1
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Chen P, Van Hassel J, Pinezich MR, Diane M, Hudock MR, Kaslow SR, Gavaudan OP, Fung K, Kain ML, Lopez H, Saqi A, Guenthart BA, Hozain AE, Romanov A, Bacchetta M, Vunjak-Novakovic G. Recovery of extracorporeal lungs using cross-circulation with injured recipient swine. J Thorac Cardiovasc Surg 2024; 167:e106-e130. [PMID: 37741314 PMCID: PMC10954590 DOI: 10.1016/j.jtcvs.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Lung transplantation remains limited by the shortage of healthy organs. Cross-circulation with a healthy swine recipient provides a durable physiologic environment to recover injured donor lungs. In a clinical application, a recipient awaiting lung transplantation could be placed on cross-circulation to recover damaged donor lungs, enabling eventual transplantation. Our objective was to assess the ability of recipient swine with respiratory compromise to tolerate cross-circulation and support recovery of donor lungs subjected to extended cold ischemia. METHODS Swine donor lungs (n = 6) were stored at 4 °C for 24 hours while recipient swine (n = 6) underwent gastric aspiration injury before cross-circulation. Longitudinal multiscale analyses (blood gas, bronchoscopy, radiography, histopathology, cytokine quantification) were performed to evaluate recipient swine and extracorporeal lungs on cross-circulation. RESULTS Recipient swine lung injury resulted in sustained, impaired oxygenation (arterial oxygen tension/inspired oxygen fraction ratio 205 ± 39 mm Hg vs 454 ± 111 mm Hg at baseline). Radiographic, bronchoscopic, and histologic assessments demonstrated bilateral infiltrates, airway cytokine elevation, and significantly worsened lung injury scores. Recipient swine provided sufficient metabolic support for extracorporeal lungs to demonstrate robust functional improvement (0 hours, arterial oxygen tension/inspired oxygen fraction ratio 138 ± 28.2 mm Hg; 24 hours, 539 ± 156 mm Hg). Multiscale analyses demonstrated improved gross appearance, aeration, and cellular regeneration in extracorporeal lungs by 24 hours. CONCLUSIONS We demonstrate that acutely injured recipient swine tolerate cross-circulation and enable recovery of donor lungs subjected to extended cold storage. This proof-of-concept study supports feasibility of cross-circulation for recipients with isolated lung disease who are candidates for this clinical application.
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Affiliation(s)
- Panpan Chen
- Department of Biomedical Engineering, Columbia University, New York, NY; Department of Surgery, Columbia University Medical Center, New York, NY
| | - Julie Van Hassel
- Department of Biomedical Engineering, Columbia University, New York, NY; Department of Surgery, Columbia University Medical Center, New York, NY
| | - Meghan R Pinezich
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - Mohamed Diane
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - Maria R Hudock
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - Sarah R Kaslow
- Department of Biomedical Engineering, Columbia University, New York, NY; Department of Surgery, Columbia University Medical Center, New York, NY
| | | | - Kenmond Fung
- Clinical Perfusion, Columbia University Medical Center, New York, NY
| | - Mandy L Kain
- Institute of Comparative Medicine, Columbia University, New York, NY
| | - Hermogenes Lopez
- Clinical Perfusion, Columbia University Medical Center, New York, NY
| | - Anjali Saqi
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Brandon A Guenthart
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
| | - Ahmed E Hozain
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Alexander Romanov
- Institute of Comparative Medicine, Columbia University, New York, NY
| | - Matthew Bacchetta
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tenn
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2
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Wu WK, Guenthart BA, O’Neill JD, Hozain AE, Tipograf Y, Ukita R, Stokes JW, Patel YJ, Pinezich M, Talackine JR, Cardwell NL, Fung K, Vunjak-Novakovic G, Bacchetta M. Technique for xenogeneic cross-circulation to support human donor lungs ex vivo. J Heart Lung Transplant 2023; 42:335-344. [PMID: 36456408 PMCID: PMC9985920 DOI: 10.1016/j.healun.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Xenogeneic cross-circulation (XC) is an experimental method for ex vivo organ support and recovery that could expand the pool of donor lungs suitable for transplantation. The objective of this study was to establish and validate a standardized, reproducible, and broadly applicable technique for performing xenogeneic XC to support and recover injured human donor lungs ex vivo. METHODS Human donor lungs (n = 9) declined for transplantation were procured, cannulated, and subjected to 24 hours of xenogeneic XC with anesthetized xeno-support swine (Yorkshire/Landrace) treated with standard immunosuppression (methylprednisolone, mycophenolate mofetil, tacrolimus) and complement-depleting cobra venom factor. Standard lung-protective perfusion and ventilation strategies, including periodic lung recruitment maneuvers, were used throughout xenogeneic XC. Every 6 hours, ex vivo donor lung function (gas exchange, compliance, airway pressures, pulmonary vascular dynamics, lung weight) was evaluated. At the experimental endpoint, comprehensive assessments of the lungs were performed by bronchoscopy, histology, and electron microscopy. Student's t-test and 1-way analysis of variance with Dunnett's post-hoc test was performed, and p < 0.05 was considered significant. RESULTS After 24 hours of xenogeneic XC, gas exchange (PaO2/FiO2) increased by 158% (endpoint: 364 ± 142 mm Hg; p = 0.06), and dynamic compliance increased by 127% (endpoint: 46 ± 20 ml/cmH2O; p = 0.04). Airway pressures, pulmonary vascular pressures, and lung weight remained stable (p > 0.05) and within normal ranges. Over 24 hours of xenogeneic XC, gross and microscopic lung architecture were preserved: airway bronchoscopy and parenchymal histomorphology appeared normal, with intact blood-gas barrier. CONCLUSIONS Xenogeneic cross-circulation is a robust method for ex vivo support, evaluation, and improvement of injured human donor lungs declined for transplantation.
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Affiliation(s)
- W. Kelly Wu
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brandon A. Guenthart
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - John D. O’Neill
- Xylyx Bio, Inc., Brooklyn, New York;,Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Ahmed E. Hozain
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Yuliya Tipograf
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rei Ukita
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John W. Stokes
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yatrik J. Patel
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meghan Pinezich
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Jennifer R. Talackine
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nancy L. Cardwell
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenmond Fung
- Perfusion Services, New York – Presbyterian Hospital, New York, New York
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, New York;,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Matthew Bacchetta
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
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3
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Honzel E, Nemeth S, Kazzi BE, Kossar AP, Sun J, Kaku Y, Takeda K, Takayama H, Argenziano M, Spellman J, Miltiades A, Fung K, Beck J, Smith CR, Kurlansky P, George I. Assessing sex-based differences in postsurgical clinical outcomes after use of del Nido cardioplegia. Eur J Cardiothorac Surg 2022; 62:ezac472. [PMID: 36165688 PMCID: PMC9531685 DOI: 10.1093/ejcts/ezac472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/25/2022] [Accepted: 09/25/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES del Nido cardioplegia is used to pharmacologically arrest the heart during cardiac surgery and decrease reperfusion- and ischaemia-related myocardial injury. Studies have demonstrated the physiological differences between male and female hearts, potentially related to cardiac size or myocyte calcium handling; we aimed to assess for between-sex differences in clinical outcomes after receipt of del Nido cardioplegia. METHODS Patients who underwent coronary artery bypass or coronary artery bypass graft/valve surgery at our institution using del Nido cardioplegia (January 2014 to December 2019) were included (n = 2118). Clinical data were collected retrospectively. After the creation of a propensity-matched cohort (n = 1252), multivariable logistic regression was used to analyse binary postoperative outcomes, and a Gamma model was used for a continuous postoperative outcome. Our primary end-point was a composite end-point comprised of 30-day mortality and/or need for a post-bypass mechanical support device. RESULTS The final cohort included 459 females and 793 males (matched up to 1:2, all standardized mean differences <0.1). Multivariable logistic regression showed that biological sex was not associated with the composite primary end-point (odds ratio = 0.898, P = 0.779). A Gamma model indicated that there were no sex-related differences in vasoactive-inotropic scores reflecting vasopressor and inotrope usage at the time of patient operating room exit (exp[est] = 1.394, P = 0.189). CONCLUSIONS Our findings showed no significant between-sex differences in clinical outcomes after receiving del Nido cardioplegia, suggesting adequate myocardial protection as currently administered. Further research is warranted to elicit if there are sex-based differences between cardioplegic solutions. IRB APPROVAL DATE (PROTOCOL NUMBER) 26 May 2021 (AAAR8359).
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Affiliation(s)
- Emily Honzel
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Samantha Nemeth
- Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Brigitte E Kazzi
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alexander P Kossar
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jocelyn Sun
- Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica Spellman
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Andrea Miltiades
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Kenmond Fung
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - James Beck
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Aung N, Fung K, Woodbridge SP, Kenawy AA, Jensen MT, Khanji MY, Petersen SE. Annotation and quality assessment of left ventricular filling and relaxation pattern using one-dimensional convolutional neural network. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute For Health Research (NIHR), UK
Introduction
Aberrations in left ventricular (LV) filling or relaxation – known as diastolic dysfunction – occur in heart failure with preserved ejection fraction. CMR is the reference modality for the assessment of ventricular systolic function, however, its role in evaluation of diastolic function is limited at present. One promising technique to assess diastolic function by CMR is the derivation of LV filling and emptying rates from the volume-time curves of cine images.
Purpose
To automatically assess the quality of LV filling-rate curves and annotate the peak emptying and filling rates.
Methods
A previously-described deep-learning network was used to automatically segment the entire cardiac cycle captured by short-axis SSFP cine images from the UK Biobank1. The LV filling-rate curves derived from the volume-time data were smoothed with Savitzky–Golay filter. The peak emptying rate (PER), early peak filling rate (PFR-E) and late peak filling rate (PFR-A) were first annotated by a simple peak finding algorithm from Python Scipy signal module. The preliminary annotated curves were reviewed by five human experts (i) to check for peak-annotation errors and (ii) to provide the curve quality score ranging from 1 to 3 for each peak (score 1 denotes good quality, score 2 represents moderate quality and score 3 indicates poor quality). Higher total score (minimum = 3, maximum = 9), therefore, represents poorer overall curve quality. This expert-annotated dataset was used to train two separate one-dimensional convolutional neural networks (1D-CNN) (Figure 1) for peak annotation and curve quality assessment (QA) using Tensorflow library in Python.
Results
The data from 6,328 LV filling-rate curves were split into the training and testing sets (80:20). The fine-tuned 1D-CNN comprising six hidden layers with two residual connections annotated the PER, PFR-E and PFR-A with the test-set accuracy of 95%, 95% and 98%, respectively. A second trained 1D-CNN for QA based on similar architecture predicted the overall curve quality score with a small error rate (mean absolute error: 0.46, mean squared error: 0.68). These two networks were used to quality check and label 19,409 UK Biobank CMR studies (See Figure 2 for exemplary results). After removing data from poor-quality curves (quality score ≥ 5), 18,735 studies remained. The mean±standard deviation of PER, PFR-E and PFR-A are 461±110 ml/s, 359±117 ml/s and 336±120 ml/s, respectively. Ageing is associated with lower PFR-E (−58.4 ml/s, 95% confidence interval [CI]: −56.1 to −60.7 ml/s per decade increment) and higher PFR-A (18.3 ml/s, 95% CI: 15.8 to 20.8 ml/s per decade increment).
Conclusion
The 1D-CNN models can be used to automatically grade the quality of LV filling rate curves and label important diastolic parameters with a high level of accuracy. The derived data recapitulate impaired LV relaxation pattern associated with ageing and can be used as surrogate indices of diastology by CMR. Figure 1Figure 2
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Affiliation(s)
- N Aung
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - S P Woodbridge
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - A A Kenawy
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - M T Jensen
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
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5
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Stevens JS, Hastie JM, Spellman J, Mittel A, Beck J, Mullin DA, Fung K, Argenziano M, Takayama H, Radhakrishnan J. Optimizing Perioperative Renal Replacement Therapy for Patients Undergoing Cardiac Surgical Procedures Requiring Cardiopulmonary Bypass. Blood Purif 2022; 51:1-7. [PMID: 35878582 DOI: 10.1159/000525837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
Coronary artery disease is highly prevalent in patients with end-stage renal disease (ESRD), and cardiovascular complications remain the most common cause of death in this patient population. Accordingly, many cardiac surgical procedures requiring cardiopulmonary bypass support are performed on these patients each year, with morbidity and mortality rates far exceeding patients without ESRD. Anuric patients lack the normal renal homeostatic functions which typically allow for physiologic protection from challenges during the operation, such as volume overload, hyperkalemia, and acidemia. Careful preoperative planning and coordination to provide pre-, intra-, and postoperative renal replacement therapies for such patients are imperative. Many different strategies have been reported in the literature. Zero-balance ultrafiltration is a newer strategy which utilizes convective ultrafiltration much like pre-filter continuous renal replacement therapy and utilizes pre-existing connections on the cardiopulmonary bypass pump performed by the perfusion team. This allows for control of potassium concentration throughout the operation with existing personnel and minimal additional equipment. Here, we describe the unique challenges caring for patients receiving renal replacement therapy undergoing cardiac surgical procedures requiring cardiopulmonary bypass.
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Affiliation(s)
- Jacob S Stevens
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan M Hastie
- Department of Anesthesia, Columbia University Irving Medical Center, New York, New York, USA
| | - Jessica Spellman
- Department of Anesthesia, Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Mittel
- Department of Anesthesia, Columbia University Irving Medical Center, New York, New York, USA
| | - James Beck
- Clinical Perfusion, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, New York, USA
| | - Dana A Mullin
- Clinical Perfusion, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, New York, USA
| | - Kenmond Fung
- Clinical Perfusion, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, New York, USA
| | - Michael Argenziano
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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McCready A, Quinn M, Francis P, Stortz R, Kuruvilla S, Stewart P, Palma D, Lang P, Read N, Sathya J, Venkatesan V, Nichols A, MacNeil D, Fung K, Mendez A, Carreau C, Hawkins S, Parker C, Warner L, Winquist E. Impact of a Head and Neck Cancer Chemoradiation (HNC CRT) Nurse Practitioner (NP) on Patient Outcomes. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Palma D, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Eapen L, Odell M, Bayley A, Dowthwaite S, Jackson J, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond J, Read N, Venkatesan V, MacNeil D, Fung K, Nichols A. A Randomized Trial of Radiotherapy vs. Trans-Oral Surgery for Treatment De-Escalation in HPV-Associated Oropharyngeal Squamous Cell Carcinoma (ORATOR2). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Fung K, MacNeil D, Mendez A, Yoo J, Warner A, Nichols A, Palma D. Survival Outcomes in Primary Head and Neck Adult Sarcoma: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1115] [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: 10/20/2022]
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9
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Fung K, MacNeil D, Mendez A, Yoo J, Warner A, Nichols A, Palma D. Survival Outcomes in Primary Angiosarcoma of the Head and Neck: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Simon J, Fung K, Raisi-Estabragh Z, Aung N, Khanji MY, Kolossvary M, Merkely B, Munroe PB, Harvey NC, Piechnik SK, Neubauer S, Petersen SE, Maurovich-Horvat P. Association of daily coffee consumption with cardiovascular health – results from the UK Biobank. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2416] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There are conflicting reports on the association of coffee consumption with cardiovascular (CV) health. The UK Biobank is a prospective cohort study including data for half a million middle-aged individuals.
Purpose
We studied the association of daily coffee consumption with all-cause and CV mortality, and incidence of the major CV diseases in the UK Biobank. In a subgroup of participants who underwent cardiovascular magnetic resonance (CMR), we evaluated the association between regular coffee intake and cardiac structure and function parameters.
Methods
UK Biobank cohort of participants without clinically manifested heart disease at the time of recruitment were included. Regular coffee intake was categorized into 3 groups: zero, light-to-moderate (0.5–3 cups/day) and high (>3 cups/day) coffee drinkers. We estimated association of daily coffee consumption with incident outcomes using multivariable Cox-regression models (median follow-up of 11 years) and, in the subset with CMR data, with left and right ventricular (LV, RV) end-systolic and end-diastolic volumes, LV mass, and LV/RV stroke volume using multivariable linear regression. Models were adjusted for potential confounders and mediators, including: age, sex, non-European ethnicities, body mass index, smoking, physical activity, Townsend deprivation index, alcohol, meat, fruit and vegetable intake, hypertension, diabetes mellitus, and cholesterol level.
Results
We included 468,629 individuals (mean age 56.2±8.1 years, 44.2% male). Among them, 22.1% did not consume coffee on a regular basis, 58.4% had 0.5–3 cups per day and 19.5% had >3 cups per day. After adjustment for potential confounders and mediators, compared to non-coffee drinkers, light-to-moderate coffee drinking was associated with lower risk of all-cause mortality (HR=0.88, p<0.001), CV mortality (HR=0.83, p=0.006), and incident stroke (HR=0.79; p=0.037). CMR data were available in 30,650 participants. In multivariable analysis, compared to non-coffee drinkers, both the light-to-moderate and high coffee consuming categories, were associated with significantly increased LV and RV ventricular end-systolic (β=0.91 and 1.64 for LV and 1.10 and 1.72 for RV), end-diastolic (β=2.21 and 3.28 for LV and 2.24 and 3.35 for RV) and stroke volumes (β=1.31 and 1.64 for LV and 1.15 and 1.63 for RV), as well as greater LV mass (β=0.78 and 1.64; all p<0.001).
Conclusion
In this large study of the UK Biobank population, regular coffee consumption of up to 3 cups per day was associated with favorable cardiovascular outcomes, in particular, decreased all-cause and CV mortality and stroke incidence. Regular coffee consumption was also associated with a pattern of CMR metrics in keeping with the reverse of age-related cardiac alterations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Simon
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - K Fung
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - Z Raisi-Estabragh
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - N Aung
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - M Y Khanji
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - M Kolossvary
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - P B Munroe
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - N C Harvey
- University of Southampton, MRC Lifecourse Epidemiology Unit, Southampton, United Kingdom
| | - S K Piechnik
- University of Oxford, National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascul, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascul, Oxford, United Kingdom
| | - S E Petersen
- Queen Mary University of London, 2William Harvey Research Institute, NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - P Maurovich-Horvat
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
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11
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Rauseo E, Lockhart L, Paiva JM, Fung K, Khanji MY, Raisi-Estabragh Z, Amir-Khalili A, Petersen SE. Automated myocardial segmentation in native t1-mapping cardiovascular magnetic resonance images based on machine learning: a validation study in the UK biobank"s covid-19 subset. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344639 DOI: 10.1093/ehjci/jeab090.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovate UK Background Regional assessment of septal native T1 values with cardiovascular magnetic resonance (CMR) is used to characterise diffuse myocardial diseases. Previous studies suggest its potential role in detecting early pathological alterations, which may help identify high-risk subjects at early disease stages. Automated analysis of myocardial native T1 images may enable faster CMR analysis and reduce inter-observer variability of manual analysis. However, the technical performance of such methodologies has not been previously reported. Purpose We tested, in a subset of UK Biobank participants, the degree of agreement between CMR septal myocardial T1 values obtained from our machine learning (ML) algorithm and septal native T1 values computed from manual segmentations. Methods We analysed the first 292 participants who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and had CMR imaging (1.5 Tesla, Siemens MAGNETOM Aera). T1 mapping was performed in a single mid-ventricular short axis (SAX) slice using ShMOLLI (WIP780B) sequences. Three experienced CMR readers independently measured native T1 values by manually placing a single region of interest (ROI) covering half of the anteroseptal and half of the inferoseptal wall using cvi42 post-processing software (version 5.11). A mean T1 value for each participant was then calculated. A ML algorithm developed by Circle Cardiovascular Imaging Inc. was then applied to the same images to derive the myocardium T1 values automatically. The algorithm was previously trained to segment myocardium from SAX T1 and non-T1 mapping images on two external CMR datasets. We compared the mean septal ROI T1 values to the mean myocardium T1 values predicted by the ML algorithm. Results Two studies were excluded after quality control. The ML-derived and the manually calculated mean T1 values were significantly correlated (r = 0.82, p < 0.001). The Bland-Altman analysis between the two methods showed a mean bias of 3.64 ms, with 95% limits of agreement of −38.88 to 53.46 ms, indicating good agreement (figure 1). Conclusions We demonstrated strong correlation and good agreement between native T1 values obtained from our automated analysis method and manual T1 septal analysis in a subset of UK Biobank participants. This algorithm may represent a valuable tool for clinicians allowing for fast and potentially less operator-dependent myocardial tissue characterisation. However, validation of more extensive datasets and quality control processes are needed.
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Affiliation(s)
- E Rauseo
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary, London, United Kingdom of Great Britain & Northern Ireland
| | - L Lockhart
- Circle Cardiovascular Imaging, Calgary, Canada
| | - JM Paiva
- Circle Cardiovascular Imaging, Calgary, Canada
| | - K Fung
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary, London, United Kingdom of Great Britain & Northern Ireland
| | - MY Khanji
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Raisi-Estabragh
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary, London, United Kingdom of Great Britain & Northern Ireland
| | | | - SE Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary, London, United Kingdom of Great Britain & Northern Ireland
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Kenawy A, Khanji MY, Chirvasa M, Fung K, Sojoudi A, Paiva JOSEM, Samy N, Farid W, Khalil TS, Petersen SE. Application of a machine learning contouring tool for the evaluation of left ventricular strain in clinical practice. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.259] [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: Private grant(s) and/or Sponsorship. Main funding source(s): AK has been funded by the Egyptian cultural centre and educational bureau of the Egyptian embassy in London and the Ministry of higher education in Egypt. SEP acknowledges support from the “SmartHeart” EPSRC programme grant (www.nihr.ac.uk; EP/P001009/1) and the London Medical Imaging and AI Centre for Value-Based Healthcare. This new centre is one of the UK Centres supported by a £50m investment from the Data to Early Diagnosis and Precision Medicine strand of the government’s Industrial Strategy Challenge Fund, managed and delivered by UK Research and Innovation (UKRI). SEP acknowledges support from the CAP-AI programme, London’s first AI enabling programme focused on stimulating growth in the capital’s AI Sector. CAP-AI is led by Capital Enterprise in partnership with Barts Health NHS Trust and Digital Catapult and is funded by the European Regional Development Fund and Barts Charity. SEP also acts as a paid consultant to Circle Cardiovascular Imaging Inc., Calgary, Canada and Servier
onbehalf
Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, UK
Background
Manual contouring of cardiovascular magnetic resonance (CMR) cine images remains common practice and the reference standard for left ventricular (LV) volumes and mass evaluation. However, it is time-consuming and machine learning (ML) may significantly reduce the time required for contouring. Accurate LV contours are the basis for reliable LV strain analysis using tissue tracking.
Purpose
To assess the impact of a ML contouring tool alone versus expert adjusted contours on LV strain.
Methods
We retrospectively selected 402 CMR studies with diagnoses of myocardial infarction (n = 108), myocarditis (n = 130) and healthy controls (n = 164) from the Barts BioResource between January 2015 to June 2018. CMR examinations were obtained using 1.5T and 3T scanners (Siemens Healthineers, Germany). We excluded 32 cases due to phase inconsistency between short (SAX) and long axes (LAX) cine images or suboptimal cine image quality. For the remaining 370 cases, steady state free precession cine images for LAX and SAX were analysed by the ML contouring tool (using CVI42 research prototype software 5.11). Manual expert adjustment for the contours was done for each case if considered suboptimal for strain analysis in the reference end-diastolic phase. Strain results from ML and expert adjusted ML methods were compared for strain agreement. Times taken by these methods were recorded and compared against the time taken for standard manual contouring.
Results
SAX and LAX derived strains by ML and expert adjusted ML methods showed good agreement by Bland-Altman analysis (Figure 1) with excellent coefficient of concordance using Kendall W which is 0.98 for global SAX, radial and circumferential strains (mean difference(MD) = -1.7% (lower and upper limits of agreement (UL,LL) -6.6,3.2), MD = 0.5% (-1.0,2.1)) and is 0.95 for global LAX derived strain (radial and longitudinal, MD = 0.7% (UL,LL -8.7 ,7.4),MD= 0.2% (-1.9,2.5), respectively). Time taken for adjustment of ML contours was significantly shorter than manual contouring (1.35 minutes vs 8.0 minutes, around 590% time saving in ML adjusted method).
Conclusions
ML contouring compared to expert manual adjustment has a clinically reasonable agreement when used for measuring LV strain. Also, using the ML tool with expert adjustment shows significant time saving for analysis and reporting time compared to entirely manual analysis, favouring its application in routine clinical practice.
Abstract Figure.
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Affiliation(s)
- A Kenawy
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom of Great Britain & Northern Ireland
| | - MY Khanji
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom of Great Britain & Northern Ireland
| | - M Chirvasa
- Circle Cardiovascular Imaging Inc., , Calgary,AB, Canada
| | - K Fung
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom of Great Britain & Northern Ireland
| | - A Sojoudi
- Circle Cardiovascular Imaging Inc., , Calgary,AB, Canada
| | - JOSE M Paiva
- Circle Cardiovascular Imaging Inc., , Calgary,AB, Canada
| | - N Samy
- Faculty of medicine Menoufia university, Menoufia, Egypt
| | - W Farid
- Faculty of medicine Menoufia university, Menoufia, Egypt
| | - TS Khalil
- Faculty of medicine Menoufia university, Menoufia, Egypt
| | - SE Petersen
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, United Kingdom of Great Britain & Northern Ireland
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Omer M, Amir-Khalili A, Sojoudi A, Thao Le T, A Cook S, Faye Toh D, Bryant J, Chin C, Miguel Paiva J, Fung K, Aung N, Y Khanji M, Rauseo E, Cooper J, E Petersen S. Assessing automated CMR contouring algorithms using systematic contour quality scoring analysis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.434] [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): SmartHeart EPSRC programme grant (www.nihr.ac.uk), London Medical Imaging and AI Centre for Value-Based Healthcare
Background
Quality measures for machine learning algorithms include clinical measures such as end-diastolic (ED) and end-systolic (ES) volume, volumetric overlaps such as Dice similarity coefficient and surface distances such as Hausdorff distance. These measures capture differences between manually drawn and automated contours but fail to capture the trust of a clinician to an automatically generated contour.
Purpose
We propose to directly capture clinicians’ trust in a systematic way. We display manual and automated contours sequentially in random order and ask the clinicians to score the contour quality. We then perform statistical analysis for both sources of contours and stratify results based on contour type.
Data
The data selected for this experiment came from the National Health Center Singapore. It constitutes CMR scans from 313 patients with diverse pathologies including: healthy, dilated cardiomyopathy (DCM), hypertension (HTN), hypertrophic cardiomyopathy (HCM), ischemic heart disease (IHD), left ventricular non-compaction (LVNC), and myocarditis. Each study contains a short axis (SAX) stack, with ED and ES phases manually annotated. Automated contours are generated for each SAX image for which manual annotation is available. For this, a machine learning algorithm trained at Circle Cardiovascular Imaging Inc. is applied and the resulting predictions are saved to be displayed in the contour quality scoring (CQS) application.
Methods: The CQS application displays manual and automated contours in a random order and presents the user an option to assign a contour quality score
1: Unacceptable, 2: Bad, 3: Fair, 4: Good. The UK Biobank standard operating procedure is used for assessing the quality of the contoured images. Quality scores are assigned based on how the contour affects clinical outcomes. However, as images are presented independent of spatiotemporal context, contour quality is assessed based on how well the area of the delineated structure is approximated. Consequently, small contours and small deviations are rarely assigned a quality score of less than 2, as they are not clinically relevant. Special attention is given to the RV-endo contours as often, mostly in basal images, two separate contours appear. In such cases, a score of 3 is given if the two disjoint contours sufficiently encompass the underlying anatomy; otherwise they are scored as 2 or 1.
Results
A total of 50991 quality scores (24208 manual and 26783 automated) are generated by five expert raters. The mean score for all manual and automated contours are 3.77 ± 0.48 and 3.77 ± 0.52, respectively. The breakdown of mean quality scores by contour type is included in Fig. 1a while the distribution of quality scores for various raters are shown in Fig. 1b.
Conclusion
We proposed a method of comparing the quality of manual versus automated contouring methods. Results suggest similar statistics in quality scores for both sources of contours.
Abstract Figure 1
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Affiliation(s)
- M Omer
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | | | - A Sojoudi
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | - T Thao Le
- National Heart Centre Singapore, Singapore, Singapore
| | - S A Cook
- National Heart Centre Singapore, Singapore, Singapore
| | - D Faye Toh
- National Heart Centre Singapore, Singapore, Singapore
| | - J Bryant
- National Heart Centre Singapore, Singapore, Singapore
| | - C Chin
- National Heart Centre Singapore, Singapore, Singapore
| | | | - K Fung
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Rauseo
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Kassirian S, Dzioba A, Hamel S, Patel K, Sahovaler A, Palma DA, Read N, Venkatesan V, Nichols AC, Yoo J, Fung K, Mendez A, MacNeil SD. Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay. Curr Oncol 2020; 27:e467-e477. [PMID: 33173386 PMCID: PMC7606041 DOI: 10.3747/co.27.6547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1-7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions At our tertiary care cancer centre, a patient's clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.
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Affiliation(s)
- S Kassirian
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A Dzioba
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - S Hamel
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - K Patel
- Department of Otolaryngology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, U.S.A
| | - A Sahovaler
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - D A Palma
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - N Read
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - V Venkatesan
- Department of Radiation Oncology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A C Nichols
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - J Yoo
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - K Fung
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - A Mendez
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
| | - S D MacNeil
- Department of Otolaryngology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, ON
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Beck JR, Holt DW, Chan C, Fung K, Patton-Rivera K, Mullin D, Takeda K, Takayama H. Discussion: can upper extremity (deltoid) near infrared spectroscopy be used to assess cerebral tissue bed saturation on femorally cannulated veno-arterial extracorporeal membrane oxygenation patients? Perfusion 2020; 36:190-199. [PMID: 32579084 DOI: 10.1177/0267659120906769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous cerebral tissue saturation monitoring with near infrared spectroscopy may help clinicians identify cerebral desaturation early; however, patients have reported discomfort from near infrared spectroscopy monitoring pads on the forehead. This study aims to compare upper extremity near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring to assess its viability as a surrogate for cerebral saturation. A retrospective analysis of 10 femorally cannulated veno-arterial extracorporeal membrane oxygenation patients was performed comparing left (L) and right (R) upper extremity (deltoid) near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring (n = 20 data sets, 10 left and 10 right) and right radial blood gasses. Deltoid and cerebral near infrared spectroscopy values were recorded every 15 minutes for at least 24 hours when possible, were plotted on scatter grams, and were analyzed using Pearson product-moment coefficient (r). Based on the concept of covariance, a moderate-good relationship r = 0.50-0.75 was noted in 10% (n = 2) of the study group. A fair relationship r = 0.25-0.50 was noted in 50% (n = 10), and little or no relationship was noted in 40% (n = 8). None of the study group displayed a good to excellent relationship (r = 0.75 or above). In addition, coefficient of multiple determination for multiple regression R2 was calculated and strong fit of the regression line was not noted. Although cerebral near infrared spectroscopy monitoring has been extremely helpful in identifying low cerebral tissue saturation on veno-arterial extracorporeal membrane oxygenation patients, the use of upper extremity (peripheral deltoid) tissue monitoring does not provide adequate correlation and should not be used as a surrogate to cerebral monitoring.
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Affiliation(s)
- James R Beck
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - David W Holt
- Clinical Perfusion Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christine Chan
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Kenmond Fung
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Killian Patton-Rivera
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Dana Mullin
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery and Clinical Perfusion, Department of Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
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Sommer DD, Engels PT, Weitzel EK, Khalili S, Corsten M, Tewfik MA, Fung K, Cote D, Gupta M, Sne N, Brown TFE, Paul J, Kost KM, Witterick IJ. Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:23. [PMID: 32340627 PMCID: PMC7184547 DOI: 10.1186/s40463-020-00414-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology - head & neck surgery. A Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic. MAIN BODY The tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any non-emergent procedure. CONCLUSION The set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.
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Affiliation(s)
- D D Sommer
- Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada.
| | - P T Engels
- Department of Surgery and Critical Care, McMaster University, Hamilton, ON, Canada
| | - E K Weitzel
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - S Khalili
- Aurora Neuroscience Innovation Institute, Milwaukee, WI, USA
| | - M Corsten
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - M A Tewfik
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - K Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - D Cote
- Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - M Gupta
- Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada
| | - N Sne
- Department of Surgery and Critical Care, McMaster University, Hamilton, ON, Canada
| | - T F E Brown
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - J Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - K M Kost
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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Hozain AE, Tipograf Y, Pinezich MR, Cunningham KM, Donocoff R, Queen D, Fung K, Marboe CC, Guenthart BA, O'Neill JD, Vunjak-Novakovic G, Bacchetta M. Multiday maintenance of extracorporeal lungs using cross-circulation with conscious swine. J Thorac Cardiovasc Surg 2019; 159:1640-1653.e18. [PMID: 31761338 PMCID: PMC7094131 DOI: 10.1016/j.jtcvs.2019.09.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
Objectives Lung remains the least-utilized solid organ for transplantation. Efforts to recover donor lungs with reversible injuries using ex vivo perfusion systems are limited to <24 hours of support. Here, we demonstrate the feasibility of extending normothermic extracorporeal lung support to 4 days using cross-circulation with conscious swine. Methods A swine behavioral training program and custom enclosure were developed to enable multiday cross-circulation between extracorporeal lungs and recipient swine. Lungs were ventilated and perfused in a normothermic chamber for 4 days. Longitudinal analyses of extracorporeal lungs (ie, functional assessments, multiscale imaging, cytokine quantification, and cellular assays) and recipient swine (eg, vital signs and blood and tissue analyses) were performed. Results Throughout 4 days of normothermic support, extracorporeal lung function was maintained (arterial oxygen tension/inspired oxygen fraction >400 mm Hg; compliance >20 mL/cm H2O), and recipient swine were hemodynamically stable (lactate <3 mmol/L; pH, 7.42 ± 0.05). Radiography revealed well-aerated lower lobes and consolidation in upper lobes of extracorporeal lungs, and bronchoscopy showed healthy airways without edema or secretions. In bronchoalveolar lavage fluid, granulocyte-macrophage colony-stimulating factor, interleukin (IL) 4, IL-6, and IL-10 levels increased less than 6-fold, whereas interferon gamma, IL-1α, IL-1β, IL-1ra, IL-2, IL-8, IL-12, IL-18, and tumor necrosis factor alpha levels decreased from baseline to day 4. Histologic evaluations confirmed an intact blood–gas barrier and outstanding preservation of airway and alveolar architecture. Cellular viability and metabolism in extracorporeal lungs were confirmed after 4 days. Conclusions We demonstrate feasibility of normothermic maintenance of extracorporeal lungs for 4 days by cross-circulation with conscious swine. Cross-circulation approaches could support the recovery of damaged lungs and enable organ bioengineering to improve transplant outcomes.
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Affiliation(s)
- Ahmed E Hozain
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY; Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY
| | - Yuliya Tipograf
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY; Departments of Thoracic and Cardiac Surgery, Vanderbilt University, Nashville, Tenn
| | - Meghan R Pinezich
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY
| | - Katherine M Cunningham
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY
| | - Rachel Donocoff
- Institute of Comparative Medicine, Columbia University Medical Center, Columbia University, New York, NY
| | - Dawn Queen
- Vagelos College of Physicians and Surgeons, Columbia University Medical Center, Columbia University, New York, NY
| | - Kenmond Fung
- Department of Clinical Perfusion, Columbia University Medical Center, Columbia University, New York, NY
| | - Charles C Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY
| | - Brandon A Guenthart
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY
| | - John D O'Neill
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY; Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY.
| | - Matthew Bacchetta
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY; Departments of Thoracic and Cardiac Surgery, Vanderbilt University, Nashville, Tenn.
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Palma D, Theurer J, Prisman E, Read N, Berthelet E, Fung K, de Almeida J, Bayley A, Richardson K, Mlynarek A, Krishnan S, Le H, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Odell M, Parker C, Kwan K, Nichols A. Radiotherapy vs. Trans-Oral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma (OPSCC): Results of a Randomized Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.485] [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: 11/16/2022]
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19
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Fung K, Vivier D, Price E, Zeglis B. Development of a MUC1-targeting PET probe for ovarian cancer. Nucl Med Biol 2019. [DOI: 10.1016/s0969-8051(19)30346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Fung K, Biasiolli L, Aung N, Hann E, Paiva JM, Lukaschuk E, Sanghvi MM, Carapella V, Rayner JJ, Werys K, Thomas K, Moon NO, Neubauer S, Piechnik SK, Petersen SE. 282Reference values for aortic distensibility derived from UK Biobank cardiovascular magnetic resonance (CMR) imaging cohort. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/15/2022] Open
Affiliation(s)
- K Fung
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - L Biasiolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M M Sanghvi
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Werys
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Thomas
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N O Moon
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
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21
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Aung N, Vargas JD, Manichaikul AW, Yang CP, Cabrera CP, Warren HR, Fung K, Tzanis E, Barnes MR, Piechnik SK, Neubauer S, Bluemke DA, Munroe PB, Petersen SE. P463Heritability and genotypic correlation of CMR-derived LV phenotypes in the UK Biobank population imaging study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.046] [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 of Great Britain & Northern Ireland
| | - J D Vargas
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, United States of America
| | - A W Manichaikul
- University of Virginia, Center for Public Health and Genomics, Department of Public Health Sciences, Charlottesville, United States of America
| | - C P Yang
- University of Virginia, Center for Public Health and Genomics, Department of Public Health Sciences, Charlottesville, United States of America
| | - C P Cabrera
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - H R Warren
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Tzanis
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M R Barnes
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - D A Bluemke
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, United States of America
| | - P B Munroe
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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22
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Akhtar AMA, Patel K, Chahal A, Akhtar M, Nay A, Fung K, Sekhri N, Treibel T, Westwood M, Davies C, Khanji M, Manisty C, Lorenzini M, Moon J, Petersen SE. P593Hypereosinophilic carditis (HEC): a cmr-based case series from a quaternary cardiology centre. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116] [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)
- A M A Akhtar
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - K Patel
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - A Chahal
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - M Akhtar
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - A Nay
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - N Sekhri
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - T Treibel
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - M Westwood
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - C Davies
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - M Khanji
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - M Lorenzini
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Health NHS Trust, Cardiology , London, United Kingdom of Great Britain & Northern Ireland
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23
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Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, De Knegt MC, Lukaschuk E, Lee AM, Carapella V, Piechnik SK, Neubauer S, Petersen SE. 347Early changes in cardiac morphology and function in individuals with diabetes and preserved ejection fraction detected by cardiovascular magnetic resonance tagging - The UK Biobank. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M T Jensen
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - M M Sanghvi
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - S Chadalavada
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - M C De Knegt
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- John Radcliffe Hospital, Department of Cardiovascular Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A M Lee
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- John Radcliffe Hospital, Department of Cardiovascular Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- John Radcliffe Hospital, Department of Cardiovascular Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- John Radcliffe Hospital, Department of Cardiovascular Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
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24
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Aung N, Vargas JD, Manichaikul AW, Yang C, Cabrera CP, Warren HR, Fung K, Tzanis E, Barnes MR, Bluemke DA, Piechnik SK, Neubauer S, Munroe PB, Petersen SE. 199Genetic architecture of left ventricular phenotypes derived from 17,000 CMR studies in the UK Biobank population imaging cohort. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J D Vargas
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, United States of America
| | - A W Manichaikul
- University of Virginia, Center for Public Health and Genomics, Department of Public Health Sciences, Charlottesville, United States of America
| | - C Yang
- University of Virginia, Center for Public Health and Genomics, Department of Public Health Sciences, Charlottesville, United States of America
| | - C P Cabrera
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - H R Warren
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Tzanis
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M R Barnes
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - D A Bluemke
- National Institutes of Health, Radiology and Imaging Sciences, Bethesda, United States of America
| | - S K Piechnik
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - P B Munroe
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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25
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Fung K, Kellman P, Mcgrath L, Xue H, Moon JC, Manisty C. P368Paradoxical worsening of myocardial perfusion with rest. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.009] [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)
- K Fung
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, United States of America
| | - L Mcgrath
- Queens Square Imaging Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, United States of America
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
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26
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Aung N, Lee AM, Sanghvi MM, Fung K, Paiva JM, Thomson RJ, Khanji MY, Munro PB, Petersen SE. P622Automatic classification of CMR image sequences with convolutional neural networks. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez116.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - A M Lee
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M M Sanghvi
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - R J Thomson
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - P B Munro
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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27
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Raisi-Estabragh Z, Fung K, Aung N, Sanghvi M, Paiva J, Khanji M, Lukaschuk E, Lee AM, Carapella V, Piechnik S, Neubauer S, Harvey N, Petersen SE. P149Measures of bone quality are associated with aortic distensibility. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z Raisi-Estabragh
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sanghvi
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J Paiva
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Khanji
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A M Lee
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Harvey
- University of Southampton, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey research institute, London, United Kingdom of Great Britain & Northern Ireland
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28
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Sanghvi M, Biasiolli L, Aung N, Cooper JA, Fung K, Lukaschuk E, Paiva JM, Carapella V, Hann E, Rayner JJ, Werys K, Puchta H, Piechnik SK, Neubauer S, Petersen SE. 345The impact of modifiable cardiovascular risk factors on aortic distensibility: insights from the UK Biobank. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Sanghvi
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - L Biasiolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J A Cooper
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - E Hann
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J J Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - K Werys
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - H Puchta
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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29
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Thomson RJ, Aung N, Sanghvi MM, Fung K, Paiva JM, Khanji MY, Lukaschuk E, Carapella V, Piechnik SK, Neubauer SK, Petersen SE. P419Cardiac structure and the QRISK cardiovascular risk prediction score: insights from the UK Biobank. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.007] [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)
- R J Thomson
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - N Aung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M M Sanghvi
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - K Fung
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J M Paiva
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Y Khanji
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - E Lukaschuk
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - V Carapella
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Piechnik
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S K Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Queen Mary University of London, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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30
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Guenthart BA, O'Neill JD, Kim J, Queen D, Chicotka S, Fung K, Simpson M, Donocoff R, Salna M, Marboe CC, Cunningham K, Halligan SP, Wobma HM, Hozain AE, Romanov A, Vunjak-Novakovic G, Bacchetta M. Regeneration of severely damaged lungs using an interventional cross-circulation platform. Nat Commun 2019; 10:1985. [PMID: 31064987 PMCID: PMC6504972 DOI: 10.1038/s41467-019-09908-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
The number of available donor organs limits lung transplantation, the only lifesaving therapy for the increasing population of patients with end-stage lung disease. A prevalent etiology of injury that renders lungs unacceptable for transplantation is gastric aspiration, a deleterious insult to the pulmonary epithelium. Currently, severely damaged donor lungs cannot be salvaged with existing devices or methods. Here we report the regeneration of severely damaged lungs repaired to meet transplantation criteria by utilizing an interventional cross-circulation platform in a clinically relevant swine model of gastric aspiration injury. Enabled by cross-circulation with a living swine, prolonged extracorporeal support of damaged lungs results in significant improvements in lung function, cellular regeneration, and the development of diagnostic tools for non-invasive organ evaluation and repair. We therefore propose that the use of an interventional cross-circulation platform could enable recovery of otherwise unsalvageable lungs and thus expand the donor organ pool.
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Affiliation(s)
- Brandon A Guenthart
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - John D O'Neill
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Jinho Kim
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, 07030, USA
| | - Dawn Queen
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Scott Chicotka
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Kenmond Fung
- Department of Clinical Perfusion, Columbia University Medical Center, Columbia University, New York, NY, 1003, USA
| | - Michael Simpson
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Rachel Donocoff
- Institute of Comparative Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Michael Salna
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Charles C Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Katherine Cunningham
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Susan P Halligan
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Holly M Wobma
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Ahmed E Hozain
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Alexander Romanov
- Institute of Comparative Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA. .,Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.
| | - Matthew Bacchetta
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA. .,Department of Thoracic and Cardiovascular Surgery, Vanderbilt University, Nashville, TN, 37232, USA.
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31
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Fleming P, Fung K, Chan A. 194 Dermatologic assessment is associated with improved melanoma outcomes: population-based cohort study. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Guenthart BA, O'Neill JD, Kim J, Fung K, Vunjak-Novakovic G, Bacchetta M. Cell replacement in human lung bioengineering. J Heart Lung Transplant 2019; 38:215-224. [PMID: 30529200 PMCID: PMC6351169 DOI: 10.1016/j.healun.2018.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/30/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the number of patients with end-stage lung disease continues to rise, there is a growing need to increase the limited number of lungs available for transplantation. Unfortunately, attempts at engineering functional lung de novo have been unsuccessful, and artificial mechanical devices have limited utility as a bridge to transplant. This difficulty is largely due to the size and inherent complexity of the lung; however, recent advances in cell-based therapeutics offer a unique opportunity to enhance traditional tissue-engineering approaches with targeted site- and cell-specific strategies. METHODS Human lungs considered unsuitable for transplantation were procured and supported using novel cannulation techniques and modified ex-vivo lung perfusion. Targeted lung regions were treated using intratracheal delivery of decellularization solution. Labeled mesenchymal stem cells or airway epithelial cells were then delivered into the lung and incubated for up to 6 hours. RESULTS Tissue samples were collected at regular time intervals and detailed histologic and immunohistochemical analyses were performed to evaluate the effectiveness of native cell removal and exogenous cell replacement. Regional decellularization resulted in the removal of airway epithelium with preservation of vascular endothelium and extracellular matrix proteins. After incubation, delivered cells were retained in the lung and showed homogeneous topographic distribution and flattened cellular morphology. CONCLUSIONS Our findings suggest that targeted cell replacement in extracorporeal organs is feasible and may ultimately lead to chimeric organs suitable for transplantation or the development of in-situ interventions to treat or reverse disease, ultimately negating the need for transplantation.
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Affiliation(s)
- Brandon A Guenthart
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, New York, USA; Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - John D O'Neill
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - Jinho Kim
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, New York, USA; Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Kenmond Fung
- Department of Clinical Perfusion, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, New York, USA; Department of Medicine, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - Matthew Bacchetta
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, New York, USA.
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MacNeil SD, Patel K, Liu K, Shariff S, Yoo J, Nichols A, Fung K, Garg AX. Survival of patients with subglottic squamous cell carcinoma. ACTA ACUST UNITED AC 2018; 25:e569-e575. [PMID: 30607125 DOI: 10.3747/co.25.3864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (os) and laryngectomy-free survival (lfs) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival. Methods This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period of interest. Linked population-based databases were used to obtain patient demographics, comorbidity measures, staging, survival, and primary treatment with laryngectomy. Results Of 4927 patients identified to have laryngeal carcinoma, 89 were defined as having primary subglottic carcinoma (1.8%). In the subglottic cohort, 68 patients were men (76.4%), and mean age at diagnosis was 68 years (interquartile range: 60-77 years). The 5-year os was 47.2%, and the 5-year lfs was 31.5%. In 13 patients (15%), the primary treatment was laryngectomy, which, compared with primary radiation, did not predict for improved os. No differences in os or lfs were observed during the 15-year study period (os p = 0.42, lfs p = 0.83). Conclusions The survival of patients with subglottic carcinoma is poor and has remained stable over time (1995-2009). Compared with primary radiation, primary treatment with laryngectomy does not appear to improve os.
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Affiliation(s)
- S D MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON.,Institute for Clinical Evaluative Sciences, Toronto, ON
| | - K Patel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - K Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - S Shariff
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - J Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - A Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - K Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON
| | - A X Garg
- Institute for Clinical Evaluative Sciences, Toronto, ON.,Department of Epidemiology and Biostatistics, Western University, London, ON.,Division of Nephrology, Department of Medicine, Western University, London, ON
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Ansari S, Fung K, MacNeil S, Nichols A, Yoo J, Sowerby L. The use of standardized order sets to improve adherence to evidence-based postoperative management in major head and neck surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S107-S111. [DOI: 10.1016/j.anorl.2018.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
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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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Ricci F, Aung N, Boubertakh R, Camaioni C, Doimo S, Fung K, Khanji M, Malcomson J, Mantini C, Paiva J, Gallina S, Fedorowski A, Mohiddin S, Aquaro GD, Petersen SE. 3004Pulmonary blood volume index as a quantitative biomarker of diastolic function in hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3004] [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: 11/13/2022] Open
Affiliation(s)
- F Ricci
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | - N Aung
- Queen Mary University of London, London, United Kingdom
| | | | - C Camaioni
- Barts Health NHS Trust, London, United Kingdom
| | - S Doimo
- University of Trieste, Trieste, Italy
| | - K Fung
- Queen Mary University of London, London, United Kingdom
| | - M Khanji
- Queen Mary University of London, London, United Kingdom
| | - J Malcomson
- Queen Mary University of London, London, United Kingdom
| | - C Mantini
- G. d'Annunzio University, Chieti, Italy
| | - J Paiva
- Queen Mary University of London, London, United Kingdom
| | - S Gallina
- G. d'Annunzio University, Chieti, Italy
| | | | - S Mohiddin
- Barts Health NHS Trust, London, United Kingdom
| | - G D Aquaro
- Gabriele Monasterio Foundation, Pisa, Italy
| | - S E Petersen
- Queen Mary University of London, London, United Kingdom
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Patton-Rivera K, Beck J, Fung K, Chan C, Beck M, Takayama H, Takeda K. Using near-infrared reflectance spectroscopy (NIRS) to assess distal-limb perfusion on venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) patients with femoral cannulation. Perfusion 2018; 33:618-623. [DOI: 10.1177/0267659118777670] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Patients requiring V-A ECMO who receive femoral cannulation have an associated risk of distal, lower-limb hypoperfusion and ischemia of the cannulated leg. This pilot study evaluated the usefulness of non-invasive lower-limb oximetry, using near-infrared reflectance spectroscopy (NIRS) to detect limb ischemia. Methods: Between June 2016 and January 2017, 25 patients receiving femoral V-A ECMO were continuously monitored using the CASMED Fore-Sight Elite (CAS Medical Systems Inc., Branford, CT) tissue oximeter. A retrospective pilot study was conducted to review the correlation between NIRS tissue saturations (StO2) and clinical indications of limb ischemia. Patients were monitored for StO2s less than 50% for more than four minutes or StO2 differentials between the cannulated and non-cannulated legs greater than 15%. Results: Twenty-five patients (age 22-78) were monitored with NIRS. Six patients had clinical indications of lower-limb ischemia: cold limb, mottled skin and pulseless Doppler ultrasound. All six patients had StO2s below 50% that persisted for longer than four minutes. Of the 25 patients, one patient had a false-positive indication of hypoperfusion with StO2 below 50% for more than four minutes due to a venous saturation below 30%. Another patient had a false-positive pulseless Doppler ultrasound caused by high doses of pressor support. The StO2 was greater than 60%, which confirmed the clinical determination of adequate perfusion. Five patients had StO2s below 50% for less than four minutes and none of these patients had clinical indications of lower-limb hypoperfusion. All patients with cannula-related obstruction of flow to the distal portion of the leg had StO2 differentials greater than 15%. No patients without cannula-related obstruction to flow had StO2 differentials greater than 15%. Conclusion: Advancements in NIRS technology seem to have improved its accuracy for continuous, non-invasive monitoring of regional tissue and may provide clinicians with an additional metric to protect the distal portion of the cannulated leg.
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Affiliation(s)
| | - James Beck
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Kenmond Fung
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Christine Chan
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Matthew Beck
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- New York Presbyterian-Columbia University Medical Center, New York, NY, USA
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Chan A, Fung K, Austin P, Kim S, Singer L, Baxter N, Alhusayen R, Rochon P. 522 Improved keratinocyte carcinoma outcomes with annual dermatology assessment after solid organ transplantation: Population-based cohort study. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chan C, Patton-Rivera K, Beck J, Fung K, Garan A, Han J, Ando M, Cevasco M, Colombo P, Naka Y, Takayama H, Takeda K. Usefulness of Near-infrared Reflectance Spectroscopy to Assess Lower-limb Perfusion on Femoral Veno-arterial Extracorporeal Membrane Oxygenation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Davidson S, Palma D, Kuruvilla S, Venkatesan V, Read N, Hammond J, Nichols A, Fung K, MacNeil D, Yoo J, Warner A, Winquist E. TPF Induction Chemotherapy Prior to Chemoradiation for Locally Advanced Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.103] [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: 11/25/2022]
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Mundi N, Theurer J, Warner A, Yoo J, Fung K, MacNeil D, Dhaliwal S, Winquist E, Palma DA, Nichols AC. The impact of seasonal operating room closures on wait times for oral cancer surgery. Curr Oncol 2018; 25:67-72. [PMID: 29507486 DOI: 10.3747/co.25.3726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours. Results Overall case volume rose significantly from 2006 to 2014 (p < 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p < 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014). Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes.
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Affiliation(s)
- N Mundi
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada
| | - J Theurer
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada
| | - A Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - J Yoo
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - K Fung
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - D MacNeil
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - S Dhaliwal
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada
| | - E Winquist
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - D A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - A C Nichols
- Department of Otolaryngology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
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Lam JS, Scott GM, Palma DA, Fung K, Louie AV. Development of an online, patient-centred decision aid for patients with oropharyngeal cancer in the transoral robotic surgery era. ACTA ACUST UNITED AC 2017; 24:318-323. [PMID: 29089799 DOI: 10.3747/co.24.3669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy (rt) has been the standard treatment for early oropharyngeal cancer, achieving excellent outcomes, but with significant toxicities. Transoral robotic surgery (tors) has emerged as a promising alternative. A decision aid (da) can help to establish patient treatment preferences. METHODS A da was developed and piloted in 40 healthy adult volunteers. Assuming equal oncologic outcomes of the treatments, participants indicated their preference. The treatment trade-off point was then established, and participant perceptions were elicited. RESULTS More than 80% of participants initially selected tors for treatment, regardless of facilitator background. For all participants, the treatment trade-off point changed after an average 15% cure benefit. Treatment toxicities, duration, novelty, and perceptions all influenced treatment selection. All subjects valued the da. CONCLUSIONS A da developed for early oropharyngeal cancer treatment holds promise in the era of shared decision-making. Assuming equal cure rates, tors was preferred over rt by healthy volunteers.
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Affiliation(s)
- J S Lam
- Department of Radiation Oncology, and
| | | | - D A Palma
- Department of Radiation Oncology, and
| | | | - A V Louie
- Department of Radiation Oncology, and
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Abdel-Qadir H, Austin P, Thavendiranathan P, Fang J, Fung K, Amir E, Lee D, Tu J, Anderson G. A RISK SCORE FOR PREDICTING CARDIOVASCULAR EVENTS AFTER EARLY STAGE BREAST CANCER. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abdel-Qadir H, Thavendiranathan P, Austin P, Lee D, Amir E, Tu J, Ma H, Fung K, Anderson G. 2020The spectrum of cardiovascular disease after early stage breast cancer: a population-based cohort study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aung N, Woodbridge S, Paiva J, Sanghvi M, Zemrak F, Cooper J, Thomson R, Fung K, Lukaschuk E, Lee A, Carapella V, Kim Y, Piechnik S, Neubauer S, Petersen S. P3992Relationship between left ventricular trabeculation and physical activity in a middle-aged population cohort. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Aung N, Sanghvi M, Zemrak F, Cooper J, Paiva J, Thomson R, Fung K, Lukaschuk E, Lee A, Carapella V, Kim Y, Piechnik S, Neubauer S, Petersen S. 2896Age attenuates the relationship between systolic blood pressure and left ventricular mass: evidence from the UK Biobank. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Stall N, Fischer H, Fung K, Bronskill S, Austin P, Mitchell S, Bell C, Rochon P. BURDENSOME INTERVENTIONS AND ANTIBIOTIC USE AMONG END-OF-LIFE NURSING HOME RESIDENTS WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N. Stall
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada,
| | - H. Fischer
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
| | - K. Fung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
| | - S. Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
| | - P. Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
| | - S. Mitchell
- Harvard Medical School, Boston, Massachusetts,
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts,
| | - C. Bell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada,
| | - P. Rochon
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
- Women’s College Research Institute, Toronto, Ontario, Canada
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Ho K, Jegathesan T, Fung K, Young E, Minhas R, Huber J. ANTICIPATORY GUIDANCE FOR THE PREVENTION OF PEDIATRIC DEATHS DUE TO HEAT STROKE CAUSED BY BEING LEFT UNATTENDED IN VEHICLES. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
PURPOSE The objective of the present study was to use a large, population-based cohort to examine the association between metformin and breast cancer stage at diagnosis while accounting for mammography differences. METHODS We used data from Ontario administrative health databases to identify women 68 years of age or older with diabetes and invasive breast cancer diagnosed from 1 January 2007 to 31 December 2012. Adjusted logistic regression models were used to compare breast cancer stage at diagnosis (stages i and ii vs. iii and iv) between the women exposed and not exposed to metformin. We also examined the association between metformin use and estrogen receptor status, tumour size, and lymph node status in the subset of women for whom those data were available. RESULTS We identified 3125 women with diabetes and breast cancer; 1519 (48.6%) had been exposed to metformin before their cancer diagnosis. Median age at breast cancer diagnosis was 76 years (interquartile range: 72-82 years), and mean duration of diabetes was 8.8 ± 5.9 years. In multivariable analyses, metformin exposure was not associated with an earlier stage of breast cancer (odds ratio: 0.98; 95% confidence interval: 0.81 to 1.19). In secondary analyses, metformin exposure was not associated with estrogen receptor-positive breast cancer, tumours larger than 2 cm, or positive lymph nodes. CONCLUSIONS This population-based study did not show an association between metformin use and breast cancer stage or tumour characteristics at diagnosis. Our study considered older women with long-standing diabetes, and therefore further studies in younger patients could be warranted.
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Affiliation(s)
- I C Lega
- Women's College Research Institute, Women's College Hospital.,Department of Medicine, University of Toronto
| | - K Fung
- Women's College Research Institute, Women's College Hospital.,Institute for Clinical Evaluative Sciences; and
| | - P C Austin
- Institute for Clinical Evaluative Sciences; and.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - L L Lipscombe
- Women's College Research Institute, Women's College Hospital.,Department of Medicine, University of Toronto.,Institute for Clinical Evaluative Sciences; and.,Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, ON
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50
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O’Neill JD, Guenthart BA, Kim J, Chicotka S, Queen D, Fung K, Marboe C, Romanov A, Huang SXL, Chen YW, Snoeck HW, Bacchetta M, Vunjak-Novakovic G. Cross-circulation for extracorporeal support and recovery of the lung. Nat Biomed Eng 2017. [DOI: 10.1038/s41551-017-0037] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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