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Zhao A, Gudmundsson E, Mogulkoc N, van Moorsel C, Corte TJ, Vasudev P, Romei C, Chapman R, Wallis TJM, Denneny E, Goos T, Savas R, Ahmed A, Brereton CJ, van Es HW, Jo H, De Liperi A, Duncan M, Pontoppidan K, De Sadeleer LJ, van Beek F, Barnett J, Cross G, Procter A, Veltkamp M, Hopkins P, Moodley Y, Taliani A, Taylor M, Verleden S, Tavanti L, Vermant M, Nair A, Stewart I, Janes SM, Young AL, Barber D, Alexander DC, Porter JC, Wells AU, Jones MG, Wuyts WA, Jacob J. Mortality surrogates in combined pulmonary fibrosis and emphysema. Eur Respir J 2024; 63:2300127. [PMID: 37973176 DOI: 10.1183/13993003.00127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) with coexistent emphysema, termed combined pulmonary fibrosis and emphysema (CPFE) may associate with reduced forced vital capacity (FVC) declines compared to non-CPFE IPF patients. We examined associations between mortality and functional measures of disease progression in two IPF cohorts. METHODS Visual emphysema presence (>0% emphysema) scored on computed tomography identified CPFE patients (CPFE/non-CPFE: derivation cohort n=317/n=183, replication cohort n=358/n=152), who were subgrouped using 10% or 15% visual emphysema thresholds, and an unsupervised machine-learning model considering emphysema and interstitial lung disease extents. Baseline characteristics, 1-year relative FVC and diffusing capacity of the lung for carbon monoxide (D LCO) decline (linear mixed-effects models), and their associations with mortality (multivariable Cox regression models) were compared across non-CPFE and CPFE subgroups. RESULTS In both IPF cohorts, CPFE patients with ≥10% emphysema had a greater smoking history and lower baseline D LCO compared to CPFE patients with <10% emphysema. Using multivariable Cox regression analyses in patients with ≥10% emphysema, 1-year D LCO decline showed stronger mortality associations than 1-year FVC decline. Results were maintained in patients suitable for therapeutic IPF trials and in subjects subgrouped by ≥15% emphysema and using unsupervised machine learning. Importantly, the unsupervised machine-learning approach identified CPFE patients in whom FVC decline did not associate strongly with mortality. In non-CPFE IPF patients, 1-year FVC declines ≥5% and ≥10% showed strong mortality associations. CONCLUSION When assessing disease progression in IPF, D LCO decline should be considered in patients with ≥10% emphysema and a ≥5% 1-year relative FVC decline threshold considered in non-CPFE IPF patients.
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Affiliation(s)
- An Zhao
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Eyjolfur Gudmundsson
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Nesrin Mogulkoc
- Department of Respiratory Medicine, Ege University Hospital, Izmir, Turkey
| | - Coline van Moorsel
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Pardeep Vasudev
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK
- Centre for Medical Image Computing, UCL, London, UK
| | - Chiara Romei
- Department of Radiology, Pisa University Hospital, Pisa, Italy
| | - Robert Chapman
- Interstitial Lung Disease Service, Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J M Wallis
- NIHR Southampton Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Emma Denneny
- Interstitial Lung Disease Service, Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tinne Goos
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Recep Savas
- Department of Radiology, Ege University Hospital, Izmir, Turkey
| | - Asia Ahmed
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Christopher J Brereton
- NIHR Southampton Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Hendrik W van Es
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Helen Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | - Mark Duncan
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Katarina Pontoppidan
- NIHR Southampton Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Laurens J De Sadeleer
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Institute of Lung Health and Immunity (LHI)/Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich, Germany
| | - Frouke van Beek
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Joseph Barnett
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Gary Cross
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Alex Procter
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marcel Veltkamp
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
| | - Peter Hopkins
- Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Chermside, Australia
| | - Yuben Moodley
- School of Medicine and Pharmacology, University Western Australia, Perth, Australia
- Fiona Stanley Hospital, Perth, Australia
| | | | - Magali Taylor
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stijn Verleden
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Laura Tavanti
- Cardiovascular and Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Marie Vermant
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, UCL, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Barber
- Centre for Artificial Intelligence, UCL, London, UK
| | | | - Joanna C Porter
- Interstitial Lung Disease Service, Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Athol U Wells
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- Imperial College London, London, UK
| | - Mark G Jones
- NIHR Southampton Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Wim A Wuyts
- BREATHE, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK
- Centre for Medical Image Computing, UCL, London, UK
- Lungs for Living Research Centre, UCL, London, UK
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2
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Wells AU, Jacob J, Sverzellati N, Cross G, Barnett J, De Lauretis A, Antoniou K, Weycker D, Atwood M, Kirchgaessler KU, Cottin V. A formula for predicting emphysema extent in combined idiopathic pulmonary fibrosis and emphysema. Respir Res 2024; 25:33. [PMID: 38238788 PMCID: PMC10795205 DOI: 10.1186/s12931-023-02589-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND No single pulmonary function test captures the functional effect of emphysema in idiopathic pulmonary fibrosis (IPF). Without experienced radiologists, other methods are needed to determine emphysema extent. Here, we report the development and validation of a formula to predict emphysema extent in patients with IPF and emphysema. METHODS The development cohort included 76 patients with combined IPF and emphysema at the Royal Brompton Hospital, London, United Kingdom. The formula was derived using stepwise regression to generate the weighted combination of pulmonary function data that fitted best with emphysema extent on high-resolution computed tomography. Test cohorts included patients from two clinical trials (n = 455 [n = 174 with emphysema]; NCT00047645, NCT00075998) and a real-world cohort from the Royal Brompton Hospital (n = 191 [n = 110 with emphysema]). The formula is only applicable for patients with IPF and concomitant emphysema and accordingly was not used to detect the presence or absence of emphysema. RESULTS The formula was: predicted emphysema extent = 12.67 + (0.92 x percent predicted forced vital capacity) - (0.65 x percent predicted forced expiratory volume in 1 second) - (0.52 x percent predicted carbon monoxide diffusing capacity). A significant relationship between the formula and observed emphysema extent was found in both cohorts (R2 = 0.25, P < 0.0001; R2 = 0.47, P < 0.0001, respectively). In both, the formula better predicted observed emphysema extent versus individual pulmonary function tests. A 15% emphysema extent threshold, calculated using the formula, identified a significant difference in absolute changes from baseline in forced vital capacity at Week 48 in patients with baseline-predicted emphysema extent < 15% versus ≥ 15% (P = 0.0105). CONCLUSION The formula, designed for use in patients with IPF and emphysema, demonstrated enhanced ability to predict emphysema extent versus individual pulmonary function tests. TRIAL REGISTRATION NCT00047645; NCT00075998.
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Affiliation(s)
- Athol U Wells
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK
- Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University Hospital Parma, Parma, Italy
| | | | | | - Angelo De Lauretis
- Department of Respiratory Medicine, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Katerina Antoniou
- Interstitial Lung Disease Unit, Department of Thoracic Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Mark Atwood
- Policy Analysis Inc. (PAI), Brookline, MA, USA
| | | | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, ERN-LUNG, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Hunter B, Argyros C, Inglese M, Linton-Reid K, Pulzato I, Nicholson AG, Kemp SV, L Shah P, Molyneaux PL, McNamara C, Burn T, Guilhem E, Mestas Nuñez M, Hine J, Choraria A, Ratnakumar P, Bloch S, Jordan S, Padley S, Ridge CA, Robinson G, Robbie H, Barnett J, Silva M, Desai S, Lee RW, Aboagye EO, Devaraj A. Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis. Br J Cancer 2023; 129:1949-1955. [PMID: 37932513 PMCID: PMC10703918 DOI: 10.1038/s41416-023-02480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Methods to improve stratification of small (≤15 mm) lung nodules are needed. We aimed to develop a radiomics model to assist lung cancer diagnosis. METHODS Patients were retrospectively identified using health records from January 2007 to December 2018. The external test set was obtained from the national LIBRA study and a prospective Lung Cancer Screening programme. Radiomics features were extracted from multi-region CT segmentations using TexLab2.0. LASSO regression generated the 5-feature small nodule radiomics-predictive-vector (SN-RPV). K-means clustering was used to split patients into risk groups according to SN-RPV. Model performance was compared to 6 thoracic radiologists. SN-RPV and radiologist risk groups were combined to generate "Safety-Net" and "Early Diagnosis" decision-support tools. RESULTS In total, 810 patients with 990 nodules were included. The AUC for malignancy prediction was 0.85 (95% CI: 0.82-0.87), 0.78 (95% CI: 0.70-0.85) and 0.78 (95% CI: 0.59-0.92) for the training, test and external test datasets, respectively. The test set accuracy was 73% (95% CI: 65-81%) and resulted in 66.67% improvements in potentially missed [8/12] or delayed [6/9] cancers, compared to the radiologist with performance closest to the mean of six readers. CONCLUSIONS SN-RPV may provide net-benefit in terms of earlier cancer diagnosis.
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Affiliation(s)
- Benjamin Hunter
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Christos Argyros
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Marianna Inglese
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Italy
| | - Kristofer Linton-Reid
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Ilaria Pulzato
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Andrew G Nicholson
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Histopathology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Samuel V Kemp
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
| | - Pallav L Shah
- Imperial College London, National Heart and Lung Institute, London, UK
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Philip L Molyneaux
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Cillian McNamara
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Toby Burn
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Emily Guilhem
- King's College Hospital, Department of Radiology, London, UK
| | | | - Julia Hine
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Anika Choraria
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Prashanthi Ratnakumar
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Susannah Bloch
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Simon Jordan
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Thoracic Surgery, London, UK
| | - Simon Padley
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Carole A Ridge
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Graham Robinson
- The Royal United Hospital, Bath, Department of Radiology, Bath, UK
| | - Hasti Robbie
- King's College Hospital, Department of Radiology, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, London, UK
| | - Mario Silva
- Section of "Scienze Radiologiche", Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sujal Desai
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
- Imperial College London, Margaret Turner-Warwick Centre for Fibrosing Lung Disease, London, UK
| | - Richard W Lee
- Imperial College London, National Heart and Lung Institute, London, UK
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- Early Diagnosis and Detection, Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Eric O Aboagye
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Anand Devaraj
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK.
- Imperial College London, National Heart and Lung Institute, London, UK.
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Saigal A, Nagoda Niklewicz C, Naidu SB, Bintalib HM, Shah AJ, Seligmann G, Hunter AS, Wey E, Abubakar I, Mahungu T, Miller D, Barnett J, Jain NG, Brill S, Goldring J, Jarvis H, Smith C, Ogbonnaya C, Hurst JR, Lipman MCI, Mandal S. Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors. BMJ Open Respir Res 2023; 10:e001667. [PMID: 37536948 PMCID: PMC10401240 DOI: 10.1136/bmjresp-2023-001667] [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: 02/14/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES COVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination. DESIGN Prospective observational cross-sectional study. SETTING Secondary care tertiary hospital in the UK. PARTICIPANTS This study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021). OUTCOME MEASURES Associations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively. RESULTS 322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44). CONCLUSIONS Patients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome.
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Affiliation(s)
- Anita Saigal
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | | | | | - Amar Jitu Shah
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - George Seligmann
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alan Stewart Hunter
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Emmanuel Wey
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Ibrahim Abubakar
- UCL Respiratory, University College London, London, UK
- Faculty of Population Health Sciences, University College London, London, UK
| | - Tabitha Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Joseph Barnett
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Neel Gautam Jain
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Simon Brill
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - James Goldring
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Hannah Jarvis
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Colette Smith
- Institute of Global Health, University College London, London, UK
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Marc C I Lipman
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Swapna Mandal
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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5
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Verdugo Meza A, Gill S, Godovannyi A, Barnett J, Haskey N, Gibson D. A49 TWO NOVEL LIVE BIOTHERAPEUTIC PRODUCTS PROTECT DSS-EXPOSED MICE FROM ACUTE COLITIS WHEN COMPARED TO 5-ASA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991334 DOI: 10.1093/jcag/gwac036.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Live biotherapeutic products (LBPs) offer a more rationalized and multitargeted approach to treating gastrointestinal diseases. BioColoniz and BioPersist are two LBPs derived from the parental strains L. reuteri and E. coli Nissle 1917 (EcN), respectively. The parental strains are known to offer some benefit in preventing relapses in IBD patients however the results are heterogeneous. To overcome this, the parental strains were approached as LBPs by introducing traits to thrive under the inflammatory conditions of the colon. Therefore, our aim is to characterize the role of these LBPs in IBD. Purpose To evaluate the therapeutic effect of the LBPs BioColoniz and BioPersist in an acute model of colitis. Method Female C57Bl/6 mice were treated with BioColoniz or BioPersist via oral gavage for three consecutive days prior to DSS challenge. Then mice were exposed to 3.5% DSS via drinking water for seven days. As controls, we also included mice treated with vehicle or the parental strains L. reuteri or EcN. In order to compare the effect of LBPs in the onset of acute colitis to current maintenance therapies for UC, we also exposed another group of mice to DSS and simultaneously administer 5-ASA. Mice were monitored daily for signs of disease and at the end of the experiment, colon tissue was collected for histopathological and molecular analysis. Result(s) The administration of BioColoniz and BioPersist delayed and decreased the colitic phenotype of mice exposed to DSS. Differences in signs of disease, such as diarrhea and weight loss, were evident by day 4 for vehicle or 5-ASA groups, whereas mice in the LBPs groups were still gaining weight. When analyzing the histopathological changes, mice in the LBPs groups presented lower scores when compared to the vehicle and 5-ASA groups. Specifically, mice treated early with BioColoniz or BioPersist presented a more preserved mucosal architecture with visible crypts. Although 5-ASA-treated mice still had vestiges of crypts, the damage in the mucosal architecture was more severe, similar to the observed in mice treated with the parental strains EcN and L. reuteri. We also looked at the expression of proinflammatory cytokines, finding an increase in TNFα, IFNγ, and IL-17a in mice treated with 5-ASA but not in mice treated with LBPs. However, the expression of protective factors such as mucin Muc2 or the antimicrobial peptide Reg3γ was similarly high in 5-ASA and LBP-treated mice when compared to vehicle or parental strains groups, suggesting some therapeutic commonalities between 5-ASA and our LBPs. Conclusion(s) The early administration of the LBPs BioColoniz and BioPersist protect mice from severe acute colitis, being more protective than 5-ASA. Since some differences and similarities were observed between the LBPs- and 5-ASA-treated mice, such as crypt preservation versus increased expression of some protective factors, the next step will aim to identify which mechanisms are specifically triggered by the LBPs. Disclosure of Interest None Declared
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Affiliation(s)
- A Verdugo Meza
- Biology, University of British Columbia, Kelowna, Canada
| | - S Gill
- Biology, University of British Columbia, Kelowna, Canada
| | - A Godovannyi
- Biology, University of British Columbia, Kelowna, Canada
| | - J Barnett
- Biology, University of British Columbia, Kelowna, Canada
| | - N Haskey
- Biology, University of British Columbia, Kelowna, Canada
| | - D Gibson
- Biology, University of British Columbia, Kelowna, Canada
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6
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Oh JH, Kim GHJ, Cross G, Barnett J, Jacob J, Hong S, Song JW. Automated quantification system predicts survival in rheumatoid arthritis-associated interstitial lung disease. Rheumatology (Oxford) 2022; 61:4702-4710. [PMID: 35302602 PMCID: PMC7615169 DOI: 10.1093/rheumatology/keac184] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/11/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The prognosis of RA-associated interstitial lung disease (RA-ILD) is difficult to predict because of the variable clinical course. This study aimed to determine the prognostic value of an automated quantification system (AQS) in RA-ILD. METHODS We retrospectively analysed the clinical data and high-resolution CT (HRCT) images of 144 patients with RA-ILD. Quantitative lung fibrosis (QLF, sum of reticulation and traction bronchiectasis) and ILD [QILD; sum of QLF, honeycombing (QHC), and ground-glass opacity (QGG)] scores were measured using the AQS. RESULTS The mean age was 61.2 years, 43.8% of the patients were male, and the 5-year mortality rate was 30.5% (median follow-up, 52.2 months). Non-survivors showed older age, higher ESR and greater AQS scores than survivors. In multivariable Cox analysis, higher QLF, QHC and QILD scores were independent prognostic factors along with older age and higher ESR. In receiver-operating characteristic curve analysis, the QLF score showed better performance in predicting 5-year mortality than the QHC and QGG scores but was similar to the QILD score. Patients with high QLF scores (≥12% of total lung volume) showed higher 5-year mortality (50% vs 17.4%, P < 0.001) than those with low QLF scores and similar survival outcome to patients with idiopathic pulmonary fibrosis (IPF). Combining with clinical variables (age, ESR) further improved the performance of QLF score in predicting 5-year mortality. CONCLUSION QLF scores might be useful for predicting prognosis in patients with RA-ILD. High QLF scores differentiate a poor prognostic phenotype similar to IPF.
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Affiliation(s)
- Ju Hyun Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Grace Hyun J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Gary Cross
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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7
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Kasprzyk-Hordern B, Adams B, Adewale ID, Agunbiade FO, Akinyemi MI, Archer E, Badru FA, Barnett J, Bishop IJ, Di Lorenzo M, Estrela P, Faraway J, Fasona MJ, Fayomi SA, Feil EJ, Hyatt LJ, Irewale AT, Kjeldsen T, Lasisi AKS, Loiselle S, Louw TM, Metcalfe B, Nmormah SA, Oluseyi TO, Smith TR, Snyman MC, Sogbanmu TO, Stanton-Fraser D, Surujlal-Naicker S, Wilson PR, Wolfaardt G, Yinka-Banjo CO. Wastewater-based epidemiology in hazard forecasting and early-warning systems for global health risks. Environ Int 2022; 161:107143. [PMID: 35176575 PMCID: PMC8842583 DOI: 10.1016/j.envint.2022.107143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 05/17/2023]
Abstract
With the advent of the SARS-CoV-2 pandemic, Wastewater-Based Epidemiology (WBE) has been applied to track community infection in cities worldwide and has proven succesful as an early warning system for identification of hotspots and changingprevalence of infections (both symptomatic and asymptomatic) at a city or sub-city level. Wastewater is only one of environmental compartments that requires consideration. In this manuscript, we have critically evaluated the knowledge-base and preparedness for building early warning systems in a rapidly urbanising world, with particular attention to Africa, which experiences rapid population growth and urbanisation. We have proposed a Digital Urban Environment Fingerprinting Platform (DUEF) - a new approach in hazard forecasting and early-warning systems for global health risks and an extension to the existing concept of smart cities. The urban environment (especially wastewater) contains a complex mixture of substances including toxic chemicals, infectious biological agents and human excretion products. DUEF assumes that these specific endo- and exogenous residues, anonymously pooled by communities' wastewater, are indicative of community-wide exposure and the resulting effects. DUEF postulates that the measurement of the substances continuously and anonymously pooled by the receiving environment (sewage, surface water, soils and air), can provide near real-time dynamic information about the quantity and type of physical, biological or chemical stressors to which the surveyed systems are exposed, and can create a risk profile on the potential effects of these exposures. Successful development and utilisation of a DUEF globally requires a tiered approach including: Stage I: network building, capacity building, stakeholder engagement as well as a conceptual model, followed by Stage II: DUEF development, Stage III: implementation, and Stage IV: management and utilization. We have identified four key pillars required for the establishment of a DUEF framework: (1) Environmental fingerprints, (2) Socioeconomic fingerprints, (3) Statistics and modelling and (4) Information systems. This manuscript critically evaluates the current knowledge base within each pillar and provides recommendations for further developments with an aim of laying grounds for successful development of global DUEF platforms.
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Affiliation(s)
| | - B Adams
- Department of Mathematical Sciences, University of Bath, BA2 7AY, UK
| | - I D Adewale
- Department of Electrical and Electronics Engineering, University of Lagos, 100213 Akoka, Lagos, Nigeria
| | - F O Agunbiade
- Department of Chemistry, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - M I Akinyemi
- Department of Mathematics, University of Lagos, Akoka, Lagos, Nigeria
| | - E Archer
- Department of Microbiology, Stellenbosch University, 7600 Stellenbosch, South Africa
| | - F A Badru
- Department of Social Work, University of Lagos, Akoka, Lagos, Nigeria
| | - J Barnett
- Department of Psychology, University of Bath, BA2 7AY, UK
| | - I J Bishop
- Earthwatch Europe, Mayfield House, 256 Banbury Road, Summertown, Oxford OX2 7DE, UK
| | - M Di Lorenzo
- Department of Chemical Engineering, University of Bath, BA2 7AY Bath, UK
| | - P Estrela
- Department of Electronic and Electrical Engineering, University of Bath, BA2 7AY, UK
| | - J Faraway
- Department of Mathematical Sciences, University of Bath, BA2 7AY, UK
| | - M J Fasona
- Department of Geography, University of Lagos, Akoka, Lagos, Nigeria
| | - S A Fayomi
- Research for Sustainable Development Unit, Peculiar Grace Youth Empowerment Initiative, Shasha, Lagos, Nigeria
| | - E J Feil
- Department of Biology and Biochemistry, University of Bath, BA2 7AY, UK
| | - L J Hyatt
- Amazon Web Services, 60 Holborn Viaduct, Holborn, London EC1A 2FD, United Kingdom
| | - A T Irewale
- Research for Sustainable Development Unit, Peculiar Grace Youth Empowerment Initiative, Shasha, Lagos, Nigeria
| | - T Kjeldsen
- Department of Architecture and Civil Engineering, University of Bath, BA2 7AY, UK
| | - A K S Lasisi
- Environmental Assessment Department, Lagos State Ministry of Environment and Water Resources, Lagos, Nigeria
| | - S Loiselle
- Earthwatch Europe, Mayfield House, 256 Banbury Road, Summertown, Oxford OX2 7DE, UK
| | - T M Louw
- Department of Process Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - B Metcalfe
- Department of Electronic and Electrical Engineering, University of Bath, BA2 7AY, UK
| | - S A Nmormah
- Centre for Human Development (CHD), Lagos, Nigeria
| | - T O Oluseyi
- Department of Chemistry, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - T R Smith
- Department of Mathematical Sciences, University of Bath, BA2 7AY, UK
| | - M C Snyman
- TecLab SP, Collaborator of Stellenbosch University Water Institute, Stellenbosch 64B. W, South Africa
| | - T O Sogbanmu
- Ecotoxicology and Conservation Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | | | - S Surujlal-Naicker
- Scientific Services Branch, Water and Sanitation Department, City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - P R Wilson
- Department of Electronic and Electrical Engineering, University of Bath, BA2 7AY, UK
| | - G Wolfaardt
- Department of Microbiology, Stellenbosch University, 7600 Stellenbosch, South Africa
| | - C O Yinka-Banjo
- Department of Computer Sciences, University of Lagos, Akoka, Lagos, Nigeria
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8
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Rose MA, Barnett J, Wendland D, Hensling FVE, Boergers JM, Moors M, Dittmann R, Taubner T, Gunkel F. Local inhomogeneities resolved by scanning probe techniques and their impact on local 2DEG formation in oxide heterostructures. Nanoscale Adv 2021; 3:4145-4155. [PMID: 36132831 PMCID: PMC9419657 DOI: 10.1039/d1na00190f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/02/2021] [Indexed: 06/16/2023]
Abstract
Lateral inhomogeneities in the formation of two-dimensional electron gases (2DEG) directly influence their electronic properties. Understanding their origin is an important factor for fundamental interpretations, as well as high quality devices. Here, we studied the local formation of the buried 2DEG at LaAlO3/SrTiO3 (LAO/STO) interfaces grown on STO (100) single crystals with partial TiO2 termination, utilizing in situ conductive atomic force microscopy (c-AFM) and scattering-type scanning near-field optical microscopy (s-SNOM). Using substrates with different degrees of chemical surface termination, we can link the resulting interface chemistry to an inhomogeneous 2DEG formation. In conductivity maps recorded by c-AFM, a significant lack of conductivity is observed at topographic features, indicative of a local SrO/AlO2 interface stacking order, while significant local conductivity can be probed in regions showing TiO2/LaO interface stacking order. These results could be corroborated by s-SNOM, showing a similar contrast distribution in the optical signal which can be linked to the local electronic properties of the material. The results are further complemented by low-temperature conductivity measurements, which show an increasing residual resistance at 5 K with increasing portion of insulating SrO-terminated areas. Therefore, we can correlate the macroscopic electrical behavior of our samples to their nanoscopic structure. Using proper parameters, 2DEG mapping can be carried out without any visible alteration of sample properties, proving c-AFM and s-SNOM to be viable and destruction-free techniques for the identification of local 2DEG formation. Furthermore, applying c-AFM and s-SNOM in this manner opens the exciting prospect to link macroscopic low-temperature transport to its nanoscopic origin.
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Affiliation(s)
- M-A Rose
- Institute of Electronic Materials (IWE II), RWTH Aachen University Aachen Germany
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
| | - J Barnett
- I. Institute of Physics (IA), RWTH Aachen University Aachen Germany
| | - D Wendland
- I. Institute of Physics (IA), RWTH Aachen University Aachen Germany
| | - F V E Hensling
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
| | - J M Boergers
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
| | - M Moors
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
| | - R Dittmann
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
| | - T Taubner
- I. Institute of Physics (IA), RWTH Aachen University Aachen Germany
| | - F Gunkel
- Institute of Electronic Materials (IWE II), RWTH Aachen University Aachen Germany
- Peter Gruenberg Institute, JARA-FIT, Forschungszentrum Juelich GmbH Juelich Germany
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9
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Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, Heightman M, Hillman TE, Jacob J, Jarvis HC, Lipman MCI, Naidu SB, Nair A, Porter JC, Tomlinson GS, Hurst JR. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax 2021; 76:396-398. [PMID: 33172844 PMCID: PMC7615158 DOI: 10.1136/thoraxjnl-2020-215818] [Citation(s) in RCA: 480] [Impact Index Per Article: 160.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Large numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post discharge, 53% reported persistent breathlessness, 34% cough and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5% had persistently elevated d-dimer and C reactive protein, respectively. 38% of chest radiographs remained abnormal with 9% deteriorating. Systematic follow-up after hospitalisation with COVID-19 identifies the trajectory of physical and psychological symptom burden, recovery of blood biomarkers and imaging which could be used to inform the need for rehabilitation and/or further investigation.
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Affiliation(s)
- Swapna Mandal
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Simon E Brill
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Jeremy S Brown
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma K Denneny
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Samanjit S Hare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Melissa Heightman
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Toby E Hillman
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hannah C Jarvis
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Marc C I Lipman
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | - Sindhu B Naidu
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London, London, UK
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gillian S Tomlinson
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Infection and Immunity, University College London, London, UK
| | - John R Hurst
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
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10
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Taivalantti M, Kerkelä M, Halt AH, Barnett J, Veijola J. Sociodemographic, lifestyle and clinical factors associated with good performance in paired associates learning (PAL) test in patients with schizophrenia. Eur Psychiatry 2021. [PMCID: PMC9475692 DOI: 10.1192/j.eurpsy.2021.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Memory and learning deficits are central among cognitive deficits in schizophrenia. However, to a varying proportion ca. 20-25% of patients could not be considered deficit. Objectives Description of sociodemographic, lifestyle and clinical factors related to good performance in PAL-test in schizophrenia patients. Methods Participants (N=4500) were members of the Finnish SUPER study on the genetic mechanisms of psychotic disorders (SUPER). The database of the Northern Finland Birth Cohort 1966 (NFBC 1966) was utilized as a reference data. Visual memory and new learning were assessed using Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning (PAL) test. The 50th percentile scores (10 error score or less) for outcome measure total errors adjusted (TEA) of NFBC 1966 was used as a cut-off for good performance in PAL test. Results The sociodemographic and lifestyle factors related good performance for both sexes were: younger age (p<.001), higher basic education (p <.001), independent form of dwelling (p<.001), hazardous drinking (p <.001), cannabis use (p <.001) and being married (females p = 0.009, males p = 0.049). The clinical factors related to good performance for both sexes were not using antipsychotic medication regularly (p <.001), not using all psychotropic medication (females p=0.05, males p <.001), less hospitalization times due to psychosis (p <.001), younger age at first hospitalization due to psychosis (p <.001), lower number of hospitalization days (p <.001) and lower percentage of time in hospital after first psychosis episode (p <.001). Conclusions Several factors related to good performance in the PAL–test in the crude analysis without any confounders.
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11
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Invernizzi R, Wu BG, Barnett J, Ghai P, Kingston S, Hewitt RJ, Feary J, Li Y, Chua F, Wu Z, Wells AU, George PM, Renzoni EA, Nicholson AG, Rice A, Devaraj A, Segal LN, Byrne AJ, Maher TM, Lloyd CM, Molyneaux PL. The Respiratory Microbiome in Chronic Hypersensitivity Pneumonitis Is Distinct from That of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2021; 203:339-347. [PMID: 32692582 PMCID: PMC7874329 DOI: 10.1164/rccm.202002-0460oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Chronic hypersensitivity pneumonitis (CHP) is a condition that arises after repeated exposure and sensitization to inhaled antigens. The lung microbiome is increasingly implicated in respiratory disease, but, to date, no study has investigated the composition of microbial communities in the lower airways in CHP. Objectives: To characterize and compare the airway microbiome in subjects with CHP, subjects with idiopathic pulmonary fibrosis (IPF), and control subjects. Methods: We prospectively recruited individuals with a CHP diagnosis (n = 110), individuals with an IPF diagnosis (n = 45), and control subjects (n = 28). Subjects underwent BAL and bacterial DNA was isolated, quantified by quantitative PCR and the 16S ribosomal RNA gene was sequenced to characterize the bacterial communities in the lower airways. Measurements and Main Results: Distinct differences in the microbial profiles were evident in the lower airways of subjects with CHP and IPF. At the phylum level, the prevailing microbiota of both subjects with IPF and subjects with CHP included Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. However, in IPF, Firmicutes dominated, whereas the percentage of reads assigned to Proteobacteria in the same group was significantly lower than the percentage found in subjects with CHP. At the genus level, the Staphylococcus burden was increased in CHP, and Actinomyces and Veillonella burdens were increased in IPF. The lower airway bacterial burden in subjects with CHP was higher than that in control subjects but lower than that of those with IPF. In contrast to IPF, there was no association between bacterial burden and survival in CHP. Conclusions: The microbial profile of the lower airways in subjects with CHP is distinct from that of IPF, and, notably, the bacterial burden in individuals with CHP fails to predict survival.
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Affiliation(s)
- Rachele Invernizzi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Benjamin G Wu
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Joseph Barnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Poonam Ghai
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Shaun Kingston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Richard J Hewitt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Yonghua Li
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Felix Chua
- Royal Brompton Hospital, London, United Kingdom
| | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | | | | | | | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | | | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
| | - Leopoldo N Segal
- Division of Pulmonary and Critical Care Medicine, New York University, New York, New York; and
| | - Adam J Byrne
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, London, United Kingdom
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12
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Kim HC, Lee JS, Lee EY, Ha YJ, Chae EJ, Han M, Cross G, Barnett J, Joseph J, Song JW. Risk prediction model in rheumatoid arthritis-associated interstitial lung disease. Respirology 2020; 25:1257-1264. [PMID: 32441061 PMCID: PMC7615175 DOI: 10.1111/resp.13848] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/20/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE RA-ILD has a variable clinical course, and its prognosis is difficult to predict. Moreover, risk prediction models for prognosis remain undefined. METHODS The prediction model was developed using retrospective data from 153 patients with RA-ILD and validated in an independent RA-ILD cohort (n = 149). Candidate variables for the prediction models were screened using a multivariate Cox proportional hazard model. C-statistics were calculated to assess and compare the predictive ability of each model. RESULTS In the derivation cohort, the median follow-up period was 54 months, and 38.6% of the subjects exhibited a UIP pattern on HRCT imaging. In multivariate Cox analysis, old age (≥60 years, HR: 2.063), high fibrosis score (≥20% of the total lung extent, HR: 4.585), a UIP pattern (HR: 1.899) and emphysema (HR: 2.596) on HRCT were significantly poor prognostic factors and included in the final model. The prediction model demonstrated good performance in the prediction of 5-year mortality (C-index: 0.780, P < 0.001); furthermore, patients at risk were divided into three groups with 1-year mortality rates of 0%, 5.1% and 24.1%, respectively. Predicted and observed mortalities at 1, 2 and 3 years were similar in the derivation cohort, and the prediction model was also effective in predicting prognosis of the validation cohort (C-index: 0.638, P < 0.001). CONCLUSION Our results suggest that a risk prediction model based on HRCT variables could be useful for patients with RA-ILD.
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Affiliation(s)
- Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minkyu Han
- Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Gary Cross
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, United Kingdom
| | - Joseph Barnett
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - Jacob Joseph
- Department of Respiratory Medicine
- Centre for Medical Image Computing, University College London, United Kingdom
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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13
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Barnett J, Pulzato I, Javed M, Lee YJ, Choraria A, Kemp SV, Rice A, Jordan S, Shah PL, Nicholson AG, Padley S, Devaraj A. Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy. Clin Radiol 2020; 76:77.e9-77.e15. [PMID: 33059852 DOI: 10.1016/j.crad.2020.08.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate multidisciplinary team (MDT) practice of radiological-pathological correlation of non-malignant biopsy results to examine the additive effect on the predictive values of computed tomography (CT) biopsy for malignancy and their subsequent management and outcomes. MATERIALS AND METHODS A service evaluation of the MDT management of non-malignant lung biopsy results (May 2014- May 2017) was undertaken. RESULTS Sixty patients had a non-malignant diagnosis on initial CT biopsy. Five patients were lost to follow-up leaving 55 in the final cohort. Forty-eight of the 55 patients had biopsy results classified as potentially non-specific, of which 26 were classified as concordant with radiology (e.g., organising pneumonia with compatible CT features), and 22 were classified as discordant (e.g., non-specific inflammation and yet sufficiently suspicious CT features). Patients with concordant negative pathology showed resolution (n=19) or stability (n=6) on imaging follow-up. One lesion demonstrated growth and was proven malignant on surgical resection. Discordant lesions were managed with repeat biopsy (n=8) or surgical resection (n=13), with 12 final benign diagnoses and nine malignancies. The negative predictive value of CT biopsy alone was 44/55 (80%), following repeat biopsy was 44/50 (88%), and following radiological-pathological assessment was 32/33 (97%). No patients underwent a shift in stage from time of biopsy to resection. CONCLUSION Combining radiological-pathological interpretation of negative biopsy results offers superior negative predictive value for lung malignancy without delayed diagnosis of lung cancer.
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Affiliation(s)
- J Barnett
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK.
| | - I Pulzato
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - M Javed
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - Y J Lee
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Choraria
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - A Rice
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - S Jordan
- Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK
| | - P L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A G Nicholson
- Department of Pathology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - S Padley
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
| | - A Devaraj
- Department of Radiology, Royal Brompton Hospital, Sydney St, Chelsea, London, SW3 6NP, UK; National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
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14
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Hare SS, Tavare AN, Dattani V, Musaddaq B, Beal I, Cleverley J, Cash C, Lemoniati E, Barnett J. Validation of the British Society of Thoracic Imaging guidelines for COVID-19 chest radiograph reporting. Clin Radiol 2020; 75:710.e9-710.e14. [PMID: 32631626 PMCID: PMC7298474 DOI: 10.1016/j.crad.2020.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022]
Abstract
AIM To validate the British Society of Thoracic Imaging issued guidelines for the categorisation of chest radiographs for coronavirus disease 2019 (COVID-19) reporting regarding reproducibility amongst radiologists and diagnostic performance. MATERIALS AND METHODS Chest radiographs from 50 patients with COVID-19, and 50 control patients with symptoms consistent with COVID-19 from prior to the emergence of the novel coronavirus were assessed by seven consultant radiologists with regards to the British Society of Thoracic Imaging guidelines. RESULTS The findings show excellent specificity (100%) and moderate sensitivity (44%) for guideline-defined Classic/Probable COVID-19, and substantial interobserver agreement (Fleiss' k=0.61). Fair agreement was observed for the “Indeterminate for COVID-19” (k=0.23), and “Non-COVID-19” (k=0.37) categories; furthermore, the sensitivity (0.26 and 0.14 respectively) and specificity (0.76, 0.80) of these categories for COVID-19 were not significantly different (McNemar's test p=0.18 and p=0.67). CONCLUSION An amalgamation of the categories of “Indeterminate for COVID-19” and “Non-COVID-19” into a single “not classic of COVID-19” classification would improve interobserver agreement, encompass patients with a similar probability of COVID-19, and remove the possibility of labelling patients with COVID-19 as “Non-COVID-19”, which is the presenting radiographic appearance in a significant minority (14%) of patients. Classic COVID-19 on chest radiograph is very specific for SARS-CoV-2. There is substantial interobserver agreement for Classic COVID-19. There is only fair agreement for Indeterminate and Non-COVID appearances. Indeterminate and Non-COVID categories have a similar probability of SARS-CoV-2. These categories should be amalgamated into a ‘Not Classic for COVID’ category.
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Affiliation(s)
- S S Hare
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - A N Tavare
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - V Dattani
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - B Musaddaq
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - I Beal
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - J Cleverley
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - C Cash
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - E Lemoniati
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - J Barnett
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK.
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15
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Poe S, Anderson C, Barnett J. On the Selection and Analysis of Clades in Comparative Evolutionary Studies. Syst Biol 2020; 70:190-196. [PMID: 32196114 DOI: 10.1093/sysbio/syaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/01/2020] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Researchers commonly present results of comparative studies of taxonomic groups. In this review, we criticize the focus on named clades, usually, comparably ranked groups such as families or orders, for comparative evolutionary analyses and question the general practice of using clades as units of analysis. The practice of analyzing sets of named groups persists despite widespread appreciation that the groups we have chosen to name are based on subjective human concerns rather than objective properties of nature. We demonstrate an effect of clade selection on results in one study and present some potential alternatives to selecting named clades for analysis that are relatively objective in clade choice. However, we note that these alternatives are only partial solutions for clade-based studies. The practice of analyzing named clades obviously is biased and problematic, but its issues portend broader problems with the general approach of employing clades as units of analysis. Most clade-based studies do not account for the nonindependence of clades, and the biological insight gained from demonstrating some pattern among a particular arbitrary sample of groups is arguable. [Clades; comparative biology; taxonomic groups.].
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Affiliation(s)
- Steven Poe
- Department of Biology, University of New Mexico, Castetter Hall, Albuquerque, NM 87131, USA
| | - Christopher Anderson
- Department of Biology, University of New Mexico, Castetter Hall, Albuquerque, NM 87131, USA
| | - Joseph Barnett
- Department of Biology, University of New Mexico, Castetter Hall, Albuquerque, NM 87131, USA
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16
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Gibson KE, Barnett J, Haslam N, Kaplan I. The mental health impacts of climate change: Findings from a Pacific Island atoll nation. J Anxiety Disord 2020; 73:102237. [PMID: 32485590 DOI: 10.1016/j.janxdis.2020.102237] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Climate change is anticipated to have profound effects on mental health, particularly among populations that are simultaneously ecologically and economically vulnerable to its impacts. Various pathways through which climate change can impact mental health have been theorised, but the impacts themselves remain understudied. PURPOSE In this article we applied psychological methods to examine if climate change is affecting individuals' mental health in the Small Island Developing State of Tuvalu, a Pacific Island nation regarded as exceptionally vulnerable to climate change. We determined the presence of psychological distress and associated impairment attributed to two categories of climate change-related stressors in particular: 1) local environmental impacts caused or exacerbated by climate change, and 2) hearing about global climate change and contemplating its future implications. METHODS The findings draw on data collected in a mixed-method study involving 100 Tuvaluan participants. Data were collected via face-to-face structured interviews that lasted 45 min on average and were subjected to descriptive, correlational, and between-group analyses. RESULTS The findings revealed participants' experiences of distress in relation to both types of stressor, and demonstrated that a high proportion of participants are experiencing psychological distress at levels that reportedly cause them impairment in one or more areas of daily life. CONCLUSIONS The findings lend weight to the claim that climate change represents a risk to mental health and obliges decision-makers to consider these risks when conceptualizing climate-related harms or tallying the costs of inaction.
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Affiliation(s)
- K E Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Level 3, 161 Barry Street, Carlton, VIC, 3053, Australia; School of Psychological Sciences, The University of Melbourne, Level 12, Redmond Barry Building, Parkville, VIC, 3010, Australia.
| | - J Barnett
- School of Geography, The University of Melbourne, 207-221 Bouverie St., Carlton, VIC, 3053, Australia.
| | - N Haslam
- School of Psychological Sciences, The University of Melbourne, Level 12, Redmond Barry Building, Parkville, VIC, 3010, Australia.
| | - I Kaplan
- The Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, VIC, 3056, Australia.
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17
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Chua F, Armstrong-James D, Desai SR, Barnett J, Kouranos V, Kon OM, José R, Vancheeswaran R, Loebinger MR, Wong J, Cutino-Moguel MT, Morgan C, Ledot S, Lams B, Yip WH, Li L, Lee YC, Draper A, Kho SS, Renzoni E, Ward K, Periselneris J, Grubnic S, Lipman M, Wells AU, Devaraj A. The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions. Lancet Respir Med 2020; 8:438-440. [PMID: 32220663 PMCID: PMC7104153 DOI: 10.1016/s2213-2600(20)30132-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
| | - Darius Armstrong-James
- Department of Infectious Disease and Medical Mycology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Onn Min Kon
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo José
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Rama Vancheeswaran
- Department of Integrated Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Michael R Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | | | - Cliff Morgan
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Boris Lams
- Respiratory Medicine and Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wing Ho Yip
- Division of Respiratory Medicine, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Leski Li
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Ying Cheong Lee
- Department of Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Adrian Draper
- Department of Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sze Shyang Kho
- Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Katie Ward
- Department of Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jimstan Periselneris
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Sisa Grubnic
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
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18
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Jacob J, Aksman L, Mogulkoc N, Procter AJ, Gholipour B, Cross G, Barnett J, Brereton CJ, Jones MG, van Moorsel CH, van Es W, van Beek F, Veltkamp M, Desai SR, Judge E, Burd T, Kokosi M, Savas R, Bayraktaroglu S, Altmann A, Wells AU. Serial CT analysis in idiopathic pulmonary fibrosis: comparison of visual features that determine patient outcome. Thorax 2020; 75:648-654. [PMID: 32345689 PMCID: PMC7402558 DOI: 10.1136/thoraxjnl-2019-213865] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/03/2022]
Abstract
AIMS Patients with idiopathic pulmonary fibrosis (IPF) receiving antifibrotic medication and patients with non-IPF fibrosing lung disease often demonstrate rates of annualised forced vital capacity (FVC) decline within the range of measurement variation (5.0%-9.9%). We examined whether change in visual CT variables could help confirm whether marginal FVC declines represented genuine clinical deterioration rather than measurement noise. METHODS In two IPF cohorts (cohort 1: n=103, cohort 2: n=108), separate pairs of radiologists scored paired volumetric CTs (acquired between 6 and 24 months from baseline). Change in interstitial lung disease, honeycombing, reticulation, ground-glass opacity extents and traction bronchiectasis severity was evaluated using a 5-point scale, with mortality prediction analysed using univariable and multivariable Cox regression analyses. Both IPF populations were then combined to determine whether change in CT variables could predict mortality in patients with marginal FVC declines. RESULTS On univariate analysis, change in all CT variables except ground-glass opacity predicted mortality in both cohorts. On multivariate analysis adjusted for patient age, gender, antifibrotic use and baseline disease severity (diffusing capacity for carbon monoxide), change in traction bronchiectasis severity predicted mortality independent of FVC decline. Change in traction bronchiectasis severity demonstrated good interobserver agreement among both scorer pairs. Across all study patients with marginal FVC declines, change in traction bronchiectasis severity independently predicted mortality and identified more patients with deterioration than change in honeycombing extent. CONCLUSIONS Change in traction bronchiectasis severity is a measure of disease progression that could be used to help resolve the clinical importance of marginal FVC declines.
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Affiliation(s)
- Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK .,Centre for Medical Image Computing, University College London, London, UK
| | - Leon Aksman
- Centre for Medical Image Computing, University College London, London, UK
| | - Nesrin Mogulkoc
- Department of Respiratory Medicine, Ege University Hospital, Izmir, Turkey
| | - Alex J Procter
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bahareh Gholipour
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gary Cross
- Department of Radiology, Royal Free Hospital, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Christopher J Brereton
- NIHR Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Mark G Jones
- NIHR Biomedical Research Centre and Clinical and Experimental Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Coline H van Moorsel
- Department of Pulmonology, St Antonius Hospital, Utrecht, The Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Nieuwegein, Utrecht, The Netherlands
| | - Wouter van Es
- Department of Respiratory Medicine, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Frouke van Beek
- Department of Pulmonology, St Antonius Hospital, Utrecht, The Netherlands
| | - Marcel Veltkamp
- Department of Pulmonology, St Antonius Hospital, Utrecht, The Netherlands
| | - Sujal R Desai
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Eoin Judge
- Department of Respiratory Medicine, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Teresa Burd
- Department of Radiology, St. George's Hospital, London, Greater London, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Recep Savas
- Department of Radiology, Ege University Hospital, Izmir, Turkey
| | | | - Andre Altmann
- Centre for Medical Image Computing, University College London, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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19
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Tavare AN, Braddy A, Brill S, Jarvis H, Sivaramakrishnan A, Barnett J, Creer DD, Hare SS. Managing high clinical suspicion COVID-19 inpatients with negative RT-PCR: a pragmatic and limited role for thoracic CT. Thorax 2020; 75:537-538. [PMID: 32317269 PMCID: PMC7361024 DOI: 10.1136/thoraxjnl-2020-214916] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Aniket N Tavare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Aaron Braddy
- Department of Respiratory Medicine, Royal Free London NHS FoundationTrust, London, UK
| | - Simon Brill
- Department of Respiratory Medicine, Royal Free London NHS FoundationTrust, London, UK
| | - Hannah Jarvis
- Department of Respiratory Medicine, Royal Free London NHS FoundationTrust, London, UK
| | | | - Joseph Barnett
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Dean D Creer
- Department of Respiratory Medicine, Royal Free London NHS FoundationTrust, London, UK
| | - Samanjit S Hare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
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20
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Invernizzi R, Barnett J, Rawal B, Nair A, Ghai P, Kingston S, Chua F, Wu Z, Wells AU, Renzoni ER, Nicholson AG, Rice A, Lloyd CM, Byrne AJ, Maher TM, Devaraj A, Molyneaux PL. Bacterial burden in the lower airways predicts disease progression in idiopathic pulmonary fibrosis and is independent of radiological disease extent. Eur Respir J 2020; 55:1901519. [PMID: 31980496 PMCID: PMC7136009 DOI: 10.1183/13993003.01519-2019] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/29/2019] [Indexed: 12/01/2022]
Abstract
Increasing bacterial burden in the lower airways of patients with idiopathic pulmonary fibrosis confers an increased risk of disease progression and mortality. However, it remains unclear whether this increased bacterial burden directly influences progression of fibrosis or simply reflects the magnitude of the underlying disease extent or severity.We prospectively recruited 193 patients who underwent bronchoscopy and received a multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Quantification of the total bacterial burden in bronchoalveolar lavage fluid was performed by 16S rRNA gene qPCR. Imaging was independently evaluated by two readers assigning quantitative scores for extent, severity and topography of radiographic changes and relationship of these features with bacterial burden was assessed.Increased bacterial burden significantly associated with disease progression (HR 2.1; 95% CI 1.287-3.474; p=0.0028). Multivariate stepwise regression demonstrated no relationship between bacterial burden and radiological features or extent of disease. When specifically considering patients with definite or probable usual interstitial pneumonia there was no difference in bacterial burden between these two groups. Despite a postulated association between pleuroparenchymal fibroelastosis and clinical infection, there was no relationship between either the presence or extent of pleuroparenchymal fibroelastosis and bacterial burden.We demonstrate that bacterial burden in the lower airways is not simply secondary to the extent of the underlying architectural destruction of the lung parenchyma seen in idiopathic pulmonary fibrosis. The independent nature of this association supports a relationship with the underlying pathogenic mechanisms and highlights the urgent need for functional studies.
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Affiliation(s)
- Rachele Invernizzi
- National Heart and Lung Institute, Imperial College London, London, UK
- Contributed equally as first authors
| | - Joseph Barnett
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
- Contributed equally as first authors
| | | | - Arjun Nair
- Dept of Radiology, University College Hospital, London, UK
| | - Poonam Ghai
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Shaun Kingston
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Zhe Wu
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | | | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam J Byrne
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
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21
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Ginn RE, Packard VS, Fox TL, Arnold E, Barnett J, Bulthaus M, Bushman P, Case R, Crevey N, Fenelon M, Fuqua R, Gilman C, Hawkinson J, Heady J, Hendrickson H, Koenig E, Messer J, Mullen R, Phillips M, Santorello J, Slamp R, Wehr M, Zimmerman A. Enumeration of Total Bacteria and Coliforms in Milk by Dry Rehydratable Film Methods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/69.3.527] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Eleven laboratories participated in a collaborative study to compare the dry rehydratable film (Petrifilm® SM and Petrifilm® VRB) methods, respectively, to the standard plate count (SPC) and violet red bile agar (VRBA) standard methods for estimation of total bacteria and coliform counts in raw and homogenized pasteurized milk. Each laboratory analyzed 16 samples (8 different samples in blind duplicate) for total count by both the SPC and Petrifilm SM methods. A second set of 16 samples was analyzed by the VRBA and Petrifilm VRB methods. The repeatability standard deviations (the square root of the between-replicates variance) of the SPC, Petrifilm SM, VRBA, and Petrifilm VRB methods were 0.0S104, 0.0444, 0.14606, and 0.13806, respectively; the reproducibility standard deviations were 0.7197, C.06380, 0.15326, and 0.13806, respectively. The difference between the mean Iog10 SPC and the mean logio Petrifilm SM results was 0.027. For the VRBA and Petrifilm VRB methods, the mean log10 difference was 0.013. These results generally indicate the suitability of the dry rehydratable film methods as alternatives to the SPC and VRBA methods for milk samples. The methods have been adopted official first action.
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Affiliation(s)
- Roy E Ginn
- Dairy Quality Control Institute, Inc., 2353 Rice St, St. Paul, MN 55113
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22
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Kelley WN, Andrews J, Appelt AW, Barber R, Barnett J, Barta L, Bass B, Bone E, Breske L, Bryant HH, Case RA, Coleman K, Cyr R, Dewald SK, Dombroski P, Dubs EL, Feldstein FF, Gay BE, Ginn RE, Gottomoller C, Grant H, Heady J, Hills DG, Jerrod L, Jones K, Kaus C, Lane AL, Leslie JE, Marchette D, Misup M, Morris L, Mullen RN, Payton C, Schmidt J, Schneider D, Share R, Sierck M, Wehr HM, Williams R. Qualitative Ampule and Multitest for Beta-Lactam Residues in Fluid Milk Products: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/65.5.1193] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was performed on a rapid Bacillus stearothermophilus agar diffusion ampule method to detect low levels of penicillin G in 7 types of fluid milk products. A multitest technique for processing a large number of samples simultaneously was also studied. Slight modifications were made in the original method to establish more uniformity and to eliminate doubtful responses by specifying a confirmation procedure. Twenty samples spiked with penicillin G (0.000 to 0.008 IU/mL) and tetracycline hydrochloride were frozen and sent to 20 laboratories in the ampule test, and 16 laboratories in the multitest. Each analyst was asked to do a screening run and a confirmation run. Results were reported by color reaction and also as positive or negative for β-lactam inhibitors. The concentrations (penicillin G) where percent positive results equal 100 or not significantly less than 100 (α = 0.05) ranged from 0.005 to 0.007 IU/mi in the ampule test and from 0.004 to 0.007 IU/mL in the multitest. Both techniques have been adopted official first action.
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23
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Abstract
Objectives: Tissue diagnosis prior to thoracic surgery with curative intent is vital in thoracic lesions concerning for lung cancer. Methods of obtaining tissue diagnosis are variable within the United Kingdom.Methods: We performed a model-based analysis to identify the most efficient method of diagnosis using both a health care perspective. Our analysis concerns adults in the UK presenting with a solitary pulmonary nodule suspicious for a primary lung malignancy, patients with more advanced disease (for example lymph node spread) were not considered. Model assumptions were derived from published sources and expert reviews, cost data were obtained from healthcare research group cost estimates (2016-17). Outcomes were measured in terms of costs experienced to healthcare trusts.Results: Our results show that CT guided percutaneous lung biopsy using an ambulatory approach, is the most cost-effective method of diagnosis. Indeed, using this approach, trust experience approximately half of the cost of an approach of surgical lung biopsy performed at the time of potential resection ('frozen section').Limitations and conclusions: Whilst this analysis is limited to the specific scenario of a solitary pulmonary nodule, these findings have implications for the implementation of lung cancer screening in the UK, which is likely to result in increased numbers of patients with such early disease.
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Affiliation(s)
- J Barnett
- Department of Radiology, Royal Brompton Hospital, London, UK
| | | | - A N Tavare
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - A Saini
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
| | - A Patel
- Department of Respiratory Medicine, Royal Free NHS Foundation Trust, London, UK
| | - M Hayward
- Department of Surgery, University College Hospital NHS Foundation Trust, London, UK
| | - S S Hare
- Department of Radiology, Royal Free NHS Foundation Trust, London, UK
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24
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Barnett J, Pulzato I, Burn T, Zafar S, Hine J, Bartlett E, Shah P, Nicholson A, Ridge C, Padley S, Molyneaux P, Kemp S, Devaraj A. P1.11-30 Very Rapid Growth of Small Pulmonary Nodules Predicts Benignity. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1103] [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: 11/16/2022]
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25
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Ivey-Miranda J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Barnett J, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Discordance between Estimate Glomerular Filtration Rate with Creatinine and Cystatin is Associated with Inflammation and Worsened Survival in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barnett J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Urine Growth Differentiation Factor-15 is Not an Independent Biomarker of Cardio-Renal Interactions in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.063] [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: 11/26/2022]
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Griffin M, Flemming J, Pattoli M, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Struyk G, Shamlian P, Mahoney D, Ivey-Miranda J, Ivey-Miranda J, Rao V, Testani J. Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Ivey-Miranda J, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Sarcopenia Strongly Affects Serum Levels of Cystatin C in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. FGF-23 and Cardio-Renal Interactions in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.545] [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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30
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Barnett J, Molyneaux PL, Rawal B, Abdullah R, Hare SS, Vancheeswaran R, Desai SR, Maher TM, Wells AU, Devaraj A. Variable utility of mosaic attenuation to distinguish fibrotic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis. Eur Respir J 2019; 54:13993003.00531-2019. [PMID: 31164428 DOI: 10.1183/13993003.00531-2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Mosaic attenuation on computed tomography (CT) has been identified in international guidelines as an important diagnostic feature of fibrotic hypersensitivity pneumonitis (FHP) as opposed to idiopathic pulmonary fibrosis (IPF). However, mosaic attenuation comprises several different radiological signs (low-density lobules, preserved lobules, air trapping and the so-called "headcheese sign") which may have differing diagnostic utility. Furthermore, the extent of mosaic attenuation required to distinguish these two diagnoses is uncertain and thresholds of mosaic attenuation from international guidelines have not been validated. METHODS Inspiratory and expiratory CT scans were evaluated by two readers in 102 patients (IPF n=57; FHP n=45) using a semiquantitative scoring system for mosaic attenuation. Findings were validated in an external cohort from a secondary referral institution (IPF n=34; FHP n=28). RESULTS Low-density lobules and air trapping were a frequent finding in IPF, present in up to 51% of patients. A requirement for increasing extent of low-density lobules and air trapping based on guidelines (American Thoracic Society and Fleischner Society) was associated with increased specificity for the diagnosis of FHP (0.96 and 0.98, respectively) but reduced sensitivity (0.16 and 0.20, respectively). The headcheese sign was found to be highly specific (0.93) and moderately sensitive (0.49) for a high-confidence diagnosis of FHP. The high specificity of the headcheese sign was maintained in the validation cohort and when patients with other CT features of FHP were excluded. CONCLUSION Mosaic attenuation is a frequent finding in IPF. However, the headcheese sign can be confidently considered as being inconsistent with a diagnosis of IPF and specific for FHP.
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Affiliation(s)
| | | | - Bhavin Rawal
- Dept of Radiology, Royal Brompton Hospital, London, UK
| | - Rezaur Abdullah
- Dept of Respiratory Medicine, Barnet Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Samanjit S Hare
- Dept of Radiology, Barnet Hospital, Royal Free NHS Foundation Trust, Royal Free NHS Foundation Trust, London, UK
| | - Rama Vancheeswaran
- Dept of Respiratory Medicine, Barnet Hospital, Royal Free NHS Foundation Trust, London, UK
| | - Sujal R Desai
- Dept of Radiology, Royal Brompton Hospital, London, UK
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Anand Devaraj
- Dept of Radiology, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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31
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Masding A, Preston SD, Toshner M, Barnett J, Harries C, Dimopoulos K, Kempny A, McCabe C, Jenkins DP, Wort SJ, Price LC. Chronic thromboembolic pulmonary hypertension following long-term peripherally inserted central venous catheter use. Pulm Circ 2019; 9:2045894019859474. [PMID: 31246163 PMCID: PMC6598327 DOI: 10.1177/2045894019859474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 36-year-old woman presented with recurrent pulmonary emboli (PE) despite oral anticoagulation. She was a type I diabetic with severe gastroparesis requiring insertion of multiple long-term peripherally inserted central catheters (PICC) over a 10-year period. Imaging at presentation demonstrated a PICC-associated mobile mass in the right atrium and signs of pulmonary hypertension (PH). She was thrombolyzed and fully anticoagulated, and diabetic management without PICC strongly recommended. PH persisted, however, and she developed chronic thromboembolic pulmonary hypertension (CTEPH), for which successful pulmonary endarterectomy (PEA) surgery led to symptomatic and hemodynamic improvement. This was the first case of CTEPH reported related to long-term PICC use outside the setting of malignant disease, and a novel observation that the PEA specimen contained multiple plastic fragments. Long-term PICC placement increases the risk of CTEPH, a life-threatening, albeit treatable, complication.
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Affiliation(s)
- Abigail Masding
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Stephen D Preston
- 2 Department of Histopathology, Royal Papworth Hospital, Cambridge, UK
| | - Mark Toshner
- 3 National Pulmonary Endarterectomy Service, Royal Papworth Hospital, Cambridge, UK
| | - Joseph Barnett
- 4 Department of Academic Radiology, Royal Brompton Hospital, London, UK
| | - Carl Harries
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | | | - Aleksander Kempny
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - David P Jenkins
- 3 National Pulmonary Endarterectomy Service, Royal Papworth Hospital, Cambridge, UK
| | - S John Wort
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Laura C Price
- 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
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32
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Semple T, Edmondson C, Rawal B, Barnett J, Short C, Bauman G, Pusterla O, Bieri O, Tibiletti M, Parker G, Carr S, Hogg C, Davies J, Padley S. P034 MRI as the new gold standard in the assessment of cystic fibrosis lung disease severity? A bespoke cystic fibrosis-MRI protocol combining quantitative ventilation and structural MRI measures to replace CT. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Semple T, Edmondson C, Rawal B, Barnett J, Short C, Bauman G, Pusterla O, Bieri O, Tibiletti M, Parker G, Carr S, Hogg C, Davies J, Padley S. WS17-4 The addition of sinus imaging to a quantitative cystic fibrosis lung MRI protocol demonstrates an association between sinus signal characteristics and lung disease severity. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30220-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
AbstractPulmonary disease represents a significant extra-articular manifestation in the majority of connective tissue diseases (CTDs). The identification, classification, and staging of pulmonary involvement are centrally important to the management of patients, aiding the prognostication of disease behavior and treatment decisions. We present a review of the high-resolution computed tomographic pulmonary features of CTD in the lung and their significance to the reporting radiologist.
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Affiliation(s)
- Joseph Barnett
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom
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35
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Haskey N, Ye J, Barnett J, Callaway A, Ghosh S, Gibson DL. A174 TYPE OF DIETARY FAT INFLUENCES DISEASE ACTIVITY IN A MURINE MODEL OF CHRONIC INTESTINAL INFLAMMATION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Haskey
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - J Ye
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - J Barnett
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - A Callaway
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - S Ghosh
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - D L Gibson
- Biology, University of British Columbia - Okanagan, Kelowna, BC, Canada
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36
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Jacob J, Hirani N, van Moorsel CHM, Rajagopalan S, Murchison JT, van Es HW, Bartholmai BJ, van Beek FT, Struik MHL, Stewart GA, Kokosi M, Egashira R, Brun AL, Cross G, Barnett J, Devaraj A, Margaritopoulos G, Karwoski R, Renzoni E, Maher TM, Wells AU. Predicting outcomes in rheumatoid arthritis related interstitial lung disease. Eur Respir J 2019; 53:13993003.00869-2018. [PMID: 30487199 PMCID: PMC6319797 DOI: 10.1183/13993003.00869-2018] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/17/2018] [Indexed: 12/18/2022]
Abstract
The aim of this study was to compare radiology-based prediction models in rheumatoid arthritis-related interstitial lung disease (RAILD) to identify patients with a progressive fibrosis phenotype. RAILD patients had computed tomography (CT) scans scored visually and using CALIPER and forced vital capacity (FVC) measurements. Outcomes were evaluated using three techniques, as follows. 1) Scleroderma system evaluating visual interstitial lung disease extent and FVC values; 2) Fleischner Society idiopathic pulmonary fibrosis (IPF) diagnostic guidelines applied to RAILD; and 3) CALIPER scores of vessel-related structures (VRS). Outcomes were compared to IPF patients. On univariable Cox analysis, all three staging systems strongly predicted outcome (scleroderma system hazard ratio (HR) 3.78, p=9×10−5; Fleischner system HR 1.98, p=2×10−3; and 4.4% VRS threshold HR 3.10, p=4×10−4). When the scleroderma and Fleischner systems were combined, termed the progressive fibrotic system (C-statistic 0.71), they identified a patient subset (n=36) with a progressive fibrotic phenotype and similar 4-year survival to IPF. On multivariable analysis, with adjustment for patient age, sex and smoking status, when analysed alongside the progressive fibrotic system, the VRS threshold of 4.4% independently predicted outcome (model C-statistic 0.77). The combination of two visual CT-based staging systems identified 23% of an RAILD cohort with an IPF-like progressive fibrotic phenotype. The addition of a computer-derived VRS threshold further improved outcome prediction and model fit, beyond that encompassed by RAILD measures of disease severity and extent. Combining the scleroderma and Fleischner staging systems in RAILD identifies patients with an IPF-like progressive fibrotic phenotype. CALIPER VRS scores further improve model fit, beyond that encompassed by RAILD measures of disease severity and extent.http://ow.ly/SUcV30mmeYI
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Affiliation(s)
- Joseph Jacob
- Dept of Respiratory Medicine, University College London, London, UK.,Centre for Medical Image Computing, University College London, London, UK
| | - Nikhil Hirani
- MRC Centre for Inflammation Research, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Coline H M van Moorsel
- St Antonius ILD Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Hendrik W van Es
- Dept of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Frouke T van Beek
- St Antonius ILD Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn H L Struik
- St Antonius ILD Center of Excellence, Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gareth A Stewart
- Edinburgh Lung Fibrosis Clinic, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ryoko Egashira
- Dept of Radiology, Faculty of Medicine, Saga University, Saga City, Japan
| | - Anne Laure Brun
- Imaging Dept, Hôpital Cochin, Paris-Descartes University, Paris, France
| | - Gary Cross
- Dept of Radiology, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Anand Devaraj
- Dept of Radiology, Royal Brompton Hospital, London, UK
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ronald Karwoski
- Dept of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, MN, USA
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Borowczyk M, Janicki A, Dworacki G, Szczepanek-Parulska E, Danieluk M, Barnett J, Antonik M, Kałużna M, Bromińska B, Czepczyński R, Bączyk M, Ziemnicka K, Ruchała M. Decreased staging of differentiated thyroid cancer in patients with chronic lymphocytic thyroiditis. J Endocrinol Invest 2019; 42:45-52. [PMID: 29619749 PMCID: PMC6304183 DOI: 10.1007/s40618-018-0882-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/24/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The biological association between chronic lymphocytic thyroiditis (CLT) and differentiated thyroid cancer (DTC) has not been elucidated yet. The aim of the study was to assess whether the presence of CLT exerts any influence on clinical or histological presentation of DTC. METHODS Nine hundred and seven consecutive patients with DTC treated in the years 1998-2016 were divided into two groups according to the presence or absence of concomitant CLT. The statistical differences were analysed. RESULTS Out of 907 patients included in the study, 331 were diagnosed with DTC and CLT (studied group), while 576 patients with DTC but without CLT constituted a control group. The distribution of papillary and follicular thyroid cancer did not differ. In CLT group, the prevalence of pT1 was greater than for pT2-pT4 DTC (P = 0.0003; OR = 1.69, 95% CI 1.27-2.24) compared to controls (68.3 vs. 56.1%, respectively). The presence of multifocal lesions was similar. The thyroid capsule infiltration without extrathyroidal invasion (P < 0.0001; OR = 0.21, 95% CI 0.14-0.31) was more frequent in the studied group, unlike extracapsular invasion, which was significantly more often present in patients with DTC but without CLT (P = 0.004; OR = 1.66; 95% CI 1.17-2.34) as well as nodal involvement (P = 0.048; OR = 0.65, 95% CI 0.42-0.99). CONCLUSIONS The collected data indicate a protective role of CLT in preventing the spread of the DTC. The presence of CLT might limit tumour growth to the primary site.
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Affiliation(s)
- M Borowczyk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - A Janicki
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - G Dworacki
- Department of Clinical Immunology, Poznan University of Medical Sciences, 5D, Rokietnicka Street, 60-806, Poznan, Poland
| | - E Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Danieluk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - J Barnett
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Antonik
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Kałużna
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - B Bromińska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - R Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - M Bączyk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
| | - K Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland.
| | - M Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49, Przybyszewskiego Street, 60-355, Poznan, Poland
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Barnett J, Pulzato I, Padley S, Jordan S, Nicholson A, Rice A, Choraria A, Javed M, Lee Y, Kemp S, Shah P, Devaraj A. Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30082-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Medina-Perucha L, Scott J, Dack C, Chapman S, Family H, Barnett J. Intersectional stigma and sexual health: A pharmacy-based service for women on opioid treatment. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.097] [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: 11/14/2022] Open
Affiliation(s)
| | - J Scott
- University of Bath, Bath, UK
| | - C Dack
- University of Bath, Bath, UK
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Jacob J, Bartholmai BJ, Rajagopalan S, van Moorsel CHM, van Es HW, van Beek FT, Struik MHL, Kokosi M, Egashira R, Brun AL, Nair A, Walsh SLF, Cross G, Barnett J, de Lauretis A, Judge EP, Desai S, Karwoski R, Ourselin S, Renzoni E, Maher TM, Altmann A, Wells AU. Predicting Outcomes in Idiopathic Pulmonary Fibrosis Using Automated Computed Tomographic Analysis. Am J Respir Crit Care Med 2018; 198:767-776. [PMID: 29684284 PMCID: PMC6222463 DOI: 10.1164/rccm.201711-2174oc] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 04/20/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Quantitative computed tomographic (CT) measures of baseline disease severity might identify patients with idiopathic pulmonary fibrosis (IPF) with an increased mortality risk. We evaluated whether quantitative CT variables could act as a cohort enrichment tool in future IPF drug trials. OBJECTIVES To determine whether computer-derived CT measures, specifically measures of pulmonary vessel-related structures (VRSs), can better predict functional decline and survival in IPF and reduce requisite sample sizes in drug trial populations. METHODS Patients with IPF undergoing volumetric noncontrast CT imaging at the Royal Brompton Hospital, London, and St. Antonius Hospital, Utrecht, were examined to identify pulmonary function measures (including FVC) and visual and computer-derived (CALIPER [Computer-Aided Lung Informatics for Pathology Evaluation and Rating] software) CT features predictive of mortality and FVC decline. The discovery cohort comprised 247 consecutive patients, with validation of results conducted in a separate cohort of 284 patients, all fulfilling drug trial entry criteria. MEASUREMENTS AND MAIN RESULTS In the discovery and validation cohorts, CALIPER-derived features, particularly VRS scores, were among the strongest predictors of survival and FVC decline. CALIPER results were accentuated in patients with less extensive disease, outperforming pulmonary function measures. When used as a cohort enrichment tool, a CALIPER VRS score greater than 4.4% of the lung was able to reduce the requisite sample size of an IPF drug trial by 26%. CONCLUSIONS Our study has validated a new quantitative CT measure in patients with IPF fulfilling drug trial entry criteria-the VRS score-that outperformed current gold standard measures of outcome. When used for cohort enrichment in an IPF drug trial setting, VRS threshold scores can reduce a required IPF drug trial population size by 25%, thereby limiting prohibitive trial costs. Importantly, VRS scores identify patients in whom antifibrotic medication prolongs life and reduces FVC decline.
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Affiliation(s)
- Joseph Jacob
- Department of Respiratory Medicine
- Centre for Medical Image Computing, and
| | | | | | - Coline H. M. van Moorsel
- St. Antonius ILD Center of Excellence, Department of Pulmonology, and
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hendrik W. van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Marjolijn H. L. Struik
- St. Antonius ILD Center of Excellence, Department of Pulmonology, and
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Saga City, Japan
| | - Anne Laure Brun
- Imaging Department, Hôpital Cochin, Paris-Descartes University, Paris, France
| | - Arjun Nair
- Department of Radiology, University College London, London, United Kingdom
| | - Simon L. F. Walsh
- Department of Radiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gary Cross
- Department of Radiology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Angelo de Lauretis
- Division of Pneumology, “Guido Salvini” Hospital, Garbagnate Milanese, Italy
| | - Eoin P. Judge
- Department of Respiratory Medicine, Aintree University Hospital, Liverpool, United Kingdom; and
| | - Sujal Desai
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Ronald Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom
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41
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Babcock L, Riggs K, Rowe VD, Hunter JA, O’Shea A, Schell D, Varona M, Miller S, Barnett J, Kadia S. 0923 The Diagnosis and Treatment of Sleep Disordered Breathing in a Hypermobile Population. Sleep 2018. [DOI: 10.1093/sleep/zsy061.922] [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: 11/14/2022] Open
Affiliation(s)
- L Babcock
- Rowe Neurology Institute, Lenexa, KS
| | - K Riggs
- Rowe Neurology Institute, Lenexa, KS
| | - V D Rowe
- Rowe Neurology Institute, Lenexa, KS
| | | | - A O’Shea
- Rowe Neurology Institute, Lenexa, KS
| | - D Schell
- Rowe Neurology Institute, Lenexa, KS
| | - M Varona
- Rowe Neurology Institute, Lenexa, KS
| | - S Miller
- Rowe Neurology Institute, Lenexa, KS
| | - J Barnett
- University Of Kansas Medical School, Kansas City, KS
| | - S Kadia
- University Of Kansas Medical School, Kansas City, KS
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Begen FM, Barnett J, Payne R, Gowland MH, DunnGalvin A, Lucas JS. Eating out with a food allergy in the UK: Change in the eating out practices of consumers with food allergy following introduction of allergen information legislation. Clin Exp Allergy 2018; 48:317-324. [PMID: 29220107 DOI: 10.1111/cea.13072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strict allergen avoidance is important in day-to-day management of food allergy and avoidance when eating outside the home can present particular difficulties. EU legislation (EU FIC) introduced in December 2014 aimed to improve food allergen information provision for customers by requiring retailers of non-prepacked foods to provide information related to the content of one or more of 14 specified food allergens within their foods. OBJECTIVES To investigate the impact of EU FIC on the behaviours, experiences and attitudes of consumers with food allergy when eating out. METHODS As part of longitudinal research, participants with food allergy from across the UK took part in either (A) pre and post legislation in-depth interviews, or (B) pre and post legislation surveys. In-depth interviews were carried out with 28 participants pre and post legislation and analysed using the framework approach. Self-report surveys were completed by 129 participants pre and post legislation, and responses were subject to quantitative analyses. RESULTS Improvements in allergen information provision and raised awareness of food allergy in eating out venues were reported following introduction of EU FIC. Whilst participants favoured written allergen information, they expressed greater confidence in communicating with eating out staff and in trusting the allergen information that they provided. Improvements were judged to be gradual, sporadic or inconsistent in implementation. CONCLUSION & CLINICAL RELEVANCE For many participants, the "ideal" eating out experience was one in which a range of information resources were available and where written allergen information was complemented by proactive and accommodating staff within an allergy-aware environment. Whilst the onus is on legislators and food providers to ensure that adequate allergen information is provided, clinicians play an important role in encouraging patients with food allergy to pursue their legal right to make allergen enquiries to avoid accidental allergen ingestion when eating out.
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Affiliation(s)
- F M Begen
- Department of Psychology, University of Bath, Bath, UK
| | - J Barnett
- Department of Psychology, University of Bath, Bath, UK
| | - R Payne
- Creative Research Ltd, Bishops Castle, UK
| | | | - A DunnGalvin
- School of Applied Psychology, University College Cork, Cork City, Ireland
| | - J S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Koike S, Barnett J, Jones PB, Richards M. Cognitive profiles in childhood and adolescence differ between adult psychotic and affective symptoms: a prospective birth cohort study. Psychol Med 2018; 48:11-22. [PMID: 28988550 PMCID: PMC5729848 DOI: 10.1017/s0033291717000393] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Differences between verbal and non-verbal cognitive development from childhood to adulthood may differentiate between those with and without psychotic symptoms and affective symptoms in later life. However, there has been no study exploring this in a population-based cohort. METHOD The sample was drawn from the MRC National Survey of Health and Development, and consisted of 2384 study members with self-reported psychotic experiences and affective symptoms at the age of 53 years, and with complete cognitive data at the ages of 8 and 15 years. The association between verbal and non-verbal cognition at age 8 years and relative developmental lag from age 8 to 15 years, and both adult outcomes were tested with the covariates adjusted, and mutually adjusted for verbal and non-verbal cognition. RESULTS Those with psychotic experiences [thought interference (n = 433), strange experience (n = 296), hallucination (n = 88)] had lower cognition at both the ages of 8 and 15 years in both verbal and non-verbal domains. After mutual adjustment, lower verbal cognition at age 8 years and greater verbal developmental lag were associated with higher likelihood of psychotic experiences within individuals, whereas there was no association between non-verbal cognition and any psychotic experience. In contrast, those with case-level affective symptoms (n = 453) had lower non-verbal cognition at age 15 years, and greater developmental lag in the non-verbal domain. After adjustment, lower non-verbal cognition at age 8 years and greater non-verbal developmental lag were associated with higher risk of case-level affective symptoms within individuals. CONCLUSIONS These results suggest that cognitive profiles in childhood and adolescence differentiate psychiatric disease spectra.
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Affiliation(s)
- S. Koike
- MRC Unit for Lifelong Health and Ageing at
UCL, 33 Bedford Place, London WC1B 5JU,
UK
- University of Tokyo Institute for Diversity
& Adaptation of Human Mind (UTIDAHM), 3-8-1 Komaba,
Meguro-ku, Tokyo 153-8902, Japan
- Center for Evolutionary Cognitive
Sciences, Graduate School of Arts and Sciences, The University of
Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902,
Japan
| | - J. Barnett
- Department of Psychiatry,
University of Cambridge, Cambridge CB2
0SZ, UK
- Cambridge Cognition Ltd,
Cambridge CB25 9TU, UK
| | - P. B. Jones
- Department of Psychiatry,
University of Cambridge, Cambridge CB2
0SZ, UK
- CAMEO, Cambridgeshire & Peterborough NHS
Foundation Trust, Cambridge CB21 5EF,
UK
| | - M. Richards
- MRC Unit for Lifelong Health and Ageing at
UCL, 33 Bedford Place, London WC1B 5JU,
UK
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Jacob J, Bartholmai BJ, Rajagopalan S, Karwoski R, Nair A, Walsh SLF, Barnett J, Cross G, Judge EP, Kokosi M, Renzoni E, Maher TM, Wells AU. Likelihood of pulmonary hypertension in patients with idiopathic pulmonary fibrosis and emphysema. Respirology 2017; 23:593-599. [PMID: 29237236 DOI: 10.1111/resp.13231] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/11/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE This study evaluated whether patients with combined pulmonary fibrosis and emphysema (CPFE) have an increased likelihood of pulmonary hypertension (PHT) when compared with idiopathic pulmonary fibrosis (IPF) patients without emphysema. METHODS Two consecutive IPF populations having undergone transthoracic echocardiography were examined (n = 223 and n = 162). Emphysema and interstitial lung disease (ILD) extent were quantified visually; ILD extent was also quantified by a software tool, CALIPER. Echocardiographic criteria categorized PHT risk. RESULTS The prevalence of an increased PHT likelihood was 29% and 31% in each CPFE cohort. Survival at 12 months was 60% across both CPFE cohorts with no significantly worsened outcome identified when compared with IPF patients without emphysema. Using logistic regression models in both cohorts, total computed tomography (CT) disease extent (ILD and emphysema) predicted the likelihood of PHT. After adjustment for total disease extent, CPFE had no stronger association with PHT likelihood than IPF patients without emphysema. CONCLUSION Our findings indicate that the reported association between CPFE and PHT is explained by the summed baseline CT extents of ILD and emphysema. Once baseline severity is taken into account, CPFE is not selectively associated with a malignant microvascular phenotype, when compared with IPF patients without emphysema.
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Affiliation(s)
- Joseph Jacob
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | | | - Ronald Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, MN, USA
| | - Arjun Nair
- Department of Radiology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Simon L F Walsh
- Department of Radiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, London, UK
| | - Gary Cross
- Department of Radiology, Royal Free Hospital, London, UK
| | - Eoin P Judge
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Medina-Perucha L, Dack C, Scott J, Family H, Barnett J. Promoting sexual health among women on opioid treatment in community pharmacy: A qualitative study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.071] [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: 11/13/2022] Open
Affiliation(s)
| | - C Dack
- University of Bath, Bath, UK
| | - J Scott
- University of Bath, Bath, UK
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Barnett J, Rowe V, Rowe E, Hunter J, Varona M, VanOwen K, O’Shea A, Schell D, Fisher S. 0518 TREATMENT OF SLEEP DISORDERED BREATHING IN HYPERMOBILE PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.517] [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: 11/13/2022] Open
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Barnett J, Rowe V, Rowe E, Hunter J, Varona M, VanOwen K, O’Shea A, Schell D, Fisher S. 0449 EVALUATION OF SLEEP DISORDERED BREATHING IN HYPERMOBILE PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.448] [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: 11/12/2022] Open
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Bidewell B, Williamson S, Payne J, Schock A, Barnett J, Wessels M, Courtenay A, Scholes S. Sporadic Cases of Multiple Haemorrhages in Pigs in Great Britain. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.155] [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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Greanya ED, Taylor SCM, BscPharm FH, Barnett J, Thiessen B. Temozolomide for malignant gliomas in British Columbia: A population-based cost-effectiveness analysis. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155204jp138oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Study objectives. To evaluate the cost-effectiveness and outcomes achieved in patients with recurrent malignant glioma treated with temozolomide in British Columbia, as compared to previous lomustine use in the same patient population, and to temozolomide literature reports. Outcomes assessed included median overall survival, 6-month overall survival and 6-month progression free survival. Methods. A retrospective analysis was conducted to identify patients who received single-agent temozolomide or lomustine during successive, prespecified time periods. Data was collected on survival, disease progression, duration of therapy, cost of drug, labour and supplies, and successive or prior chemotherapy. Results. Six-month progression free survival (PFS) occurred in 52% and 42.9% of patients in the temozolomide and lomustine cohorts, respectively (P=0.44). Six-month overall survival and median overall survival (OS) were 72% and 40.86 weeks for temozolomide patients and 64.3% and 46.7 weeks for lomustine patients. These outcomes were not statistically different between the two treatment groups. Associated with these outcomes, temozolomide patients received a median of six cycles of drug treatment, with a median cost per patient of $11 660 (CAN). Alternatively, lomustine patients received a median of four cycles with a median cost per patient of $189 (CAN). In the cost-effectiveness analysis for median OS, temozolomide was not a cost-effective alternative, and for 6-month PFS, the incremental cost effectiveness ratio (ICER) of temozolomide was $1261 (CAN) for each additional percent of patients progression free at 6-months. Sensitivity analysis varying both median OS and 6-month PFS resulted in ICER’s of temozolomide ranging from $332 to $3277. Conclusions. No significant differences in outcomes were observed between patients treated with single-agent lomustine or temozolomide. Temozolomide therapy has an incremental cost increase over lomustine of $11 471 per patient. It appears when only survival outcomes and direct treatment costs are considered, lomustine is a more cost-effective treatment strategy in the specific setting of recurrent malignant glioma.
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Affiliation(s)
- ED Greanya
- University of British Columbia, BC, Canada
| | - SCM Taylor
- British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6
| | - F Hu BscPharm
- British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6
| | - J Barnett
- British Columbia Cancer Agency (BCCA) Provincial Pharmacy Program, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6
| | - B Thiessen
- Division of Medical Oncology, British Columbia Cancer Agency (BCCA), 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
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Barnett J, Begen F, Howes S, Regan A, McConnon A, Marcu A, Rowntree S, Verbeke W. Consumers' confidence, reflections and response strategies following the horsemeat incident. Food Control 2016. [DOI: 10.1016/j.foodcont.2015.06.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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