwain ME, Modinos G, Mouchlianitis E, Nakamura J, Nenadic I, Öngür D, Ota M, Palaniyappan L, Pantelis C, Patel T, Plitman E, Posporelis S, Purdon SE, Reichenbach JR, Renshaw PF, Reyes-Madrigal F, Russell BR, Sawa A, Schaefer M, Shungu DC, Smesny S, Stanley JA, Stone J, Szulc A, Taylor R, Thakkar KN, Théberge J, Tibbo PG, van Amelsvoort T, Walecki J, Williamson PC, Wood SJ, Xin L, Yamasue H, McGuire P, Egerton A. Variability and magnitude of brain glutamate levels in schizophrenia: a meta and mega-analysis. Mol Psychiatry 2023; 28:2039-2048. [PMID: 36806762 PMCID: PMC10575771 DOI: 10.1038/s41380-023-01991-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/07/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/19/2023]
Abstract
Glutamatergic dysfunction is implicated in schizophrenia pathoaetiology, but this may vary in extent between patients. It is unclear whether inter-individual variability in glutamate is greater in schizophrenia than the general population. We conducted meta-analyses to assess (1) variability of glutamate measures in patients relative to controls (log coefficient of variation ratio: CVR); (2) standardised mean differences (SMD) using Hedges g; (3) modal distribution of individual-level glutamate data (Hartigan's unimodality dip test). MEDLINE and EMBASE databases were searched from inception to September 2022 for proton magnetic resonance spectroscopy (1H-MRS) studies reporting glutamate, glutamine or Glx in schizophrenia. 123 studies reporting on 8256 patients and 7532 controls were included. Compared with controls, patients demonstrated greater variability in glutamatergic metabolites in the medial frontal cortex (MFC, glutamate: CVR = 0.15, p < 0.001; glutamine: CVR = 0.15, p = 0.003; Glx: CVR = 0.11, p = 0.002), dorsolateral prefrontal cortex (glutamine: CVR = 0.14, p = 0.05; Glx: CVR = 0.25, p < 0.001) and thalamus (glutamate: CVR = 0.16, p = 0.008; Glx: CVR = 0.19, p = 0.008). Studies in younger, more symptomatic patients were associated with greater variability in the basal ganglia (BG glutamate with age: z = -0.03, p = 0.003, symptoms: z = 0.007, p = 0.02) and temporal lobe (glutamate with age: z = -0.03, p = 0.02), while studies with older, more symptomatic patients associated with greater variability in MFC (glutamate with age: z = 0.01, p = 0.02, glutamine with symptoms: z = 0.01, p = 0.02). For individual patient data, most studies showed a unimodal distribution of glutamatergic metabolites. Meta-analysis of mean differences found lower MFC glutamate (g = -0.15, p = 0.03), higher thalamic glutamine (g = 0.53, p < 0.001) and higher BG Glx in patients relative to controls (g = 0.28, p < 0.001). Proportion of males was negatively associated with MFC glutamate (z = -0.02, p < 0.001) and frontal white matter Glx (z = -0.03, p = 0.02) in patients relative to controls. Patient PANSS total score was positively associated with glutamate SMD in BG (z = 0.01, p = 0.01) and temporal lobe (z = 0.05, p = 0.008). Further research into the mechanisms underlying greater glutamatergic metabolite variability in schizophrenia and their clinical consequences may inform the identification of patient subgroups for future treatment strategies.
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Affiliation(s)
- Kate Merritt
- Division of Psychiatry, UCL, Institute of Mental Health, London, UK.
| | | | - André Aleman
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sarah Ashley
- Division of Psychiatry, UCL, Institute of Mental Health, London, UK
| | - Katherine Beck
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wolfgang Block
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Oswald J N Bloemen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Faith Borgan
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christiana Boules
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Juan R Bustillo
- Department of Psychiatry and Behavioral Sciences, Center for Psychiatric Research, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Aristides A Capizzano
- Department of Radiology, Division of Neuroradiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Jennifer M Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony David
- Division of Psychiatry, UCL, Institute of Mental Health, London, UK
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Arsime Demjaha
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kara Dempster
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Kim Q Do
- Center for Psychiatric Neuroscience (CNP), Department of Psychiatry, Lausanne University Hospital-CHUV, Prilly-Lausanne, Switzerland
| | - Fei Du
- Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Peter Falkai
- Department of Psychiatry, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Beata Galińska-Skok
- Department of Psychiatry, Medical University of Bialystok, Bialystok, Poland
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Cedric E Ginestet
- Department of Biostatistics and Health Informatics (S2.06), Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Naoki Goto
- Department of Psychiatry, Kokura Gamo Hospital, Kitakyushu, Fukuoka, 8020978, Japan
| | - Ariel Graff-Guerrero
- Multimodal Neuroimaging Schizophrenia Group, Research Imaging Centre, Geriatric Mental Health Program at Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Beng-Choon Ho
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Oliver Howes
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sameer Jauhar
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter Jeon
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - Tadafumi Kato
- Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Charles A Kaufmann
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute (NYSPI), New York, NY, USA
| | - Lawrence S Kegeles
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, NY, USA
| | | | | | - Bridget King
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hiroshi Kunugi
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-0031, Japan
| | - J Lauriello
- Jefferson Health-Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Pablo León-Ortiz
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
- Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Edith Liemburg
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
| | - Meghan E Mcilwain
- School of Pharmacy, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Gemma Modinos
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Elias Mouchlianitis
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jun Nakamura
- Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Miho Ota
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, 187-0031, Japan
| | - Lena Palaniyappan
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Tulsi Patel
- Division of Psychiatry, UCL, Institute of Mental Health, London, UK
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sotirios Posporelis
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK
| | - Scot E Purdon
- Neuropsychology Department, Alberta Hospital Edmonton, Edmonton, AB, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology (IDIR), Jena University Hospital, Jena, Germany
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Francisco Reyes-Madrigal
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Bruce R Russell
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Akira Sawa
- Departments of Psychiatry, Neuroscience, Mental Health, Biomedical Engineering, and Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Dikoma C Shungu
- Department of Radiology, Weill Cornell Medical College, New York City, NY, USA
| | - Stefan Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jeffrey A Stanley
- Brain Imaging Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - James Stone
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Reggie Taylor
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Katharine N Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University, East Lansing, MI, USA
| | - Jean Théberge
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | | | - Peter C Williamson
- Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia
- Institute for Mental Health, University of Birmingham, Edgbaston, UK
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lijing Xin
- Animal Imaging and Technology Core (AIT), Center for Biomedical Imaging (CIBM), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Philip McGuire
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Egerton
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Kulyk A, Shafer LA, Graff LA, Stone J, Witges K, Targownik LE, Bernstein C. A74 URGENCY FOR BOWEL MOVEMENTS IS A HIGHLY DISCRIMINATORY SYMPTOM FOR ACTIVE DISEASE IN PERSONS WITH IBD (THE MANITOBA LIVING WITH IBD STUDY). J Can Assoc Gastroenterol 2023. [PMCID: PMC9991290 DOI: 10.1093/jcag/gwac036.074] [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: 03/09/2023] Open
Abstract
Background The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity. Purpose We aimed to assess the prevalence of symptoms, and examine which symptoms are most associated with disease activity as measured by a symptom index and objective measure of inflammation. Method The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly Inflammatory Bowel Disease Symptom Inventory (IBDSI) surveys. Relative risks (RR) (with 95% confidence interval (CI)), positive and negative predictive values (PPV, NPV), and area under receiver operator curve (AUC) were reported for each symptom to predict active disease defined as: (1) active IBDSI, (2) self-reported flare, and (3) elevated fecal calprotectin (FCAL) (>250µg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn’s disease (CD) and ulcerative colitis (UC)). Result(s) In total, 69.2% of participants were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all 3 disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). Absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV, RR and AUC across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR in men = 3.5, 95% CI 1.2-9.9, RR in women = 1.8, 95% CI 1.2-2.7, AUC in men = 0.73, 95% CI 0.59-0.84, AUC in women = 0.65, 95% CI 0.56-0.72), as did blood in stool in females with UC (RR = 1.8, 95% CI 1.2-2.7). In men with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of elevated FCAL in females with CD. Conclusion(s) Fatigue was the most prevalent symptom irrespective of disease activity. Urgency stood out as being consistently associated with disease activity, irrespective of the disease measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A Kulyk
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - L A Shafer
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - L A Graff
- Internal Medicine, University of Manitoba,Department of Clinical Health Psychology, University of Manitoba
| | - J Stone
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - K Witges
- University of Manitoba IBD Clinical and Research Centre
| | - L E Targownik
- University of Manitoba IBD Clinical and Research Centre,Internal Medicine, University of Toronto, Winnipeg, Canada
| | - C Bernstein
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
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10
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Silva-Santisteban A, Mehta N, Trasolini R, Stone J, Pleskow DK. Endoscopic holmium laser lithotripsy for therapy of Bouveret syndrome. VideoGIE 2023; 8:115-117. [PMID: 36935808 PMCID: PMC10020008 DOI: 10.1016/j.vgie.2022.11.011] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Video 1Video of holmium laser lithotripsy procedure.
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Affiliation(s)
- Andy Silva-Santisteban
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Neal Mehta
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Roberto Trasolini
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - James Stone
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Douglas K Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology & Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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11
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Ozemek C, Arena R, Rouleau CR, Campbell TS, Hauer T, Wilton SB, Stone J, Laddu D, Williamson TM, Liu H, Chirico D, Austford LD, Aggarwal S. Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity. J Cardiopulm Rehabil Prev 2023; 43:109-114. [PMID: 36203224 DOI: 10.1097/hcr.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). METHODS This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. RESULTS Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. CONCLUSION Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Drs Ozemek, Arena, and Laddu); TotalCardiology Research Network, Calgary, Canada (Drs Arena, Rouleau, Campbell, Wilton, Stone, Chirico, and Aggarwal and Ms Austford); TotalCardiology™ Rehabilitation, Calgary, Canada (Drs Rouleau and Aggarwal and Ms Hauer); Departments of Psychology (Drs Rouleau, Campbell, and Aggarwal and Ms Williamson), Community Health Sciences (Dr Liu), and Kinesiology (Dr Chirico), University of Calgary, Calgary, Canada; and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada (Drs Wilton, Stone, and Liu)
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12
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Doshi SK, Kar S, Sadhu A, Horton R, Osorio J, Ellis C, Stone J, Shah M, Dukkipati SR, Adler S, Nair DG, Kim J, Wazni O, Price MJ, Holmes DR, Shipley R, Christen T, Allocco DJ, Reddy VY. Two-Year Outcomes With a Next-Generation Left Atrial Appendage Device: Final Results of the PINNACLE FLX Trial. J Am Heart Assoc 2023; 12:e026295. [PMID: 36789852 PMCID: PMC10111496 DOI: 10.1161/jaha.122.026295] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background The PINNACLE FLX (Protection Against Embolism for Non-valvular AF [Atrial Fibrillation] Patients: Investigational Device Evaluation of the Watchman FLX LAA [Left Atrial Appendage] Closure Technology) trial evaluated the safety and efficacy of a next-generation left atrial appendage closure device (WATCHMAN FLX; Boston Scientific, Marlborough, MA). At 1 year, the study met the primary end points of safety and anatomical efficacy/appendage closure. This final report of the PINNACLE FLX trial includes the prespecified secondary end point of ischemic stroke or systemic embolism at 2 years, also making it the first report of 2-year outcomes with this next-generation left atrial appendage closure device. Methods and Results Patients with nonvalvular atrial fibrillation with CHA2DS2-VASc score ≥2 (men) or ≥3 (women), with an appropriate rationale for left atrial appendage closure, were enrolled to receive the left atrial appendage closure device at 29 US centers. Adverse events were assessed by an independent clinical events committee, and imaging was assessed by independent core laboratories. Among 395 implanted patients (36% women; mean age, 74 years; CHA2DS2-VASc, 4.2±1.5), the secondary efficacy end point of 2-year ischemic stroke or systemic embolism was met, with an absolute rate of 3.4% (annualized rate, 1.7%) and an upper 1-sided 95% confidence bound of 5.3%, which was superior to the 8.7% performance goal. Two-year rates of adverse events were as follows: 9.3% all-cause mortality, 5.5% cardiovascular death, 3.4% all stroke, and 10.1% major bleeding (Bleeding Academic Research Consortium 3 or 5). There were no additional systemic embolisms, device embolizations, pericardial effusions, or symptomatic device-related thrombi after 1 year. Conclusions The secondary end point of 2-year stroke or systemic embolism was met at 3.4%. In these final results of the PINNACLE FLX trial, the next-generation WATCHMAN FLX device demonstrated favorable safety and efficacy outcomes.
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Affiliation(s)
- Shephal K Doshi
- Providence, Saint Johns Health Center Pacific Heart Institute Santa Monica CA
| | - Saibal Kar
- Los Robles Regional Medical Center Thousand Oaks CA
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group Phoenix AZ
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview Birmingham AL
| | | | | | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai New York NY
| | | | - Devi G Nair
- St Bernard's Heart and Vascular Center Jonesboro AR
| | - Jamie Kim
- New England Heart and Vascular Institute at Catholic Medical Center Manchester NH
| | | | | | | | | | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai New York NY
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13
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Kulyk A, Shafer LA, Graff LA, Stone J, Witges K, Targownik LE, Bernstein CN. Urgency for bowel movements is a highly discriminatory symptom of active disease in persons with IBD (the Manitoba Living with IBD study). Aliment Pharmacol Ther 2022; 56:1570-1580. [PMID: 36225106 DOI: 10.1111/apt.17241] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/16/2022] [Revised: 07/05/2022] [Accepted: 09/17/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity. There have yet to be more granular analyses on which symptoms are most associated with active disease. AIMS To assess the prevalence of symptoms, and to examine which are most associated with disease activity as measured by a symptom index and objective measure of inflammation METHODS: The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly IBDSI. Relative risks (RR) and predictive values (NPV and PPV) were reported for each symptom to predict active disease defined as active IBDSI, self-reported flare and elevated faecal calprotectin (FCAL) (>250 μg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn's disease [CD] and ulcerative colitis [UC]). RESULTS In total, 69.2% were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all three disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). The absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV and RR across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR males = 3.5, 95% CI 1.2-9.9, RR females = 1.8, 95% CI 1.2-2.7), as did blood in stool in UC females (RR = 1.8, 95% CI 1.2-2.7). In males with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of an elevated FCAL in CD females. CONCLUSIONS Urgency was consistently associated with disease activity, irrespective of the disease measure. Fatigue was the most prevalent symptom irrespective of disease activity measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD.
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Affiliation(s)
- Andrea Kulyk
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh Anne Shafer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley A Graff
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Stone
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelcie Witges
- University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Beck K, Arumuham A, Brugger S, McCutcheon RA, Veronese M, Santangelo B, McGinnity CJ, Dunn J, Kaar S, Singh N, Pillinger T, Borgan F, Sementa T, Neji R, Jauhar S, Aigbirhio F, Boros I, Turkheimer F, Hammers A, Lythgoe D, Stone J, Howes OD. The association between N-methyl-d-aspartate receptor availability and glutamate levels: A multi-modal PET-MR brain imaging study in first-episode psychosis and healthy controls. J Psychopharmacol 2022; 36:1051-1060. [PMID: 36120998 DOI: 10.1177/02698811221099643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence from post-mortem studies and in vivo imaging studies suggests there may be reduced N-methyl-d-aspartate receptor (NMDAR) levels in the hippocampus in patients with schizophrenia. Other studies have reported increased glutamate in striatum in schizophrenia patients. It has been hypothesised that NMDAR hypofunction leads to the disinhibition of glutamatergic signalling; however, this has not been tested in vivo. METHODS In this study, we investigated the relationship between hippocampal NMDAR and striatal glutamate using simultaneous positron emission tomography-magnetic resonance (PET-MR) imaging. We recruited 40 volunteers to this cross-sectional study; 21 patients with schizophrenia, all in their first episode of illness, and 19 healthy controls. We measured hippocampal NMDAR availability using the PET ligand [18F]GE179. This was indexed relative to whole brain as the distribution volume ratio (DVR). Striatal glutamatergic indices (glutamate and Glx) were acquired simultaneously, using combined PET-MR proton magnetic resonance spectroscopy (1H-MRS). RESULTS A total of 33 individuals (15 healthy controls, 18 patients) were included in the analyses (mean (SD) age of controls, 27.31 (4.68) years; mean (SD) age of patients, 24.75 (4.33), 27 male and 6 female). We found an inverse relationship between hippocampal DVR and striatal glutamate levels in people with first-episode psychosis (rho = -0.74, p < 0.001) but not in healthy controls (rho = -0.22, p = 0.44). CONCLUSION This study show that lower relative NMDAR availability in the hippocampus may drive increased striatal glutamate levels in patients with schizophrenia. Further work is required to determine whether these findings may yield new targets for drug development in schizophrenia.
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Affiliation(s)
- Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Atheeshaan Arumuham
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Stefan Brugger
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Mattia Veronese
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Barbara Santangelo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colm J McGinnity
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Joel Dunn
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Stephen Kaar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Nisha Singh
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - Faith Borgan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Teresa Sementa
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Radhouene Neji
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Franklin Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Istvan Boros
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Federico Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexander Hammers
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - David Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Stone
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Department of Psychiatry, Eastbourne District General Hospital, Sussex Partnership NHS Foundation Trust, Eastbourne, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
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15
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DeBolt CA, Rosenberg HM, Pruzan A, Goldberger C, Kaplowitz E, Buckley A, Vieira L, Stone J, Bianco A. Patients with resolution of low-lying placenta and placenta previa remain at increased risk of postpartum hemorrhage. Ultrasound Obstet Gynecol 2022; 60:103-108. [PMID: 34826174 DOI: 10.1002/uog.24825] [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: 06/28/2021] [Revised: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine whether women who experience resolution of low placentation (low-lying placenta or placenta previa) are at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. METHODS This was a retrospective cohort study of women who delivered at Mount Sinai Hospital between 2015 and 2019, and who were diagnosed with low-lying placenta or placenta previa on transvaginal ultrasound at the time of the second-trimester anatomical survey, with resolution of low placentation on subsequent ultrasound examination. Women undergoing second-trimester anatomical survey who had normal placentation on transvaginal ultrasound 3 days before or after the cases were randomly identified for comparison. The primary outcome was the rate of postpartum hemorrhage. Secondary outcomes included the need for a blood transfusion, use of additional uterotonic medication, the need for additional procedures to control bleeding, and maternal admission to the intensive care unit. Outcomes were assessed using a multivariable logistic regression model. RESULTS A total of 1256 women were identified for analysis, of whom 628 had resolved low placentation and 628 had normal placentation. Women with resolved low placentation, compared to those with normal placentation throughout pregnancy, had significantly higher mean age (33.0 ± 5.4 years vs 31.9 ± 5.5 years; P < 0.01) and lower mean body mass index at delivery (27.9 ± 5.5 kg/m2 vs 30.2 ± 5.7 kg/m2 ; P < 0.01), and were more likely to have undergone in-vitro fertilization, be of non-Hispanic white race, have posterior placental location (all P < 0.01) and have private/commercial health insurance (P = 0.04). Patients with resolved low placentation vs normal placentation had greater odds of postpartum hemorrhage (adjusted odds ratio (aOR), 3.5 (95% CI, 2.0-6.0); P < 0.01), use of additional uterotonic medication (aOR, 2.2 (95% CI, 1.5-3.1); P < 0.01) and increased rates of additional procedures to control bleeding (aOR, 4.0 (95% CI, 1.3-11.9); P = 0.01). CONCLUSION Despite high rates of resolution of low-lying placenta and placenta previa by term, women with resolved low placentation remain at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C A DeBolt
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H M Rosenberg
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Pruzan
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Goldberger
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Buckley
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Vieira
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Bianco
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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17
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Blum SM, Zlotoff DA, Smith N, Ramesh S, Kernin I, Sen P, Zubiri L, Tirard A, Nasrallah M, Tantivit J, Barth JL, Juric D, Sullivan RJ, Boland GM, Mino-Kenudson M, Stone J, Thomas M, Reynolds KL, Neilan TG, Villani AC. Single-cell profiling of human heart and blood in immune checkpoint inhibitor-associated myocarditis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2507] [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
2507 Background: Myocarditis due to immune checkpoint inhibitors (ICIs) is uncommon; however, myocarditis due to ICIs leads to severe morbidity and even death in 20-40% of cases. The molecular underpinnings of ICI-associated myocarditis are poorly understood, and there is an unmet clinical need to identify therapeutic targets and biomarkers that can aid in disease management. Methods: Heart tissue was obtained through endomyocardial biopsy or autopsy of patients receiving ICIs and was profiled with paired single-cell RNA sequencing (scRNA-seq) and T cell receptor sequencing (TCR) using the 10x Genomics Chromium system. A control dataset was constructed using scRNAseq data of heart tissue from patients receiving ICIs but without myocarditis and a published dataset from healthy patients not receiving ICIs. Peripheral blood mononuclear cells (PBMCs) were collected at the time of myocarditis diagnosis in a larger cohort of patients and analyzed with ICI-treated controls. The CITE-Seq protocol was used to measure paired scRNA-seq, TCR, and surface proteomics in PBMCs, using serial timepoints where available. Results: Heart tissue from 13 patients with myocarditis, including three fatal cases, and seven controls yielded 77,712 single cells. Blood profiling from 27 patients with ICI myocarditis and ICI-treated controls across 54 samples yielded over 230,000 cells. ICI myocarditis tissue demonstrated an increased T cell infiltrate (OR 8.94, FDR = 0.0021). Expression of multiple inflammatory pathways, most notably interferon responses, was up-regulated across multiple immune and non-immune cell types in the setting of myocarditis, providing important pathophysiological insights. T cell clones were also found to be shared between blood and heart, enabling the identification of putative pathogenic T cell subsets. Conclusions: Increased intramyocardial T cells and the activation of interferon response gene networks were seen in the setting of ICI myocarditis. These preliminary findings highlight potential pathological pathways in ICI myocarditis that could serve as biomarkers or therapeutic targets.
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Affiliation(s)
| | | | - Neal Smith
- Massachusetts General Hospital, Boston, MA
| | | | | | - Pritha Sen
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Kerry Lynn Reynolds
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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18
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Getelman M, Stone J, Tokish JT, Cole B, McIntyre L, Stiefel E. Letter to the Editor: Editorial: The New AAOS Guidelines on Knee Arthroscopy for Degenerative Meniscus Tears Are a Step in the Wrong Direction. Clin Orthop Relat Res 2022; 480:1222-1224. [PMID: 35471421 PMCID: PMC9263456 DOI: 10.1097/corr.0000000000002218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/29/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Mark Getelman
- Arthroscopy Association of North America, Rosemont, IL, USA
| | - James Stone
- Arthroscopy Association of North America, Rosemont, IL, USA
| | - John T. Tokish
- Arthroscopy Association of North America, Rosemont, IL, USA
| | - Brian Cole
- Arthroscopy Association of North America, Rosemont, IL, USA
| | - Louis McIntyre
- Arthroscopy Association of North America, Rosemont, IL, USA
| | - Eric Stiefel
- Arthroscopy Association of North America, Rosemont, IL, USA
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19
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Beck K, Arumuham A, Brugger S, Mccutcheon R, Veronese M, Kaar S, Pillinger T, Stone J, Howes O. N-Methyl-D-Aspartate Receptor availability in First-Episode Psychosis: a multi-modal PET-MR brain imaging study. Eur Psychiatry 2022. [PMCID: PMC9565749 DOI: 10.1192/j.eurpsy.2022.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction N-Methyl-D-Aspartate Receptor (NMDAR) hypofunction is hypothesised to underlie psychosis but this has not been tested early in illness. Objectives
Our aim was to determine if NMDAR availability was lower in patients with first episode psychosis compared to healthy controls. Methods To address this, we studied 40 volunteers (21 patients with first episode psychosis and 19 matched healthy controls) using PET imaging with an NMDAR selective ligand, [18F]GE179, that binds to the ketamine binding site to index its distribution volume ratio (DVR) and volume of distribution (VT). Striatal glutamatergic indices (glutamate and Glx) were measured simultaneously using magnetic resonance spectroscopy imaging (1H-MRS). Results
Hippocampal DVR, but not VT, was significantly lower in patients relative to controls (p=0.02, Cohen’s d=0.81; p=0.15, Cohen’s d=0.49), and negatively associated with total (rho=-0.47, p= 0.04), depressive (rho=-0.67, p=0.002), and general symptom severity (rho=-0.74, p<0.001). Exploratory analyses found no significant differences in other brain regions (anterior cingulate cortex, thalamus, striatum and temporal cortex). We found an inverse relationship between hippocampal NMDAR availability and striatal glutamate levels in people with first-episode psychosis (rho = -0.74, p <0.001) but not in healthy controls (rho = -0.22, p = 0.44). Conclusions These findings are consistent with the NMDAR hypofunction hypothesis and identify the hippocampus as a key locus for relative NMDAR hypofunction, although further studies should test specificity and causality. Disclosure No significant relationships.
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20
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Abramson BL, Al-Omran M, Anand SS, Albalawi Z, Coutinho T, de Mestral C, Dubois L, Gill HL, Greco E, Guzman R, Herman C, Hussain MA, Huckell VF, Jetty P, Kaplovitch E, Karlstedt E, Kayssi A, Lindsay T, Mancini GBJ, McClure G, McMurtry MS, Mir H, Nagpal S, Nault P, Nguyen T, Petrasek P, Rannelli L, Roberts DJ, Roussin A, Saw J, Srivaratharajah K, Stone J, Szalay D, Wan D, Cox H, Verma S, Virani S. Canadian Cardiovascular Society 2022 Guidelines for Peripheral Arterial Disease. Can J Cardiol 2022; 38:560-587. [PMID: 35537813 DOI: 10.1016/j.cjca.2022.02.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with widespread atherosclerosis such as peripheral artery disease (PAD) have a high risk of cardiovascular and limb symptoms and complications, which affects their quality of life and longevity. Over the past 2 decades there have been substantial advances in diagnostics, pharmacotherapy, and interventions including endovascular and open surgical to aid in the management of PAD patients. To summarize the evidence regarding approaches to diagnosis, risk stratification, medical and intervention treatments for patients with PAD, guided by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework, evidence was synthesized, and assessed for quality, and recommendations provided-categorized as weak or strong for each prespecified research question. Fifty-six recommendations were made, with 27% (15/56) graded as strong recommendations with high-quality evidence, 14% (8/56) were designated as strong recommendations with moderate-quality evidence, and 20% (11/56) were strong recommendations with low quality of evidence. Conversely 39% (22/56) were classified as weak recommendations. For PAD patients, strong recommendations on the basis of high-quality evidence, include smoking cessation interventions, structured exercise programs for claudication, lipid-modifying therapy, antithrombotic therapy with a single antiplatelet agent or dual pathway inhibition with low-dose rivaroxaban and aspirin; treatment of hypertension with an angiotensin converting enzyme or angiotensin receptor blocker; and for those with diabetes, a sodium-glucose cotransporter 2 inhibitor should be considered. Furthermore, autogenous grafts are more effective than prosthetic grafts for surgical bypasses for claudication or chronic limb-threatening ischemia involving the popliteal or distal arteries. Other recommendations indicated that new endovascular techniques and hybrid procedures be considered in patients with favourable anatomy and patient factors, and finally, the evidence for perioperative risk stratification for PAD patients who undergo surgery remains weak.
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Affiliation(s)
- Beth L Abramson
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Mohammed Al-Omran
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | | | - Thais Coutinho
- Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Luc Dubois
- LHSC and Western University, London, Ontario, Canada
| | | | - Elisa Greco
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Randolph Guzman
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mohamad A Hussain
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor F Huckell
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Prasad Jetty
- Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric Kaplovitch
- University Health Network/Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Erin Karlstedt
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas Lindsay
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - G B John Mancini
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Hassan Mir
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir Nagpal
- Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrice Nault
- McGill University, Campus Outaouais, Gatineau, Quebec, Canada, Alberta, Canada
| | - Thang Nguyen
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Petrasek
- Cumming School of Medicine, University of Calgary, Peter Lougheed Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Derek J Roberts
- University of Ottawa, The Ottawa Hospital, and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - James Stone
- University of Calgary, Calgary, Alberta, Canada
| | | | - Darryl Wan
- McMaster University, Hamilton, Ontario, Canada
| | - Heather Cox
- Peterborough Regional Hospital, Peterborough, Ontario, Canada
| | - Subodh Verma
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sean Virani
- University of British Columbia, Vancouver, British Columbia, Canada
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21
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Su S, Stone J, Bernstein CN. A154 COMPARING RESPONSE TO INTRAVENOUS IRON INFUSION IN CROHN’S DISEASE AND ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859146 DOI: 10.1093/jcag/gwab049.153] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Iron deficiency anemia (IDA) is common in persons with inflammatory bowel disease (IBD). Current evidence-based guidelines suggest iron replacement therapy in IBD patients with IDA. Intravenous (IV) iron has been demonstrated to be more effective than oral iron replacement in the IBD population, and this is thought to be related to oral iron being poorly tolerated, absorbed, and possibly having an adverse impact on the gut microbiome. Studies have not directly compared the response of IV iron between persons with ulcerative colitis (UC) and Crohn’s disease (CD).
Aims
(1) To compare the increase in serum hemoglobin and ferritin following IV iron therapy between persons with UC and CD. (2) To determine factors associated with response to IV iron (other than disease type), including age, sex, IBD therapies, abdominal surgeries, and IBD phenotype.
Methods
In a retrospective chart review, we evaluated 536 IV iron infusions (iron sucrose) prescribed to 117 IBD patients by a single gastroenterologist between 2012–2020, and collected data on IBD type, age, sex, medications (IBD therapies, NSAIDs, ASA, oral iron), abdominal surgeries, and IBD phenotype. Statistical analysis was performed using SPSS version 26.
Results
Most IV iron infusions were given to patients with CD (77% of infusions, 68% of persons). The majority of infusions were given as a series of multiple iron infusions (84%) over a mean of 27 weeks, rather than a single infusion. Persons with UC had a greater increase in serum ferritin than those with CD (mean difference ± SE of 13.2 ± 5.6 µg/L, p = 0.02). There was no significant difference in the increase in serum hemoglobin between UC and CD (UC= 6.5 ± 1.0 g/L; CD 4.9 ± 2.1 g/L; p = 0.62).
Conclusions
Persons with UC had a better ferritin response to IV iron therapy than persons with CD. Patients with UC were prescribed less IV iron than those with CD. In summary, persons with CD may require greater dosing of IV iron therapy than patients with UC. Further studies are needed to discern if this difference is secondary to CD being associated with a greater extent of mucosal disease burden, impaired iron absorption, or a greater intolerance to oral iron.
Funding Agencies
Fellowship Funding from Pfizer Canada
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Affiliation(s)
- S Su
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - J Stone
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
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22
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Sparasci O, Bhui K, Biswas A, Chamberlain S, Dubicka B, Dudas R, Farooq S, Ford T, Husain N, Jones I, Killaspy H, Lee W, Lingford-Hughes A, Mulholland C, Rubinsztein J, Shankar R, Sharma A, Sinclair L, Stone J, Young A. Impact of COVID-19 on mental health research: is this the breaking point? Br J Psychiatry 2022; 220:1-3. [PMID: 35172915 PMCID: PMC7612706 DOI: 10.1192/bjp.2022.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.
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Affiliation(s)
- Oli Sparasci
- Department of Psychiatry, Pennine Care NHS Foundation Trust, UK
| | - Kamaldeep Bhui
- Department of Psychiatry & Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Asit Biswas
- Learning Disabilities Department, Leicestershire Partnership NHS Trust, UK
| | - Samuel Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK
| | - Bernadka Dubicka
- The University of Manchester and Pennine Care NHS Foundation Trust, UK
| | - Robert Dudas
- Department of Psychiatry, University of Cambridge, UK
| | - Saeed Farooq
- Keele University, UK and Midlands Partnership NHS Foundation Trust, UK
| | - Tamsin Ford
- University of Cambridge, UK and Cambridge and Peterborough NHS Foundation Trust, UK
| | - Nusrat Husain
- The University of Manchester, UK and Lancashire Care NHS Foundation Trust, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, UK
| | | | - William Lee
- University of Exeter, UK and Cornwall Partnership NHS Foundation Trust, UK
| | | | - Ciaran Mulholland
- Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, UK and Northern Health and Social Care Trust, UK
| | - Judy Rubinsztein
- Cambridgeshire and Peterborough NHS Foundation Trust, UK and Department of Psychiatry, University of Cambridge, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth Peninsula School of Medicine, UK
| | - Aditya Sharma
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - James Stone
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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23
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Sebastiani G, Patel K, Ratziu V, Feld JJ, Neuschwander-Tetri BA, Pinzani M, Petta S, Berzigotti A, Metrakos P, Shoukry N, Brunt EM, Tang A, Cobbold JF, Ekoe JM, Seto K, Ghali P, Chevalier S, Anstee QM, Watson H, Bajaj H, Stone J, Swain MG, Ramji A. Current considerations for clinical management and care of non-alcoholic fatty liver disease: Insights from the 1st International Workshop of the Canadian NASH Network (CanNASH). Can Liver J 2022; 5:61-90. [PMID: 35990786 PMCID: PMC9231423 DOI: 10.3138/canlivj-2021-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 08/30/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) affects approximately 8 million Canadians. NAFLD refers to a disease spectrum ranging from bland steatosis to non-alcoholic steatohepatitis (NASH). Nearly 25% of patients with NAFLD develop NASH, which can progress to liver cirrhosis and related end-stage complications. Type 2 diabetes and obesity represent the main risk factors for the disease. The Canadian NASH Network is a national collaborative organization of health care professionals and researchers with a primary interest in enhancing understanding, care, education, and research around NAFLD, with a vision of best practices for this disease state. At the 1st International Workshop of the CanNASH network in April 2021, a joint event with the single topic conference of the Canadian Association for the Study of the Liver (CASL), clinicians, epidemiologists, basic scientists, and community members came together to share their work under the theme of NASH. This symposium also marked the initiation of collaborations between Canadian and other key opinion leaders in the field representative of international liver associations. The main objective is to develop a policy framework that outlines specific targets, suggested activities, and evidence-based best practices to guide provincial, territorial, and federal organizations in developing multidisciplinary models of care and strategies to address this epidemic.
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Affiliation(s)
- Giada Sebastiani
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Keyur Patel
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Division of Medicine - Royal Free Hospital, London, UK
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, Università di Palermo, Palermo, Italy
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Switzerland
| | - Peter Metrakos
- Cancer Research Program, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Naglaa Shoukry
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Canada
| | - Jeremy F Cobbold
- Department of Gastroenterology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jean-Marie Ekoe
- Montreal Institute for Clinical Research, Division of Endocrinology and Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
| | - Karen Seto
- Canadian Liver Foundation, Markham, Ontario, Canada
| | - Peter Ghali
- University of Florida, Gainesville, Florida, USA
| | | | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Harpreet Bajaj
- LMC Diabetes and Endocrinology, Brampton, Ontario, Canada
| | - James Stone
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark G Swain
- Calgary Liver Unit, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Immerzeel J, Debruyne F, Schatteman P, De Naeyer G, Beerlage H, Stone J, Stone N. Remote training using augmented reality on surgical phantoms. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Tavares V, Vassos E, Marquand A, Stone J, Valli I, Barker GJ, Ferreira H, Prata D. Prediction of transition to psychosis from an at-risk mental state using structural neuroimaging, genetic, and environmental data. Front Psychiatry 2022; 13:1086038. [PMID: 36741573 PMCID: PMC9892839 DOI: 10.3389/fpsyt.2022.1086038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Psychosis is usually preceded by a prodromal phase in which patients are clinically identified as being at in an "At Risk Mental State" (ARMS). A few studies have demonstrated the feasibility of predicting psychosis transition from an ARMS using structural magnetic resonance imaging (sMRI) data and machine learning (ML) methods. However, the reliability of these findings is unclear due to possible sampling bias. Moreover, the value of genetic and environmental data in predicting transition to psychosis from an ARMS is yet to be explored. METHODS In this study we aimed to predict transition to psychosis from an ARMS using a combination of ML, sMRI, genome-wide genotypes, and environmental risk factors as predictors, in a sample drawn from a pool of 246 ARMS subjects (60 of whom later transitioned to psychosis). First, the modality-specific values in predicting transition to psychosis were evaluated using several: (a) feature types; (b) feature manipulation strategies; (c) ML algorithms; (d) cross-validation strategies, as well as sample balancing and bootstrapping. Subsequently, the modalities whose at least 60% of the classification models showed an balanced accuracy (BAC) statistically better than chance level were included in a multimodal classification model. RESULTS AND DISCUSSION Results showed that none of the modalities alone, i.e., neuroimaging, genetic or environmental data, could predict psychosis from an ARMS statistically better than chance and, as such, no multimodal classification model was trained/tested. These results suggest that the value of structural MRI data and genome-wide genotypes in predicting psychosis from an ARMS, which has been fostered by previous evidence, should be reconsidered.
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Affiliation(s)
- Vânia Tavares
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley National Health System Trust, London, United Kingdom
| | - Andre Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands
| | - James Stone
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Isabel Valli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Hugo Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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26
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Kotoula V, Webster T, Stone J, Mehta MA. Resting-state connectivity studies as a marker of the acute and delayed effects of subanaesthetic ketamine administration in healthy and depressed individuals: A systematic review. Brain Neurosci Adv 2021; 5:23982128211055426. [PMID: 34805548 PMCID: PMC8597064 DOI: 10.1177/23982128211055426] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/24/2021] [Indexed: 11/15/2022] Open
Abstract
Acute ketamine administration has been widely used in neuroimaging research to mimic psychosis-like symptoms. Within the last two decades, ketamine has also emerged as a potent, fast-acting antidepressant. The delayed effects of the drug, observed 2–48 h after a single infusion, are associated with marked improvements in depressive symptoms. At the systems’ level, several studies have investigated the acute ketamine effects on brain activity and connectivity; however, several questions remain unanswered around the brain changes that accompany the drug’s antidepressant effects and how these changes relate to the brain areas that appear with altered function and connectivity in depression. This review aims to address some of these questions by focusing on resting-state brain connectivity. We summarise the studies that have examined connectivity changes in treatment-naïve, depressed individuals and those studies that have looked at the acute and delayed effects of ketamine in healthy and depressed volunteers. We conclude that brain areas that are important for emotional regulation and reward processing appear with altered connectivity in depression whereas the default mode network presents with increased connectivity in depressed individuals compared to healthy controls. This finding, however, is not as prominent as the literature often assumes. Acute ketamine administration causes an increase in brain connectivity in healthy volunteers. The delayed effects of ketamine on brain connectivity vary in direction and appear to be consistent with the drug normalising the changes observed in depression. The limited number of studies however, as well as the different approaches for resting-state connectivity analysis make it very difficult to draw firm conclusions and highlight the importance of data sharing and larger future studies.
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Affiliation(s)
- Vasileia Kotoula
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Mitul A Mehta
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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27
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Allen P, Hird EJ, Orlov N, Modinos G, Bossong M, Antoniades M, Sampson C, Azis M, Howes O, Stone J, Perez J, Broome M, Grace AA, McGuire P. Adverse clinical outcomes in people at clinical high-risk for psychosis related to altered interactions between hippocampal activity and glutamatergic function. Transl Psychiatry 2021; 11:579. [PMID: 34759289 PMCID: PMC8580992 DOI: 10.1038/s41398-021-01705-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022] Open
Abstract
Preclinical rodent models suggest that psychosis involves alterations in the activity and glutamatergic function in the hippocampus, driving dopamine activity through projections to the striatum. The extent to which this model applies to the onset of psychosis in clinical subjects is unclear. We assessed whether interactions between hippocampal glutamatergic function and activity/striatal connectivity are associated with adverse clinical outcomes in people at clinical high-risk (CHR) for psychosis. We measured functional Magnetic Resonance Imaging of hippocampal activation/connectivity, and 1H-Magnetic Resonance Spectroscopy of hippocampal glutamatergic metabolites in 75 CHR participants and 31 healthy volunteers. At follow-up, 12 CHR participants had transitioned to psychosis and 63 had not. Within the clinical high-risk cohort, at follow-up, 35 and 17 participants had a poor or a good functional outcome, respectively. The onset of psychosis (ppeakFWE = 0.003, t = 4.4, z = 4.19) and a poor functional outcome (ppeakFWE < 0.001, t = 5.52, z = 4.81 and ppeakFWE < 0.001, t = 5.25, z = 4.62) were associated with a negative correlation between the hippocampal activation and hippocampal Glx concentration at baseline. In addition, there was a negative association between hippocampal Glx concentration and hippocampo-striatal connectivity (ppeakFWE = 0.016, t = 3.73, z = 3.39, ppeakFWE = 0.014, t = 3.78, z = 3.42, ppeakFWE = 0.011, t = 4.45, z = 3.91, ppeakFWE = 0.003, t = 4.92, z = 4.23) in the total CHR sample, not seen in healthy volunteers. As predicted by preclinical models, adverse clinical outcomes in people at risk for psychosis are associated with altered interactions between hippocampal activity and glutamatergic function.
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Affiliation(s)
- Paul Allen
- Department of Psychology, University of Roehampton, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Emily J Hird
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- National Institute of Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, UK.
| | - Natasza Orlov
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Liu Lab, Harvard Medical School, Athinoula Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab for Precision Brain Imaging, Department of Neuroscience, Precision Brain Imaging Lab, Medical University of South Carolina, Charleston, SC, USA
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Matthijs Bossong
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathilde Antoniades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carly Sampson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute of Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, UK
- Medical Research Council London Institute of Medical Sciences, Hammersmith Hospital, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - James Stone
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Jesus Perez
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Matthew Broome
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute of Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust, London, UK
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28
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Lee SC, Pirikahu S, Phillips M, Bellinge J, Stone J, Wylie E, Stuckey BGA, Schultz C. Reproductive factors and breast arterial calcification: a systematic review and meta-analysis. Climacteric 2021; 25:147-154. [PMID: 34668812 DOI: 10.1080/13697137.2021.1985991] [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: 10/20/2022]
Abstract
BACKGROUND Breast arterial calcification (BAC) is a common incidental finding on screening mammography. Recent evidence suggests that BAC is associated with cardiovascular disease (CVD). We systematically reviewed the associations between BAC and reproductive factors (menopausal status, hormone replacement therapy [HRT] use, oral contraceptive [OC] use and parity). METHODS MEDLINE and EMBASE databases, references of relevant papers and Web of Science were searched up to February 2020 for English-language studies that evaluated these associations. Study quality were determined and a random effects model was used to assess these associations. RESULTS Nineteen observational studies (n = 47,249; three cohort studies, seven case-control studies, nine cross-sectional studies) were included. BAC was associated with menopause (nine studies; n = 15,870; odds ratio [OR] 2.67; 95% confidence interval [CI] 1.50-4.77) and parity (seven studies; n = 27,728; OR 2.50; 95% CI 1.68-3.71) and inversely with HRT use (10 studies; n = 33,156; OR 0.57; 95% CI 0.40-0.80). No association was found with OC use. Eleven studies were considered good in quality. Marked heterogeneity existed across all analyses. CONCLUSIONS BAC is associated with HRT use, menopause and parity. However, careful interpretation is required as marked heterogeneity existed across all analyses. Traditional cardiovascular risk factors may need to be taken into account in future investigations of associations between BAC and reproductive factors. PROSPERO CRD42020141644.
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Affiliation(s)
- S C Lee
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - S Pirikahu
- Genetic Epidemiology Group, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - M Phillips
- Centre for Medical Research (affiliated with the Harry Perkins Institute of Medical Research), University of Western Australia, Perth, WA, Australia
| | - J Bellinge
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - J Stone
- Genetic Epidemiology Group, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - E Wylie
- School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - B G A Stuckey
- School of Medicine, University of Western Australia, Perth, WA, Australia.,Keogh Institute for Medical Research, Perth, WA, Australia.,Department of Endocrinology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - C Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
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29
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Guillo S, Takao M, Stone J, Bauer T. From improved knowledge to certain technical revolutions: Many advances in foot and ankle surgery. Orthop Traumatol Surg Res 2021; 107:103014. [PMID: 34273583 DOI: 10.1016/j.otsr.2021.103014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Stéphane Guillo
- SOS Pied Cheville Bordeaux, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, 341-1, Mangoku, Kisarazu, 2920003 Chiba, Japan
| | - James Stone
- Orthopedic Institute of Wisconsin, Assistant Clinical Professor of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas Bauer
- Department of Orthopedic Surgery and Traumatology, Ambroise-Paré University Hospital, University Paris Saclay, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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30
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Beck K, Arumuham A, Veronese M, Santangelo B, McGinnity CJ, Dunn J, McCutcheon RA, Kaar SJ, Singh N, Pillinger T, Borgan F, Stone J, Jauhar S, Sementa T, Turkheimer F, Hammers A, Howes OD. N-methyl-D-aspartate receptor availability in first-episode psychosis: a PET-MR brain imaging study. Transl Psychiatry 2021; 11:425. [PMID: 34385418 PMCID: PMC8361127 DOI: 10.1038/s41398-021-01540-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
N-methyl-D-aspartate receptor (NMDAR) hypofunction is hypothesised to underlie psychosis but this has not been tested early in illness. To address this, we studied 40 volunteers (21 patients with first-episode psychosis and 19 matched healthy controls) using PET imaging with an NMDAR selective ligand, [18F]GE-179, that binds to the ketamine binding site to index its distribution volume ratio (DVR) and volume of distribution (VT). Hippocampal DVR, but not VT, was significantly lower in patients relative to controls (p = 0.02, Cohen's d = 0.81; p = 0.15, Cohen's d = 0.49), and negatively associated with total (rho = -0.47, p = 0.04), depressive (rho = -0.67, p = 0.002), and general symptom severity (rho = -0.74, p < 0.001). Exploratory analyses found no significant differences in other brain regions (anterior cingulate cortex, thalamus, striatum and temporal cortex). These findings are consistent with the NMDAR hypofunction hypothesis and identify the hippocampus as a key locus for relative NMDAR hypofunction, although further studies should test specificity and causality.
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Affiliation(s)
- Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
| | - Atheeshaan Arumuham
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Mattia Veronese
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Barbara Santangelo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colm J McGinnity
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Joel Dunn
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Stephen J Kaar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Nisha Singh
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Faith Borgan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- COMPASS Pathways plc, London, UK
| | - James Stone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Teresa Sementa
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Federico Turkheimer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexander Hammers
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK.
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
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Witges K, Sexton K, Graff LA, Targownik LE, Lix LM, Haviva C, Stone J, Shafer LA, Vagianos K, Bernstein CN. What Is a Flare? The Manitoba Living With IBD Study. Inflamm Bowel Dis 2021; 28:862-869. [PMID: 34347048 PMCID: PMC9165552 DOI: 10.1093/ibd/izab192] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Flare is a poorly defined term used by patients and clinicians to indicate inflammatory bowel disease (IBD) status. This study aimed to evaluate the validity of a single-item 7-point flare indicator relative to other measures of disease flare. METHODS The longitudinal Manitoba Living with IBD Study followed persons with IBD for 1 year; they completed biweekly online surveys and provided 3 stool samples. Disease flare on a single-item flare indicator with 7 possible responses developed for the study was defined by report of symptoms as "moderately" or "much" worse. The flare indicator was evaluated against 5 measures of disease activity: fecal calprotectin score (FCAL), a 2-point disease status indicator, a 4-point flare certainty indicator, the IBD Symptom Index short form (SIBDSI), and the short form IBD Questionnaire (SIBDQ). Participants in a flare, based on the 7-point measure, were matched to a nonflaring participant, and a stool sample was collected. RESULTS Of the 155 IBD participants, almost half (n = 74) experienced a flare. Of those who flared, 97.0% endorsed active IBD on the 2-point indicator (controls 42.5%; P < .001); 91.9% endorsed active IBD on the 4-point certainty indicator (controls 32.9%; P < .001); 90.5% endorsed active disease on the SIBDSI (controls 34.2%; P < .001); and 48.5% had an elevated FCAL (controls 34.3%; P < .05). The mean SIBDQ was lower for the flare group compared with controls (43.9 [SD 11.1] vs 58.3 [SD 8.5]; P < .001), indicating worse disease. CONCLUSIONS The 7-point flare indicator robustly identified symptomatic flares. This patient self-report indicator reflected meaningful changes in more complex clinical indices and had only weak concordance with the presence of inflammation.
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Affiliation(s)
- Kelcie Witges
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kathryn Sexton
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley A Graff
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Clinical Health Psychology Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laura E Targownik
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Lisa M Lix
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Clove Haviva
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Stone
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Leigh Anne Shafer
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kathy Vagianos
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, Canada
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,Address correspondence to: Charles N. Bernstein, MD, 804F-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E3P4 ()
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32
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Pollak TA, Vincent A, Iyegbe C, Coutinho E, Jacobson L, Rujescu D, Stone J, Jezequel J, Rogemond V, Jamain S, Groc L, David A, Egerton A, Kahn RS, Honnorat J, Dazzan P, Leboyer M, McGuire P. Relationship Between Serum NMDA Receptor Antibodies and Response to Antipsychotic Treatment in First-Episode Psychosis. Biol Psychiatry 2021; 90:9-15. [PMID: 33536130 PMCID: PMC8191702 DOI: 10.1016/j.biopsych.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND When psychosis develops in NMDA receptor (NMDAR) antibody encephalitis, it usually has an acute or subacute onset, and antipsychotic treatment may be ineffective and associated with adverse effects. Serum NMDAR antibodies have been reported in a minority of patients with first-episode psychosis (FEP), but their role in psychosis onset and response to antipsychotic treatment is unclear. METHODS Sera from 387 patients with FEP (duration of psychosis <2 years, minimally or never treated with antipsychotics) undergoing initial treatment with amisulpride as part of the OPTiMiSE (Optimization of Treatment and Management of Schizophrenia in Europe) trial (ClinicalTrials.gov number NCT01248195) were tested for NMDAR IgG antibodies using a live cell-based assay. Symptom severity was assessed using the Positive and Negative Syndrome Scale and the Clinical Global Impressions Scale at baseline and again after 4 weeks of treatment with amisulpride. RESULTS At baseline, 15 patients were seropositive for NMDAR antibodies and 372 were seronegative. The seropositive patients had similar symptom profiles and demographic features to seronegative patients but a shorter duration of psychosis (median 1.5 vs. 4.0 months; p = .031). Eleven seropositive and 284 seronegative patients completed 4 weeks of amisulpride treatment: after treatment, there was no between-groups difference in improvement in Positive and Negative Syndrome Scale scores or in the frequency of adverse medication effects. CONCLUSIONS These data suggest that in FEP, NMDAR antibody seropositivity alone is not an indication for using immunotherapy instead of antipsychotic medications. Further studies are required to establish what proportion of patients with FEP who are NMDAR antibody seropositive have coexisting cerebrospinal fluid inflammatory changes or other paraclinical evidence suggestive of a likely benefit from immunotherapy.
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Affiliation(s)
- Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, University College London, London, United Kingdom.
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom
| | - Ester Coutinho
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - James Stone
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, University College London, London, United Kingdom
| | - Julie Jezequel
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom; Interdisciplinary Institute for Neuroscience, University of Bordeaux, Bordeaux, France
| | - Veronique Rogemond
- Rare Disease Reference Center on Autoimmune Encephalitis, Hospices Civils de Lyon, Institut NeuroMyoGene Institut National de la Santé et de la Recherche Médicale U1217/Centre National de la Recherche Scientifique, University Claude Bernard, Universite de Lyon, Lyon, France
| | - Stephane Jamain
- Psychiatry and Addictology Department (DMU IMPACT), University Paris Est Créteil, Hopitaux Universitaires Henri Mondor, L'Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Laurent Groc
- Interdisciplinary Institute for Neuroscience, University of Bordeaux, Bordeaux, France
| | - Anthony David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom
| | - Rene S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jerome Honnorat
- Rare Disease Reference Center on Autoimmune Encephalitis, Hospices Civils de Lyon, Institut NeuroMyoGene Institut National de la Santé et de la Recherche Médicale U1217/Centre National de la Recherche Scientifique, University Claude Bernard, Universite de Lyon, Lyon, France
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom
| | - Marion Leboyer
- Psychiatry and Addictology Department (DMU IMPACT), University Paris Est Créteil, Hopitaux Universitaires Henri Mondor, L'Assistance Publique-Hôpitaux de Paris, Créteil, France; Translational Neuropsychiatry Laboratory, Institut National de la Santé et de la Recherche Médicale U955, Créteil, France; FondaMental Foundation, Créteil, France
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, University College London, London, United Kingdom
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Doelman DS, Snik F, Por EH, Bos SP, Otten GPPL, Kenworthy M, Haffert SY, Wilby M, Bohn AJ, Sutlieff BJ, Miller K, Ouellet M, de Boer J, Keller CU, Escuti MJ, Shi S, Warriner NZ, Hornburg K, Birkby JL, Males J, Morzinski KM, Close LM, Codona J, Long J, Schatz L, Lumbres J, Rodack A, Van Gorkom K, Hedglen A, Guyon O, Lozi J, Groff T, Chilcote J, Jovanovic N, Thibault S, de Jonge C, Allain G, Vallée C, Patel D, Côté O, Marois C, Hinz P, Stone J, Skemer A, Briesemeister Z, Boehle A, Glauser AM, Taylor W, Baudoz P, Huby E, Absil O, Carlomagno B, Delacroix C. Vector-apodizing phase plate coronagraph: design, current performance, and future development [Invited]. Appl Opt 2021; 60:D52-D72. [PMID: 34263828 DOI: 10.1364/ao.422155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
Over the last decade, the vector-apodizing phase plate (vAPP) coronagraph has been developed from concept to on-sky application in many high-contrast imaging systems on 8 m class telescopes. The vAPP is a geometric-phase patterned coronagraph that is inherently broadband, and its manufacturing is enabled only by direct-write technology for liquid-crystal patterns. The vAPP generates two coronagraphic point spread functions (PSFs) that cancel starlight on opposite sides of the PSF and have opposite circular polarization states. The efficiency, that is, the amount of light in these PSFs, depends on the retardance offset from a half-wave of the liquid-crystal retarder. Using different liquid-crystal recipes to tune the retardance, different vAPPs operate with high efficiencies (${\gt}96\%$) in the visible and thermal infrared (0.55 µm to 5 µm). Since 2015, seven vAPPs have been installed in a total of six different instruments, including Magellan/MagAO, Magellan/MagAO-X, Subaru/SCExAO, and LBT/LMIRcam. Using two integral field spectrographs installed on the latter two instruments, these vAPPs can provide low-resolution spectra (${\rm{R}} \sim 30$) between 1 µm and 5 µm. We review the design process, development, commissioning, on-sky performance, and first scientific results of all commissioned vAPPs. We report on the lessons learned and conclude with perspectives for future developments and applications.
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Ozemek C, Arena R, Rouleau CR, Campbell TS, Hauer T, Wilton SB, Stone J, Laddu D, Williamson TM, Liu H, Austford LD, Roman MA, Aggarwal S. Identification of Patients With COPD in a Cardiac Rehabilitation Setting: THE COnCuR STUDY. J Cardiopulm Rehabil Prev 2021; 41:172-175. [PMID: 32947328 DOI: 10.1097/hcr.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the feasibility of screening for chronic obstructive pulmonary disease (COPD) in an outpatient cardiac rehabilitation (CR) setting and to evaluate the detection rate of COPD using a targeted screening protocol. METHODS A total of 95 patients (62.5 ± 10.0 yr; men, n = 77), >40-yr old with a history of smoking were included in the study sample. Each participant answered the 5-item Canadian Lung Health Test (CLHT) questionnaire assessing symptoms such as coughing, phlegm, wheezing, shortness of breath, and frequent colds. Endorsing ≥1 item was indicative of potential COPD and warranted pulmonary function testing (PFT) and/or spirometry to diagnose or rule out COPD. RESULTS The CLHT questionnaire identified 44 patients at risk for COPD, with an average of 1.9 ± 1.2 items endorsed. Of the patients who underwent PFT, 6 new cases of mild COPD were diagnosed, resulting in a true positive rate with CLHT screening of 19% and a false-positive rate of 81%. CONCLUSIONS Implementing the CLHT to patients referred to CR correctly identified COPD in <20% of cases. Using the CLHT to screen for COPD prior to starting CR may not be optimal, due to disparities between true- and false-positive rates.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Drs Ozemek, Arena, and Laddu); TotalCardiology Research Network, Calgary, Canada (Drs Arena, Rouleau, Campbell, Wilton, Stone, Austford, and Aggarwal); TotalCardiology Rehabilitation, Calgary, Canada (Drs Rouleau and Aggarwal and Mss Hauer and Austford); Departments of Psychology (Drs Rouleau, Campbell, and Aggarwal and Ms Williamson) and Community Health Sciences (Dr Liu), University of Calgary, Calgary, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada (Drs Wilton, Stone, and Liu); and Division of Respiratory Medicine, Rockyview Hospital, University of Calgary, Calgary, Canada (Dr Roman)
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Kar S, Doshi SK, Sadhu A, Horton R, Osorio J, Ellis C, Stone J, Shah M, Dukkipati SR, Adler S, Nair DG, Kim J, Wazni O, Price MJ, Asch FM, Holmes DR, Shipley RD, Gordon NT, Allocco DJ, Reddy VY. Primary Outcome Evaluation of a Next-Generation Left Atrial Appendage Closure Device: Results From the PINNACLE FLX Trial. Circulation 2021; 143:1754-1762. [PMID: 33820423 DOI: 10.1161/circulationaha.120.050117] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) occlusion provides an alternative to oral anticoagulation for thromboembolic risk reduction in patients with nonvalvular atrial fibrillation. Since regulatory approval in 2015, the WATCHMAN device has been the only LAA closure device available for clinical use in the United States. The PINNACLE FLX study (Protection Against Embolism for Nonvalvular AF Patients: Investigational Device Evaluation of the Watchman FLX LAA Closure Technology) evaluated the safety and effectiveness of the next-generation WATCHMAN FLX LAA closure device in patients with nonvalvular atrial fibrillation in whom oral anticoagulation is indicated, but who have an appropriate rationale to seek a nonpharmaceutical alternative. METHODS This was a prospective, nonrandomized, multicenter US Food and Drug Administration study. The primary safety end point was the occurrence of one of the following events within 7 days after the procedure or by hospital discharge, whichever was later: death, ischemic stroke, systemic embolism, or device- or procedure-related events requiring cardiac surgery. The primary effectiveness end point was the incidence of effective LAA closure (peri-device flow ≤5 mm), as assessed by the echocardiography core laboratory at 12-month follow-up. RESULTS A total of 400 patients were enrolled. The mean age was 73.8±8.6 years and the mean CHA2DS2-VASc score was 4.2±1.5. The incidence of the primary safety end point was 0.5% with a 1-sided 95% upper CI of 1.6%, meeting the performance goal of 4.2% (P<0.0001). The incidence of the primary effectiveness end point was 100%, with a 1-sided 95% lower CI of 99.1%, again meeting the performance goal of 97.0% (P<0.0001). Device-related thrombus was reported in 7 patients, no patients experienced pericardial effusion requiring open cardiac surgery, and there were no device embolizations. CONCLUSIONS LAA closure with this next-generation LAA closure device was associated with a low incidence of adverse events and a high incidence of anatomic closure. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02702271.
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Affiliation(s)
- Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.).,Bakersfield Heart Hospital, Bakersfield, CA (S.K.)
| | - Shephal K Doshi
- Providence, Saint Johns Health Center, Pacific Heart Institute, Santa Monica, CA (S.K.D.)
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group, AZ (A.S.)
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, AL (J.O.)
| | | | - James Stone
- North Mississippi Medical Center, Tupelo (J.S.)
| | - Manish Shah
- MedStar Health Medical Center, Washington, DC (M.S.)
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.R.D.)
| | | | - Devi G Nair
- St Bernard's Heart and Vascular Center, Jonesboro, AR (D.G.N.)
| | - Jamie Kim
- New England Heart and Vascular Institute at Catholic Medical Center, Manchester, NH (J.K.)
| | | | | | | | | | - Robert D Shipley
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
| | - Nicole T Gordon
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
| | - Dominic J Allocco
- Boston Scientific Corporation, Marlborough, MA (R.D.S., N.T.G., D.J.A.)
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Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, Francis GA, Genest J, Grégoire J, Grover SA, Gupta M, Hegele RA, Lau D, Leiter LA, Leung AA, Lonn E, Mancini GBJ, Manjoo P, McPherson R, Ngui D, Piché ME, Poirier P, Sievenpiper J, Stone J, Ward R, Wray W. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiol 2021; 37:1129-1150. [PMID: 33781847 DOI: 10.1016/j.cjca.2021.03.016] [Citation(s) in RCA: 315] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022] Open
Abstract
The 2021 guidelines primary panel selected clinically relevant questions and produced updated recommendations, on the basis of important new findings that have emerged since the 2016 guidelines. In patients with clinical atherosclerosis, abdominal aortic aneurysm, most patients with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol ≥ 5 mmol/L, statin therapy continues to be recommended. We have introduced the concept of lipid/lipoprotein treatment thresholds for intensifying lipid-lowering therapy with nonstatin agents, and have identified the secondary prevention patients who have been shown to derive the largest benefit from intensification of therapy with these agents. For all other patients, we emphasize risk assessment linked to lipid/lipoprotein evaluation to optimize clinical decision-making. Lipoprotein(a) measurement is now recommended once in a patient's lifetime, as part of initial lipid screening to assess cardiovascular risk. For any patient with triglycerides ˃ 1.5 mmol/L, either non-high-density lipoprotein cholesterol or apolipoprotein B are the preferred lipid parameter for screening, rather than low-density lipoprotein cholesterol. We provide updated recommendations regarding the role of coronary artery calcium scoring as a clinical decision tool to aid the decision to initiate statin therapy. There are new recommendations on the preventative care of women with hypertensive disorders of pregnancy. Health behaviour modification, including regular exercise and a heart-healthy diet, remain the cornerstone of cardiovascular disease prevention. These guidelines are intended to provide a platform for meaningful conversation and shared-decision making between patient and care provider, so that individual decisions can be made for risk screening, assessment, and treatment.
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Affiliation(s)
- Glen J Pearson
- Faculty of Medicine and Dentistry, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
| | - George Thanassoulis
- McGill University Health Center, McGill University, Montréal, Québec, Canada
| | - Todd J Anderson
- Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Arden R Barry
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Couture
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Québec, Canada
| | | | - Gordon A Francis
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacques Genest
- McGill University Health Center, McGill University, Montréal, Québec, Canada
| | - Jean Grégoire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Robert A Hegele
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Lau
- Department of Medicine, Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexander A Leung
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - G B John Mancini
- University of British Columbia; Department of Medicine, Division of Cardiology, Vancouver, British Columbia, Canada
| | - Priya Manjoo
- University of British Columbia, Victoria, British Columbia, Canada
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Ngui
- University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - John Sievenpiper
- Department of Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital and Departments of Nutritional Sciences and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James Stone
- University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Rick Ward
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wendy Wray
- McGill University Health Centre, Montréal, Québec, Canada
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Woodfield J, Brennan PM, Statham P, Stone J, Hoeritzauer I. Suspected cauda equina syndrome: no reduction in investigation, referral and treatment during the COVID-19 pandemic. Ann R Coll Surg Engl 2021; 103:432-437. [PMID: 33682481 DOI: 10.1308/rcsann.2021.0011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Compression of the cauda equina can lead to bladder, bowel and sexual dysfunction with lower limb pain, numbness and weakness. Urgent surgical decompression aims to prevent progressive neurological deficit. Symptoms of cauda equina syndrome (CES), such as back pain, sciatica and bladder dysfunction are common in the population, but the majority of those investigated do not have radiological cauda equina compression. However, a missed diagnosis can have significant medical, social and legal consequences. We investigated the effect of the COVID-19 pandemic on presentation and management of suspected CES. METHODS This retrospective cohort study analysed referral, investigation and treatment of CES in a regional neurosurgical centre during the initial COVID-19 surge between March and May 2020 compared with March to May 2019. RESULTS Referrals for suspected CES were similar during the COVID-19 pandemic (n = 275) compared with 2019 (n = 261, p = 0.596) despite a significant (19%) decrease in total emergency neurosurgical referrals (1248 in 2020 vs 1544 in 2019, p < 0.001). Nineteen (7%) of the suspected CES referrals underwent decompression in 2020, similar to 16 (6%) in 2019 (p = 0.867). There were no differences in outcomes or complications and no evidence of delays in presentation or treatment. CONCLUSIONS Unlike other emergency neurosurgical conditions, the number of referrals for suspected CES and the percentage of referrals with radiological cauda equina compression were unchanged during the COVID-19 pandemic. The persistence of CES referrals when many people stayed away from hospital highlights the distress and worry caused by suspected CES and its symptoms to both patients and healthcare providers.
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Affiliation(s)
- J Woodfield
- University of Edinburgh, UK.,NHS Lothian, UK
| | - P M Brennan
- University of Edinburgh, UK.,NHS Lothian, UK
| | | | - J Stone
- University of Edinburgh, UK.,NHS Lothian, UK
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Stone J, Shafer L, Graff LA, Witges K, Lix L, Haviva C, Targownik LE, Bernstein CN. A172 THE ASSOCIATION OF EFFICACY, OPTIMISM, UNCERTAINTY AND HEALTH ANXIETY IN INFLAMMATORY BOWEL DISEASE ACTIVITY OVER TIME. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We aimed to assess if the presence of positive or negative psychological attributes are associated with disease activity in a prospective inflammatory bowel disease (IBD) cohort using validated psychological assessment tools and various measures of disease activity.
Methods
The study included 146 adults with confirmed and recently active IBD enrolled in a prospective longitudinal cohort study. Demographics, disease information, validated measures of psychological functioning related to self-efficacy, optimism, health anxiety and intolerance of uncertainty were collected at baseline, week 26 and week 52. Disease activity indicators included fecal calprotection (FCAL), the Inflammatory Bowel Disease Symptom Inventory (IBDSI), and self-reported flares and were collected at study baseline, week 26 and week 52. Logistic regression was used to identify the relationship between psychological functioning and disease activity.
Results
Participants’ mean age was 42.9 years (SD 12.6; range 18–70), with 70.5% women. Almost two thirds (65.1%) had a diagnosis of Crohn’s disease (CD), 34.2% had ulcerative colitis (UC), and 0.7% (n=1) was IBD unclassified. 22% had income <$50,000 and 63% were in a current relationship. Patient-reported active disease (i.e., IBDSI; flare self-report) was significantly less likely with higher self-efficacy [OR= 0.87, 95% CI 0.82–0.93 (IBDSI); OR= 0.86, 95% CI 0.81–0.91 (self-report)] and significantly more likely with higher health anxiety (OR=1.09, 95% CI 1.04–1.15) with the association remaining for self-reported flares after adjusting for demographic variables. The psychological attributes were not associated with active disease based on FCAL levels.
Conclusions
Higher health anxiety increases the likelihood of experiencing an IBD flare, while higher general self-efficacy may be protective of a disease flare.
Funding Agencies
None
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Affiliation(s)
- J Stone
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L Shafer
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - K Witges
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L Lix
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - C Haviva
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L E Targownik
- Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Fernandes S, Williams G, Williams E, Ehrlich K, Stone J, Finlayson N, Bradley M, Thomson RR, Akram AR, Dhaliwal K. Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies. Eur Respir J 2021; 57:2002537. [PMID: 33060152 PMCID: PMC8174723 DOI: 10.1183/13993003.02537-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/29/2020] [Indexed: 12/18/2022]
Abstract
Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Current diagnostic pathways involve endobronchial/transthoracic tissue biopsies or radiological surveillance, which can be associated with suboptimal diagnostic yield, healthcare costs and patient anxiety. Cutting-edge technologies are needed to disrupt and improve, existing care pathways. Optical fibre-based techniques, which can be delivered via the working channel of a bronchoscope or via transthoracic needle, may deliver advanced diagnostic capabilities in patients with SPNs. Optical endomicroscopy, an autofluorescence-based imaging technique, demonstrates abnormal alveolar structure in SPNs in vivo Alternative optical fingerprinting approaches, such as time-resolved fluorescence spectroscopy and fluorescence-lifetime imaging microscopy, have shown promise in discriminating lung cancer from surrounding healthy tissue. Whilst fibre-based Raman spectroscopy has enabled real-time characterisation of SPNs in vivo Fibre-based technologies have the potential to enable in situ characterisation and real-time microscopic imaging of SPNs, which could aid immediate treatment decisions in patients with SPNs. This review discusses advances in current imaging modalities for evaluating SPNs, including computed tomography (CT) and positron emission tomography-CT. It explores the emergence of optical fibre-based technologies, and discusses their potential role in patients with SPNs and suspected lung cancer.
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Affiliation(s)
- Susan Fernandes
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Gareth Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Elvira Williams
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Katjana Ehrlich
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - James Stone
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Centre for Photonics and Photonic Materials, Dept of Physics, The University of Bath, Bath, UK
| | - Neil Finlayson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute for Integrated Micro and Nano Systems, School of Engineering, The University of Edinburgh, Edinburgh, UK
| | - Mark Bradley
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- EaStCHEM, School of Chemistry, The University of Edinburgh, Edinburgh, UK
| | - Robert R. Thomson
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute of Photonics and Quantum Sciences, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - Ahsan R. Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Abstract
Open anatomic reconstruction of the lateral ligament (AntiRoLL) of the ankle with a gracilis Y graft and the inside-out technique are commonly used and have evolved to minimally invasive surgery, including arthroscopic AntiRoLL (A-AntiRoLL) and percutaneous AntiRoLL procedures. A-AntiRoLL allows assessment and treatment of intra-articular pathologies of the ankle concurrently with stabilization. However, the A-AntiRoLL technique is technically demanding, especially in the process of calcaneofibular ligament reconstruction under subtalar arthroscopy. In contrast, the percutaneous AntiRoLL procedure is a simple concept that does not require the skill of an experienced arthroscopist but requires an extra skin incision to assess and treat intra-articular pathologies of the ankle. This study describes the application of a minimally invasive anatomic reconstruction technique-hybrid AntiRoLL-for chronic instability of the ankle that does not require advanced arthroscopic technique to assess and treat intra-articular pathology simultaneously.
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Affiliation(s)
- Kosui Iwashita
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
| | - Yasuyuki Jujo
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - James Stone
- Midwest Orthopedic Specialty Hospital, Milwaukee, Wisconsin, U.S.A
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan,Address correspondence to Masato Takao, M.D., Ph.D., Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
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Rosmalen JGM, Burton C, Carson A, Cosci F, Frostholm L, Lehnen N, Olde Hartman TC, Rask CU, Rymaszewska J, Stone J, Tak LM, Witthöft M, Löwe B. The European Training Network ETUDE (Encompassing Training in fUnctional Disorders across Europe): a new research and training program of the EURONET-SOMA network recruiting 15 early stage researchers. J Psychosom Res 2021; 141:110345. [PMID: 33385705 DOI: 10.1016/j.jpsychores.2020.110345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dimence Group, Deventer, the Netherlands.
| | - C Burton
- University of Sheffield, Sheffield, UK
| | - A Carson
- University of Edinburgh, Edinburgh, UK
| | - F Cosci
- University of Florence, Florence, Italy
| | | | - N Lehnen
- Technical University Munich, Munich, Germany
| | | | - C U Rask
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J Stone
- University of Edinburgh, Edinburgh, UK
| | - L M Tak
- Dimence Group, Deventer, the Netherlands
| | - M Witthöft
- Johannes Gutenberg-University, Mainz, Germany
| | - B Löwe
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ricker J, Douglass KO, Syssoev S, Stone J, Avdiaj S, Hendricks JH. Transient heating in fixed length optical cavities for use as temperature and pressure standards. Metrologia 2021; 58:10.1088/1681-7575/abe8e0. [PMID: 34446973 PMCID: PMC8384112 DOI: 10.1088/1681-7575/abe8e0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Optical refractometry techniques enable realization of both pressure and temperature directly from properties of the gas. The NIST refractometer, a fixed length optical cavity (FLOC) has previously been evaluated for operation as pressure standard, and now in this paper, is evaluated for the feasibility of operation as a primary temperature standard as well. The challenge is that during operation, one cavity is filled with gas. Gas dynamics predicts that this will result in heating which in turn will affect the cavity temperature uniformity, impeding the ability to measure the gas temperature with sufficient accuracy to make the standard useful as a primary standard for temperature or pressure. Temperature uniformity across the refractometer must be less than 0.5 mK for measurements of the refractivity to be sufficiently accurate for the FLOC. This paper compares computer modeling to laboratory measurements, enabling us to validate the model to predict thermal behavior and to accurately determine the measurement uncertainty of the technique. The results presented in this paper show that temperature of the glass elements of the refractometer and 'thermal-shell' copper chamber are equivalent to within 0.5 mK after an equilibration time of 3000 s (when going from 1 kPa to 100 kPa). This finding enables measurements of the copper chamber to determine the gas temperature to within an uncertainty (k = 1) of 0.5 mK. Additionally, the NIST refractometer is evaluated for feasibility of operation as temperature standard.
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Affiliation(s)
- J Ricker
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
| | - K O Douglass
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
| | - S Syssoev
- MKS Instruments, Inc, Andover, MA, United States of America
| | - J Stone
- Dimensional Metrology Group, NIST, Gaithersburg, MD, United States of America
- Retired
| | - S Avdiaj
- Department of Physics, University of Prishtina, Prishtina, Kosovo
- Guest researcher (Fulbright Scholar) at Thermodynamic Metrology Group, NIST, Gaithersburg, MD, USA
| | - J H Hendricks
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
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Trickey A, Stone J, Semchuk N, Saliuk T, Sazonova Y, Varetska O, Lim AG, Walker JG, Vickerman P. Is contact between men who have sex with men and non-governmental organizations providing harm reduction associated with improved HIV outcomes? HIV Med 2020; 22:262-272. [PMID: 33179855 PMCID: PMC7984049 DOI: 10.1111/hiv.13010] [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] [Accepted: 10/09/2020] [Indexed: 11/27/2022]
Abstract
Objectives There is a high prevalence of HIV (5.2% in 2018) among men who have sex with men (MSM) in Ukraine. HIV testing, condom provision and facilitated linkage to HIV treatment have been funded by various bodies through non‐governmental organizations (NGOs). We investigated whether contact with these NGOs was associated with improved prevention and treatment outcomes among MSM in Ukraine. Methods Data were taken from four rounds of integrated bio‐behavioural surveys among MSM in Ukraine (2011, N = 5950; 2013, N = 8101; 2015, N = 4550; 2018, N = 5971) including HIV testing combined with questionnaire responses. Data were analysed using mixed‐effect regression models, which estimated associations between being an NGO client and behavioural, HIV testing and HIV treatment outcomes, adjusted for demographic factors. Results Those MSM who were NGO clients were more likely than non‐clients to have been HIV tested in the last year [adjusted odds ratio (aOR) = 7.01, 95% confidence interval (CI): 6.45–7.62] or ever (aOR = 11.00, 95% CI: 9.77–12.38), to have used a condom for the last anal sex act (aOR = 1.32, 95% CI: 1.21–1.43), and to have recently either bought or received condoms (aOR = 21.27, 95% CI: 18.01–25.12). HIV‐positive MSM were more likely to have contact with NGOs (aOR = 1.61, 95% CI: 1.39–1.86). Among the HIV‐positive MSM, those who were NGO clients were more likely to be registered at an AIDS centre (aOR = 2.24, 95% CI: 1.61–3.11) and to be on antiretroviral treatment (aOR = 2.20, 95% CI: 1.51–3.20). Conclusions In Ukraine, being in contact with MSM‐targeted NGOs is associated with better outcomes for HIV prevention, testing and treatment, suggesting that NGO harm reduction projects for MSM have had a beneficial impact on reducing HIV transmission and morbidity.
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Affiliation(s)
- A Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - J Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - N Semchuk
- Alliance for Public Health, Kiev, Ukraine
| | - T Saliuk
- Alliance for Public Health, Kiev, Ukraine
| | - Y Sazonova
- Alliance for Public Health, Kiev, Ukraine
| | - O Varetska
- Alliance for Public Health, Kiev, Ukraine
| | - A G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - J G Walker
- Population Health Sciences, University of Bristol, Bristol, UK
| | - P Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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Egerton A, Grace AA, Stone J, Bossong MG, Sand M, McGuire P. Glutamate in schizophrenia: Neurodevelopmental perspectives and drug development. Schizophr Res 2020; 223:59-70. [PMID: 33071070 DOI: 10.1016/j.schres.2020.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/12/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022]
Abstract
Research into the neurobiological processes that may lead to the onset of schizophrenia places growing emphasis on the glutamatergic system and brain development. Preclinical studies have shown that neurodevelopmental, genetic, and environmental factors contribute to glutamatergic dysfunction and schizophrenia-related phenotypes. Clinical research has suggested that altered brain glutamate levels may be present before the onset of psychosis and relate to outcome in those at clinical high risk. After psychosis onset, glutamate dysfunction may also relate to the degree of antipsychotic response and clinical outcome. These findings support ongoing efforts to develop pharmacological interventions that target the glutamate system and could suggest that glutamatergic compounds may be more effective in specific patient subgroups or illness stages. In this review, we consider the updated glutamate hypothesis of schizophrenia, from a neurodevelopmental perspective, by reviewing recent preclinical and clinical evidence, and discuss the potential implications for novel therapeutics.
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Affiliation(s)
- Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James Stone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthijs G Bossong
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Singh JP, Berger RD, Doshi RN, Lloyd M, Moore D, Stone J, Daoud EG. Targeted Left Ventricular Lead Implantation Strategy for Non-Left Bundle Branch Block Patients. JACC Clin Electrophysiol 2020; 6:1171-1181. [DOI: 10.1016/j.jacep.2020.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 10/23/2022]
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Costa C, Wang Y, Ly A, Hosono Y, Murchie E, Walmsley CS, Huynh T, Healy C, Peterson R, Yanase S, Jakubik CT, Henderson LE, Damon LJ, Timonina D, Sanidas I, Pinto CJ, Mino-Kenudson M, Stone J, Dyson NJ, Ellisen LW, Bardia A, Ebi H, Benes CH, Engelman JA, Juric D. Abstract 1903: PTEN loss mediates clinical cross-resistance to CDK4/6 and PI3Ká inhibitors in breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1903] [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: 11/16/2022]
Abstract
Abstract
The combination of CDK4/6 inhibitors with anti-estrogen therapies significantly improves clinical outcomes in ER-positive advanced breast cancer. To identify mechanisms of acquired resistance, we analyzed serial biopsies and rapid autopsies from patients treated with the combination of the CDK4/6 inhibitor ribociclib with letrozole. This study revealed that some resistant tumors acquired RB loss, whereas other tumors lost PTEN expression at the time of progression. In breast cancer cells ablation of PTEN, through increased AKT activation, was sufficient to promote resistance to CDK4/6 inhibition in vitro and in vivo. Mechanistically, PTEN loss resulted in exclusion of p27 from the nucleus, leading to increased activation of both CDK4 and CDK2. Since PTEN loss also causes resistance to PI3Kα-inhibitors, currently approved in the post-CDK4/6 setting, these findings provide critical insight into how this single genetic event may cause clinical cross-resistance to multiple targeted therapies in the same patient, with implications for optimal treatment sequencing strategies.
Citation Format: Carlotta Costa, Ye Wang, Amy Ly, Yasuyuki Hosono, Ellen Murchie, Charlotte S. Walmsley, Tiffany Huynh, Christopher Healy, Rachel Peterson, Shogo Yanase, Charles T. Jakubik, Laura E. Henderson, Leah J. Damon, Daria Timonina, Ioannis Sanidas, Christopher J. Pinto, Mari Mino-Kenudson, James Stone, Nicholas J. Dyson, Leif W. Ellisen, Aditya Bardia, Hiromichi Ebi, Cyril H. Benes, Jeffrey A. Engelman, Dejan Juric. PTEN loss mediates clinical cross-resistance to CDK4/6 and PI3Ká inhibitors in breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1903.
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Affiliation(s)
- Carlotta Costa
- 1Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Ye Wang
- 2Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Amy Ly
- 3Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | - Shogo Yanase
- 4Aichi Cancer Center Research Institute, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Hiromichi Ebi
- 4Aichi Cancer Center Research Institute, Nagoya, Japan
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Breathett K, Yee E, Pool N, Hebdon M, Crist J, Yee R, Knapp S, Solola S, Luy L, Herrera‐Theut K, Zabala L, Stone J, McEwen M, Calhoun E, Sweitzer N. Sex and Race Biases in Allocation of Advanced Heart Failure Therapies. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13397] [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: 12/01/2022] Open
Affiliation(s)
| | - E. Yee
- University of Arizona Tucson AZ United States
| | - N. Pool
- University of Arizona Tucson AZ United States
| | - M. Hebdon
- University of Arizona Tucson AZ United States
| | - J. Crist
- University of Arizona Tucson AZ United States
| | - R. Yee
- University of Arizona Tucson AZ United States
| | - S. Knapp
- University of Arizona Tucson AZ United States
| | - S. Solola
- University of Arizona Tucson AZ United States
| | - L. Luy
- University of Rochester Rochester NY United States
| | | | - L. Zabala
- University of Arizona Tucson AZ United States
| | - J. Stone
- University of Arizona Tucson AZ United States
| | - M. McEwen
- University of Arizona Tucson AZ United States
| | - E. Calhoun
- University of Arizona Tucson AZ United States
| | - N. Sweitzer
- University of Arizona Tucson AZ United States
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Abstract
OBJECTIVES The main objective of this study was to compare neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammation, between patients diagnosed with International Classification of Diseases 10th Revision (ICD-10) psychiatric disorders and control participants. DESIGN A cross-sectional methodology was employed to retrospectively analyse electronic health records and records derived from a national health survey. SETTING A secondary mental healthcare service consisting of four boroughs in South London. PARTICIPANTS A diverse sample of 13 888 psychiatric patients extracted from South London and Maudsley electronic health records database and 3920 control participants extracted from National Health and Nutrition Survey (2015-2016) were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: NLR levels in patients with mental health diagnoses, NLR between patients with different mental health diagnoses. Secondary: relationship of NLR to length of hospitalisation and to mortality. RESULTS NLR was elevated compared with controls in patients with diagnoses including dementia, alcohol dependence, schizophrenia, bipolar affective disorder, depression, non-phobic anxiety disorders and mild mental retardation (p<0.05). NLR also correlated with age, antipsychotic use and hypnotic use. NLR was found to be higher in individuals of 'white' ethnicity and lower in individuals of 'black' ethnicity. Elevated NLR was associated with increased mortality (β=0.103, p=2.9e-08) but not with hospital admissions or face-to-face contacts. CONCLUSIONS Elevated NLR may reflect a transdiagnostic pathological process occurring in a subpopulation of psychiatric patients. NLR may be useful to identify and stratify patients who could benefit from adjunctive anti-inflammatory treatment.
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Affiliation(s)
- Aimee Brinn
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Stone
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lidstone SC, Araújo R, Stone J, Bloem BR. Ten myths about functional neurological disorder. Eur J Neurol 2020; 27:e62-e64. [DOI: 10.1111/ene.14310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- S. C. Lidstone
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease Faculty of Medicine Toronto Western Hospital University of Toronto Toronto ON Canada
| | - R. Araújo
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
- Department of Clinical Neurosciences and Mental Health Faculty of Medicine of University of Porto Porto Portugal
| | - J. Stone
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
| | - B. R. Bloem
- Donders Institute for Brain Cognition and Behaviour Department of Neurology Centre of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre Nijmegen The Netherlands
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Chandy E, Taylor H, Gaito S, Wells E, Jones C, Meehan C, Burland H, Stone J, Snowball C, Mashru J, Riddell C, Hon Y, Welsh L, Saran F, Mandeville H. Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults. Clin Oncol (R Coll Radiol) 2020; 32:316-326. [DOI: 10.1016/j.clon.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
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