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Boulin M, Cransac A, Adam H, Vadot L, Pistre P, Gilbert K. Effets du confinement lié à la COVID-19 chez les patients atteints de maladies chroniques. Le Pharmacien Clinicien 2022. [PMCID: PMC9748199 DOI: 10.1016/j.phacli.2022.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zhao D, Ferdian E, Maso Talou GD, Gilbert K, Quill GM, Wang VY, Pedrosa J, D'hooge J, Sutton T, Lowe BS, Legget ME, Ruygrok PN, Doughty RN, Young AA, Nash MP. Leveraging CMR for 3D echocardiography: an annotated multimodality dataset for AI. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand (HRC)
National Heart Foundation of New Zealand (NHF)
Segmentation of the left ventricular myocardium and cavity in 3D echocardiography (3DE) is a critical task for the quantification of systolic function in heart disease. Continuing advances in 3DE have considerably improved image quality, prompting increased clinical uptake in recent years, particularly for volumetric measurements. Nevertheless, analysis of 3DE remains a difficult problem due to inherently complex noise characteristics, anisotropic image resolution, and regions of acoustic dropout.
One of the primary challenges associated with the development of automated methods for 3DE analysis is the requirement of a sufficiently large training dataset. Historically, ground truth annotations have been difficult to obtain due to the high degree of inter- and intra-observer variability associated with manual 3DE segmentation, thus, limiting the scope of AI-based solutions. To address the lack of expert consensus, we instead used labels derived from cardiac magnetic resonance (CMR) images of the same subjects. By spatiotemporally registering CMR labels to corresponding 3DE image data on a per subject basis (Figure 1), we collated 520 annotated 3DE images from a mixed cohort of 130 human subjects (2 independent single-beat acquisitions per subject at end-diastole and end-systole) consisting of healthy controls and patients with acquired cardiac disease. Comprising images acquired across a range of patient demographics, this curated dataset exhibits variation in image quality, 3DE acquisition parameters, as well as left ventricular shape and pose within the 3D image volume.
To demonstrate the utility of such a dataset, nn-UNet, a self-configuring deep learning method for semantic segmentation was employed. An 80/20 split of the dataset was used for training and testing, respectively, and data augmentations were applied in the form of scaling, rotation, and reflection. The trained network was capable of reproducing measurements derived from CMR for end-diastolic volume, end-systolic volume, ejection fraction, and mass, while outperforming an expert human observer in terms of accuracy as well as scan-rescan reproducibility (Table I).
As part of ongoing efforts to improve the accuracy and efficiency of 3DE analysis, we have leveraged the high resolution and signal-to-noise-ratio of CMR (relative to 3DE), to create a novel, publicly available benchmark dataset for developing and evaluating 3DE labelling methods. This approach not only significantly reduces the effects of observer-specific bias and variability in training data arising from conventional manual 3DE analysis methods, but also improves the agreement between cardiac indices derived from 3DE and CMR.
Figure 1. Data annotation workflow Table I. Results
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Affiliation(s)
- D Zhao
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
| | - E Ferdian
- The University of Auckland, Department of Anatomy and Medical Imaging , Auckland , New Zealand
| | - G D Maso Talou
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
| | - G M Quill
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
| | - V Y Wang
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
| | - J Pedrosa
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC) , Porto , Portugal
| | - J D'hooge
- KU Leuven, Department of Cardiovascular Sciences , Leuven , Belgium
| | - T Sutton
- Counties Manukau Health Cardiology , Auckland , New Zealand
| | - B S Lowe
- Auckland City Hospital, Green Lane Cardiovascular Service , Auckland , New Zealand
| | - M E Legget
- The University of Auckland, Department of Medicine , Auckland , New Zealand
| | - P N Ruygrok
- The University of Auckland, Department of Medicine , Auckland , New Zealand
| | - R N Doughty
- The University of Auckland, Department of Medicine , Auckland , New Zealand
| | - A A Young
- King's College London, Department of Biomedical Engineering , London , United Kingdom of Great Britain & Northern Ireland
| | - M P Nash
- The University of Auckland, Auckland Bioengineering Institute , Auckland , New Zealand
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Quill G, Zhao D, Gilbert K, Wang VY, Legget ME, Ruygrok PN, Doughty RN, Young AA, Nash MP. Left ventricular dimensions and mass measurement from 3D echocardiography: are we there yet? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand and National Heart Foundation (NHF) of New Zealand
Introduction—Echocardiographic measures of left ventricular (LV) structure and size, including LV wall thickness and LV end-diastolic dimension (LVID), provide important information in the assessment of patients with heart disease. For example, LV mass is a predictor of outcome for patients with hypertension and LVID is a predictor of cardiac resynchronisation response in patients with heart failure. Advances in 3D echocardiography (3DE) have enabled full-volume acquisitions, which overcome geometric assumptions present in conventional 2D echocardiography (2DE), providing a more accurate representation of cardiac geometry. Although numerous validation studies have been performed for 3DE-derived LV volumes, comparisons of LV dimension by 3DE against established methods are limited.
Purpose—We sought to compare routine LV dimension measurements between 3DE and 2DE, with validation using cardiac magnetic resonance (CMR) imaging.
Methods—Transthoracic echocardiography (2D and 3D) and cine CMR imaging were performed in 62 prospectively recruited participants (47 healthy controls, 9 patients with LVH, 6 patients with aortic regurgitation), <1 h apart. 2DE LV dimension measurements (interventricular septum [IVS], posterior wall thickness [PWT], and LVID) were taken at end-diastole from the parasternal long axis, and mass was calculated using the linear method based on ASE/EACVI guidelines. For 3DE, 3D geometric models of the LV were constructed by interactively fitting surfaces to the endocardium and epicardium using previously validated software, from which corresponding LV dimension measurements and mass were extracted. Measurements were obtained from CMR by a similar 3D geometric modelling process.
Results—Differences (mean ± SD) in LV dimension measurements between the three modalities and intraclass correlation coefficients (ICC) are presented in Table I. When compared with CMR, 3DE exhibited higher agreement in terms of LVID and mass than 2DE, but lower agreement in wall thickness measurements. Statistically significant differences were found between 2DE and 3DE for PWT, LVID, and mass, as well as 2DE and CMR for LVID and mass (where P < 0.01 for a paired sample t-test, marked with an asterisk). Meanwhile, there were no statistically significant differences between 3DE and CMR for IVS, PWT, LVID, or mass.
Conclusions—Our results demonstrate that 3DE is superior to 2DE in terms of LVID and mass quantification, exhibiting good agreement with CMR. 3DE exhibited moderate and poor agreement for IVS and PWT, respectively, with both 2DE and CMR, likely due to the lower spatial resolution of 3DE. Further advances in 3DE image quality and analysis tools are therefore needed to improve accuracy of wall thickness measurements. Since 2DE imaging plane and probe positioning can result in oblique measurement and underestimation of LVID, the assessment of LVID and mass by 3DE is likely to lead to more accurate diagnostic and prognostic outcomes. Abstract Table 1
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Affiliation(s)
- G Quill
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - D Zhao
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - VY Wang
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - ME Legget
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - PN Ruygrok
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - RN Doughty
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - AA Young
- King"s College London, Biomedical Engineering & Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - MP Nash
- The University of Auckland, Department of Engineering Science, Auckland, New Zealand
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Zhao D, Quill GM, Gilbert K, Wang VY, Sutton T, Lowe BS, Legget ME, Doughty RN, Young AA, Nash MP. Longitudinal strain measurement by 3D modelling from cine CMR: feasibility and comparison to 2D speckle tracking echocardiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Global longitudinal strain (GLS) has emerged as a sensitive index of left ventricular (LV) systolic function with greater prognostic value than LV ejection fraction (LVEF) in a variety of cardiac disorders. While GLS is routinely derived from 2D speckle tracking echocardiography (STE) and feature tracking in cardiac magnetic resonance (CMR) imaging, calculation of strain via 3D geometric modelling enables analyses of deformation that are independent of 2D image plane constraints.
Purpose
We sought to compare longitudinal strain measurements extracted from geometric 3D analysis of CMR against values obtained from conventional 2D-STE.
Methods
Consecutive 2D-echocardiography (2D-echo) and steady-state free precession multiplanar cine CMR scans were performed in 80 prospectively recruited participants (48 healthy controls with LVEF range 53–74%, 30 patients with non-ischaemic cardiac disease with LVEF range 25–77%, and 2 heart transplant recipients with LVEF 53% and 58%), <1 hour apart. Average endocardial peak GLS from 2D-STE was calculated offline using vendor-independent clinical software from apical triplane (2, 3 and 4-chamber) images for each of the standardised LV walls (anterior, anteroseptal, inferoseptal, inferior, inferolateral, anterolateral). Dynamic 3D geometric models of the LV were reconstructed from 3 long- and 6 short-axis CMR slices over one cardiac cycle. Corresponding longitudinal strain measurements were then evaluated by extracting analogous endocardial arc lengths (apex to base of each LV wall) from the 3D LV model. Finally, an average peak GLS was calculated as the mean of the peak longitudinal strains in each LV wall.
Results
GLS measured by 2D-STE ranged between −6.5% and −27.9% for the study population. A two-way mixed-effects intraclass correlation coefficient (ICC) for absolute agreement of 0.820 (95% CI: [0.720, 0.885]) demonstrated good correlation between average GLS obtained from 2D-STE and CMR. A Bland-Altman analysis revealed a minimal bias (<1%) and 95% limits of agreement (LOA) between −6.3% and 5.5% (Fig. 1), with no apparent proportional bias. Comparatively lower correlation and wider LOA between longitudinal strains from 2D-STE and CMR were observed for each LV wall (Table I).
Conclusions
Fully automated calculation of LV GLS can be obtained from geometric 3D CMR analysis. Average peak GLS from cine CMR exhibits good agreement with 2D-STE, despite showing only moderate agreement at each LV wall. The increased discrepancy in regional longitudinal strain may be attributed to subjective plane positioning in 2D-echo, which can be expected to improve with advances in 3D-STE. The calculation of GLS by 3D geometric modelling may enhance the diagnostic value of routine cine CMR examinations for LV systolic function assessment.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand and National Heart Foundation (NHF) of New Zealand Figure 1. Bland-Altman analysisTable I. Regional correlations
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Affiliation(s)
- D Zhao
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - G M Quill
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - V Y Wang
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - T Sutton
- Counties Manukau Health Cardiology, Auckland, New Zealand
| | - B S Lowe
- Auckland City Hospital, Green Lane Cardiovascular Service, Auckland, New Zealand
| | - M E Legget
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - R N Doughty
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - A A Young
- King's College London, Biomedical Engineering & Imaging Sciences, London, United Kingdom
| | - M P Nash
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
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Elsayed A, Mauger C, Ferdian E, Gilbert K, Scadeng M, Pushparajah K, Young A. Flow vorticity relationships with right ventricular geometry in adult tetralogy of Fallot. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Repaired tetralogy of Fallot adults (rToF) undergo right ventricular (RV) remodeling, in part due to volume overload of residual pulmonary regurgitation volume (PRV). Time-resolved phase-contrast cardiac magnetic resonance imaging (4D Flow MRI) enables the qualitative and quantitative measurement of altered blood flow patterns, including vorticity. Cardiac atlases allow for complex three-dimensional heart shapes to be expressed as morphometric scores. Those scores show the extent of geometrical shift and can help explore uncharted relationships between vorticity and architecture.
Purpose
We aimed to quantify vorticity, incorporating deep learning to enhance 4D Flow data, and correlate this with global cardiac parameters and morphometric scores.
Methods
12 Adult rToF patients and 10 age-matched controls underwent 4D flow MRI and cine imaging. RV interventricular vorticity was calculated for outflow and inflow tracts. EDV, ESV and SV were computed from cines which were also used to build three-dimensional shape models.
The biventricular models were projected onto an atlas generated from 95 rToF patients, and twenty-one principal component analysis shape modes were correlated with cardiac metrics and vorticity to identify global shape variations. Association between biventricular shape and vorticity was further analysed using multivariate multiple regression models.
Results
Strong correlation was found between PRV and the right ventricular outflow tract (RVOT) vorticity. PRV and RVOT vorticity both correlated with the same 3 shape modes (r=−0.55, −0.50 and 0.6 (p<0.05) respectively for PR and r=0.63, −0.82 and 0.60 (p<0.05) respectively for vorticity) i.e., the RV dilates with an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV, and a paradoxical movement of the septum (Figure 1). However, RV vorticity correlated with 2 modes that did not correlate with PRV, (r=−0.62, −0.69, p<0.05). With higher vorticity the RV was longer, increased tilting of the tricuspid annulus and an increased basal bulge around the tricuspid area. The multivariate analysis model demonstrated that higher vorticity was associated with displacement of the pulmonary valve and change in the RVOT length and direction. A septal displacement towards the left ventricle was observed and increased apical flatness of the RV (Figure 1). Qualitatively, vorticity in rToF group was more heterogeneous than controls (Figure 2).
Conclusions
Vorticity is a novel marker based on the influence of blood motion providing new insight into early diagnosis and prognosis of cardiac disease. This is the first study to examine the relationships between vorticity and regional RV shape changes in rToF. Mode associations with vorticity were different to associations with PRV. More longitudinal studies are required for standardization of change in vorticity with the disease process.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The New Zealand heart foundation Mode variations and morphometric modelVorticity visualization and analysis
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Affiliation(s)
- A Elsayed
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - C Mauger
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - E Ferdian
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - M Scadeng
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - K Pushparajah
- King's College London, Department of Biomedical Engineering, London, United Kingdom
| | - A Young
- King's College London, Department of Biomedical Engineering, London, United Kingdom
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Wang V, Freytag B, Zhao D, Gilbert K, Quill G, Hasaballa A, Babarenda Gamage T, Doughty R, Legget M, Ruygrok P, Young A, Nash M. Derivation of in vivo pressure-volume loops for post-heart transplant patients using real-time 3D echocardiography and left ventricular catheterisation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Image-based methods that combine catheterisation with non-concurrent cardiac magnetic resonance (CMR) imaging data and echocardiography (echo) is gaining more interest than the conductance catheter method to derive pressure-volume loops (PVLs) due to improved accuracy and accessibility of LV volume quantification [1–3]. However, accurate temporal registration between LV pressure and volume is not well developed.
Purpose
We propose a framework for temporally registering invasive LV and aortic pressures (LVP and AOP) acquired during left heart catheterisation with real time 3D echocardiography (RT3DE) to generate in vivo PVLs in a group of heart transplant (HTx) recipients.
Methods
25 orthotopic HTx recipients (mean age: 54±8 years and 7 female) indicated for routine coronary assessment were recruited for invasive hemodynamic measurement and RT3DE imaging. A fluid-filled pigtail catheter was used to measure LVP and AOP with simultaneous electrocardiogram (ECG) over several (9–15) heartbeats. Within an hour of catheterisation, single-beat transthoracic RT3DE of the LV was performed from the apical window in a left lateral decubitus position. Imaging parameters were optimized for each patient to maximize the temporal resolution (between 15–41 imaging frames per cycle). We developed a piecewise linear temporal scaling method based on cardiac events (end-diastole (ED), end of isovolumic contraction (eIVC), end-systole (ES), end of isovolumic relaxation (eIVR), and diastasis (DS)) of RT3DE and haemodynamic measurement to resample the LVP at the RT3DE imaging frames between the cardiac events to construct PVLs (Fig. 1a). Geometric LV models were manually fitted at ED and ES, followed by automatic tracking across intermediary frames to estimate LV volume over the entire cardiac cycle (Fig. 1b). The temporally aligned pressure values were further averaged to find the beat-averaged LV PVL (Fig. 1c).
Results
Based on the number of cardiac cycles selected for haemodynamic analysis, multiple in vivo PVLs were constructed for each patient. A beat-averaged PVL was also computed for each patient (Fig.1d). With the exception of one case, the beat-averaged PVLs exhibited classically representative shape with distinct isovolumic contraction and isovolumic relaxation phases. The individual diastolic PVRs for all patients are shown in Fig.1e, with beat-to-beat variation observed in most patients. For some cases, the variation manifested as an offset in LVP, whereas changes in the diastolic PVR slope were observed in other cases.
Conclusion
Temporal alignment scheme based on cardiac events allowed accurate derivation of patient-specific in vivo PVLs from catheterization and RT3DE measurements. Application to heart transplant recipients revealed beat-to-beat variation of haemodynamic state. Further analysis of the diastolic PVRs will allow quantification of chamber stiffness for HTx recipients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand Patient-specific PVLs
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Affiliation(s)
- V.Y Wang
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - B Freytag
- INSERM, Creatis, CNRS UMR5220, Lyon, France
| | - D Zhao
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - G Quill
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - A Hasaballa
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - T.P Babarenda Gamage
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - R.N Doughty
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - M.E Legget
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - P Ruygrok
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - A.A Young
- King's College London, Department of Biomedical Engineering, London, United Kingdom
| | - M.P Nash
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
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Henry A, Dawoud B, Kent S, McDonald C, Logan G, Hennedige A, Exely R, Regan A, Kulkarni R, Gilbert K, Basyuni S, Young D, Kyzas P, Morrison R, McCaul J. Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2021; 59:433-438. [PMID: 33715891 DOI: 10.1016/j.bjoms.2020.08.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022]
Abstract
Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management, and clinical features of patients hospitalised with CFI. Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis, and presenting clinical features. One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median (range) age was 34 (1-94) years. The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%). Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team, and members of the OMFS team.
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Affiliation(s)
- A Henry
- Morriston Hospital, Swansea, United Kingdom.
| | - B Dawoud
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - S Kent
- Morriston Hospital, Swansea, United Kingdom
| | - C McDonald
- Ninewells Hospital, Dundee, United Kingdom
| | - G Logan
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - A Hennedige
- Manchester Royal Infirmary, Manchester, United Kingdom
| | - R Exely
- Northwick Park Hospital, London, United Kingdom
| | - A Regan
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - R Kulkarni
- Northampton General Hospital, Northampton, United Kingdom
| | - K Gilbert
- The Whittington Hospital NHS Trust, London, United Kingdom
| | - S Basyuni
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - D Young
- Department of Mathematics, University of Strathclyde, Glasgow, United Kingdom
| | - P Kyzas
- East Lancashire Teaching Hospital NHS Trust, United Kingdom
| | - R Morrison
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - J McCaul
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Zhao D, Ferdian E, Maso Talou GD, Quill GM, Gilbert K, Babarenda Gamage TP, Wang VY, Pedrosa J, D"hooge J, Legget M, Ruygrok PN, Doughty RN, Camara O, Young AA, Nash MP. Automated analysis of 3D-echocardiography using spatially registered patient-specific CMR meshes. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Foundation (NHF) of New Zealand Health Research Council (HRC) of New Zealand
Artificial intelligence shows considerable promise for automated analysis and interpretation of medical images, particularly in the domain of cardiovascular imaging. While application to cardiac magnetic resonance (CMR) has demonstrated excellent results, automated analysis of 3D echocardiography (3D-echo) remains challenging, due to the lower signal-to-noise ratio (SNR), signal dropout, and greater interobserver variability in manual annotations. As 3D-echo is becoming increasingly widespread, robust analysis methods will substantially benefit patient evaluation.
We sought to leverage the high SNR of CMR to provide training data for a convolutional neural network (CNN) capable of analysing 3D-echo. We imaged 73 participants (53 healthy volunteers, 20 patients with non-ischaemic cardiac disease) under both CMR and 3D-echo (<1 hour between scans). 3D models of the left ventricle (LV) were independently constructed from CMR and 3D-echo, and used to spatially align the image volumes using least squares fitting to a cardiac template. The resultant transformation was used to map the CMR mesh to the 3D-echo image. Alignment of mesh and image was verified through volume slicing and visual inspection (Fig. 1) for 120 paired datasets (including 47 rescans) each at end-diastole and end-systole.
100 datasets (80 for training, 20 for validation) were used to train a shallow CNN for mesh extraction from 3D-echo, optimised with a composite loss function consisting of normalised Euclidian distance (for 290 mesh points) and volume. Data augmentation was applied in the form of rotations and tilts (<15 degrees) about the long axis. The network was tested on the remaining 20 datasets (different participants) of varying image quality (Tab. I). For comparison, corresponding LV measurements from conventional manual analysis of 3D-echo and associated interobserver variability (for two observers) were also estimated.
Initial results indicate that the use of embedded CMR meshes as training data for 3D-echo analysis is a promising alternative to manual analysis, with improved accuracy and precision compared with conventional methods. Further optimisations and a larger dataset are expected to improve network performance.
(n = 20) LV EDV (ml) LV ESV (ml) LV EF (%) LV mass (g) Ground truth CMR 150.5 ± 29.5 57.9 ± 12.7 61.5 ± 3.4 128.1 ± 29.8 Algorithm error -13.3 ± 15.7 -1.4 ± 7.6 -2.8 ± 5.5 0.1 ± 20.9 Manual error -30.1 ± 21.0 -15.1 ± 12.4 3.0 ± 5.0 Not available Interobserver error 19.1 ± 14.3 14.4 ± 7.6 -6.4 ± 4.8 Not available Tab. 1. LV mass and volume differences (means ± standard deviations) for 20 test cases. Algorithm: CNN – CMR (as ground truth). Abstract Figure. Fig 1. CMR mesh registered to 3D-echo.
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Affiliation(s)
- D Zhao
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - E Ferdian
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - GD Maso Talou
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - GM Quill
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - TP Babarenda Gamage
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - VY Wang
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - J Pedrosa
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - J D"hooge
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - M Legget
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - PN Ruygrok
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - RN Doughty
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - O Camara
- Universitat Pompeu Fabra, Department of Information and Communication Technologies, Barcelona, Spain
| | - AA Young
- King"s College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - MP Nash
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
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9
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Zhao D, Quill G, Gilbert K, Wang V, Sutton T, Lowe B, Legget M, Doughty R, Young A, Nash M. Comparison of Global Longitudinal Strain Measurement by Cardiac Magnetic Resonance Imaging and Speckle Tracking Echocardiography. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.049] [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: 10/21/2022]
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10
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Zhao D, Quill G, Gilbert K, Wang V, Legget M, Doughty R, Young A, Nash M. Heterogeneous Differences in Regional Left Ventricular Geometry Between 3D-Echocardiography and Cardiac Magnetic Resonance Imaging. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.05.050] [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: 10/21/2022]
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11
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary. Rheumatology (Oxford) 2020; 59:487-494. [PMID: 31970410 DOI: 10.1093/rheumatology/kez664] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa.,Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre - Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O' Sullivan
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK.,University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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12
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Austin K, Dures E, Almeida C, Cramp F, Gilbert K, Guly C, Hill C, Mackie S, O'Brien A, Watts R, Robson J. P185 Patient perceptions of physical activity following a diagnosis of giant cell arteritis: a multinational qualitative study. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Giant cell arteritis (GCA) is the most common vasculitis in the UK, with an incidence of 220 cases per million in adults over 50 years of age. The physical symptoms as well as the side effects of glucocorticoids may impact patients’ ability to exercise. Maintaining physical activity (PA) has been shown to be beneficial to disease activity in other inflammatory conditions and is also a specific priority for GCA patients. The aim of this project was to explore patient perceptions of physical activity in GCA.
Methods
Multinational qualitative study, using interviews with 36 patients from the UK (25) and Australia (11), all of whom had a definitive diagnosis from imaging or biopsy. Interviews were recorded, transcribed, and analysed using inductive thematic analysis. This is secondary analysis of data collected to explore health-related quality of life in people with GCA.
Results
107 individual themes were reported by patients, which divided broadly into two overarching themes: barriers to (59) and facilitators of (48) physical activity. Four sub-themes were identified within each overarching theme. For barriers, these were: negative physical symptoms (including effects of disease flares, visual loss, fatigue, weakness, pain and stiffness), lack of physical capability (including poor stamina, confidence and mobility), negative perceptions around PA, and negative reinforcement (i.e. new physical symptoms following PA). Facilitators of physical activity were also grouped into four sub-themes: external facilitators (including motivation from healthcare professionals), access to appropriate facilities, personal strategies (including pacing and goal-setting) and personal facilitators (including internal motivation to improve symptoms, and positive reinforcement from noticing physical and psychological benefits of PA).
Conclusion
There are a variety of barriers to physical activity in GCA patients, including patients being fearful of exercise. In other inflammatory conditions, patients report improved symptoms following physical activity as well as wider benefits to general wellbeing and cardiovascular health. Education, motivational interviewing, and personalised strategies may be beneficial components of an intervention to support physical activity in patients with GCA.
Disclosures
K. Austin None. E. Dures Grants/research support; Has previously received an independent learning grant from Pfizer, however the work has been completed and the grant has been closed. C. Almeida None. F. Cramp None. K. Gilbert None. C. Guly None. C. Hill None. S. Mackie None. A. O'Brien None. R. Watts None. J. Robson None.
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Affiliation(s)
- Keziah Austin
- Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| | - Celia Almeida
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
| | | | - Catherine Guly
- Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
| | - Catherine Hill
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, AUSTRALIA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
- NIHR Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UNITED KINGDOM
| | - Anne O'Brien
- School of Health and Rehabilitation, Keele University, Keele, UNITED KINGDOM
| | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, UNITED KINGDOM
| | - Joanna Robson
- Department of Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UNITED KINGDOM
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UNITED KINGDOM
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13
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford) 2020; 59:e1-e23. [DOI: 10.1093/rheumatology/kez672] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria
- South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre – Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O’ Sullivan
- Department of Ophthalmology, King’s College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK
- University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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14
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Henry A, Logan G, McDonald C, Hennedige A, Kent S, Dawoud B, Kulkarni R, Gilbert K, Exley R, Basyuni S, Kyzas P, Morrison R, McCaul J. How frequently is pus sent and how often does it change practice? A Maxillofacial Trainee Research Collaborative (MTReC) Project. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.245] [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: 10/25/2022]
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15
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Kent S, McDonald C, Hennedige A, Logan G, Henry A, Dawoud B, Kulkarni R, Gilbert K, Exley R, Basyuni S, Kyzas P, Morrison R, McCaul J. Steroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) project. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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McDonald C, Hennedige A, Logan G, Kent S, Henry A, Dawoud B, Kulkarni R, Gilbert K, Exley R, Basyuni S, Kyzas P, Morrison R, McCaul J. The development and progress of the maxillofacial trainee research collaborative (MTReC). How trainees can design and deliver national research projects. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Dawoud B, McDonald C, Hennedige A, Logan G, Kent S, Henry A, Kulkarni R, Gilbert K, Exley R, Basyuni S, Kyzas P, Morrison R, McCaul J. Demographic features of CERVicofacial infections. A maxillofacial trainee research collaborative (MTReC) project. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.259] [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: 10/25/2022]
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18
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Logan G, McDonald C, Hennedige A, Kent S, Henry A, Dawoud B, Kulkarni R, Gilbert K, Exley R, Basyuni S, Kyzas P, Morrison R, McCaul J. Airway problems and higher level care in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) Project. Br J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.bjoms.2019.10.244] [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: 10/25/2022]
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19
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Zhao D, Gilbert K, McDougal CR, Wang VY, Houle H, Doughty R, Young AA, Nash MP. P4360Personalised shape models of the left ventricle from 3D echocardiography: an initial comparison to cardiac magnetic resonance imaging. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The heart constantly adapts to maintain cardiac output. In the longer term, this process (remodeling) can manifest as changes in ventricular volume, sphericity, and/or wall thickness, amongst several other morphological indices. Previous studies have shown the significance of remodeling in evaluations of survival, and as a determinant of the clinical course of heart failure. Yet surprisingly, diagnostic measures, typically of left ventricular (LV) mass and ejection fraction, neglect much of the shape information that is available through imaging. A recent UK Biobank study revealed that morphometric atlases show more compelling associations with cardiovascular risk factors, than do LV mass and volumes. While it has been possible to construct shape models from cardiac magnetic resonance imaging (MRI), such a framework is still under development for echocardiography (echo).
Purpose
Despite MRI being long regarded as the gold standard, it is greatly limited by high costs, long scan times and incompatibility with ferromagnetic cardiac devices. In contrast, echo has presented as a convenient alternative, whilst also offering good temporal resolution. The advancements of 3D echo now provide adequate spatial resolution and thus elicit the possibility of conducting more complex analyses on this modality. With the ability to extract LV geometry directly from 3D echo acquisitions, we sought to create dynamic, 3D patient-specific models–and subsequently compare these results to those derived from MRI.
Methods
As part of an ongoing study, 8 volunteers with no known cardiovascular problems (nor family history thereof), were recruited for non-invasive imaging. Cine MRI and 3D echo of the LV were acquired within a 2 hour session. A Siemens Avanto Fit 1.5 T MRI scanner and Siemens ACUSON SC2000 Ultrasound System with a 4Z1c Transducer were used. 3D models of the LV were generated independently from echo (EchobuildR 2.7 prototype software, Siemens Ultrasound) and MRI acquisitions (Cardiac Image Modeller v8.1), and registered to fiducial landmarks (apex, base plane, right ventricular inserts) and myocardial contours.
Results
Euclidian distances between 1682 corresponding points sampled from the surface of echo/MRI models were calculated, and used as a discrepancy measure (Figure). Across the 8 cases, we found an average root mean square deviation (RMSD) of 5.71 mm at end-systole and 6.03 mm at end-diastole. The maximum RMSD for a single model was 9.47 mm (case 8, ES).
Conclusion
We demonstrate that it is possible to create shape models from 3D echo examinations for comparison with MRI. As more cases are collected, we will devise methods to objectively quantify the mismatch that may arise between models derived from the two modalities. The establishment of such a framework would not only provide previously unavailable measures of shape and function, but in turn leverage the significantly wider clinical reach of echocardiography.
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Affiliation(s)
- D Zhao
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - K Gilbert
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - C R McDougal
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - V Y Wang
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
| | - H Houle
- Siemens Medical Solutions USA, San Francisco, United States of America
| | - R Doughty
- The University of Auckland, School of Medicine, Auckland, New Zealand
| | - A A Young
- Kings College London, Biomedical Engineering Department, London, United Kingdom
| | - M P Nash
- The University of Auckland, Auckland Bioengineering Institute, Auckland, New Zealand
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20
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Ehlers L, Askling J, Bijlsma HW, Cid MC, Cutolo M, Dasgupta B, Dejaco C, Dixon WG, Feltelius N, Finckh A, Gilbert K, Mackie SL, Mahr A, Matteson EL, Neill L, Salvarani C, Schmidt WA, Strangfeld A, van Vollenhoven RF, Buttgereit F. 2018 EULAR recommendations for a core data set to support observational research and clinical care in giant cell arteritis. Ann Rheum Dis 2019; 78:1160-1166. [PMID: 30898837 DOI: 10.1136/annrheumdis-2018-214755] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 11/04/2022]
Abstract
Giant cell arteritis (GCA) represents the most common form of primary systemic vasculitis and is frequently associated with comorbidities related to the disease itself or induced by the treatment. Systematically collected data on disease course, treatment and outcomes of GCA remain scarce. The aim of this EULAR Task Force was to identify a core set of items which can easily be collected by experienced clinicians, in order to facilitate collaborative research into the course and outcomes of GCA. A multidisciplinary EULAR task force group of 20 experts including rheumatologists, internists, epidemiologists and patient representatives was assembled. During a 1-day meeting, breakout groups discussed items from a previously compiled collection of parameters describing GCA status and disease course. Feedback from breakout groups was further discussed. Final consensus was achieved by means of several rounds of email discussions after the meeting. A three-round Delphi survey was conducted to determine a core set of parameters including the level of agreement. 117 parameters were regarded as relevant. Potential items were subdivided into the following categories: General, demographics, GCA-related signs and symptoms, other medical conditions and treatment. Possible instruments and assessment intervals were proposed for documentation of each item. To facilitate implementation of the recommendations in clinical care and clinical research, a minimum core set of 50 parameters was agreed. This proposed core set intends to ensure that relevant items from different GCA registries and databases can be compared for the dual purposes of facilitating clinical research and improving clinical care.
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Affiliation(s)
- Lisa Ehlers
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Johan Askling
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | | | - Maria Cinta Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maurizio Cutolo
- Department Internal Medicine University of Genova, Research Laboratory and Academic Clinical Unit of Rheumatology, Viale Benedetto, Italy
| | | | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,Rheumatology, Hospital Of Bruneck, Bruneck, Italy
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Nils Feltelius
- Medical Products Agency, Uppsala, Sweden.,Cross-Committee Task Force on Registries at the European Medicines Agency, London, UK
| | - Axel Finckh
- Division of Rheumatology, University of Geneva, Geneva, Switzerland
| | | | - Sarah Louise Mackie
- UK and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic, Rochester, New York, USA
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Dundee, UK
| | - Carlo Salvarani
- Division of Rheumatology, Azienda Ospedaliera IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Modena, Italy
| | - Wolfgang A Schmidt
- Rheumatology, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Ronald F van Vollenhoven
- Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
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21
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Morton C, Muller S, Bucknall M, Gilbert K, Mallen CD, Hider SL. Examining management and research priorities in patients with polymyalgia rheumatica: a primary care questionnaire survey. Clin Rheumatol 2019; 38:1767-1772. [PMID: 30617599 PMCID: PMC6544756 DOI: 10.1007/s10067-018-04405-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
Abstract
Introduction/objectives Polymyalgia rheumatica (PMR) is a common inflammatory disorder that is usually managed with oral glucocorticoids, which although effective can cause significant adverse events. Support group survey data suggests length of glucocorticoid treatment and managing side effects are key priority areas of management for patients. Recognising that not all patients will access patient support organisations, our objective was to identify priorities for PMR management and research among primary care PMR patients. Method All adults aged ≥ 50 years registered with 150 English general practices who had a first read code for PMR in their medical records in the preceding 3 years were mailed a self-completion questionnaire (n = 704). Survey items included questions regarding patient priorities for PMR management (from a pre-defined list of 10 items) and suggestions for future research (8 items, plus a free-text option), which were developed in collaboration with PMRGCAuk. Results Five hundred fifty patients responded (78%). The mean (SD) age was 74.1 (8.5) years and 361 (66%) were female. Priority research areas were focused on how to better manage pain, stiffness and fatigue (431, 78%), improving the diagnosis of PMR (393, 71%) and steroid management (342, 62%). Conclusions This survey of PMR patients suggests that symptom management, early diagnosis and managing medication are key areas for patients for future research. Researchers and funding organisations should be aware of these priorities if we are to generate research findings that are relevant to the widest range of stakeholders.
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Affiliation(s)
- Chris Morton
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Sara Muller
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milica Bucknall
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Samantha L Hider
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
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22
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Elsayed A, Gilbert K, Pontre B, Nash M, Doughty R, Stubbs M, Young A. Vortex Visualisation and Qualitative Assessment Using 4D Flow MRI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gilbert K, Gilbert M, Chiriboga D, Park N, Molinari V. DEMENTIA-SPECIFIC DAYCARE FOR PATIENTS WITH ALZHEIMER’S DISEASE OR RELATED DISORDERS & THEIR CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1968] [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)
- K Gilbert
- Alzheimer’s Community Care, West Palm Beach, Florida
| | - M Gilbert
- Alzheimer’s Community Care, West Palm Beach, Florida
| | - D Chiriboga
- Dept of Child & Family, College of Behavioral and Community Sciences, University of South Florida
| | - N Park
- University of South Florida
| | - V Molinari
- School of Aging Studies, College of Behavioral and Community Sciences, USF
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Muller S, O'Brien A, Helliwell T, Hay CA, Gilbert K, Mallen CD, Busby K. Support available for and perceived priorities of people with polymyalgia rheumatica and giant cell arteritis: results of the PMRGCAuk members' survey 2017. Clin Rheumatol 2018; 37:3411-3418. [PMID: 30066282 DOI: 10.1007/s10067-018-4220-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Polymyalgia rheumatica and giant cell arteritis are relatively common, but under research inflammatory rheumatological conditions. This survey aimed to ascertain the matters in which patients feel they need support with these conditions and appraise how the Charity PMRGCAuk currently supports these needs and could do so in the future. PMRGCAuk members (n = 910) were invited to complete an on-line survey. The survey requested the respondent's history of PMR and or GCA, their perceived priorities for support for people with PMR and or GCA and views on the services already provided by the Charity. A total of 209 people completed the survey. Less than 24% had heard of either PMR or GCA before their diagnosis. Priorities in supporting people with PMR and or GCA included: being on and tapering off glucocorticoids (76.6%), specifically, length of treatment and the risks versus benefits and managing side effects. Respondents generally reported satisfaction with the services currently provided by PMRGCAuk. The support provided by PMRGCAuk is very helpful to members and fills an important gap in provision for people with PMR and or GCA. The areas in which the greatest proportions of participants requested support do not have an evidence base to underpin them. It is incumbent on the research community to address patients' concerns and provide an evidence base where it is required by those affected.
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Affiliation(s)
- Sara Muller
- Research Institute for Primary Care and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG, UK.
| | - Anne O'Brien
- Research Institute for Primary Care and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG, UK.,School of Health and Rehabilitation, Keele University, Keele, UK
| | - Toby Helliwell
- Research Institute for Primary Care and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG, UK
| | - Charles A Hay
- Research Institute for Primary Care and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG, UK
| | | | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, David Weatherall Building, Keele University, Keele, ST5 5BG, UK
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Aung N, Gilbert K, Suinesiaputra A, Lee A, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Lukaschuk E, Carapella V, Kim YJ, Piechnik SK, Neubauer S, Young AA, Petersen SE. P3693Impact of cardiovascular risk factors on atlas-based left ventricular shape phenotypes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3693] [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: 11/12/2022] Open
Affiliation(s)
- N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - K Gilbert
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - A Suinesiaputra
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - A Lee
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - M M Sanghvi
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - F Zemrak
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - J M Paiva
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
| | - E Lukaschuk
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - V Carapella
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - Y J Kim
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S K Piechnik
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A A Young
- The University of Auckland, Department of Anatomy and Medical Imaging, Auckland, New Zealand
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom
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Mauger C, Gilbert K, Suinesiaputra A, Pontre B, Omens J, McCulloch A, Young A. An Iterative Diffeomorphic Algorithm for Registration of Subdivision Surfaces: Application to Congenital Heart Disease. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:596-599. [PMID: 30440467 PMCID: PMC8175008 DOI: 10.1109/embc.2018.8512394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this paper, we present a new diffeomorphic registration algorithm for the registration of 3D models to 3D points. A biventricular template is iteratively fitted to the data by a series of implicitly constrained diffeomorphic linear least squares fits with decreasing regularization weights before performing an explicitly constrained diffeomorphic fit. The algorithm has been tested on a set of manual contours from 20 patients with a variety of congenital heart disease. Registration accuracy was assessed by calculating the mean point-to-point distance and the Dice overlap metric. Results showed that the method was able to accurately fit the biventricular model to 3D points and that the deformable model was able to fit all the pathologies while being diffeomorphic. The algorithm took approximately 5 minutes to fit each case, with an average of 52,580 points per case.
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Ho MW, Pick AS, Sutton DN, Dyker K, Cardale K, Gilbert K, Johnson J, Quantrill J, McCaul JA. Recruitment of patients into head and neck clinical trials: acceptability of studies to patients from perspective of the research team. Br J Oral Maxillofac Surg 2018. [PMID: 29523362 DOI: 10.1016/j.bjoms.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We reviewed longitudinal recruitment data to assess recruitment into head and neck cancer trials, and to identify factors that could influence this and affect their acceptability to patients. We retrieved data from the prospective computerised database (2009-2016) to measure acceptability to patients using the recruitment:screening ratio, and compared observational with interventional studies, single specialty (or site) with multispecialty (or site) studies, and "step-up" randomisation with "non-inferiority" randomisation designs. A total of 1283 patients were screened and 583 recruited. The recruitment:screening ratio for all National Institute for Health Research (NIHR) portfolio studies combined was 0.47 (486/1133). Studies that involved treatment by several specialties or at several sites had a significantly adverse impact on acceptability (p=0.01). Recruitment into non-inferiority randomised controlled studies was lower than that into step-up randomised studies (p=0.06). The complexity of a study's design did not compromise recruitment. Treatment across several specialties or several sites and perceived non-inferiority designs, reduced the acceptability of some trials.
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Affiliation(s)
- M W Ho
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK; Oral and Maxillofacial Surgery, Leeds Dental Institute, University of Leeds, West Yorkshire LS2 9LU, UK.
| | - A S Pick
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - D N Sutton
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - K Dyker
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK; Clinical Oncology, Leeds Teaching Hospitals NHS Trust, West Yorkshire, UK
| | - K Cardale
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK; Clinical Oncology, Leeds Teaching Hospitals NHS Trust, West Yorkshire, UK
| | - K Gilbert
- Clinical Trials, Northwick Park Hospital, North-West London, UK
| | - J Johnson
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - J Quantrill
- Head and Neck Research, Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - J A McCaul
- Clinical Trials, Northwick Park Hospital, North-West London, UK; Oral and Maxillofacial/Head and Neck Surgery, NHS Greater Glasgow and Clyde, Scotland
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McDonald C, Hennedige A, Henry A, Dawoud B, Kulkarni R, Gilbert K, Kyzas P, Morrison R, McCaul J. Management of cervicofacial infections: a survey of current practice in maxillofacial units in the UK. Br J Oral Maxillofac Surg 2017; 55:940-945. [DOI: 10.1016/j.bjoms.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022]
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Park N, Chiriboga D, Molinari V, Barnes M, Herd K, Gilbert K. PREDICTION OF CAREGIVER BURDEN IN THE CONTEXT OF DEMENTIA-SPECIFIC DAY CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1721] [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)
- N.S. Park
- University of South Florida, Tampa, Florida,
| | | | | | - M.M. Barnes
- Alzheimer’s Community Care, West Palm Beach, Florida
| | - K.J. Herd
- Alzheimer’s Community Care, West Palm Beach, Florida
| | - K. Gilbert
- Alzheimer’s Community Care, West Palm Beach, Florida
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Goldstein I, Knoll D, Lipshultz L, Tursi J, Smith T, Kaufman G, Gilbert K, Rosen R, MacMahon C. PS-06-007 Changes in the effects of Peyronie's disease after treatment with collagenase clostridium histolyticum according to men with Peyronie's disease and their female sexual partners. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.047] [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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Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, Abril A, Bachta A, Balint P, Barraclough K, Bianconi L, Buttgereit F, Carsons S, Ching D, Cid M, Cimmino M, Diamantopoulos A, Docken W, Duftner C, Fashanu B, Gilbert K, Hildreth P, Hollywood J, Jayne D, Lima M, Maharaj A, Mallen C, Martinez-Taboada V, Maz M, Merry S, Miller J, Mori S, Neill L, Nordborg E, Nott J, Padbury H, Pease C, Salvarani C, Schirmer M, Schmidt W, Spiera R, Tronnier D, Wagner A, Whitlock M, Matteson EL, Dasgupta B. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol 2016; 67:2569-80. [PMID: 26352874 DOI: 10.1002/art.39333] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/13/2015] [Indexed: 12/12/2022]
Abstract
Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.
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Affiliation(s)
- Christian Dejaco
- Medical University Graz, Department of Rheumatology, Graz, Austria, and Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Yogesh P Singh
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, Epidemiology and Population Health Faculty, London, UK
| | - Andrew Hutchings
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
| | - Dario Camellino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | - Sarah Mackie
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Andy Abril
- Mayo Clinic, Department of Rheumatology, Jacksonville, Florida
| | - Artur Bachta
- Military Institute of Medicine, Department of Internal Medicine and Rheumatology, Warsaw, Poland
| | - Peter Balint
- National Institute of Rheumatology and Physiotherapy, 3rd Rheumatology Department, Budapest, Hungary
| | | | | | - Frank Buttgereit
- Charité University Medicine, Department of Rheumatology, Berlin, Germany
| | - Steven Carsons
- Stony Brook University School of Medicine, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital Campus, Mineola, New York
| | - Daniel Ching
- Timaru Hospital, Department of Rheumatology, Timaru, New Zealand
| | - Maria Cid
- University of Barcelona Hospital Clinic, Department of Systemic Autoimmune Diseases, Barcelona, Spain
| | - Marco Cimmino
- University of Genoa, Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, Genoa, Italy
| | | | - William Docken
- Brigham and Women's Hospital, Division of Rheumatology, Boston, Massachusetts
| | - Christina Duftner
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Billy Fashanu
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - Kate Gilbert
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Pamela Hildreth
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Jane Hollywood
- Southend University Hospital, Department of Rheumatology, Essex, UK
| | - David Jayne
- University of Cambridge, Department of Medicine, Cambridge, UK
| | - Manuella Lima
- Hospital Universitário Pedro Ernesto, Department of Rheumatology, Rio de Janeiro, Brazil
| | - Ajesh Maharaj
- University of Kwa Zulu Natal, Prince Mshiyeni Memorial Hospital, Nelson R. Mandela School of Medicine, Department of Internal Medicine, Durban, South Africa
| | - Christian Mallen
- Keele University, Arthritis Research UK Primary Care Centre, Keele, UK
| | - Victor Martinez-Taboada
- Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Servicio de Reumatología, Santander, Spain
| | - Mehrdad Maz
- University of Kansas Medical Center, Department of Medicine, Division of Allergy, Clinical Immunology, and Rheumatology, Kansas City
| | - Steven Merry
- Mayo Clinic, Department of Family Medicine, Rochester, Minnesota
| | - Jean Miller
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Shunsuke Mori
- NHO Kumamoto Saishunsou National Hospital, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, Kohshi, Kumamoto, Japan
| | - Lorna Neill
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Elisabeth Nordborg
- Sahlgren University Hospital, Department of Rheumatology, Göteborg, Sweden
| | - Jennifer Nott
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Hannah Padbury
- patient representatives from Polymyalgia Rheumatica and Giant Cell Arteritis UK, London, UK
| | - Colin Pease
- University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Carlo Salvarani
- Azienda Ospedaliera-IRCCS di Reggio Emilia, Department of Internal Medicine, Division of Rheumatology, Reggio Emilia, Italy
| | - Michael Schirmer
- Medical University of Innsbruck, Department of Internal Medicine-Clinic VI, Innsbruck, Austria
| | - Wolfgang Schmidt
- Immanuel Krankenhaus Berlin and Medical Center for Rheumatology Berlin-Buch, Berlin, Germany
| | - Robert Spiera
- Hospital for Special Surgery, Department of Medicine, New York, New York
| | - David Tronnier
- patient representative from the Mayo Clinic, Rochester, Minnesota
| | - Alexandre Wagner
- Universidade Federal de São Paulo, Department of Internal Medicine, São Paulo, Brazil
| | | | - Eric L Matteson
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Division of Rheumatology, Rochester, Minnesota
| | - Bhaskar Dasgupta
- Southend University Hospital, Department of Rheumatology, Essex, UK
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Cymerman J, Kulkarni R, Gilbert K, Kerawala C, Bisase B, Visavadia B, Gilhooly M, Amin M, Kumar M, McCaul J. Cook-Swartz implantable Doppler: an ongoing UK analysis: arterial vs. venous placement: is there a difference? Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.224] [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: 10/22/2022]
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Kulkarni R, Cymerman J, Gilbert K, Pick A, Ho M, Sutton D, McCaul J. The role of Pentoxifylline–Tocopherol–Clodronate (PENTOCLO) in osteoradionecrosis (ORN) of the mandible. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.078] [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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Gilbert K, Hayes G, McCaul J. Good clinical practice for surgeons: facilitating surgical research in the NHS. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gilbert K, Lam HI, Pontré B, Cowan BR, Occleshaw CJ, Liu JY, Young AA. An interactive tool for rapid biventricular analysis of congenital heart disease. Clin Physiol Funct Imaging 2015; 37:413-420. [PMID: 26577068 PMCID: PMC5484291 DOI: 10.1111/cpf.12319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
Cardiac malformations are the most common birth defect. Better interventions in early life have improved mortality for children with congenital heart disease, but heart failure is a significant problem in adulthood. These patients require regular imaging and analysis of biventricular (left and right ventricular) function. In this study, we describe a rapid method to analyse left and right ventricular shape and function from cardiac MRI examinations. A 4D (3D+time) finite element model template is interactively customized to the anatomy and motion of the biventricular unit. The method was validated in 17 patients and 10 ex-vivo hearts. Interactive model updates were achieved through preconditioned conjugate gradient optimization on a multithread system, and by precomputing points predicted from a coarse mesh optimization.
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Affiliation(s)
- K Gilbert
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H-I Lam
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B Pontré
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B R Cowan
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C J Occleshaw
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J Y Liu
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A A Young
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, Abril A, Bachta A, Balint P, Barraclough K, Bianconi L, Buttgereit F, Carsons S, Ching D, Cid M, Cimmino M, Diamantopoulos A, Docken W, Duftner C, Fashanu B, Gilbert K, Hildreth P, Hollywood J, Jayne D, Lima M, Maharaj A, Mallen C, Martinez-Taboada V, Maz M, Merry S, Miller J, Mori S, Neill L, Nordborg E, Nott J, Padbury H, Pease C, Salvarani C, Schirmer M, Schmidt W, Spiera R, Tronnier D, Wagner A, Whitlock M, Matteson EL, Dasgupta B. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74:1799-807. [DOI: 10.1136/annrheumdis-2015-207492] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gilbert K. PARE0008 Using Online Self-Publishing to Publish and Market a Book for Patient Education (Polymyalgia Rheumatica and Giant Cell Arteritis: A Survival Guide): A Description and Analysis of the Process and an Evaluation of the Result. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1500] [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: 11/04/2022]
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Malick M, Gilbert K, Daniel J, Arseneault-Breard J, Tompkins TA, Godbout R, Rousseau G. Vagotomy prevents the effect of probiotics on caspase activity in a model of postmyocardial infarction depression. Neurogastroenterol Motil 2015; 27:663-71. [PMID: 25786501 DOI: 10.1111/nmo.12540] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/13/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with apoptosis in the amygdala and, ultimately, with clinical signs of depression. Different treatments have proven to be beneficial in preventing depression, including combination of the probiotics Lactobacillus helveticus and Bifidobacterium longum for prophylaxis. We have speculated previously that the benefit of these probiotics is due to their anti-inflammatory properties, and evidence suggests that an intact vagus nerve is important for this effect to occur. This study was designed to ascertain vagus nerve involvement in the beneficial influence of probiotics on caspase activities in our post-MI animal model of depression. METHODS Probiotics and/or vehicle were administered daily to male adult rats, 14 days before MI and until euthanasia. Vagotomy was performed in subgroups of rats 40 min before MI. They were sacrificed after 3 days of reperfusion, and MI size was assessed along with caspase-3 and -8 activities in the amygdala. KEY RESULTS Probiotics had no effect on infarct size but vagotomy increased it. Caspase-3 and caspase-8 activities in the amygdala were higher in MI than in sham-operated rats, and this outcome was reversed by probiotics. The beneficial influence of probiotics was abolished by vagotomy. CONCLUSIONS & INFERENCES Our data indicate that the effect of probiotics on caspase activities in the amygdala after MI depends on an intact vagus nerve.
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Affiliation(s)
- M Malick
- Centre de biomédecine, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada; Département de pharmacologie, Université de Montréal, Montréal, QC, Canada
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Gilbert K, Lachaise-Machet M, Cormier P, Chabrol A. Réduction de la consommation de carbapénèmes : impact d’un avis infectieux précoce. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.221] [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: 10/24/2022]
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Cumming J, Gilbert K. OP0245-PARE The emotional and information support needs of people living with polymyalgia rheumatica. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1928] [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: 11/04/2022]
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Lteif AA, Chisholm RL, Gilbert K, Considine RV, Mather KJ. Effects of losartan on whole body, skeletal muscle and vascular insulin responses in obesity/insulin resistance without hypertension. Diabetes Obes Metab 2012; 14:254-61. [PMID: 22051059 PMCID: PMC3277658 DOI: 10.1111/j.1463-1326.2011.01522.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS Renin-angiotensin system antagonists have been found to improve glucose metabolism in obese hypertensive and type 2 diabetic subjects. The mechanism of these effects is not well understood. We hypothesized that the angiotensin receptor antagonist losartan would improve insulin-mediated vasodilation, and thereby improve insulin-stimulated glucose uptake in skeletal muscle of insulin-resistant subjects. METHODS We studied subjects with obesity and insulin resistance but without hypertension, hypercholesterolaemia or dysglycaemia [age 39.0 ± 9.6 yr (mean ± SD), body mass index (BMI) 33.2 ± 5.9 kg/m(2) , BP 115.8 ± 12.2/70.9 ± 7.2 mmHg, LDL 2.1 ± 0.5 mmol/l]. Subjects were randomized to 12 weeks' double-blind treatment with losartan 100 mg once daily (n = 9) or matching placebo (n = 8). Before and after treatment, under hyperinsulinaemic euglycaemic clamp conditions we measured whole-body insulin-stimulated glucose disposal, insulin-mediated vasodilation, and insulin-stimulated leg glucose uptake by the limb balance technique. RESULTS Whole-body insulin-stimulated glucose disposal was not significantly increased by losartan. Insulin-mediated vasodilation was augmented following both treatments [increase in leg vascular conductance: pretreatment 0.7 ± 0.3 l/min/mmHg (losartan, mean ± SEM) and 0.9 ± 0.3 (placebo), posttreatment 1.0 ± 0.4 (losartan) and 1.3 ± 0.6 (placebo)] but not different between treatment groups (p = 0.53). Insulin's action to augment nitric oxide (NO) production and to augment endothelium-dependent vasodilation was also not improved. Leg glucose uptake was not significantly changed by treatments, and not different between groups (p = 0.11). CONCLUSIONS These findings argue against the hypothesis that losartan might improve skeletal muscle glucose metabolism by improving insulin-mediated vasodilation in normotensive insulin-resistant obese subjects. The metabolic benefits of angiotensin receptor blockers may require the presence of hypertension in addition to obesity-associated insulin resistance.
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Affiliation(s)
- A A Lteif
- Department of Medicine, Division of Endocrinology & Metabolism, Indiana University School of Medicine, 541 North Clinical Drive, Indianapolis, IN, USA
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Lee P, Greenfield JR, Gilbert K, Campbell LV. Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control? Intern Med J 2012; 42:198-202. [DOI: 10.1111/j.1445-5994.2011.02653.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Desgranges FP, Desebbe O, Ghazouani A, Gilbert K, Keller G, Chiari P, Robin J, Bastien O, Lehot JJ, Cannesson M. Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. Br J Anaesth 2011; 107:329-35. [PMID: 21680600 DOI: 10.1093/bja/aer165] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plethysmographic variability index (PVI) is an accurate predictor of fluid responsiveness in mechanically ventilated patients. However, the site of measurement of the plethysmographic waveform impacts its morphology and its respiratory variation. The goal of this study was to investigate the ability of PVI to predict fluid responsiveness at three sites of measurement (the forehead, ear, and finger) in mechanically ventilated patients under general anaesthesia. METHODS We studied 28 subjects after induction of general anaesthesia. Subjects were monitored with a pulmonary artery catheter and three pulse oximeter sensors (the finger, ear, and forehead). Pulse pressure variation, central venous pressure, cardiac index (CI), and PVI measured at the forehead, ear, and finger (PVI(forehead), PVI(ear), and PVI(finger)) were recorded before and after fluid loading (FL). Subjects were responders to volume expansion if CI increased >15% after FL. RESULTS Areas under the receiver-operating curves to predict fluid responsiveness were 0.906, 0.880, and 0.836 for PVI(forehead), PVI(ear), and PVI(finger), respectively (P<0.05). PVI(forehead), PVI(ear), and PVI(finger) had a threshold value to predict fluid responsiveness of 15%, 16%, and 12% with sensitivities of 89%, 74%, and 74% and specificities of 78%, 74%, and 67%, respectively. CONCLUSIONS PVI can predict fluid responsiveness in anaesthetized and ventilated subjects at all three sites of measurement. However, the threshold values for predicting fluid responsiveness differ with the site of measurement. These results support the use of this plethysmographic dynamic index in the cephalic region when the finger is inaccessible or during states of low peripheral perfusion.
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Affiliation(s)
- F-P Desgranges
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France
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Blossom S, Gilbert K, Gomez-Acevedo H, Ashley N. Mechanism of T cell programming by trichloroethylene. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.685] [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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Gilbert K, Dalley RW, Maronian N, Anzai Y. Staging of laryngeal cancer using 64-channel multidetector row CT: comparison of standard neck CT with dedicated breath-maneuver laryngeal CT. AJNR Am J Neuroradiol 2010; 31:251-6. [PMID: 19875464 PMCID: PMC7964147 DOI: 10.3174/ajnr.a1796] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 07/01/2009] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE With a 64-channel multidetector row CT, imaging acquisition during speech, swallowing, or phonation has become feasible. However, the actual benefit of these additional focused images should be critically evaluated with respect to radiation dose. The purpose of this study was to determine if dedicated laryngeal CT using breath-holding and straw-blowing improved the accuracy of TNM-staging for patients with biopsy-proved laryngeal carcinomas in comparison with a standard neck CT. MATERIALS AND METHODS A total of 27 patients underwent a standard neck CT and a laryngeal CT with additional images acquired while patients held their breath or blew through a straw. Two radiologists interpreted the neck CT and later the laryngeal CT and assigned a TNM-stage for each case. These interpretations were compared with a TNM-stage determined by surgery and/or clinical examination for the individual patients. The accuracy of standard neck CT was compared with the accuracy of laryngeal CT. RESULTS The overall accuracy was not significantly different between standard neck CT and the additional laryngeal CT and was, in fact, lower in cases with additional larynx images. The accuracy of staging was slightly improved with the additional laryngeal CT for glottic cancers; however, it was decreased for supraglottic cancers. The accuracy of a dichotomous diagnosis of early-versus-advanced-stage cancer was 0.86 for the standard neck CT and 0.80 for the laryngeal CT. The readers' confidence levels did not improve with the use of the additional images. CONCLUSIONS In the era of isovoxel multidetector CT technology and judicious monitoring of radiation dose, a standard neck CT with coronal and sagittal reformats should suffice for the staging of laryngeal cancer.
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Affiliation(s)
- K Gilbert
- Department of Radiology, University of Washington, Seattle, Washington 98195-7115, USA
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Courtin F, Stone WB, Risatti G, Gilbert K, Van Kruiningen HJ. Pathologic findings and liver elements in hibernating bats with white-nose syndrome. Vet Pathol 2010; 47:214-9. [PMID: 20110222 DOI: 10.1177/0300985809358614] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two groups of vespertilionid bats were collected from affected hibernacula. In group 1 (n, 14; pathology and microbiology), the average body weights of all species were at the lower limit of published ranges. Twelve bats (86%) had mycotic growth in the epidermis, hair follicles, and sebaceous glands. Geomyces destructans, with its characteristic curved conidia, was observed microscopically, cultured, and confirmed by polymerase chain reaction. Dermatitis and mural folliculitis was nil to mild. When focally coinfected with Gram-negative bacteria, there was necrosis and pustules. Fat stores were little to abundant in 12 bats (86%) and nil in 2. Thirteen bats (93%) had pulmonary congestion and 7 (50%) had bone marrow granulocytosis. In group 2 (n, 24; liver elements), 3 bats (13%) had potentially toxic lead levels and 1 (4%), potentially toxic arsenic level. There was no evidence of major organ failure or consistent element toxicity.
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Affiliation(s)
- F Courtin
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06269, USA.
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Lis C, Birdsall T, Stark J, Cain L, Campbell K, Gilbert K, Gupta D. Identifying Symptom Clusters in Breast Cancer: Implications on Patient Quality of Life. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients undergoing treatment for advanced cancer often experience multiple symptoms. These symptoms occur with varying frequency, intensity, and impact. Pain, fatigue, insomnia, anorexia and dyspnea are consistently among the 10 most prevalent symptoms associated with cancer and its treatment. We conducted a multivariate analysis to investigate the impact of cancer symptoms on patient quality of life (QoL) in breast cancer.Material and Methods: A consecutive series of 226 breast cancer patients treated at the Cancer Treatment Centers of America at Southwestern Regional Medical Center between Jan 2001 and Nov 2006. Cancer symptoms were assessed using the symptom subscales of European Organization for Research Treatment of Cancer - Quality of Life Questionnaire (QLQ-C30). Symptom scores range from 0-100 with lower scores indicating better while higher scores indicating worse symptoms. QoL was assessed using Ferrans and Powers Quality of Life Index (QLI). QLI measures overall QoL and QoL in 4 major subscales: health/physical, social/economic, psychological/spiritual, and family. QLI scores range from 0-30 with higher scores indicating better QoL. The relationship between QLQ-C30 symptoms and QLI was evaluated using multivariate linear regression.Results: Of 226 patients, 98 were newly diagnosed while 128 had failed prior treatment before coming to our hospital. The mean age was 52.5 years (range = 27-82 years). We found that every 10 unit increase in fatigue (p=.004) and pain (p=.001) was significantly associated with 0.65 and 0.66 unit decline in QLI health/physical subscale after controlling for age, treatment history, stage at diagnosis and other cancer symptoms. Similarly, every 10 unit increase in insomnia (p=.02) was significantly associated with 0.35 unit decline in QLI family subscale. Finally, every 10 unit increase in pain (p=.01) and insomnia (p=.03) was significantly associated with 0.34 and 0.21 unit decline in overall QoL.Discussion: We found fatigue, pain and insomnia to be independent predictors of QoL after controlling for each other, age, treatment history and stage at diagnosis. Recognition and timely treatment of symptom clusters could result in improved QoL in patients with breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5043.
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Affiliation(s)
- C. Lis
- 1Cancer Treatment Centers of America, IL,
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- 2Cancer Treatment Centers of America, OK,
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- 2Cancer Treatment Centers of America, OK,
| | | | - K. Gilbert
- 2Cancer Treatment Centers of America, OK,
| | - D. Gupta
- 1Cancer Treatment Centers of America, IL,
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