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Mitchell JM, Walsh S, O'Byrne LJ, Conrick V, Burke R, Khashan AS, Higgins J, Greene R, Maher GM, McCarthy FP. Association between intrapartum fetal pulse oximetry and adverse perinatal and long-term outcomes: a systematic review and meta-analysis protocol. HRB Open Res 2024; 6:63. [PMID: 38628596 PMCID: PMC11019289 DOI: 10.12688/hrbopenres.13802.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Current methods of intrapartum fetal monitoring based on heart rate, increase the rates of operative delivery but do not prevent or accurately detect fetal hypoxic brain injury. There is a need for more accurate methods of intrapartum fetal surveillance that will decrease the incidence of adverse perinatal and long-term neurodevelopmental outcomes while maintaining the lowest possible rate of obstetric intervention. Fetal pulse oximetry (FPO) is a technology that may contribute to improved intrapartum fetal wellbeing evaluation by providing a non-invasive measurement of fetal oxygenation status. Objective This systematic review and meta-analysis aims to synthesise the evidence examining the association between intrapartum fetal oxygen saturation levels and adverse perinatal and long-term outcomes in the offspring. Methods We will include randomised control trials (RCTs), cohort, cross-sectional and case-control studies which examine the use of FPO during labour as a means of measuring intrapartum fetal oxygen saturation and assess its effectiveness at detecting adverse perinatal and long-term outcomes compared to existing intrapartum surveillance methods. A detailed systematic search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.Gov and WHO ICTRP will be conducted following a detailed search strategy until February 2024. Three authors will independently review titles, abstracts and full text of articles. Two reviewers will independently extract data using a pre-defined data extraction form and assess the quality of included studies using the Risk of Bias tool for RCTs and Newcastle-Ottawa Scale for observational studies. The grading of recommendations, assessment, development, and evaluation (GRADE) approach will be used to evaluate the certainty of the evidence. We will use random-effects meta-analysis for each exposure-outcome association to calculate pooled estimates using the generic variance method. This systematic review will follow the Preferred Reporting Items for Systematic reviews and Meta-analyses and MOOSE guidelines. PROSPERO registration CRD42023457368 (04/09/2023).
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Affiliation(s)
- Jill M. Mitchell
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Siobhan Walsh
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Laura J. O'Byrne
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Virginia Conrick
- UCC Library, University College Cork, Cork, County Cork, Ireland
| | - Ray Burke
- Tyndall National Institute, University College Cork, Cork, County Cork, Ireland
| | - Ali S. Khashan
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- School of Public Health, University College Cork, Cork, County Cork, Ireland
| | - John Higgins
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
| | - Richard Greene
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
- National Perinatal Epidemiology Centre, University College Cork, Cork, County Cork, Ireland
| | - Gillian M. Maher
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- School of Public Health, University College Cork, Cork, County Cork, Ireland
| | - Fergus P. McCarthy
- INFANT Research Centre, University College Cork, Cork, County Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, County Cork, Ireland
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Kress J, Nandita E, Jones E, Sanou M, Higgins J, Kosanam H. A targeted liquid chromatography mass spectrometry method for routine monitoring of cell culture media components for bioprocess development. J Chromatogr A 2023; 1706:464281. [PMID: 37566999 DOI: 10.1016/j.chroma.2023.464281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
The analysis of cell culture media (CCM) components is critical for understanding cell growth kinetics and overall product quality during biomanufacturing. Given the diverse physical and chemical nature of CCM compounds present at a wide range of concentrations, there is an increasing demand for single-platform analytical assays with exceptional specificity and sensitivity. This study presents a targeted LC-MS/MS method for the identification and quantitation of 110 CCM analytes is presented, where target metabolites are monitored over an 20-min gradient. The analyte panel constitutes amino acids, vitamins, organic acids, nucleic acids, carbohydrates, and lipids. The method employs isotopically labeled standards to enable specific and accurate relative quantitation of CCM compounds based on physicochemical properties and retention time. Quantitation is performed on a triple quadrupole mass spectrometer operated in multiple reaction monitoring (MRM) mode. The method demonstrates strong linearity with an R2 of ≥0.99 with three orders of linear dynamic range and inter-day and intra-day precision with a%CV of <10% for spiked-in quality control samples. We also present three case studies to demonstrate method applicability in the bioprocessing space for developing vaccines and biologics.
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Affiliation(s)
- Jared Kress
- Global Vaccines and Biologics Commercialization, Merck & Co., Inc, West Point, PA, USA
| | | | | | - Missa Sanou
- Global Vaccines and Biologics Commercialization, Merck & Co., Inc, West Point, PA, USA
| | - John Higgins
- Global Vaccines and Biologics Commercialization, Merck & Co., Inc, West Point, PA, USA
| | - Hari Kosanam
- Global Vaccines and Biologics Commercialization, Merck & Co., Inc, West Point, PA, USA.
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3
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Dukic E, van Maldegem KA, Shaikh KM, Fukuda K, Töpel M, Solymosi K, Hellsten J, Hansen TH, Husted S, Higgins J, Sano S, Ishijima S, Spetea C. Chloroplast magnesium transporters play essential but differential roles in maintaining magnesium homeostasis. Front Plant Sci 2023; 14:1221436. [PMID: 37692441 PMCID: PMC10484576 DOI: 10.3389/fpls.2023.1221436] [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] [Received: 05/12/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023]
Abstract
Magnesium (Mg2+) is essential for photosynthesis in the chloroplasts of land plants and algae. Being the central ion of chlorophyll, cofactor and activator of many photosynthetic enzymes including RuBisCO, magnesium-deficient plants may suffer from leaf chlorosis symptoms and retarded growth. Therefore, the chloroplast Mg2+ concentration is tightly controlled by magnesium transport proteins. Recently, three different transporters from two distinct families have been identified in the chloroplast inner envelope of the model plant Arabidopsis thaliana: MGT10, MGR8, and MGR9. Here, we assess the individual roles of these three proteins in maintaining chloroplast Mg2+ homeostasis and regulating photosynthesis, and if their role is conserved in the model green alga Chlamydomonas reinhardtii. Phylogenetic analysis and heterologous expression revealed that the CorC-like MGR8 and MGR9 transport Mg2+ by a different mechanism than the CorA-like MGT10. MGR8 and MGT10 genes are highest expressed in leaves, indicating a function in chloroplast Mg2+ transport. MGR9 is important for chloroplast function and plant adaptation in conditions of deficiency or excess of Mg2+. Transmission electron microscopy indicated that MGT10 plays a differential role in thylakoid stacking than MGR8 and MGR9. Furthermore, we report that MGR8, MGR9, and MGT10 are involved in building up the pH gradient across the thylakoid membrane and activating photoprotection in conditions of excess light, however the mechanism has not been resolved yet. While there are no chloroplast MGR-like transporters in Chlamydomonas, we show that MRS4 is a homolog of MGT10, that is required for photosynthesis and cell growth. Taken together, our findings reveal that the studied Mg2+ transporters play essential but differential roles in maintaining chloroplast Mg2+ homeostasis.
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Affiliation(s)
- Emilija Dukic
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kim A. van Maldegem
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kashif Mohd Shaikh
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kento Fukuda
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Mats Töpel
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
- IVL Swedish Environmental Research Institute, Gothenburg, Sweden
| | - Katalin Solymosi
- Department of Plant Anatomy, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Jonna Hellsten
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Hesselhøj Hansen
- Copenhagen Plant Science Centre, Department of Plant and Environmental Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Husted
- Copenhagen Plant Science Centre, Department of Plant and Environmental Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Higgins
- Department of Geosciences, Princeton University, Princeton, NJ, United States
| | - Satoshi Sano
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Sumio Ishijima
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Cornelia Spetea
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
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4
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LeDesma R, Heller B, Biswas A, Maya S, Gili S, Higgins J, Ploss A. Structural features stabilized by divalent cation coordination within hepatitis E virus ORF1 are critical for viral replication. eLife 2023; 12:e80529. [PMID: 36852909 PMCID: PMC9977285 DOI: 10.7554/elife.80529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023] Open
Abstract
Hepatitis E virus (HEV) is an RNA virus responsible for over 20 million infections annually. HEV's open reading frame (ORF)1 polyprotein is essential for genome replication, though it is unknown how the different subdomains function within a structural context. Our data show that ORF1 operates as a multifunctional protein, which is not subject to proteolytic processing. Supporting this model, scanning mutagenesis performed on the putative papain-like cysteine protease (pPCP) domain revealed six cysteines essential for viral replication. Our data are consistent with their role in divalent metal ion coordination, which governs local and interdomain interactions that are critical for the overall structure of ORF1; furthermore, the 'pPCP' domain can only rescue viral genome replication in trans when expressed in the context of the full-length ORF1 protein but not as an individual subdomain. Taken together, our work provides a comprehensive model of the structure and function of HEV ORF1.
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Affiliation(s)
- Robert LeDesma
- Department of Molecular Biology, Lewis Thomas Laboratory, Princeton UniversityPrincetonUnited States
| | - Brigitte Heller
- Department of Molecular Biology, Lewis Thomas Laboratory, Princeton UniversityPrincetonUnited States
| | - Abhishek Biswas
- Department of Molecular Biology, Lewis Thomas Laboratory, Princeton UniversityPrincetonUnited States
| | - Stephanie Maya
- Department of Molecular Biology, Lewis Thomas Laboratory, Princeton UniversityPrincetonUnited States
| | - Stefania Gili
- Department of Geosciences, Princeton UniversityPrincetonUnited States
| | - John Higgins
- Department of Geosciences, Princeton UniversityPrincetonUnited States
| | - Alexander Ploss
- Department of Molecular Biology, Lewis Thomas Laboratory, Princeton UniversityPrincetonUnited States
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5
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Jiang T, Edwards N, Sukumar N, Mayers M, Higgins J, Kosanam H. Development and validation of LC-MS/MS method for quantification of protease inhibitor Pepstatin A to monitor its robust clearance in vaccine downstream process. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1215:123589. [PMID: 36592589 DOI: 10.1016/j.jchromb.2022.123589] [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: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Pepstatin A reversibly inhibits aspartic acid proteases and minimizes the impact of protease-induced degradation in recombinant protein manufacturing process. Pepstatin A is considered as a process-related impurity and must be characterized and controlled during manufacturing. Herein we describe the development and validation of an LC-MS/MS method for the quantitation of pepstatin A to monitor its robust clearance in vaccine purification process. Analyte extraction from process intermediates was carried out using 10% acetonitrile/water extraction method. Acetyl-pepstatin was used as internal standard (IS). Pepstatin A and IS were resolved on a C18 column using 10 mM ammonium acetate in water and methanol/acetonitrile mobile phase system. A triple quadrupole mass spectrometer operating in the positive electrospray ionization mode with multiple reaction monitoring was used to detect Pepstatin A and IS transitions of m/z 686.5 to 229.3 and 644.5 to 229.3, respectively. The method was validated for specificity, linearity, accuracy, repeatability (precision), intermediate precision, and assay robustness. The assay was linear over the range of calibration standards 0.5-100 ng/mL. The Lower-limit-of-quantification (LLOQ) of the method was 0.50 ng/mL.
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Affiliation(s)
- Tingting Jiang
- Global Vaccines and Biologics Commercialization, Merck, 770 Sumneytown Pike, West Point, PA, USA
| | - Nathan Edwards
- Global Vaccines and Biologics Commercialization, Merck, 770 Sumneytown Pike, West Point, PA, USA
| | - Neelima Sukumar
- Biologics and Vaccine Analytics, Merck, 770 Sumneytown Pike, West Point, PA, USA
| | - Michael Mayers
- Biologics and Vaccine Analytics, Merck, 770 Sumneytown Pike, West Point, PA, USA
| | - John Higgins
- Global Vaccines and Biologics Commercialization, Merck, 770 Sumneytown Pike, West Point, PA, USA
| | - Hari Kosanam
- Global Vaccines and Biologics Commercialization, Merck, 770 Sumneytown Pike, West Point, PA, USA.
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6
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Proulx CE, Higgins J, Vincent C, Vaughan T, Hewko M, Gagnon DH. User-centered development process of an operating interface to couple a robotic glove with a virtual environment to optimize hand rehabilitation following a stroke. J Rehabil Assist Technol Eng 2023; 10:20556683231166574. [PMID: 37077202 PMCID: PMC10107379 DOI: 10.1177/20556683231166574] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
Introduction Task-specific neurorehabilitation is crucial to optimize hand recovery shortly after a stroke, but intensive neurorehabilitation remains limited in resource-constrained healthcare systems. This has led to a growing interest in the use of robotic gloves as an adjunct intervention to intensify hand-specific neurorehabilitation. This study aims to develop and assess the usability of an operating interface supporting such a technology coupled with a virtual environment through a user-centered design approach. Methods Fourteen participants with hand hemiparesis following a stroke were invited to don the robotic glove before browsing through the operating interface and its functionalities, and perform two mobility exercises in a virtual environment. Feedback was collected for improving technology usability. Participants completed the System Usability Scale and ABILHAND questionnaires and their recommendations were gathered and prioritized in a Pugh Matrix. Results The System Usability Scale (SUS) score for the operating interface was excellent (M = 87.0 SD = 11.6). A total of 74 recommendations to improve the user interface, calibration process, and exercise usability were identified. Conclusion The application of a full cycle of user-centred design approach confirms the high level of usability of the system which is perceived by end users as acceptable and useful for intensifying neurorehabilitation.
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Affiliation(s)
- CE Proulx
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - J Higgins
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - C Vincent
- Department of Rehabilitation, Université Laval, Quebec, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé
et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - T Vaughan
- Simulation and Digital Health,
Medical Devices Research Centre, National Research Council
Canada, Boucherville, QC, Canada
| | - M Hewko
- Simulation and Digital Health,
Medical Devices Research Centre, National Research Council Canada,
Winnipeg, Winnipeg, MB, Canada
| | - DH Gagnon
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- DH Gagnon, School of Rehabilitation,
Université de Montréal-Pavillon Ave du Parc, C.P. 6128, succursale Centre-Ville,
Montreal, QC H3C 3J7, Canada.
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Miller P, Lei L, Charu V, Higgins J, Troxell M, Kambham N. Clinicopathologic features of non-lupus membranous nephropathy in a pediatric population. Pediatr Nephrol 2022; 37:3127-3137. [PMID: 35333973 DOI: 10.1007/s00467-022-05503-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Membranous nephropathy is an uncommon cause of nephrotic syndrome in pediatrics. METHODS We reviewed our kidney biopsy records for patients ≤ 20 years of age with membranous nephropathy without evidence of systemic lupus erythematosus within 6 months of biopsy (January 1995-September 2020). Staining for PLA2R, NELL1, THSD7A, SEMA3B, EXT2 (3 biopsies), and IgG-subclass were performed. RESULTS Sixteen children (≤ 12 years) and 25 adolescents (13-20 years) were identified. Four children and 15 adolescents showed autoantigen positivity: PLA2R+/SEMA3B- (13), SEMA3B+/PLA2R+ (2), SEMA3B+/PLA2R- (1), NELL1 (1), EXT2+ (2), and THSD7A (0). Co-morbidities associated with PLA2R positivity included IPEX syndrome, active hepatitis B, Von Hippel Lindau syndrome, solitary kidney, type 1 diabetes, hyperuricemia, pregnancy (1), obesity (3), type II diabetes, H. pylori, viral prodrome, and nephrolithiasis. The SEMA3B+/PLA2R- adolescent was pregnant, the NELL1+ adolescent was obese, and the two EXT2+ adolescents eventually met the clinical criteria for lupus (4, 9 years post-biopsy). Co-morbidities among the remaining 24 patients included remote hepatitis B (2), Down's syndrome, lysinuric protein intolerance, recurrent UTIs, hypothyroidism, pregnancy (3), and obesity (2). Follow-up data was available for 12 children and 16 adolescents. Of the 12 children, 6 achieved complete remission, 4 achieved partial remission, and 2 had no response to treatment (1 transplant). Of the 16 adolescents, 4 achieved complete remission, 4 achieved partial remission, and 8 had no response to treatment (3 transplants). A child with "full-house" immunofluorescence staining achieved spontaneous disease remission. CONCLUSION Our non-lupus membranous nephropathy cohort represents one of the largest pediatric studies to date. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Paul Miller
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA.
| | - Li Lei
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA.,UC Davis, Sacramento, CA, USA
| | - Vivek Charu
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - John Higgins
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Megan Troxell
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
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Higgins J, Tomaszewska P, Pellny TK, Castiblanco V, Arango J, Tohme J, Schwarzacher T, Mitchell RA, Heslop-Harrison JS, De Vega JJ. Diverged subpopulations in tropical Urochloa (Brachiaria) forage species indicate a role for facultative apomixis and varying ploidy in their population structure and evolution. Ann Bot 2022; 130:657-669. [PMID: 36112370 PMCID: PMC9670755 DOI: 10.1093/aob/mcac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Urochloa (syn. Brachiaria) is a genus of tropical grasses sown as forage feedstock, particularly in marginal soils. Here we aimed to clarify the genetic diversity and population structure in Urochloa species to understand better how population evolution relates to ploidy level and occurrence of apomictic reproduction. METHODS We explored the genetic diversity of 111 accessions from the five Urochloa species used to develop commercial cultivars. These accessions were conserved from wild materials collected at their centre of origin in Africa, and they tentatively represent the complete Urochloa gene pool used in breeding programmes. We used RNA-sequencing to generate 1.1 million single nucleotide polymorphism loci. We employed genetic admixture, principal component and phylogenetic analyses to define subpopulations. RESULTS We observed three highly differentiated subpopulations in U. brizantha, which were unrelated to ploidy: one intermixed with U. decumbens, and two diverged from the former and the other species in the complex. We also observed two subpopulations in U. humidicola, unrelated to ploidy; one subpopulation had fewer accessions but included the only characterized sexual accession in the species. Our results also supported a division of U. decumbens between diploids and polyploids, and no subpopulations within U. ruziziensis and U. maxima. CONCLUSIONS Polyploid U. decumbens are more closely related to polyploid U. brizantha than to diploid U. decumbens, which supports the divergence of both polyploid groups from a common tetraploid ancestor and provides evidence for the hybridization barrier of ploidy. The three differentiated subpopulations of apomictic polyploid U. brizantha accessions constitute diverged ecotypes, which can probably be utilized in hybrid breeding. Subpopulations were not observed in non-apomictic U. ruziziensis. Sexual Urochloa polyploids were not found (U. brizantha, U. decumbens) or were limited to small subpopulations (U. humidicola). The subpopulation structure observed in the Urochloa sexual-apomictic multiploidy complexes supports geographical parthenogenesis, where the polyploid genotypes exploit the evolutionary advantage of apomixis, i.e. uniparental reproduction and clonality, to occupy extensive geographical areas.
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Affiliation(s)
- J Higgins
- Earlham Institute, Norwich Research Park, Norwich NR4 7UZ, UK
| | - P Tomaszewska
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
- Department of Genetics and Cell Physiology, Faculty of Biological Sciences, University of Wroclaw, 50-328 Wroclaw, Poland
| | - T K Pellny
- Rothamsted Research, Harpenden, Hertfordshire AL5 2JQ, UK
| | - V Castiblanco
- International Center for Tropical Agriculture (CIAT), 6713 Cali, Colombia
| | - J Arango
- International Center for Tropical Agriculture (CIAT), 6713 Cali, Colombia
| | - J Tohme
- International Center for Tropical Agriculture (CIAT), 6713 Cali, Colombia
| | - T Schwarzacher
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - R A Mitchell
- Rothamsted Research, Harpenden, Hertfordshire AL5 2JQ, UK
| | - J S Heslop-Harrison
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
- Key Laboratory of Plant Resources Conservation and Sustainable Utilization/Guangdong Provincial, Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
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Sandha P, Higgins J, LeGros Strickler K, Weitzner M. Using Photovoice with Middle and High School Students to Capture Youth Voices on Food Environments and the impact of COVID-19. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.071] [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: 11/25/2022]
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10
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Grune J, Lewis AJM, Yamazoe M, Hulsmans M, Rohde D, Xiao L, Zhang S, Ott C, Calcagno DM, Zhou Y, Timm K, Shanmuganathan M, Pulous FE, Schloss MJ, Foy BH, Capen D, Vinegoni C, Wojtkiewicz GR, Iwamoto Y, Grune T, Brown D, Higgins J, Ferreira VM, Herring N, Channon KM, Neubauer S, Sosnovik DE, Milan DJ, Swirski FK, King KR, Aguirre AD, Ellinor PT, Nahrendorf M. Neutrophils incite and macrophages avert electrical storm after myocardial infarction. Nat Cardiovasc Res 2022; 1:649-664. [PMID: 36034743 PMCID: PMC9410341 DOI: 10.1038/s44161-022-00094-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death, arising from abnormal electrical conduction, occurs frequently in patients with coronary heart disease. Myocardial ischemia simultaneously induces arrhythmia and massive myocardial leukocyte changes. In this study, we optimized a mouse model in which hypokalemia combined with myocardial infarction triggered spontaneous ventricular tachycardia in ambulatory mice, and we showed that major leukocyte subsets have opposing effects on cardiac conduction. Neutrophils increased ventricular tachycardia via lipocalin-2 in mice, whereas neutrophilia associated with ventricular tachycardia in patients. In contrast, macrophages protected against arrhythmia. Depleting recruited macrophages in Ccr2 -/- mice or all macrophage subsets with Csf1 receptor inhibition increased both ventricular tachycardia and fibrillation. Higher arrhythmia burden and mortality in Cd36 -/- and Mertk -/- mice, viewed together with reduced mitochondrial integrity and accelerated cardiomyocyte death in the absence of macrophages, indicated that receptor-mediated phagocytosis protects against lethal electrical storm. Thus, modulation of leukocyte function provides a potential therapeutic pathway for reducing the risk of sudden cardiac death.
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Affiliation(s)
- Jana Grune
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew J. M. Lewis
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- These authors contributed equally and are listed in alphabetical order: Andrew J. M. Lewis, Masahiro Yamazoe
| | - Masahiro Yamazoe
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- These authors contributed equally and are listed in alphabetical order: Andrew J. M. Lewis, Masahiro Yamazoe
| | - Maarten Hulsmans
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Rohde
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ling Xiao
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuang Zhang
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christiane Ott
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - David M. Calcagno
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Yirong Zhou
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kerstin Timm
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Mayooran Shanmuganathan
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute for Health (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Fadi E. Pulous
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Maximilian J. Schloss
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brody H. Foy
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Diane Capen
- Program in Membrane Biology, Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Claudio Vinegoni
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory R. Wojtkiewicz
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tilman Grune
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Dennis Brown
- Program in Membrane Biology, Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John Higgins
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Neil Herring
- National Institute for Health (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Keith M. Channon
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute for Health (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute for Health (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | | | - David E. Sosnovik
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Filip K. Swirski
- Cardiovascular Research Institute and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin R. King
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego La Jolla, CA, USA
| | - Aaron D. Aguirre
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick T. Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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11
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Stout JN, Lin PY, Sutin J, Higgins J, Ellen Grant P. Magnetic resonance imaging metrics of oxygen extraction fraction: Contradictions or insight into pathophysiological mechanisms? Am J Hematol 2022; 97:679-681. [PMID: 35405034 PMCID: PMC10353571 DOI: 10.1002/ajh.26567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Jeffrey N. Stout
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Pei-Yi Lin
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Jason Sutin
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - John Higgins
- Center for Systems Biology and Department of Pathology,
Massachusetts General Hospital Boston, Department of Systems Biology, Harvard
Medical School, Boston, Massachusetts, USA
| | - P. Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
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12
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Norgaard Z, Higgins J, Yaplee J, Blake J, Prieve M, Lo FY, Delaney C, Valentine C, Salk J. Process Development and Manufacturing: ULTRA-SENSITIVE DUPLEX SEQUENCING FOR QUANTIFYING MULTI-INDIVIDUAL CELL THERAPY SUB-POPULATION FRACTIONS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00455-8] [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: 11/25/2022]
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13
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Brown JR, Ricket IM, Reeves RM, Shah RU, Goodrich CA, Gobbel G, Stabler ME, Perkins AM, Minter F, Cox KC, Dorn C, Denton J, Bray BE, Gouripeddi R, Higgins J, Chapman WW, MacKenzie T, Matheny ME. Information Extraction From Electronic Health Records to Predict Readmission Following Acute Myocardial Infarction: Does Natural Language Processing Using Clinical Notes Improve Prediction of Readmission? J Am Heart Assoc 2022; 11:e024198. [PMID: 35322668 PMCID: PMC9075435 DOI: 10.1161/jaha.121.024198] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Social risk factors influence rehospitalization rates yet are challenging to incorporate into prediction models. Integration of social risk factors using natural language processing (NLP) and machine learning could improve risk prediction of 30‐day readmission following an acute myocardial infarction. Methods and Results Patients were enrolled into derivation and validation cohorts. The derivation cohort included inpatient discharges from Vanderbilt University Medical Center between January 1, 2007, and December 31, 2016, with a primary diagnosis of acute myocardial infarction, who were discharged alive, and not transferred from another facility. The validation cohort included patients from Dartmouth‐Hitchcock Health Center between April 2, 2011, and December 31, 2016, meeting the same eligibility criteria described above. Data from both sites were linked to Centers for Medicare & Medicaid Services administrative data to supplement 30‐day hospital readmissions. Clinical notes from each cohort were extracted, and an NLP model was deployed, counting mentions of 7 social risk factors. Five machine learning models were run using clinical and NLP‐derived variables. Model discrimination and calibration were assessed, and receiver operating characteristic comparison analyses were performed. The 30‐day rehospitalization rates among the derivation (n=6165) and validation (n=4024) cohorts were 15.1% (n=934) and 10.2% (n=412), respectively. The derivation models demonstrated no statistical improvement in model performance with the addition of the selected NLP‐derived social risk factors. Conclusions Social risk factors extracted using NLP did not significantly improve 30‐day readmission prediction among hospitalized patients with acute myocardial infarction. Alternative methods are needed to capture social risk factors.
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Affiliation(s)
- Jeremiah R Brown
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Iben M Ricket
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Ruth M Reeves
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN.,Geriatric Research Education and Clinical Care Center Tennessee Valley Healthcare System VA Nashville TN
| | - Rashmee U Shah
- Division of Cardiovascular Medicine University of Utah School of Medicine Salt Lake City UT
| | - Christine A Goodrich
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Glen Gobbel
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN.,Geriatric Research Education and Clinical Care Center Tennessee Valley Healthcare System VA Nashville TN.,Department of Biostatistics Vanderbilt University Medical Center Nashville TN.,Division of General Internal Medicine Vanderbilt University Medical Center Nashville TN
| | - Meagan E Stabler
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Amy M Perkins
- Geriatric Research Education and Clinical Care Center Tennessee Valley Healthcare System VA Nashville TN.,Department of Biostatistics Vanderbilt University Medical Center Nashville TN
| | - Freneka Minter
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Kevin C Cox
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Chad Dorn
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Jason Denton
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Bruce E Bray
- Division of General Internal Medicine Vanderbilt University Medical Center Nashville TN.,Department of Biomedical Informatics University of Utah School of Medicine Salt Lake City UT
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics University of Utah School of Medicine Salt Lake City UT.,Utah Clinical & Translational Science InstituteUniversity of Utah Salt Lake City UT
| | - John Higgins
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Wendy W Chapman
- Centre for Digital Transformation of Health University of Melbourne Melbourne Victoria Australia
| | - Todd MacKenzie
- Departments of Epidemiology and Biomedical Data Science Dartmouth Geisel School of Medicine Hanover NH
| | - Michael E Matheny
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN.,Geriatric Research Education and Clinical Care Center Tennessee Valley Healthcare System VA Nashville TN.,Department of Biostatistics Vanderbilt University Medical Center Nashville TN.,Division of General Internal Medicine Vanderbilt University Medical Center Nashville TN
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14
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Youn JH, Oh YT, Gili S, McDonough AA, Higgins J. Estimating in vivo potassium distribution and fluxes with stable potassium isotopes. Am J Physiol Cell Physiol 2022; 322:C410-C420. [PMID: 35080924 PMCID: PMC8917925 DOI: 10.1152/ajpcell.00351.2021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extracellular potassium (K+) homeostasis is achieved by a concerted effort of multiple organs and tissues. A limitation in studies of K+ homeostasis is inadequate techniques to quantify K+ fluxes into and out of organs and tissues in vivo. The goal of the present study was to test the feasibility of a novel approach to estimate K+ distribution and fluxes in vivo using stable K+ isotopes. 41K was infused as KCl into rats consuming control or K+-deficient chow (n = 4 each), 41K-to-39K ratios in plasma and red blood cells (RBCs) were measured by inductively coupled plasma mass spectrometry, and results were subjected to compartmental modeling. The plasma 41K/39K increased during 41K infusion and decreased upon infusion cessation, without altering plasma total K+ concentration ([K+], i.e., 41K + 39K). The time course of changes was analyzed with a two-compartmental model of K+ distribution and elimination. Model parameters, representing transport into and out of the intracellular pool and renal excretion, were identified in each rat, accurately predicting decreased renal K+ excretion in rats fed K+-deficient vs. control diet (P < 0.05). To estimate rate constants of K+ transport into and out of RBCs, 41K/39K were subjected to a simple model, indicating no effects of the K+-deficient diet. The findings support the feasibility of the novel stable isotope approach to quantify K+ fluxes in vivo and sets a foundation for experimental protocols using more complex models to identify heterogeneous intracellular K+ pools and to answer questions pertaining to K+ homeostatic mechanisms in vivo.
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Affiliation(s)
- Jang H. Youn
- 1Department of Physiology and Neuroscience, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Young Taek Oh
- 1Department of Physiology and Neuroscience, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Stefania Gili
- 2Department of Geosciences, Princeton University, Princeton, New Jersey
| | - Alicia A. McDonough
- 1Department of Physiology and Neuroscience, University of Southern California Keck School of Medicine, Los Angeles, California
| | - John Higgins
- 2Department of Geosciences, Princeton University, Princeton, New Jersey
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15
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Holloway GL, Higgins J, Beranek JP. Split staphylectomy to address soft palate thickness in brachycephalic dogs: 75 cases (2016-2018). J Small Anim Pract 2022; 63:460-467. [PMID: 35137415 DOI: 10.1111/jsap.13485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Describe the split staphylectomy procedure to address soft palate thickness and assess the complications and long-term outcome of this procedure as a part of multi-level surgery for brachycephalic obstructive airway syndrome. To consider whether same-day discharge following this surgery can be recommended. MATERIALS AND METHODS Medical records of dogs treated for brachycephalic obstructive airway syndrome using the split staphylectomy were reviewed. Owners were contacted to complete a questionnaire assessing initial postoperative concerns, the long-term outcome and the effect of surgery on their dog's quality of life. RESULTS Seventy-five dogs underwent split staphylectomy during the study period. The overall complication rate was 8.3%, of which 2.7% were considered major. No life-threatening complications occurred, and no complications were related to the staphylectomy. The questionnaire was completed by 66.7% of owners (median follow-up 459 days), of which 88% felt that surgery had improved the quality of life for their dog. The majority (88%) of dogs were discharged from hospital on the day of surgery. Of the surveyed owners, 14% sought veterinary attention between their dog leaving the hospital and the scheduled postoperative reassessment 2 weeks after surgery. Four dogs were presented for veterinary intervention during this time period, but no intervention was related to the staphylectomy or for a life-threatening condition. CLINICAL SIGNIFICANCE The split staphylectomy offers a safe, straightforward method of addressing both excess thickness and length of soft palate in dogs with brachycephalic obstructive airway syndrome. Dogs can be discharged on the same day as brachycephalic obstructive airway syndrome surgery including split staphylectomy without an increased risk of complications.
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Affiliation(s)
| | - J Higgins
- Kentdale Referrals, Cumbria, LA7 7NU, UK
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16
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Spencer BF, Church SA, Thompson P, Cant DJH, Maniyarasu S, Theodosiou A, Jones AN, Kappers MJ, Binks DJ, Oliver RA, Higgins J, Thomas AG, Thomson T, Shard AG, Flavell WR. Characterization of buried interfaces using Ga Kα hard X-ray photoelectron spectroscopy (HAXPES). Faraday Discuss 2022; 236:311-337. [DOI: 10.1039/d2fd00021k] [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: 11/21/2022]
Abstract
HAXPES enables the detection of buried interfaces with an increased photo electron sampling depth.
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Affiliation(s)
- B. F. Spencer
- Henry Royce Institute, Photon Science Institute, Department of Materials, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - S. A. Church
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - P. Thompson
- Department of Computer Science, School of Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - D. J. H. Cant
- Surface Technologies, Chemical and Biological Sciences Department, National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | - S. Maniyarasu
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - A. Theodosiou
- The Nuclear Graphite Research Group, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - A. N. Jones
- The Nuclear Graphite Research Group, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M. J. Kappers
- Department of Materials Science & Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge, CB3 0FS, UK
| | - D. J. Binks
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - R. A. Oliver
- Department of Materials Science & Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge, CB3 0FS, UK
| | | | - A. G. Thomas
- Henry Royce Institute, Photon Science Institute, Department of Materials, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - T. Thomson
- Department of Computer Science, School of Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - A. G. Shard
- Surface Technologies, Chemical and Biological Sciences Department, National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, UK
| | - W. R. Flavell
- Henry Royce Institute, Photon Science Institute, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Manchester, M13 9PL, UK
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17
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Tucker TJ, Embrey MW, Alleyne C, Amin RP, Bass A, Bhatt B, Bianchi E, Branca D, Bueters T, Buist N, Ha SN, Hafey M, He H, Higgins J, Johns DG, Kerekes AD, Koeplinger KA, Kuethe JT, Li N, Murphy B, Orth P, Salowe S, Shahripour A, Tracy R, Wang W, Wu C, Xiong Y, Zokian HJ, Wood HB, Walji A. A Series of Novel, Highly Potent, and Orally Bioavailable Next-Generation Tricyclic Peptide PCSK9 Inhibitors. J Med Chem 2021; 64:16770-16800. [PMID: 34704436 DOI: 10.1021/acs.jmedchem.1c01599] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Proprotein convertase subtilisin-like/kexin type 9 (PCSK9) is a key regulator of plasma LDL-cholesterol (LDL-C) and a clinically validated target for the treatment of hypercholesterolemia and coronary artery disease. Starting from second-generation lead structures such as 2, we were able to refine these structures to obtain extremely potent bi- and tricyclic PCSK9 inhibitor peptides. Optimized molecules such as 44 demonstrated sufficient oral bioavailability to maintain therapeutic levels in rats and cynomolgus monkeys after dosing with an enabled formulation. We demonstrated target engagement and LDL lowering in cynomolgus monkeys essentially identical to those observed with the clinically approved, parenterally dosed antibodies. These molecules represent the first report of highly potent and orally bioavailable macrocyclic peptide PCSK9 inhibitors with overall profiles favorable for potential development as once-daily oral lipid-lowering agents. In this manuscript, we detail the design criteria and multiparameter optimization of this novel series of PCSK9 inhibitors.
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Affiliation(s)
- Thomas J Tucker
- Department of Medicinal Chemistry, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Mark W Embrey
- Department of Medicinal Chemistry, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Candice Alleyne
- Department of Discovery Pharmaceutical Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Rupesh P Amin
- Department of Safety Assessment and Laboratory Animal Resources, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Alan Bass
- Department of Safety Assessment and Laboratory Animal Resources, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Bhavana Bhatt
- Department of Safety Assessment and Laboratory Animal Resources, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Elisabetta Bianchi
- Peptides and Small Molecule Research and Development Department, IRBM S.p.A., Via Pontina km 30600, 00071 Pomezia (RM), Italy
| | - Danila Branca
- Peptides and Small Molecule Research and Development Department, IRBM S.p.A., Via Pontina km 30600, 00071 Pomezia (RM), Italy
| | - Tjerk Bueters
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Nicole Buist
- Department of Discovery Pharmaceutical Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Sookhee N Ha
- Department of Modeling and Informatics, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Mike Hafey
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Huaibing He
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - John Higgins
- Department of Discovery Pharmaceutical Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Douglas G Johns
- Department of Discovery Biology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Angela D Kerekes
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Kenneth A Koeplinger
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Jeffrey T Kuethe
- Department of Process Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Nianyu Li
- Department of Safety Assessment and Laboratory Animal Resources, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - BethAnn Murphy
- Department of Discovery Biology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Peter Orth
- Department of Structural Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Scott Salowe
- Department of Discovery Biology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Aurash Shahripour
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Rodger Tracy
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Weixun Wang
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Chengwei Wu
- Department of Medicinal Chemistry, Merck & Co., Inc., 770 Sumneytown Pike, P.O. Box 4, West Point, Pennsylvania 19486 United States
| | - Yusheng Xiong
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Hratch J Zokian
- Department of Discovery Biology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Harold B Wood
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
| | - Abbas Walji
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey 07033 United States
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18
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Weil S, Jung E, Domínguez Azorín D, Higgins J, Reckless J, Ramsden N, Keller P, Grainger D, Wick W, Winkler F. P10.02 Combined methods of a micropump system and a chronic cranial window allows tumor observation with multi photon laser scanning microscopy under continuous treatment. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastomas are notoriously therapy resistant tumors. As opposed to other tumor entities, no major advances in therapeutic success have been made in the past decades. This has been calling for a deeper biological understanding of the tumor, its growth and resistance patterns. We have been using a xenograft glioma model, where human glioblastoma cells are implanted under chronic cranial windows and studied longitudinally over many weeks and months using multi photon laser scanning microscopy (MPLSM). To test the effect of (new) drugs, a stable and direct delivery system avoiding the blood-brain-barrier has come into our interest.
MATERIAL AND METHODS
We implanted cranial windows and fluorescently labeled human glioblastoma stem-like cells into NMRI nude mice to follow up on the tumor development in our MPLSM model. After tumor establishment, an Alzet® micropump was implanted to directly deliver agents via a catheter system continuously over 28 days directly under the cranial window onto the brain surface. Using the MPLSM technique, the continuous delivery and infusion of drugs onto the brain and into the tumor was measured over many weeks in detail using MPLSM.
RESULTS
The establishment of the combined methods allowed reliable concurrent drug delivery over 28 days bypassing the blood-brain-barrier. Individual regions and tumor cells could be measured and followed up before, and after the beginning of the treatment, as well as after the end of the pump activity. Fluorescently labelled drugs were detectable in the MPLSM and its distribution into the brain parenchyma could be quantified. After the end of the micropump activity, further MPLSM measurements offer the possibility to observe long term effects of the applied drug on the tumor.
CONCLUSION
The combination of tumor observation in the MPSLM and concurrent continuous drug delivery is a feasible and reliable method for the investigation of (novel) anti-tumor agents, especially drugs that are not blood-brain-barrier penetrant. Morphological or even functional changes of individual tumor cells can be measured under and after treatment. These techniques can be used to test new drugs targeting the tumor, its tumor microtubes and tumor cells networks, and measure the effects longitudinally.
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Affiliation(s)
- S Weil
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - E Jung
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Domínguez Azorín
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Higgins
- Divide & Conquer, Cambridge, United Kingdom
| | - J Reckless
- Divide & Conquer, Cambridge, United Kingdom
| | - N Ramsden
- Divide & Conquer, Cambridge, United Kingdom
| | - P Keller
- Divide & Conquer, Cambridge, United Kingdom
| | - D Grainger
- Divide & Conquer, Cambridge, United Kingdom
| | - W Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Bradbrook JS, Higgins J, Hobbs RM, Miller JE. Further Improvements to the Disc Technique for Preparing Thin Foils for Electron Microscopy / Weitere Verbesserungen der Scheibentechnik zum Präparieren dünner Folien für die Elektronenmikroskopie. ACTA ACUST UNITED AC 2021. [DOI: 10.1515/pm-1971-080603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Norgaard Z, Higgins J, Yaplee J, Valentine C, Williams L, Salk J. Ultra-sensitive duplex sequencing for tracking of allogeneic cell therapies. Cytotherapy 2021. [DOI: 10.1016/s1465324921005478] [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: 11/15/2022]
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21
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Youn J, Oh YT, Ramos D, Gili S, McDonough A, Higgins J. A New Stable Isotope Method for Quantifying Potassium Distribution and Fluxes
In Vivo. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jang Youn
- Physiology and NeuroscienceUniversity of Southern CaliforniaCypressCA
| | | | | | | | - Alicia McDonough
- Physiology and NeuroscienceUniversity of Southern CaliforniaLos AngelesCA
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22
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Klinkhammer B, Higgins J. CLINICAL AND ECHOCARDIOGRAPHIC FACTORS WHICH PREDICT AN EARLY EVALUATION OF ISCHEMIC ETIOLOGY IN PATIENTS WITH NEW ONSET HEART FAILURE: A DESCRIPTIVE ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02069-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mukerji SS, Das S, Alabsi H, Brenner LN, Jain A, Magdamo C, Collens SI, Ye E, Keller K, Boutros CL, Leone MJ, Newhouse A, Foy B, Li MD, Lang M, Anahtar MN, Shao YP, Ge W, Sun H, Triant VA, Kalpathy-Cramer J, Higgins J, Rosand J, Robbins GK, Westover MB. Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19. Front Neurol 2021; 12:642912. [PMID: 33897598 PMCID: PMC8062773 DOI: 10.3389/fneur.2021.642912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/05/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Patients with comorbidities are at increased risk for poor outcomes in COVID-19, yet data on patients with prior neurological disease remains limited. Our objective was to determine the odds of critical illness and duration of mechanical ventilation in patients with prior cerebrovascular disease and COVID-19. Methods: A observational study of 1,128 consecutive adult patients admitted to an academic center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. We tested the association between prior cerebrovascular disease and critical illness, defined as mechanical ventilation (MV) or death by day 28, using logistic regression with inverse probability weighting of the propensity score. Among intubated patients, we estimated the cumulative incidence of successful extubation without death over 45 days using competing risk analysis. Results: Of the 1,128 adults with COVID-19, 350 (36%) were critically ill by day 28. The median age of patients was 59 years (SD: 18 years) and 640 (57%) were men. As of June 2nd, 2020, 127 (11%) patients had died. A total of 177 patients (16%) had a prior cerebrovascular disease. Prior cerebrovascular disease was significantly associated with critical illness (OR = 1.54, 95% CI = 1.14-2.07), lower rate of successful extubation (cause-specific HR = 0.57, 95% CI = 0.33-0.98), and increased duration of intubation (restricted mean time difference = 4.02 days, 95% CI = 0.34-10.92) compared to patients without cerebrovascular disease. Interpretation: Prior cerebrovascular disease adversely affects COVID-19 outcomes in hospitalized patients. Further study is required to determine if this subpopulation requires closer monitoring for disease progression during COVID-19.
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Affiliation(s)
- Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Haitham Alabsi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Laura N Brenner
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Aayushee Jain
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Colin Magdamo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Sarah I Collens
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Elissa Ye
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Kiana Keller
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Christine L Boutros
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Michael J Leone
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Amy Newhouse
- Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Brody Foy
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
- Department of Systems Biology, Harvard Medical School, Boston, MA, United States
| | - Matthew D Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Melis N Anahtar
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | - Yu-Ping Shao
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Wendong Ge
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Virginia A Triant
- Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - Jayashree Kalpathy-Cramer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - John Higgins
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
- Department of Systems Biology, Harvard Medical School, Boston, MA, United States
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Gregory K Robbins
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Clinical Data A.I. Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
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Yamashita R, Long J, Longacre T, Peng L, Berry G, Martin B, Higgins J, Rubin DL, Shen J. Deep learning model for the prediction of microsatellite instability in colorectal cancer: a diagnostic study. Lancet Oncol 2021; 22:132-141. [PMID: 33387492 DOI: 10.1016/s1470-2045(20)30535-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [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: 05/31/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Detecting microsatellite instability (MSI) in colorectal cancer is crucial for clinical decision making, as it identifies patients with differential treatment response and prognosis. Universal MSI testing is recommended, but many patients remain untested. A critical need exists for broadly accessible, cost-efficient tools to aid patient selection for testing. Here, we investigate the potential of a deep learning-based system for automated MSI prediction directly from haematoxylin and eosin (H&E)-stained whole-slide images (WSIs). METHODS Our deep learning model (MSINet) was developed using 100 H&E-stained WSIs (50 with microsatellite stability [MSS] and 50 with MSI) scanned at 40× magnification, each from a patient randomly selected in a class-balanced manner from the pool of 343 patients who underwent primary colorectal cancer resection at Stanford University Medical Center (Stanford, CA, USA; internal dataset) between Jan 1, 2015, and Dec 31, 2017. We internally validated the model on a holdout test set (15 H&E-stained WSIs from 15 patients; seven cases with MSS and eight with MSI) and externally validated the model on 484 H&E-stained WSIs (402 cases with MSS and 77 with MSI; 479 patients) from The Cancer Genome Atlas, containing WSIs scanned at 40× and 20× magnification. Performance was primarily evaluated using the sensitivity, specificity, negative predictive value (NPV), and area under the receiver operating characteristic curve (AUROC). We compared the model's performance with that of five gastrointestinal pathologists on a class-balanced, randomly selected subset of 40× magnification WSIs from the external dataset (20 with MSS and 20 with MSI). FINDINGS The MSINet model achieved an AUROC of 0·931 (95% CI 0·771-1·000) on the holdout test set from the internal dataset and 0·779 (0·720-0·838) on the external dataset. On the external dataset, using a sensitivity-weighted operating point, the model achieved an NPV of 93·7% (95% CI 90·3-96·2), sensitivity of 76·0% (64·8-85·1), and specificity of 66·6% (61·8-71·2). On the reader experiment (40 cases), the model achieved an AUROC of 0·865 (95% CI 0·735-0·995). The mean AUROC performance of the five pathologists was 0·605 (95% CI 0·453-0·757). INTERPRETATION Our deep learning model exceeded the performance of experienced gastrointestinal pathologists at predicting MSI on H&E-stained WSIs. Within the current universal MSI testing paradigm, such a model might contribute value as an automated screening tool to triage patients for confirmatory testing, potentially reducing the number of tested patients, thereby resulting in substantial test-related labour and cost savings. FUNDING Stanford Cancer Institute and Stanford Departments of Pathology and Biomedical Data Science.
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Affiliation(s)
- Rikiya Yamashita
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, CA, USA
| | - Jin Long
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, CA, USA
| | - Teri Longacre
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lan Peng
- Department of Pathology, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Gerald Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brock Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - John Higgins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, CA, USA
| | - Jeanne Shen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Stanford, CA, USA.
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Matheny ME, Ricket I, Goodrich CA, Shah RU, Stabler ME, Perkins AM, Dorn C, Denton J, Bray BE, Gouripeddi R, Higgins J, Chapman WW, MacKenzie TA, Brown JR. Development of Electronic Health Record-Based Prediction Models for 30-Day Readmission Risk Among Patients Hospitalized for Acute Myocardial Infarction. JAMA Netw Open 2021; 4:e2035782. [PMID: 33512518 PMCID: PMC7846941 DOI: 10.1001/jamanetworkopen.2020.35782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE In the US, more than 600 000 adults will experience an acute myocardial infarction (AMI) each year, and up to 20% of the patients will be rehospitalized within 30 days. This study highlights the need for consideration of calibration in these risk models. OBJECTIVE To compare multiple machine learning risk prediction models using an electronic health record (EHR)-derived data set standardized to a common data model. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study that developed risk prediction models for 30-day readmission among all inpatients discharged from Vanderbilt University Medical Center between January 1, 2007, and December 31, 2016, with a primary diagnosis of AMI who were not transferred from another facility. The model was externally validated at Dartmouth-Hitchcock Medical Center from April 2, 2011, to December 31, 2016. Data analysis occurred between January 4, 2019, and November 15, 2020. EXPOSURES Acute myocardial infarction that required hospital admission. MAIN OUTCOMES AND MEASURES The main outcome was thirty-day hospital readmission. A total of 141 candidate variables were considered from administrative codes, medication orders, and laboratory tests. Multiple risk prediction models were developed using parametric models (elastic net, least absolute shrinkage and selection operator, and ridge regression) and nonparametric models (random forest and gradient boosting). The models were assessed using holdout data with area under the receiver operating characteristic curve (AUROC), percentage of calibration, and calibration curve belts. RESULTS The final Vanderbilt University Medical Center cohort included 6163 unique patients, among whom the mean (SD) age was 67 (13) years, 4137 were male (67.1%), 1019 (16.5%) were Black or other race, and 933 (15.1%) were rehospitalized within 30 days. The final Dartmouth-Hitchcock Medical Center cohort included 4024 unique patients, with mean (SD) age of 68 (12) years; 2584 (64.2%) were male, 412 (10.2%) were rehospitalized within 30 days, and most of the cohort were non-Hispanic and White. The final test set AUROC performance was between 0.686 to 0.695 for the parametric models and 0.686 to 0.704 for the nonparametric models. In the validation cohort, AUROC performance was between 0.558 to 0.655 for parametric models and 0.606 to 0.608 for nonparametric models. CONCLUSIONS AND RELEVANCE In this study, 5 machine learning models were developed and externally validated to predict 30-day readmission AMI hospitalization. These models can be deployed within an EHR using routinely collected data.
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Affiliation(s)
- Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Deparment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville
| | - Iben Ricket
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Christine A. Goodrich
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Rashmee U. Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City
| | - Meagan E. Stabler
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Amy M. Perkins
- Deparment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason Denton
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bruce E. Bray
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
| | - Ram Gouripeddi
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
| | - John Higgins
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Wendy W. Chapman
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
- Centre for Clinical and Public Health Informatics, University of Melbourne, Melbourne, Victoria, Australia
| | - Todd A. MacKenzie
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Jeremiah R. Brown
- Departments of Epidemiology and Biomedical Data Science, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
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Higgins J, Schmuhl N, Wautlet C, Rice L. P32 The silent majority: Physicians’ knowledge of and attitudes toward restrictive abortion policies in a battleground state. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.051] [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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Charu V, Andeen N, Walavalkar V, Lapasia J, Kim JY, Lin A, Sibley R, Higgins J, Troxell M, Kambham N. Membranous nephropathy in patients with HIV: a report of 11 cases. BMC Nephrol 2020; 21:401. [PMID: 32948130 PMCID: PMC7501617 DOI: 10.1186/s12882-020-02042-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background Membranous nephropathy (MN) has been recognized to occur in patients with human immunodeficiency virus (HIV) infection since the beginning of the HIV epidemic. The prevalence of phospholipase A2 receptor (PLA2R)-associated MN in this group has not been well studied. Methods We conducted a retrospective review of electronic pathology databases at three institutions to identify patients with MN and known HIV at the time of renal biopsy. Patients with comorbidities and coinfections known to be independently associated with MN were excluded. Results We identified 11 HIV-positive patients with biopsy-confirmed MN meeting inclusion and exclusion criteria. Patient ages ranged from 39 to 66 years old, and 10 of 11 patients (91%) were male. The majority of patients presented with nephrotic-range proteinuria, were on anti-retroviral therapy at the time of biopsy and had low or undetectable HIV viral loads. Biopsies from 5 of 10 (50%) patients demonstrated capillary wall staining for PLA2R. Measurement of serum anti-PLA2R antibodies was performed in three patients, one of whom had positive anti-PLA2R antibody titers. Follow-up data was available on 10 of 11 patients (median length of follow-up: 44 months; range: 4–145 months). All patients were maintained on anti-retroviral therapy (ARV) and 5 patients (52%) received concomitant immunosuppressive regimens. Three patients developed end-stage renal disease (ESRD) during the follow-up period. Conclusions MN in the setting of HIV is often identified in the setting of an undetectable viral loads, and similar to other chronic viral infection-associated MNs, ~ 50% of cases demonstrate tissue reactivity with PLA2R antigen, which may be seen without corresponding anti-PLA2R serum antibodies.
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Affiliation(s)
- Vivek Charu
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA.
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Vighnesh Walavalkar
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Jessica Lapasia
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Jin-Yon Kim
- Department of Nephrology, The Permanente Medical Group, Sacramento, CA, USA
| | - Andrew Lin
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Richard Sibley
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - John Higgins
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Megan Troxell
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
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Lei L, Oh G, Sutherland S, Abra G, Higgins J, Sibley R, Troxell M, Kambham N. Myelin bodies in LMX1B-associated nephropathy: potential for misdiagnosis. Pediatr Nephrol 2020; 35:1647-1657. [PMID: 32356190 DOI: 10.1007/s00467-020-04564-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myelin figures, or zebra bodies, seen on electron microscopy were historically considered pathognomonic of Fabry disease, a rare lysosomal storage disorder caused by alpha-galactosidase A deficiency and associated with X-linked recessive mode of inheritance. More recently, iatrogenic phospholipidosis has emerged as an important alternate cause of myelin figures in the kidney. METHODS We report two families with autosomal dominant nephropathy presenting with proteinuria and microscopic hematuria, and the kidney biopsies were notable for the presence of myelin figures and zebra bodies. RESULTS Laboratory and genetic work-up for Fabry disease was negative. Genetic testing in both families revealed the same heterozygous missense mutation in LMX1B (C.737G>A, p.Arg246Gln). LMX1B mutations are known to cause nail-patella syndrome, featuring dysplastic nails and patella with or without nephropathy, as well as isolated LMX1B-associated nephropathy in the absence of extrarenal manifestations. CONCLUSIONS LMX1B mutation-associated nephropathy should be considered in hereditary cases of proteinuria and/or hematuria, even in the absence of unique glomerular basement membrane changes indicative of nail-patella syndrome. In addition, LMX1B mutation should be included in the differential diagnosis of myelin figures and zebra bodies on kidney biopsy, so as to avoid a misdiagnosis.
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Affiliation(s)
- Li Lei
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Gia Oh
- Randall Children's Hospital, Portland, OR, USA
| | - Scott Sutherland
- Department of Pediatrics & Division of Nephrology, Stanford University, Stanford, CA, USA
| | | | - John Higgins
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Richard Sibley
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Megan Troxell
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University, H2110, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AMW, Flanigan DC. Corrigendum to "The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study [The Knee 26 (2019) 1198-1203]". Knee 2020; 27:1291. [PMID: 32620349 DOI: 10.1016/j.knee.2020.06.002] [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] [Indexed: 02/02/2023]
Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - James C Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - John Higgins
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Andrew Hair
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Ajit M W Chaudhari
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
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Withrow D, Depner CM, Boland EM, Birks BR, Melanson EL, Higgins J, Eckel RH, Perreault L, Bergman BC, Wright KP. 0132 Sex Differences in Evening Food Intake and Associated Weight Gain During Insufficient Sleep. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Timing of food intake has emerged as a novel risk factor for weight gain and obesity. Higher evening food intake, especially during insufficient sleep, is associated with weight gain. We aimed to explore initial changes in evening food intake and the respiratory quotient (RQ) during insufficient sleep and subsequent weight gain. We also explored sex differences.
Methods
28 healthy adults (14F) aged 26.3±4.5y completed a 14–16 daylong laboratory protocol. In their home environment participants maintained one week of ~9h/night sleep schedules and consumed energy balanced diets for 3 days prior to completing the laboratory protocol. The laboratory protocol consisted of 3 baseline days of 9h/night scheduled sleep with energy balanced diets followed by 10 days of 5h/night scheduled sleep with ad-libitum food intake, with (n=14) and without (n=14) weekend recovery sleep. RQ was assessed on days 3 and 5 in a whole room calorimeter. Evening (dinner and after-dinner snacks) energy intake and body weight were assessed daily.
Results
A significant sex by condition effect was observed for evening food intake such that men and women were similar at baseline, but men ate more than women during insufficient sleep, when controlling for body mass (p<0.05). A significant sex by condition effect was also observed for RQ with women showing similar RQ during baseline and insufficient sleep and men showing a higher RQ during insufficient sleep versus baseline (p<0.05). Linear regression with food intake and RQ as predictors of weight gain showed that increased evening food intake, but not RQ, on the second day of sleep restriction was associated with weight gain in men, but not women, at the end of the study eight days later (p<0.05).
Conclusion
Findings suggest that rapid changes in evening food intake during insufficient sleep contributes to subsequent weight gain during sustained insufficient sleep, especially in men.
Support
NIH HL109706, DK111161, TR001082, DK048520, Sleep Research Society Foundation grant 011-JP-16 and Office of Naval Research MURI (N00014-15-1-2809).
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Affiliation(s)
- D Withrow
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - C M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - E M Boland
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - B R Birks
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - E L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - J Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - R H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - L Perreault
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - B C Bergman
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - K P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, CO
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Murphy NC, Burke N, Breathnach FM, Burke G, McAuliffe FM, Morrison JJ, Turner MJ, Dornan S, Higgins J, Cotter A, Geary MP, Cody F, McParland P, Mulcahy C, Daly S, Dicker P, Tully EC, Malone FD. Inter-hospital comparison of Cesarean delivery rates should not be considered to reflect quality of care without consideration of patient heterogeneity: An observational study. Eur J Obstet Gynecol Reprod Biol 2020; 250:112-116. [PMID: 32438274 DOI: 10.1016/j.ejogrb.2020.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Contemporary approaches to monitoring quality of care in obstetrics often focus on comparing Cesarean Delivery rates. Varied rates can complicate interpretation of quality of care. We previously developed a risk prediction tool for nulliparous women who may require intrapartum Cesarean delivery which identified five key predictors. Our objective with this study was to ascertain if patient heterogeneity can account for much of the observed variation in Cesarean delivery rates, thereby enabling Cesarean delivery rates to be a better marker of quality of care. MATERIALS AND METHODS This is a secondary analysis of the Genesis study. This was a large prospective study of 2336 nulliparous singleton pregnancies recruited at seven hospitals. A heterogeneity score was calculated for each hospital. An adjusted Cesarean delivery rate was also calculated incorporating the heterogeneous risk score. RESULTS A cut-off at the 90th percentile was determined for each predictive factor. Above the 90th percentile was considered to represent 'high risk' (with the exception of maternal height which identified those below the 10th percentile). The patient heterogeneous risk score was defined as the number of risk factors > 90th percentile (<10th percentile for height). An unequal distribution of high-risk patients between centers was observed (p < 0.001). The correlation between the Cesarean delivery rate and the patient heterogeneous risk score was high (0.76, p < 0.05). When adjusted for patient heterogeneity, Cesarean delivery rates became closer aligned. CONCLUSION Inter-institutional diversity is common. We suggest that crude comparison of Cesarean delivery rates between different hospitals as a marker of care quality is inappropriate. Allowing for marked differences in patient characteristics is essential for correct interpretation of such comparisons.
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Affiliation(s)
| | - Naomi Burke
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Gerard Burke
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | | | - Michael J Turner
- UCD Centre for Human Reproduction Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - John Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Amanda Cotter
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | | | - Peter McParland
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | - Cecelia Mulcahy
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | - Sean Daly
- Coombe Women and Infants University Hospital, Dublin, Ireland
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Ingo C, Lin C, Higgins J, Arevalo YA, Prabhakaran S. Diffusion Properties of Normal-Appearing White Matter Microstructure and Severity of Motor Impairment in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2019; 41:71-78. [PMID: 31831465 DOI: 10.3174/ajnr.a6357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/30/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The effect of white matter hyperintensities as measured by FLAIR MR imaging on functional impairment and recovery after ischemic stroke has been investigated thoroughly. However, there has been growing interest in investigating normal-appearing white matter microstructural integrity following ischemic stroke onset with techniques such as DTI. MATERIALS AND METHODS Fifty-two patients with acute ischemic stroke and 36 without stroke were evaluated with a DTI and FLAIR imaging protocol and clinically assessed for the severity of motor impairment using the Motricity Index within 72 hours of suspected symptom onset. RESULTS There were widespread decreases in fractional anisotropy and increases in mean diffusivity and radial diffusivity for the acute stroke group compared with the nonstroke group. There was a significant positive association between fractional anisotropy and motor function and a significant negative association between mean diffusivity/radial diffusivity and motor function. The normal-appearing white matter ROIs that were most sensitive to the Motricity Index were the anterior/posterior limb of the internal capsule in the infarcted hemisphere and the splenium of the corpus callosum, external capsule, posterior limb/retrolenticular part of the internal capsule, superior longitudinal fasciculus, and cingulum (hippocampus) of the intrahemisphere/contralateral hemisphere. CONCLUSIONS The microstructural integrity of normal-appearing white matter is a significant parameter to identify neural differences not only between those individuals with and without acute ischemic stroke but also correlated with the severity of acute motor impairment.
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Affiliation(s)
- C Ingo
- From the Departments of Neurology (C.I., Y.A.A.) .,Physical Therapy and Human Movement Sciences (C.I.)
| | - C Lin
- Department of Neurology (C.L.), University of Alabama at Birmingham, Birmingham, Alabama
| | - J Higgins
- Radiology (J.H.), Northwestern University, Chicago, Illinois
| | - Y A Arevalo
- From the Departments of Neurology (C.I., Y.A.A.)
| | - S Prabhakaran
- Department of Neurology (S.P.), University of Chicago Medical Center, Chicago, Illinois
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34
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Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AAMW, Flanigan DC. The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study. Knee 2019; 26:1198-1203. [PMID: 31439366 DOI: 10.1016/j.knee.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/14/2018] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iliotibial band friction syndrome (ITBFS) is an overuse injury with pain at the level of the knee lateral epicondyle. We sought to determine whether there is greater knee lateral epicondyle prominence among patients with ITBFS versus matched controls. METHODS Seventy five patients with ITBFS and 75 age-, height-, and sex-matched controls (n = 150 total patients) with knee magnetic resonance imaging from 2015 to 2017 were included. All cases had a diagnosis of ITBFS and a lack of other identified lateral knee injuries on magnetic resonance imaging. Controls had medial knee pain with medial meniscus tear on MRI and no clinical evidence of ITBFS. Lateral knee epicondyle height in millimeters was measured. RESULTS Mean patient age was 39.1 years (SD 15.1), 57% were female, and mean height was 170.0 cm (SD 9.3) with no difference between cases and controls. Mean lateral epicondyle height for cases was 13.1 mm (SD 1.6) and for controls was 12.2 (SD 1.4) with a mean difference of 0.9 mm (95% CI 0.4-1.3 mm) between matched pairs (p < 0.001). Mean epicondyle height:condylar AP width ratio was 0.211 (SD 0.023) for cases and 0.198 (SD 0.020) for controls with a mean difference of 0.013 (95% CI 0.006-0.020) between matched pairs (p < 0.001). CONCLUSIONS There is a significant association between greater lateral epicondyle prominence and IT band friction syndrome, suggesting another anatomic risk factor for this multifactorial condition.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - James C Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - John Higgins
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Andrew Hair
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Ajit A M W Chaudhari
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
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Askar B, Higgins J, Barrow P, Foster N. Immune evasion by Salmonella: exploiting the VPAC1/VIP axis in human monocytes. Immunology 2019; 158:230-239. [PMID: 31408534 DOI: 10.1111/imm.13107] [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: 03/26/2019] [Revised: 07/02/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022] Open
Abstract
Immune evasion is a critical survival mechanism for bacterial colonization of deeper tissues and may lead to life-threatening conditions such as endotoxaemia and sepsis. Understanding these immune evasion pathways would be an important step for the development of novel anti-microbial therapeutics. Here, we report a hitherto unknown mechanism by which Salmonella exploits an anti-inflammatory pathway in human immune cells to obtain survival advantage. We show that Salmonella enterica serovar Typhimurium strain 4/74 significantly (P < 0·05) increased expression of mRNA and surface protein of the type 1 receptor (VPAC1) for anti-inflammatory vasoactive intestinal peptide (VIP) in human monocytes. However, we also show that S. Typhimurium induced retrograde recycling of VPAC1 from early endosomes to Rab11a-containing sorting endosomes, associated with the Golgi apparatus, and anterograde trafficking via Rab3a and calmodulin 1. Expression of Rab3a and calmodulin 1 were significantly increased by S. Typhimurium infection and W-7 (calmodulin antagonist) decreased VPAC1 expression on the cell membrane while CALP-1 (calmodulin agonist) increased VPAC1 expression (P < 0·05). When infected monocytes were co-cultured with VIP, a significantly higher number of S. Typhimurium were recovered from these monocytes, compared with S. Typhimurium recovered from monocytes cultured only in cell media. We conclude that S. Typhimurium infection exploits host VPAC1/VIP to gain survival advantage in human monocytes.
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Affiliation(s)
| | - John Higgins
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Paul Barrow
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Neil Foster
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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36
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Hehir MP, Burke N, Burke G, Turner MJ, Breathnach FM, Mcauliffe FM, Morrison JJ, Dornan S, Higgins J, Cotter A, Geary MP, Mcparland P, Daly S, Cody F, Dicker P, Tully E, Malone FD. Sonographic markers of fetal adiposity and risk of Cesarean delivery. Ultrasound Obstet Gynecol 2019; 54:338-343. [PMID: 30887629 DOI: 10.1002/uog.20263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Increased fetal size is associated with shoulder dystocia during labor and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically in late pregnancy is associated with increased risk of operative delivery. METHODS This secondary analysis of the Genesis Study recruited 2392 nulliparous women with singleton pregnancy in cephalic presentation, in a prospective, multicenter study, to examine prenatal and intrapartum predictors of Cesarean delivery. Participants underwent ultrasound and clinical evaluation between 39 + 0 and 40 + 6 weeks' gestation. Data on fetal biometry were not revealed to patients or to their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal wall thickness was compiled for each infant in order to determine whether fetal adiposity > 90th centile was associated with an increased risk of Cesarean or operative vaginal delivery. RESULTS After exclusions, data were available for 2330 patients. Patients with a fetal adiposity composite > 90th centile had a higher maternal body mass index (BMI) (25 ± 5 kg/m2 vs 24 ± 4 kg/m2 ; P = 0.005), birth weight (3872 ± 417 g vs 3585 ± 401 g; P < 0.0001) and rate of induction of labor (47% (108/232) vs 40% (834/2098); P = 0.048) than did those with an adiposity composite ≤ 90th centile. Fetuses with adiposity composite > 90th centile were more likely to require Cesarean delivery than were those with adiposity composite ≤ 90th centile (P < 0.0001). After adjusting for birth weight, maternal BMI and need for induction of labor, fetal adiposity > 90th centile remained a risk factor for Cesarean delivery (P < 0.0001). A fetal adiposity composite > 90th centile was more predictive of the need for unplanned Cesarean delivery than was an estimated fetal weight > 90th centile (odds ratio, 2.20 (95% CI, 1.65-2.94; P < 0.001) vs 1.74 (95% CI, 1.29-2.35; P < 0.001). Having an adiposity composite > 90th centile was not associated with an increased likelihood of operative vaginal delivery when compared with having an adiposity composite ≤ 90th centile (P = 0.37). CONCLUSIONS Fetuses with increased adipose deposition are more likely to require Cesarean delivery than are those without increased adiposity. Consideration should, therefore, be given to adding fetal thigh adiposity and abdominal wall thickness to fetal sonographic assessment in late pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M P Hehir
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - N Burke
- Rotunda Hospital, Dublin, Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M J Turner
- University College Dublin Centre for Human Reproduction, School of Medicine and Medical Science, Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F M Mcauliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - S Dornan
- Royal Jubilee Maternity Hospital, Belfast, Ireland
| | - J Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - A Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - P Mcparland
- National Maternity Hospital, Dublin, Ireland
| | - S Daly
- Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F Cody
- Rotunda Hospital, Dublin, Ireland
| | - P Dicker
- Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Tully
- Rotunda Hospital, Dublin, Ireland
| | - F D Malone
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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Askar B, Higgins J, Barrow P, Foster N. Immunomodulation by vasoactive intestinal peptide is associated with increased survival and growth of Salmonella Typhimurium in mice. Cytokine 2019; 125:154787. [PMID: 31404818 DOI: 10.1016/j.cyto.2019.154787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
Studies have shown that administration of vasoactive intestinal peptide (VIP) in mice rescues them from lethal endotoxaemia and that this is correlated with decreased concentration of inflammatory cytokines. VIP has, therefore, been proposed as a novel anti-inflammatory which could be used in the treatment of Gram negative sepsis. However, the effect of VIP has not been reported in mice infected with viable Gram negative bacteria. Here, we show that Salmonella enterica serovar Typhimurium 4/74 significantly increased expression of mRNA of a type 1 receptor (VPAC1) for anti-inflammatory vasoactive intestinal peptide (VIP) in murine ileum and mesenteric lymph nodes at day 6 post-infection (d6 pi) and in the spleen at d3 pi. When VIP (5 nmol/ml) was administered to S. Typhimurium-infected mice, there was a significant increase in the number of S. Typhimurium cultured from murine faeces and ileum at d3 and 6 pi and in MLN and spleen at d3 dpi, compared to faeces and tissues examined from mice infected with S. Typhimurium (without VIP administration). Administration of VIP to S. Typhimurium-infected mice also altered the splenic architecture, resulting in a lack of discernable periarterial lymphoid sheaths or marginal zones at d6 pi but liver histology appeared similar on both d3 and d6 pi. The effects of VIP administration were correlated with a significant decrease in expression of inflammatory cytokine mRNA, associated with systemic inflammatory response syndrome (SIRS) of bacteraemia and acute sepsis. We conclude that VIP inhibits expression of diagnostic/prognostic cytokine biomarkers of sepsis in S. Typhimurium-infected mice. However, this occurred with a concomitant increase in Salmonella growth in tissues and increased bacterial shedding in faeces. Thus, VIP may have potential as an adjunctive therapy to antibiotics in sepsis.
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Affiliation(s)
- Basim Askar
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - John Higgins
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Paul Barrow
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Neil Foster
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK.
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Palmer EL, Hassanpour S, Higgins J, Doherty JA, Onega T. Building a tobacco user registry by extracting multiple smoking behaviors from clinical notes. BMC Med Inform Decis Mak 2019; 19:141. [PMID: 31340796 PMCID: PMC6657102 DOI: 10.1186/s12911-019-0863-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 07/02/2019] [Indexed: 12/18/2022] Open
Abstract
Background Usage of structured fields in Electronic Health Records (EHRs) to ascertain smoking history is important but fails in capturing the nuances of smoking behaviors. Knowledge of smoking behaviors, such as pack year history and most recent cessation date, allows care providers to select the best care plan for patients at risk of smoking attributable diseases. Methods We developed and evaluated a health informatics pipeline for identifying complete smoking history from clinical notes in EHRs. We utilized 758 patient-visit notes (from visits between 03/28/2016 and 04/04/2016) from our local EHR in addition to a public dataset of 502 clinical notes from the 2006 i2b2 Challenge to assess the performance of this pipeline. We used a machine-learning classifier to extract smoking status and a comprehensive set of text processing regular expressions to extract pack years and cessation date information from these clinical notes. Results We identified smoking status with an F1 score of 0.90 on both the i2b2 and local data sets. Regular expression identification of pack year history in the local test set was 91.7% sensitive and 95.2% specific, but due to variable context the pack year extraction was incomplete in 25% of cases, extracting packs per day or years smoked only. Regular expression identification of cessation date was 63.2% sensitive and 94.6% specific. Conclusions Our work indicates that the development of an EHR-based Smokers’ Registry containing information relating to smoking behaviors, not just status, from free-text clinical notes using an informatics pipeline is feasible. This pipeline is capable of functioning in external EHRs, reducing the amount of time and money needed at the institute-level to create a Smokers’ Registry for improved identification of patient risk and eligibility for preventative and early detection services. Electronic supplementary material The online version of this article (10.1186/s12911-019-0863-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - John Higgins
- Dartmouth College, HB 7920, 03755, Hanover, NH, USA
| | - Jennifer A Doherty
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Tracy Onega
- Dartmouth College, HB 7927, 03755, Hanover, NH, USA
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Palmer EL, Higgins J, Hassanpour S, Sargent J, Robinson CM, Doherty JA, Onega T. Assessing data availability and quality within an electronic health record system through external validation against an external clinical data source. BMC Med Inform Decis Mak 2019; 19:143. [PMID: 31345210 PMCID: PMC6657182 DOI: 10.1186/s12911-019-0864-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Approximately 20% of deaths in the US each year are attributable to smoking, yet current practices in the recording of this health risk in electronic health records (EHRs) have not led to discernable changes in health outcomes. Several groups have developed algorithms for extracting smoking behaviors from clinical notes, but none of these approaches were assessed with external data to report on anticipated clinical performance. METHODS Previously, we developed an informatics pipeline that extracts smoking status, pack year history, and cessation date from clinical notes. Here we report on the clinical implementation performance of our pipeline using 1,504 clinical notes matched to an external questionnaire. RESULTS We found that 73% of available notes contained no smoking behavior information. The weighted Cohen's kappa between the external questionnaire and EHR smoking status was 0.62 (95% CI 0.56-0.69) for the clinical notes we were able to extract information from. The correlation between pack years reported by our pipeline and the external questionnaire was 0.39 on the 81 notes for which this information was present in both. We also assessed for lung cancer screening eligibility using notes from individuals identified as never smokers or smokers with pack year history extracted by our pipeline (n = 196). We found a positive predictive value of 85.4%, a negative predictive value of 83.8%, sensitivity of 63.1%, and specificity of 94.7%. CONCLUSIONS We have demonstrated that our pipeline can extract smoking behaviors from unannotated EHR notes when the information is present. This information is reliable enough to identify patients most likely to be eligible for smoking related services. Ensuring capture of smoking information during clinical encounters should continue to be a high priority.
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Affiliation(s)
- John Higgins
- Ashridge Executive Education at Hult International Business School, Ashridge House, Berkhamsted HP4 1NS, UK
| | - Megan Reitz
- Ashridge Executive Education at Hult International Business School, Ashridge House, Berkhamsted HP4 1NS, UK
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Mulcahy C, Mone F, McParland P, Breathnach F, Cody F, Morrison JJ, Higgins J, Daly S, Dornan S, Cotter A, Dicker P, Tully E, Malone FD, McAuliffe FM. The Impact of Aspirin on Ultrasound Markers of Uteroplacental Flow in Low-Risk Pregnancy: Secondary Analysis of a Multicenter RCT. Am J Perinatol 2019; 36:855-863. [PMID: 30396226 DOI: 10.1055/s-0038-1675208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This article evaluates the effect of low-dose aspirin on uterine artery (UtA) Doppler, placental volume, and vascularization flow indices in low-risk pregnancy. STUDY DESIGN In this secondary analysis of the TEST randomized controlled trial, low-risk nulliparous women were originally randomized at 11 weeks to: (1) routine aspirin 75 mg; (2) no aspirin; and (3) aspirin based upon the preeclampsia Fetal Medicine Foundation screening test. UtA Doppler, three-dimensional (3D) placental volume, and vascularization flow indices were assessed prior to and 6 weeks postaspirin commencement. RESULTS A total of 546 women were included (aspirin n = 192, no aspirin n = 354). Between first and second trimesters, aspirin use was not associated with a change in UtA Doppler, placental volume, or vascular flow indices. There was no significant difference in the change in UtA Doppler pulsatility index (PI) Z-scores or notching (PI Z-score -0.2 vs. -0.2, p = 0.17), nor was there a significant change in placental volume Z-score and vascular flow indices (volume Z-score change: 0.74 vs. 0.62, p = 0.34). CONCLUSION Low-dose aspirin commenced at 11 weeks in low-risk women does not appear to improve uterine and placental perfusion or placental volume. Any perceived effect on uteroplacental vasculature is not reflected in changes in placental volume nor uteroplacental flow as assessed by two-dimensional and 3D ultrasound.
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Affiliation(s)
- Cecilia Mulcahy
- Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala Mone
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Peter McParland
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Fionnuala Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fiona Cody
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - John J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - John Higgins
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, Coombe Women's and Infant's University Hospital, Dublin, Ireland
| | - Samina Dornan
- Royal Jubilee Maternity Hospital, Belfast, United Kingdom
| | - Amanda Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Patrick Dicker
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Elizabeth Tully
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
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Burnett C, Hamlin P, Dabovic K, Higgins J, Persky D. A PHASE 1/2 STUDY OF MT-3724 TO EVALUATE SAFETY, PHARMACODYNAMICS AND EFFICACY OF MT-3724 FOR THE TREATMENT OF PATIENTS WITH RELAPSED OR REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.13_2632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C.A. Burnett
- Clinical Development; Molecular Templates, Inc.; Jersey City NJ United States
| | - P. Hamlin
- Division of Hematologic Malignancies; Memorial Sloan Kettering Cancer Center; New York NY United States
| | - K. Dabovic
- Clinical Development; Molecular Templates, Inc.; Jersey City NJ United States
| | - J. Higgins
- Manufacturing; Molecular Templates, Inc.; Austin TX United States
| | - D.O. Persky
- Division of Hematology and Oncology; University of Arizona Cancer Center; Tucson AZ United States
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Isom R, Shoor S, Higgins J, Cara-Fuentes G, Johnson RJ. Abatacept in Steroid-Dependent Minimal Change Disease and CD80-uria. Kidney Int Rep 2019; 4:1349-1353. [PMID: 31517155 PMCID: PMC6732767 DOI: 10.1016/j.ekir.2019.05.1155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Robert Isom
- Division of Nephrology. Stanford University School of Medicine, Stanford, California, USA
| | - Stanford Shoor
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - John Higgins
- Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Gabriel Cara-Fuentes
- Division of Pediatric Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Mone F, O'Mahony JF, Tyrrell E, Mulcahy C, McParland P, Breathnach F, Morrison JJ, Higgins J, Daly S, Cotter A, Hunter A, Dicker P, Tully E, Malone FD, Normand C, McAuliffe FM. Preeclampsia Prevention Using Routine Versus Screening Test-Indicated Aspirin in Low-Risk Women. Hypertension 2019; 72:1391-1396. [PMID: 30571234 DOI: 10.1161/hypertensionaha.118.11718] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to evaluate whether routine aspirin 75 mg is more cost-effective than the Fetal Medicine Foundation screen-and-treat approach for preeclampsia prevention in low-risk nulliparous women. A health economic decision analytical model was devised to estimate the discounted net health and cost outcomes of routine aspirin versus Fetal Medicine Foundation screening test-indicated aspirin for a cohort of 100 000 low-risk nulliparous women. Both strategies were compared with no intervention. A subanalysis also compared disaggregated components of the algorithm. The analysis used data from hospital administration, literature, and a randomized controlled trial. Sensitivity analyses assessed the impact of aspirin adherence, test cost, and accuracy on study results. Presumed rates of preeclampsia were 3.75% with no intervention versus 0.45% with aspirin use. Results found that routine aspirin was the preferred strategy, in terms of greater health gains and larger cost savings. It provided 163 quality-adjusted life-years relative to no intervention, whereas the screen-and-treat policy achieved 108 quality-adjusted life-years. Routine aspirin would result in an estimated cost saving of €14.9 million annually relative to no intervention, whereas screen-and-treat approach would result in a smaller cost saving of €3.1 million. When the analysis was extended to consider alternative screen-and-treat strategies, routine aspirin remained the optimally cost-effective approach. In conclusion, routine aspirin use in low-risk nulliparous women has a greater health gain and cost saving compared with both the Fetal Medicine Foundation and other screen-and-treat approaches.
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Affiliation(s)
- Fionnuala Mone
- From the UCD Perinatal Research Centre, National Maternity Hospital, Obstetrics and Gynaecology, School of Medicine, University College Dublin, Ireland (F.M., C.M., P.M., F.M.M.)
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland (J.F.O., E.T., C.N.)
| | - Ella Tyrrell
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland (J.F.O., E.T., C.N.)
| | - Cecilia Mulcahy
- From the UCD Perinatal Research Centre, National Maternity Hospital, Obstetrics and Gynaecology, School of Medicine, University College Dublin, Ireland (F.M., C.M., P.M., F.M.M.)
| | - Peter McParland
- From the UCD Perinatal Research Centre, National Maternity Hospital, Obstetrics and Gynaecology, School of Medicine, University College Dublin, Ireland (F.M., C.M., P.M., F.M.M.)
| | - Fionnuala Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin (F.B., P.D., E.T., F.D.M.)
| | - John J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway (J.J.M.)
| | - John Higgins
- Department of Obstetrics and Gynaecology, University College Cork, Ireland (J.H.)
| | - Sean Daly
- Department of Obstetrics and Gynaecology, Coombe Women's and Infant's University Hospital, Dublin, Ireland (S.D.)
| | - Amanda Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Ireland (A.C.)
| | - Alyson Hunter
- Department of Fetal Medicine, Royal Jubilee Maternity Hospital, Belfast, United Kingdom (A.H.)
| | - Patrick Dicker
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin (F.B., P.D., E.T., F.D.M.)
| | - Elizabeth Tully
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland (J.F.O., E.T., C.N.).,Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin (F.B., P.D., E.T., F.D.M.)
| | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin (F.B., P.D., E.T., F.D.M.)
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland (J.F.O., E.T., C.N.).,Cicely Saunders Institute, King's College London, United Kingdom (C.N.)
| | - Fionnuala M McAuliffe
- From the UCD Perinatal Research Centre, National Maternity Hospital, Obstetrics and Gynaecology, School of Medicine, University College Dublin, Ireland (F.M., C.M., P.M., F.M.M.)
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45
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Healy EF, Burke N, Burke G, Breathnach F, McAuliffe F, Morrison J, Turner MJ, Dornan S, Higgins J, Cotter A, Geary G, McParland P, Daly S, Dicker P, Tully E, Malone FD. 772: A comparison of low and high-dose oxytocin for induction of labor in term nulliparous women. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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46
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Rau JG, Wu LS, May AF, Taylor AE, Liu IL, Higgins J, Butch NP, Ross KA, Nair HS, Lumsden MD, Gingras MJP, Christianson AD. Behavior of the breathing pyrochlore lattice Ba 3Yb 2Zn 5O 11 in applied magnetic field. J Phys Condens Matter 2018; 30:455801. [PMID: 30256218 DOI: 10.1088/1361-648x/aae45a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The breathing pyrochlore lattice material Ba3Yb2Zn5O11 exists in the nearly decoupled limit, in contrast to most other well-studied breathing pyrochlore compounds. As a result, it constitutes a useful platform to benchmark theoretical calculations of exchange interactions in insulating Yb3+ magnets. Here we study Ba3Yb2Zn5O11 at low temperatures in applied magnetic fields as a further probe of the physics of this model system. Experimentally, we consider the behavior of polycrystalline samples of Ba3Yb2Zn5O11 with a combination of inelastic neutron scattering and heat capacity measurements down to 75 mK and up to fields of 10 T. Consistent with previous work, inelastic neutron scattering finds a level crossing near 3 T, but no significant dispersion of the spin excitations is detected up to the highest applied fields. Refinement of the theoretical model previously determined at zero field can reproduce much of the inelastic neutron scattering spectra and specific heat data. A notable exception is a low temperature peak in the specific heat at ∼0.1 K. This may indicate the scale of interactions between tetrahedra or may reflect undetected disorder in Ba3Yb2Zn5O11.
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Affiliation(s)
- J G Rau
- Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada. Max-Planck-Institut für Physik komplexer Systeme, 01187 Dresden, Germany
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Scrimgeour D, Higgins J, Bucknall V, Arnett R, Featherstone C, Cleland J, Lee A, Brennan P. Do surgeon interviewers have human factor-related issues during the long day UK National Trauma and Orthopaedic specialty recruitment process? Surgeon 2018. [DOI: 10.1016/j.surge.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Higgins J, Carpenter E, Christianson L, Everett B, Greene M, Haider S, Hendrick CE, Powell J. “Will taking the pill make me less gay?”: contraceptive norms, contexts and conflicts among sexual minority women from three cities. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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49
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Siegel S, Fan L, Goldman A, Higgins J, Goates S, Partridge J. The Impact of Hospital Quality Improvement Initiatives on Health Outcomes. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Mone F, Mulcahy C, McParland P, Breathnach F, Downey P, McCormack D, Culliton M, Stanton A, Cody F, Morrison JJ, Daly S, Higgins J, Cotter A, Hunter A, Tully EC, Dicker P, Alfirevic Z, Malone FD, McAuliffe FM. Trial of feasibility and acceptability of routine low-dose aspirin versus Early Screening Test indicated aspirin for pre-eclampsia prevention ( TEST study): a multicentre randomised controlled trial. BMJ Open 2018; 8:e022056. [PMID: 30056389 PMCID: PMC6067363 DOI: 10.1136/bmjopen-2018-022056] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Evaluate the feasibility and acceptability of routine aspirin in low-risk women, compared with screening-test indicated aspirin for the prevention of pre-eclampsia and fetal growth restriction. DESIGN Multicentre open-label feasibility randomised controlled trial. SETTING Two tertiary maternity hospitals in Dublin, Ireland. PARTICIPANTS 546 low-risk nulliparous women completed the study. INTERVENTIONS Women underwent computerised randomisation to: Group 1-routine aspirin 75 mg from 11 until 36 weeks; Group 2-no aspirin and; Group 3-aspirin based on the Fetal Medicine Foundation screening test. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Proportion agreeing to participate; (2) compliance with protocol; (3) proportion where first trimester uterine artery Doppler was obtainable and; (4) time taken to issue a screening result. Secondary outcomes included rates of pre-eclampsia and small-for-gestational-age fetuses. RESULTS 546 were included in the routine aspirin (n=179), no aspirin (n=183) and screen and treat (n=184) groups. 546 of 1054 were approached (51.8%) and enrolled. Average aspirin adherence was 90%. The uterine artery Doppler was obtained in 98.4% (181/184) and the average time to obtain a screening result was 7.6 (0-26) days. Of those taking aspirin, vaginal spotting was greater; n=29 (15.1%), non-aspirin n=28 (7.9%), OR 2.1 (95% CI 1.2 to 3.6). Postpartum haemorrhage >500 mL was also greater; aspirin n=26 (13.5%), no aspirin n=20 (5.6%), OR 2.6 (95% CI 1.4 to 4.8). CONCLUSION Low-risk nulliparous women are open to taking aspirin in pregnancy and had high levels of adherence. Aspirin use was associated with greater rates of vaginal bleeding. An appropriately powered randomised controlled trial is now required to address the efficacy and safety of universal low-dose aspirin in low-risk pregnancy compared with a screening approach. TRIAL REGISTRATION NUMBER ISRCTN (15191778); Post-results.
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Affiliation(s)
- Fionnuala Mone
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cecilia Mulcahy
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Peter McParland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Paul Downey
- Department of Pathology and Laboratory Medicine, National Maternity Hospital, Dublin, Ireland
| | - Dorothy McCormack
- Department of Pharmacy, National Maternity Hospital, Dublin, Ireland
| | - Marie Culliton
- Department of Pathology and Laboratory Medicine, National Maternity Hospital, Dublin, Ireland
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Cody
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - John J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, Coombe Women's and Infant's University Hospital, Dublin, Ireland
| | - John Higgins
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Amanda Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - Elizabeth C Tully
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Patrick Dicker
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Zarko Alfirevic
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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