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Koger B, Teo K, Salerno M, Haertter AL, Kennedy C, Alonso-Basanta M, Dong L, Li T. Accuracy of Electron Density Mapping of a Novel kVCBCT System Designed for Planning. Int J Radiat Oncol Biol Phys 2023; 117:e680. [PMID: 37786003 DOI: 10.1016/j.ijrobp.2023.06.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A recently developed advanced kVCBCT system, designed for simulation and planning, includes improvements to the imaging panel and reconstruction technique, enabling more accurate electron density mapping than a typical CBCT. This study investigates the accuracy, limitations, and dosimetric impact of this new system. MATERIALS/METHODS CBCT images were taken of both large (pelvis) and small (head) electron density phantoms with inserts ranging from lung (0.29) to cortical bone (1.69). Images were taken with several pre-set protocols with energies of 125 kVp and 140 kVp. The effects of longitudinal buildup (for scatter due to the cone-beam geometry) and blade position were also investigated. The HU values of each insert were measured over a small region of interest. Several electron density curves were generated - pelvis protocol on the large phantom, head protocol on the small phantom, and average - and imported into a treatment planning system. Dose calculation was performed using each curve and differences were observed. RESULTS HU to electron density mapping was sensitive to the use of longitudinal buildup and blade position, with differences in the curves observed at both low and high electron densities, due to imager saturation effects not found in typical clinical scenarios. Subsequent studies used both longitudinal buildup and fully opened blades. Under these conditions, mapping was not sensitive to technique or phantom size at low electron densities. At higher values, the curves diverged, with the head protocol showing higher HU values and the pelvis protocol showing lower. The average curve matched very closely with the curve from our standard CT simulator. Dose calculation showed little dependence on the curve chosen, with max point dose differences of 1.2% between the pelvis and average scans, though most of the plan was <0.5% different. Results for the head protocol were similar. CONCLUSION The system provides reliable HU values comparable to a CT simulator, though it is important to consider the effects of imager saturation by choosing appropriate scatter and collimation. The calibration is slightly sensitive to the choice of phantom size and beam energy, though these differences led to negligible (<0.5%) differences in dose calculation accuracy.
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Affiliation(s)
- B Koger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - M Salerno
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - A L Haertter
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Kennedy
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - M Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - T Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Yegya-Raman N, Lee SH, Friedes C, Iocolano M, Kim KN, Duan L, Li B, Sun L, Cohen R, Cengel KA, Levin WP, Langer C, Aggarwal C, Ky B, O'Quinn RP, Zou W, Teo K, Deasy JO, Xiao Y, Feigenberg SJ. Association of Cardiac Dose with Cardiac Events and Survival for Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC) Treated with Concurrent Chemoradiotherapy (cCRT) in the Era of Immune Checkpoint Inhibitor (ICI) Consolidation. Int J Radiat Oncol Biol Phys 2023; 117:S169-S170. [PMID: 37784421 DOI: 10.1016/j.ijrobp.2023.06.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the association of cardiac dose with post-cCRT cardiac events and survival among patients (pts) with LA-NSCLC after adoption of ICI consolidation, modern radiotherapy (RT) techniques, and data-driven cardiac constraints. MATERIALS/METHODS This single-institution, multi-site retrospective study included 335 pts with LA-NSCLC treated with definitive cCRT (60-70 Gy) from October 2017 to December 2021. Pts were evaluated for ICI consolidation. Cardiac dose constraints included heart volume receiving ≥50 Gy (V50) <25% and mean heart dose (MHD) <20 Gy. Heart, left anterior descending artery (LAD), and left ventricle were autocontoured, manually reviewed, and edited. 21 dosimetric parameters (mean dose, max dose, and min dose to the hottest x% volume [Dx%(Gy); x from 5-95 in 5% intervals]) for each were extracted, as well as LAD V15. Baseline cardiovascular disease (bCVD) was defined as heart failure (HF), coronary artery disease, peripheral vascular disease, or cerebrovascular disease. Primary endpoint was post-cCRT major adverse cardiac events (MACE), defined as acute coronary syndrome, HF hospitalization/urgent visit, coronary revascularization, or cardiac death. Secondary endpoints were grade ≥3 cardiac events (CTCAE v5.0), overall survival (OS), cancer specific mortality (CSM), and other cause mortality (OCM). Competing risk regression was used for MACE and grade ≥3 cardiac events, and Cox regression for OS, CSM, and OCM. RESULTS Median age was 68 years, 139 (41%) had bCVD, and 225 (67%) received consolidation ICI. Proton therapy was used in 117 (35%), intensity-modulated RT in 199 (59%), and 3D conformal RT in 19 (6%). Median MHD was 8.7 Gy (IQR 4.6-14.4) and median LAD V15 1.4% (IQR 0-22). Median follow-up was 39.5 months. 35 MACE events occurred; 1- and 2-year cumulative incidence (CI) were 4.2% and 9.5%. No cardiac dosimetric parameter associated with MACE after adjusting for bCVD and age (e.g., MHD sHR 0.98/Gy, 95% CI 0.93-1.03, p = 0.43) or within the following 3 subgroups: no bCVD, photon therapy, and ICI consolidation. 87 grade ≥3 cardiac events occurred; 1- and 2- year CI were 12.6% and 20.4%. Heart dose was not associated with grade ≥3 cardiac events after adjusting for bCVD, ECOG, and BMI (e.g., MHD sHR 1.00/Gy, 95% CI 0.97-1.03, p = 0.85) or within the 3 aforesaid subgroups. 183 OS events occurred, including 125 CSM and 58 OCM events. Multiple cardiac dosimetric parameters associated with worse OS on multivariable analysis (e.g., LAD V15 HR 1.01/%, 95% CI 1.00-1.02, p = 0.003), driven by associations with CSM (LAD V15 HR 1.02/%, p<0.001) but not OCM (LAD V15 HR 1.00/%, p = 0.73). Median OS was worse for LAD V15 ≥10% (22.2 vs 35.1 months, p = 0.004). CONCLUSION Among pts with LA-NSCLC treated with cCRT after adoption of ICI consolidation, modern RT techniques, and cardiac constraints, post-cCRT cardiac events were common but showed no association with cardiac dose. Cardiac dose associated with OS, driven by an association with CSM and not OCM, which may not reflect cardiac toxicity.
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Affiliation(s)
- N Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - S H Lee
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Friedes
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - M Iocolano
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K N Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Duan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - B Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Sun
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - R Cohen
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - K A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - W P Levin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Langer
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Aggarwal
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - B Ky
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - R P O'Quinn
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - W Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - J O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - S J Feigenberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Haertter AL, Salerno M, Koger B, Teo K, Kennedy C, Alonso-Basanta M, Dong L, Li T. ACR Accreditation of a Novel Linac-Based kV-CBCT System on a High-Speed Ring-Gantry. Int J Radiat Oncol Biol Phys 2023; 117:S163. [PMID: 37784409 DOI: 10.1016/j.ijrobp.2023.06.259] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) An advanced kV-CBCT imaging system mounted on a high-speed ring-gantry Linac has recently been introduced, offering improved imaging hardware and reconstruction software to produce high quality CBCT images usable for treatment planning. Imaging performance of the system was assessed using the American College of Radiology (ACR) accreditation designed for diagnostic CT systems, additionally comparing its results to pre-existing diagnostic CT and Linac-based CBCT systems. MATERIALS/METHODS All imaging protocols on the novel imaging system were scanned with the ACR head phantom and evaluated using ACR recommended testing and passing criteria. ACR image quality parameters include contrast-to-noise ratio (CNR), spatial resolution, HU accuracy, image scaling, and HU uniformity. CNR ≥1.0 for adult head and body, ≥0.7 for pediatric head, and ≥0.4 for pediatric body imaging protocols pass ACR criteria. Spatial resolution ≥6 line-pairs/cm for head and ≥5 line-pairs/cm for body protocols pass ACR criteria. HU accuracy passing criteria includes acrylic (110 to 135 HU), air (-1005 to -970 HU), bone (850 to 970 HU), polyethylene (-107 to -84 HU), and water (-7 to 7 HU). Image scaling measurements with errors ≤5% and HU uniformity maximum differences ≤5 HU pass ACR criteria. For machine cross-comparisons, adult Head and Pelvis imaging protocols were acquired on an existing diagnostic CT and 2 Linac-based CBCT systems (1 traditional C-arm and 1 ring-gantry) and analyzed with the same ACR methodology and passing criteria, with passing rates compared. RESULTS On the novel imaging system, all standard patient size imaging protocols using 125 kVp (Head, H&N, Thorax, Thorax Slow, Breast, Abdomen, Pelvis, Pediatric Head, and Pediatric Abdomen) passed all ACR criteria; while 2 larger patient focused imaging protocols using 140 kVp (Abdomen Large and Pelvis Large) produced minor deviations on HU uniformity (maximum differences of 5 - 7 HU) but passed all other ACR criteria. The novel system matched passing rates of a diagnostic CT simulator, and outperformed pre-existing Linac based CBCT imaging systems. CONCLUSION This newly developed advanced imaging system produces high quality images, meeting diagnostic CT ACR recommendations and far surpassing the CBCT image quality currently available on pre-existing Linacs.
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Affiliation(s)
- A L Haertter
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - M Salerno
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - B Koger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Kennedy
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - M Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - T Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Iocolano M, Yegya-Raman N, Wang X, Friedes C, Lee SH, Duan L, Li B, Levin WP, Cengel KA, Langer C, Cohen R, Sun L, Aggarwal C, Doucette A, Xiao Y, Teo K, O'Reilly SE, Zou W, Simone CB, Feigenberg SJ. Proton Beam Therapy (PBT) Versus Intensity-Modulated Radiotherapy (IMRT) for Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC) in the Era of Immune Checkpoint Inhibitor (ICI) Consolidation: A Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e26. [PMID: 37784996 DOI: 10.1016/j.ijrobp.2023.06.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients (pts) with LA-NSCLC treated with concurrent chemoradiation (cCRT) and ICI consolidation are at high risk for treatment-related toxicities and subsequent hospitalization. We hypothesized that PBT is associated with a reduction in acute unplanned hospitalizations as compared to IMRT in the era of ICI consolidation. MATERIALS/METHODS This single institution, multi-site retrospective study included consecutive pts with LA-NSCLC treated with definitive cCRT with either PBT or IMRT from October 2017 to December 2021. Pts were evaluated for consolidative ICI. Primary endpoint was unplanned treatment-related hospitalization within 90 days of first radiation (RT) treatment. Secondary endpoints included grade 3+ pneumonitis, grade 3+ esophagitis, PFS and OS. Logistic regression was used to assess associations with 90-day hospitalization. Competing risk regression was used for grade 3+ pneumonitis and esophagitis, and Cox regression for PFS and OS. RESULTS A total of 316 pts were included: 117 (37%) received PBT and 199 (63%) IMRT. Median age was 68.5 yrs; median RT dose 66.6 Gy (IQR 65.9-70.0). PBT group was older (median 71.1 vs 67.2 yrs, p<0.005) and had a higher Charlson comorbidity index (CCI) (median 4 vs 3, p = 0.02). There was no significant difference in ECOG, smoking pack-years, T stage, N stage, target volume size, or receipt of ICI consolidation (66.7% vs 68.3%, p = 0.76). PBT group had lower mean heart dose (5.9 vs 10.8 Gy, p<0.001), LAD V15 (0 vs 6 %, p = 0.001), mean lung dose (14.7 vs 15.7 Gy, p <0.008) and effective dose to immune circulating cells (median 3.7 vs 4.9 Gy, p<0.001) but not mean esophagus dose. PBT was associated with fewer unplanned 90-day hospitalizations (23.9% vs 34.7%); which persisted on multivariable analysis (OR 0.52, 95% CI 0.30-0.90, p = 0.02) after adjusting for CCI, smoking pack-years, T4 tumors and target volume. Reasons for hospitalization in PBT and IMRT groups included progression (1.7% vs 1.5%), definite/probable toxicity from cCRT (11.1% vs 18.6%), possible toxicity from cCRT (7.7% vs 12.6%) or unrelated to cCRT (3.4% vs 2.0%). There was no significant difference between PBT or IMRT groups in G3+ pneumonitis (1-year 6.0% vs 9.1%, p = 0.49), G3+ esophagitis (1-year 6.0% vs 6.5%, p = 0.71), PFS (median 14.4 vs 15.1 months, p = 0.69), or OS (median 34.2 vs 29.4 months, p = 0.41). CONCLUSION Among pts with LA-NSCLC treated with cCRT in the era of ICI consolidation, PBT was associated with fewer acute unplanned hospitalizations compared to IMRT. There was no difference in G3+ pneumonitis, G3+ esophagitis, PFS or OS.
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Affiliation(s)
- M Iocolano
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - N Yegya-Raman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - X Wang
- University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
| | - C Friedes
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - S H Lee
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Duan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - B Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - W P Levin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Langer
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - R Cohen
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - L Sun
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - C Aggarwal
- Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - A Doucette
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Y Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - S E O'Reilly
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - W Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - S J Feigenberg
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Joseph P, Pais P, Gao P, Teo K, Xavier D, Lopez-Jaramillo P, Yusoff K, Santoso A, Gamra H, Talukder SH, Christou C, Dagenais G, Tyrwhitt J, Bosch J, Dans A, Yusuf S. Vitamin D supplementation and adverse skeletal and non-skeletal outcomes in individuals at increased cardiovascular risk: Results from the International Polycap Study (TIPS)-3 randomized controlled trial. Nutr Metab Cardiovasc Dis 2023; 33:434-440. [PMID: 36604262 DOI: 10.1016/j.numecd.2022.11.001] [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: 04/12/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Vitamin D has mostly been tested in Western populations. We examined the effect of high dose vitamin D in a population drawn predominantly from outside of Western countries. METHODS AND RESULTS This randomized trial tested vitamin D 60,000 IU monthly in 5670 participants without vascular disease but at increased CV risk. The primary outcome was fracture. The secondary outcome was the composite of CV death, myocardial infarction stroke, cancer, fracture or fall. Death was a pre-specified outcome. Mean age was 63.9 years, and 3005 (53.0%) were female. 3034 (53.5%) participants resided in South Asia, 1904 (33.6%) in South East Asia, 480 (8.5%) in South America, and 252 (4.4%) in other regions. Mean follow-up was 4.6 years. A fracture occurred in 20 participants (0.2 per 100 person years) assigned to vitamin D, and 19 (0.1 per 100 person years) assigned to placebo (HR 1.06, 95% CI 0.57-1.99, p-value = 0.86). The secondary outcome occurred in 222 participants (1.8 per 100 person years) assigned to vitamin D, and 198 (1.6 per 100 person years) assigned to placebo (HR 1.13, 95% CI 0.93-1.37, p = 0.22). 172 (1.3 per 100 person years) participants assigned to vitamin D died, compared with 135 (1.0 per 100 person years) assigned to placebo (HR 1.29, 95% CI 1.03-1.61, p = 0.03). CONCLUSION In a population predominantly from South Asia, South East Asia and South America, high-dose vitamin D did not reduce adverse skeletal or non-skeletal outcomes. Higher mortality was observed in the vitamin D group. REGISTRATION NUMBER NCT01646437.
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Affiliation(s)
- P Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - P Pais
- St. John's Medical College, Bangalore, India
| | - P Gao
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - D Xavier
- St. John's Medical College, Bangalore, India
| | - P Lopez-Jaramillo
- Masira Research Institute Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - K Yusoff
- UiTM Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - A Santoso
- Universitas Indonesia, National Cardiovascular Centre, Jakarta, Indonesia
| | - H Gamra
- Fattouma Bourguiba University Hospital and University of Monastir, Tunisia
| | | | - C Christou
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - G Dagenais
- Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - J Tyrwhitt
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - J Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - A Dans
- University of the Philippines, Manila, Philippines
| | - S Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Tuck NL, Teo K, Kuhlmann L, Olesen SS, Johnson M, Bean DJ, Rashid U, MacCormick AD, Srikumar G, Drewes AM, Windsor JA. Pain patterns in chronic pancreatitis and chronic primary pain. Pancreatology 2022; 22:572-582. [PMID: 35562269 DOI: 10.1016/j.pan.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Abdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator. AIMS This cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes. METHODS Patients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics. RESULTS Compared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent. CONCLUSIONS Within CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.
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Affiliation(s)
- N L Tuck
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Auckland Regional Pain Service (TARPS), Auckland District Health Board (ADHB), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand.
| | - K Teo
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - L Kuhlmann
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S S Olesen
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - D J Bean
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand
| | - U Rashid
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| | - A D MacCormick
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand; Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - G Srikumar
- Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - A M Drewes
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
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Teo K, Cheow Y, Zhang S, Shi J, Lai R, Lim S, Toh W. Exosomes/EVs: MSC-SEVS ALLEVIATE LOCAL AND SYSTEMIC INFLAMMATION TO PROMOTE JOINT REPAIR IN OSTEOARTHRITIS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00252-3] [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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Jiang Y, Teo K, Zhang S, Shi J, Lai R, Lim S, Toh W. Exosomes/EVs: MSC EXOSOMES ALLEVIATE OSTEOARTHRITIS THROUGH COMPLEMENT INHIBITION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00251-1] [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: 11/29/2022]
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Chuah S, Yong C, Chew J, Cheow Y, Teo K, Zhang S, Lai R, Wong R, Lim A, Lim S, Tohu W. Mesenchymal stromal cell-derived small extracellular vesicles promote angio-osteogenesis and modulate macrophage polarization to enhance bone regeneration. Cytotherapy 2021. [DOI: 10.1016/s1465324921004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Teo K, Zhang S, Chuah S, Lai R, Lim S, Toh W. Mesenchymal stromal cell-derived small extracellular vesicles promote osteoarthritic joint repair and pain recovery through immunomodulation. Cytotherapy 2021. [DOI: 10.1016/s1465324921004515] [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: 11/17/2022]
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Teo K, Abeysekera KWM, Adams L, Aigner E, Anstee QM, Banales JM, Banerjee R, Basu P, Berg T, Bhatnagar P, Buch S, Canbay A, Caprio S, Chatterjee A, Ida Chen YD, Chowdhury A, Daly AK, Datz C, de Gracia Hahn D, DiStefano JK, Dong J, Duret A, Emdin C, Fairey M, Gerhard GS, Guo X, Hampe J, Hickman M, Heintz L, Hudert C, Hunter H, Kelly M, Kozlitina J, Krawczyk M, Lammert F, Langenberg C, Lavine J, Li L, Lim HK, Loomba R, Luukkonen PK, Melton PE, Mori TA, Palmer ND, Parisinos CA, Pillai SG, Qayyum F, Reichert MC, Romeo S, Rotter JI, Im YR, Santoro N, Schafmayer C, Speliotes EK, Stender S, Stickel F, Still CD, Strnad P, Taylor KD, Tybjærg-Hansen A, Umano GR, Utukuri M, Valenti L, Wagenknecht LE, Wareham NJ, Watanabe RM, Wattacheril J, Yaghootkar H, Yki-Järvinen H, Young KA, Mann JP. rs641738C>T near MBOAT7 is associated with liver fat, ALT and fibrosis in NAFLD: A meta-analysis. J Hepatol 2021; 74:20-30. [PMID: 32882372 PMCID: PMC7755037 DOI: 10.1016/j.jhep.2020.08.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS A common genetic variant near MBOAT7 (rs641738C>T) has been previously associated with hepatic fat and advanced histology in NAFLD; however, these findings have not been consistently replicated in the literature. We aimed to establish whether rs641738C>T is a risk factor across the spectrum of NAFLD and to characterise its role in the regulation of related metabolic phenotypes through a meta-analysis. METHODS We performed a meta-analysis of studies with data on the association between rs641738C>T genotype and liver fat, NAFLD histology, and serum alanine aminotransferase (ALT), lipids or insulin. These included directly genotyped studies and population-level data from genome-wide association studies (GWAS). We performed a random effects meta-analysis using recessive, additive and dominant genetic models. RESULTS Data from 1,066,175 participants (9,688 with liver biopsies) across 42 studies were included in the meta-analysis. rs641738C>T was associated with higher liver fat on CT/MRI (+0.03 standard deviations [95% CI 0.02-0.05], pz = 4.8×10-5) and diagnosis of NAFLD (odds ratio [OR] 1.17 [95% CI 1.05-1.3], pz = 0.003) in Caucasian adults. The variant was also positively associated with presence of advanced fibrosis (OR 1.22 [95% CI 1.03-1.45], pz = 0.021) in Caucasian adults using a recessive model of inheritance (CC + CT vs. TT). Meta-analysis of data from previous GWAS found the variant to be associated with higher ALT (pz = 0.002) and lower serum triglycerides (pz = 1.5×10-4). rs641738C>T was not associated with fasting insulin and no effect was observed in children with NAFLD. CONCLUSIONS Our study validates rs641738C>T near MBOAT7 as a risk factor for the presence and severity of NAFLD in individuals of European descent. LAY SUMMARY Fatty liver disease is a common condition where fat builds up in the liver, which can cause liver inflammation and scarring (including 'cirrhosis'). It is closely linked to obesity and diabetes, but some genes are also thought to be important. We did this study to see whether one specific change ('variant') in one gene ('MBOAT7') was linked to fatty liver disease. We took data from over 40 published studies and found that this variant near MBOAT7 is linked to more severe fatty liver disease. This means that drugs designed to work on MBOAT7 could be useful for treating fatty liver disease.
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Affiliation(s)
- Kevin Teo
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Leon Adams
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University Salzburg, Austria
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jesus M Banales
- Department on Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Ali Canbay
- Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sonia Caprio
- Yale University, Department of Pediatrics, New Haven, CT, USA
| | | | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abhijit Chowdhury
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
| | | | - Johanna K DiStefano
- Diabetes and Fibrotic Disease Unit Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Connor Emdin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, MA, USA
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Matthew Hickman
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Lena Heintz
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Christian Hudert
- Department of Pediatric Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Joel Lavine
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Lin Li
- BioStat Solutions LLC, Frederick, MD, USA
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, CA, USA
| | - Panu K Luukkonen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Yale University School of Medicine, New Haven, CT, USA
| | - Phillip E Melton
- School of Global Population Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Trevor A Mori
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Constantinos A Parisinos
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Faiza Qayyum
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nicola Santoro
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of Medicine and Health Sciences 'V. Tiberio' University of Molise, Campobasso, Italy
| | - Clemens Schafmayer
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | - Elizabeth K Speliotes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stefan Stender
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Pavel Strnad
- Medical Clinic III, University Hospital RWTH Aachen, Aachen, Germany
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Giuseppina Rosaria Umano
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of the Woman, the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Richard M Watanabe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Julia Wattacheril
- Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hannele Yki-Järvinen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Jake P Mann
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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Thoi F, Scherer D, Teo K, Sanders P, Worthley M, Pearson T, Stokes M. Trends in Cardiac Magnetic Resonance (CMR) Imaging Characteristics in Patients With Methamphetamine-Induced Cardiomyopathy (MA-CMP). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.013] [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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Yoon S, Freedman G, Anamalayil S, Dong L, Hubley E, Kennedy C, Teo K, Taunk N, Metz J, Zou W, Li T. Daily Dosimetric Robustness of Prone-Position Whole Breast Radiotherapy (WBRT) Planned With Electronic Tissue Compensation (ECOMP) and 6MV Flattening Filter Free (6X-FFF) Beam Energy: Dose Variation and Predictive Factors. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.637] [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: 10/23/2022]
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Canoy D, Copland E, Ramakrishnan R, Pinho-Gomes A, Nazarzadeh M, Bidel Z, Salimi-Khorshidi G, Woodward M, Davis B, Pepine C, Chalmers J, Teo K, Rahimi K. Stratified effects of blood pressure-lowering treatment on long-term blood pressure: an individual patient-level meta-analysis involving 50 randomised trials and 334,219 participants. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Meta-analyses of randomised controlled trials (RCT) have shown the efficacy of pharmacologic lowering of blood pressure (BP) in reducing cardiovascular disease (CVD) risk. While efficacy has been shown across important patient characteristics, meta-analysis based on aggregate data could not fully account for potential sources of variation due to individual-level characteristics. Moreover, it is unclear if any variation in treatment effects due to patient characteristics are reflected in differential effects of BP-lowering treatment on long-term BP according to these characteristics.
Purpose
We determined the effects of BP-lowering treatment on repeated measures of blood pressure, identified trial- and participant-level sources of heterogeneity, and examined consistency of these BP-lowering effects across different patient characteristics.
Methods
We conducted an individual patient-level data meta-analysis (N=50 trials) using one-stage approach. We classified trials according to trial design: drug comparison (N=28), placebo-controlled (N=21) and BP-lowering intensity (N=8) trials. We fitted mixed models with fixed treatment effects and fixed time effect, random intercepts at trial and participant level, and a random slope for time at participant level. We adjusted for age, sex and baseline BP (except when used as stratification factor). We used likelihood ratio test and Akaike information criterion to compare models.
Results
This meta-analysis included 334,219 (42% women) participants. At baseline, mean age=65 (SD=9) years, among whom 18% were current smokers, 47% had cardiovascular disease, 29% had diabetes, and 73% were previously on BP-lowering medication. Participants had an average of 8 BP measurements over 4 years of mean follow-up. For drug comparison trials, mean differences (95% confidence interval) in systolic BP (SBP) and diastolic BP (DBP) between comparison arms were 1.3 (1.2 to 1.3) mmHg and 0.5 (0.5 to 0.5) mmHg, respectively; for placebo-controlled trials, the SBP and DBP differences were 4.2 (4.0 to 4.3) mmHg and 1.9 (1.9 to 2.0) mmHg, respectively; and for BP-lowering intensity trials, the SBP and DBP differences were 8.2 (8.0 to 8.4) mmHg and 3.7 (3.6 to 3.9) mmHg, respectively. However, BP reduction differed by duration of follow-up, type of trial. In particular, for placebo-controlled and BP-intensity trials, heterogeneity in BP reductions according to patient characteristics such as baseline BP, age, sex, prior CVD, diabetes and non-randomised anti-hypertensive use were observed.
Conclusion
This study shows the role of pharmacologic agents in effectively reducing long-term BP across individuals with a wide range of characteristics. The magnitude of BP reduction varied by several patient characteristics. This might have implications for investigation and explanation of any differential effects of BP treatment on major clinical outcomes.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): British Heart Foundation; NIHR Oxford Biomedial Research Centre
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Affiliation(s)
- D Canoy
- University of Oxford, Oxford, United Kingdom
| | - E Copland
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Z Bidel
- University of Oxford, Oxford, United Kingdom
| | | | - M Woodward
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - B.R Davis
- University of Texas, School of Public Health, Austin, United States of America
| | - C.J Pepine
- University of Florida, Department of Medicine, Florida, United States of America
| | - J Chalmers
- The George Institute for Global Health, Sydney, Australia
| | - K Teo
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - K Rahimi
- University of Oxford, Oxford, United Kingdom
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Zhang S, Wong K, Wang M, Teo K, Chuah S, Lai R, Lim S, Lee E, Hui J, Toh W. Optimising administration of MSC exosomes for cartilage repair in the clinic. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.077] [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: 10/24/2022]
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Diffenderfer ES, Verginadis II, Kim MM, Shoniyozov K, Velalopoulou A, Goia D, Putt M, Hagan S, Avery S, Teo K, Zou W, Lin A, Swisher-McClure S, Koch C, Kennedy AR, Minn A, Maity A, Busch TM, Dong L, Koumenis C, Metz J, Cengel KA. Design, Implementation, and in Vivo Validation of a Novel Proton FLASH Radiation Therapy System. Int J Radiat Oncol Biol Phys 2020; 106:440-448. [PMID: 31928642 DOI: 10.1016/j.ijrobp.2019.10.049] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/11/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Recent studies suggest that ultrahigh-dose-rate, "FLASH," electron radiation therapy (RT) decreases normal tissue damage while maintaining tumor response compared with conventional dose rate RT. Here, we describe a novel RT apparatus that delivers FLASH proton RT (PRT) using double scattered protons with computed tomography guidance and provide the first report of proton FLASH RT-mediated normal tissue radioprotection. METHODS AND MATERIALS Absolute dose was measured at multiple depths in solid water and validated against an absolute integral charge measurement using a Faraday cup. Real-time dose rate was obtained using a NaI detector to measure prompt gamma rays. The effect of FLASH versus standard dose rate PRT on tumors and normal tissues was measured using pancreatic flank tumors (MH641905) derived from the KPC autochthonous PanCa model in syngeneic C57BL/6J mice with analysis of fibrosis and stem cell repopulation in small intestine after abdominal irradiation. RESULTS The double scattering and collimation apparatus was dosimetrically validated with dose rates of 78 ± 9 Gy per second and 0.9 ± 0.08 Gy per second for the FLASH and standard PRT. Whole abdominal FLASH PRT at 15 Gy significantly reduced the loss of proliferating cells in intestinal crypts compared with standard PRT. Studies with local intestinal irradiation at 18 Gy revealed a reduction to near baseline levels of intestinal fibrosis for FLASH-PRT compared with standard PRT. Despite this difference, FLASH-PRT did not demonstrate tumor radioprotection in MH641905 pancreatic cancer flank tumors after 12 or 18 Gy irradiation. CONCLUSIONS We have designed and dosimetrically validated a FLASH-PRT system with accurate control of beam flux on a millisecond time scale and online monitoring of the integral and dose delivery time structure. Using this system, we found that FLASH-PRT decreases acute cell loss and late fibrosis after whole-abdomen and focal intestinal RT, whereas tumor growth inhibition is preserved between the 2 modalities.
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Affiliation(s)
- Eric S Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ioannis I Verginadis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khayrullo Shoniyozov
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Denisa Goia
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Putt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Hagan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Avery
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cameron Koch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann R Kennedy
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andy Minn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Costas Koumenis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - James Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Abstract
PURPOSE To explore contemporary clincial case management of patients with Ebola virus disease. METHODS A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - S Mullin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Lane, North York, ON, M3K 0A1, Canada
| | - N K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - R A Fowler
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
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Vergalasova I, Liu H, Alonso-Basanta M, Dong L, Li J, Nie K, Shi W, Teo K, Yu Y, Yue N, Zou W, Li T. Evaluation of Contemporary Stereotactic Radiosurgery Techniques for the Treatment of Multiple Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jain V, O'Reilly S, Huang Q, Teo K, Zhang M, Diffenderfer E, Levin W, Xiao Y, Dong L, Feigenberg S, Zou W, Berman A. Avoiding Highly Functional Ventilation Zones as Defined by 4D Simulation Decreases the Risk of Radiation Pneumonitis During Proton Radiation Therapy for Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toh W, Zhang S, Teo K, Chuah S, Lai R, Lim S. MSC exosomes alleviate pain and degeneration in A rat model of temporomandibular joint osteoarthritis. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.031] [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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Toscano S, Souris K, Sterpin E, Janssens G, Petzoldt J, Vander Stappen F, Smeets J, Geets X, Teo K. OC-0081: From range measurements to dose: in-vivo dosimetry using the prompt gamma camera. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30391-8] [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: 11/15/2022]
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Chong PH, De Castro Molina JA, Teo K, Tan WS. Paediatric palliative care improves patient outcomes and reduces healthcare costs: evaluation of a home-based program. BMC Palliat Care 2018; 17:11. [PMID: 29298714 PMCID: PMC5751774 DOI: 10.1186/s12904-017-0267-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background Around the world, different models of paediatric palliative care have responded to the unique needs of children with life shortening conditions. However, research confirming their utility and impact is still lacking. This study compared patient-related outcomes and healthcare expenditures between those who received home-based paediatric palliative care and standard care. The quality of life and caregiver burden for patients receiving home-based paediatric palliative care were also tracked over the first year of enrolment to evaluate the service’s longitudinal impact. Method A structured impact and cost evaluation of Singapore-based HCA Hospice Care’s Star PALS (Paediatric Advance Life Support) programme was conducted over a three-year period, employing both retrospective and prospective designs with two patient groups. Results Compared to the control group (n = 67), patients receiving home-based paediatric palliative care (n = 71) spent more time at home than in hospital in the last year of life by 52 days (OR = 52.30, 95% CI: 25.44–79.17) with at least two fewer hospital admissions (OR = 2.46, 95% CI: 0.43–4.48); and were five times more likely to have an advance care plan formulated (OR = 5.51, 95% CI: 1.55–19.67). Medical costs incurred by this group were also considerably lower (by up to 87%). Moreover, both patients’ quality of life (in terms of pain and emotion), and caregiver burden showed improvement within the first year of enrolment into the programme. Discussion Our findings suggest that home-based paediatric palliative care brings improved resource utilization and cost-savings for both patients and healthcare providers. More importantly, the lives of patients and their caregivers have improved, with terminally ill children and their caregivers being able to spend more quality time at home at the final stretch of the disease. Conclusions The benefits of a community paediatric palliative care programme have been validated. Study findings can become key drivers when engaging service commissioners or even policy makers in appropriate settings.
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Affiliation(s)
- P H Chong
- HCA Hospice Care, Singapore, Singapore.
| | | | - K Teo
- National Healthcare Group Singapore, Singapore, Singapore
| | - W S Tan
- National Healthcare Group Singapore, Singapore, Singapore
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Khokhar K, Lau D, Mahajan R, Elliott A, Stiles M, Mishima R, Munawar D, Kadhim K, Linz D, Thiyagarajah A, Harrington J, Wilson L, Stokes M, Emami M, Agbaedeng T, Teo K, Nelson A, Gallaghar C, Sanders P. Central Blood Pressure Assessment in Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Tee S, Teo K. Case Study: Cardiac Sarcoidosis Diagnosed by Multimodality Imaging. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Teo K, Johnson MH, Drewes AM, Windsor JA. A comprehensive pain assessment tool (COMPAT) for chronic pancreatitis: Development, face validation and pilot evaluation. Pancreatology 2017; 17:706-719. [PMID: 28733149 DOI: 10.1016/j.pan.2017.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/15/2017] [Accepted: 07/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Chronic pancreatitis (CP) pain is challenging to treat. Treatment selection is hampered by there being no validated pain assessment tool that accounts for the complexity of CP pain and its underlying mechanisms. This study aims to develop a comprehensive pain assessment tool (COMPAT) specific for CP, evaluate its face validity with experts and patients and test it with a pilot cohort of patients. METHODS COMPAT was developed from existing pain assessment tools and a literature review. Face validity was conducted by pancreatologists and CP patients using an item-content validity index for importance, relevance and clarity. Subsequent revisions were made to COMPAT. A pilot cohort of CP patients tested COMPAT. RESULTS COMPAT was developed and covered all important aspects of CP pain. Experts and CP patients reported that 70% of questions were important and relevant to CP pain. Most experts were willing to use COMPAT in clinic, ward/hospital and research settings. The most common location of pain was the epigastrium and food was the most important trigger. Pain Pattern C (constant background pain with pain attacks), had significantly higher frequency of pain attacks, higher opioid use, and affective descriptors of pain than Pattern A (pain attacks with no background pain). CONCLUSIONS COMPAT has high face validity and met with high acceptance. CP patients successfully self-reported their pain with COMPAT. The results reveal many differences in the CP pain within the pilot cohort, which may reflect different mechanisms of pain. A larger prospective cohort study is planned to further validate COMPAT.
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Affiliation(s)
- K Teo
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - M H Johnson
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - A M Drewes
- Centre for Pancreas Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - J A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Chirvase C, Teo K, Barlow R, Bentefour E. PO-0802: Experimental validation of single detector proton radiography with scanning beams. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31239-2] [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: 10/19/2022]
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27
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Teo K, Johnson MH, Truter S, Pandanaboyana S, Windsor JA. Pain assessment in chronic pancreatitis: A comparative review of methods. Pancreatology 2016; 16:931-939. [PMID: 27693097 DOI: 10.1016/j.pan.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/10/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with chronic pancreatitis (CP) frequently report chronic abdominal pain that adversely impacts their quality of life. Assessment of pain in CP is required for clinical management and clinical studies. International consensus guidelines recognized a lack of specific and validated pain assessment tools for CP. Therefore, the aim of this systematic review is to identify and compare all clinical studies that assessed pain in the context of a treatment for pain in CP. METHODS A systematic literature search was performed in PubMed, Cochrane Library and Ovid MEDLINE. The search identified all intervention studies for pain in CP and the pain assessment tools used based on pre-defined inclusion and exclusion criteria. RESULTS Of 341 articles identified, 137 studies were included. Pain assessment tools were both general and CP-specific. The latter were used in only 22 (16%) studies. Despite recommendations the aspects of pain assessed were limited and variable between tools. Validation of these tools in CP patients was limited to quality of life measures. None of the pain assessment tools evaluated duration of pain and postprandial pain. CONCLUSIONS There are no published pain assessment tools for CP that includes all relevant aspects of pain. There is the need to develop a comprehensive and validated pain assessment tool for patients with CP to standardised pain assessment, identify likely underlying pain mechanisms, help select appropriate treatments, report outcomes from interventions, improve clinical communication and aid the allocation of patients to clinical trials.
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Affiliation(s)
- K Teo
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - M H Johnson
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - S Truter
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - S Pandanaboyana
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - J A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Rajwani A, Nelson A, Shirazi M, Wong D, Delacroix S, Chokka R, Disney P, Teo K, Young G, Worthley S. Left Atrial Appendage Closure: CT Sizing is Associated with Highly Favourable Procedural Outcomes. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hung J, Stokes M, Roberts-Thomson R, Parvar S, Nelson A, Williams K, Brown M, Disney P, Teo K. Right Ventricular Remodelling After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Assessment With Cardiovascular Magnetic Resonance. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.735] [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: 11/17/2022]
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Wong G, Cursaro M, Scherer D, Nelson A, Roberts-Thomson R, Teo K, Shirazi M. Ruptured Sinus of Valsalva Aneurysm and Bicuspid Aortic Valve. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Lamelas P, Mente A, Diaz R, Avezum A, Lanas F, Lopez Jaramillo P, Donell M, Rangarajan S, Teo K, Yusuf S. PT077 Association of Urinary Sodium Excretion With Blood Pressure and Cardiovascular Clinical Events in 17,033 Latin Americans. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.483] [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] Open
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Mente A, O'Donnell M, Teo K, Rangarajan S, McQueen M, Yusuf S. PT046 Urinary Sodium Excretion Versus Mortality and Cardiovascular Events in Those With and Without Hypertension. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.467] [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: 11/29/2022] Open
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El Sayed A, Ibrahim A, Elhassan H, Zuhlke L, Engel M, Karthikeyan G, Teo K, Yusuf S, Mayosi B. PM276 The Global Rheumatic Heart Disease Study (Remedy) – Data From Sudan. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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34
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Joseph P, Yusuf S, Lee S, Ibrahim Q, Teo K, Rangarajan S, Anand S. OC06_10 Applicability of a Non-Laboratory- and a Laboratory Based Cardiovascular Disease Risk Score Across Seven Regions of the World. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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35
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Tan K, Teo K, Chen A, Reuveny S, Oh S. Albumin-Associated Compounds in Serum-Free Media Formulations Affect Mesenchymal Stromal Cell Growth. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Böhm M, Schumacher H, Linz D, Reil JC, Ukena C, Lonn E, Teo K, Sliwa K, Schmieder RE, Sleight P, Yusuf S. Low resting heart rates are associated with new-onset atrial fibrillation in patients with vascular disease: results of the ONTARGET/TRANSCEND studies. J Intern Med 2015; 278:303-12. [PMID: 25872921 DOI: 10.1111/joim.12373] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elevated systolic blood pressure (SBP) and high resting heart rate (HR) are associated with cardiovascular end-points. Although the association between atrial fibrillation (AF) and SBP is well established, the relation between AF and HR remains unclear. METHODS In patients from the ONTARGET and TRANSCEND studies with high cardiovascular disease risk (n = 27 064), new-onset AF was evaluated in relation to mean SBP, visit-to-visit variation in SBP (SBP-CV; i.e. SD/mean × 100%), mean HR and visit-to-visit variation in HR (HR-CV). RESULTS Low mean HR (P < 0.0001) and high SBP (P = 0.0021) were associated with incident AF. High SBP-CV (P = 0.031) and HR-CV (P < 0.0001) were also associated with incident AF. After adjustment for confounders, SBP and SBP-CV were no longer significantly associated with AF. The detrimental effect of low HR was particularly evident in subjects who were not receiving treatment with beta-blockers (P = 0.014 for interaction between beta-blocker use and mean HR). In addition to low HR, high HR-CV and high SBP had additive effects on incident AF. CONCLUSIONS Low mean HR (<60 beats min(-1) ) is independently associated with incident AF, and low HR-CV and high SBP further increase the incidence of new-onset AF in patients at high risk of cardiovascular disease.
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Affiliation(s)
- M Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - D Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - J-C Reil
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - C Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - E Lonn
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - K Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - K Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany
| | - P Sleight
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - S Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Böhm M, Schumacher H, Schmieder RE, Mann JFE, Teo K, Lonn E, Sleight P, Mancia G, Linz D, Mahfoud F, Ukena C, Sliwa K, Bakris G, Yusuf S. Resting heart rate is associated with renal disease outcomes in patients with vascular disease: results of the ONTARGET and TRANSCEND studies. J Intern Med 2015; 278:38-49. [PMID: 25431275 DOI: 10.1111/joim.12333] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Resting heart rate (RHR) is associated with cardiovascular disease outcomes in high-risk patients. It is not known whether RHR is predictive of renal outcomes such as albuminuria, end-stage renal disease (ESRD) or doubling of creatinine. We evaluated whether RHR could predict renal endpoints in patients at a high risk of cardiovascular disease. We also tested the effects of RHR at different levels of systolic blood pressure (SBP). METHODS We analysed data from 28 757 patients in the ONTARGET and TRANSCEND trials. RHR and SBP were available for a mean of 4.9 ± 0.4 visits (range 3-5) within the first 2 years of the studies. Albuminuria was determined at baseline, at 2 years and at study end. RESULTS Mean RHR was predictive of incident micro-albuminuria [hazard ratio (HR) for RHR ≥80 vs. <60 beats min(-1) 1.49, 95% confidence interval (CI) 1.29-1.71, P < 0.0001], incident macro-albuminuria (HR 1.84, 95% CI 1.39-2.42, P < 0.0001), doubling of creatinine (HR 1.47, 95% CI 1.00-2.17, P = 0.050) and ESRD (HR 1.78, 95% CI 1.00-3.16, P = 0.050), and the combined renal end-point (HR 1.51, 95% CI 1.32-1.74, P < 0.0001). Associations were robust at SBPs from <120 to ≥150 mmHg, with the lowest risk at a SBP of 130-140 mmHg. CONCLUSION Resting heart rate is a potent predictor of these renal outcomes, as well as their combination, in patients with cardiovascular disease. RHR at all SBP levels should be considered as a possible renal disease risk predictor and should be investigated as a treatment target with RHR-reducing agents.
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Affiliation(s)
- M Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - R E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany
| | - J F E Mann
- Department of Nephrology and Hypertension, Klinikum Schwabing, Munich, Germany
| | - K Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - E Lonn
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - P Sleight
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - G Mancia
- IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - D Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - F Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - C Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - K Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Bakris
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - S Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Sohani Z, Anand S, Robiou-du-Pont S, Morrison K, McDonald S, Atkinson S, Teo K, Meyre D. 137: Genes Increasing Glucose Levels in Early Childhood Provide Support for the Fetal Insulin Hypothesis: Results from the Family Study. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e84] [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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Rosengren A, Teo K, Rangarajan S, Kabali C, Khumalo I, Kutty VR, Gupta R, Yusuf R, Iqbal R, Ismail N, Altuntas Y, Kelishadi R, Diaz R, Avezum A, Chifamba J, Zatonska K, Wei L, Liao X, Lopez-Jaramillo P, Yusufali A, Seron P, Lear SA, Yusuf S. Psychosocial factors and obesity in 17 high-, middle- and low-income countries: the Prospective Urban Rural Epidemiologic study. Int J Obes (Lond) 2015; 39:1217-23. [PMID: 25869608 PMCID: PMC4766924 DOI: 10.1038/ijo.2015.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Received: 06/18/2014] [Revised: 10/21/2014] [Accepted: 11/23/2014] [Indexed: 02/05/2023]
Abstract
Background/Objectives: Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study. Subjects/Methods: This observational, cross-sectional study enrolled 151 966 individuals aged 35–70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression). Results: After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ⩾30 kg m−2) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99–1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97–1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04–1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00–1.03)). Conclusions: Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity.
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Affiliation(s)
- A Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - S Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - C Kabali
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - I Khumalo
- North-West University, Optentia Research Programme, Faculty of Humanities, Vanderbilpark, South Africa
| | - V R Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R Gupta
- Fortis Escorts Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - R Yusuf
- Independent University Bangladesh, Dhaka, Bangladesh
| | - R Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - N Ismail
- Department of Community Health, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | - Y Altuntas
- SB Pediatric Endocrinology and Metabolism, Training and Research Hospital, Istanbul, Turkey
| | - R Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina
| | - A Avezum
- Dante Pazzanese Institute of cardiology, Sao Paulo, Brazil
| | - J Chifamba
- Physiology Department, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - K Zatonska
- Department of Social Medicine, Medical University of Wrocław, Wrocław, Poland
| | - L Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Liao
- Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - P Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Santander, Colombia
| | | | - P Seron
- Universidad de La Frontera, Temuco, Chile
| | - S A Lear
- Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - S Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Baillie T, Teo K, Sidharta S, Worthley S, Sanders P, Steele P, Nicholls S, Worthley M. A novel non-invasive pulmonary vasoreactive challenge utilising cardiac magnetic resonance imaging: comparison of subjects with and without pulmonary arterial hypertension. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.482] [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: 10/23/2022]
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Pathak R, Nelson A, Meredith M, Carbone A, Mehta A, Teo K, Williams K, Mahajan R, Twomey D, Lau D, Abhayaratna W, Sanders P. Effect of weight loss and risk factor management on pericardial fat and cardiac structure in-patients with atrial fibrillation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.531] [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: 10/23/2022]
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42
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Wong G, Parvar S, Rajwani A, Williams K, Scherer D, Pisaniello A, Roberts-Thomson R, Shirazi M, Brown M, Worthley S, Teo K. Large apical thrombus due to Takotsubo cardiomyopathy. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.553] [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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Wong G, Parvar S, Rajwani A, Williams K, Scherer D, Roberts-Thomson R, Nelson A, Shirazi M, Worthley S, Teo K. A mediastinal mass following coronary artery bypass surgery. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.480] [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: 10/23/2022]
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Wong G, Parvar S, Williams K, Rajwani A, Scherer D, Roberts-Thomson R, Nelson A, Brown M, Young G, Sanders P, Worthley S, Teo K. MR conditional pacemaker - An initial CMR experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mahajan R, Nelson A, Wong C, Brooks A, Pathak R, Middeldorp M, Twomey D, Alasady M, Carbone A, Teo K, Selvanayagam J, Lau D, Sanders P. Obesity and atrial fibrillation: electroanatomical left atrial remodelling with pronounced changes adjacent to epicardial fat. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.311] [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: 10/23/2022]
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Ahn P, Anamalayil S, Lustig R, Teo K. Comparison of the Effect of Full-Neck Volumetric Modulated Arc Therapy IMRT Versus Split-Field IMRT Techniques on Radiation Dose to Low Neck Structures. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dise J, Liang X, Lin L, Teo K. Development and Evaluation of an Automatic Interstitial Catheter Digitization Tool for HDR Brachytherapy of Gynecologic Cancers. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Apisarnthanarax S, Fernandes AT, Lin Y, Rosen MA, Plastaras JP, Metz JM, Ben-Josef E, Teo K. Cinematic MRI imaging for hepatic malignancies: Implications for improving accuracy of radiation therapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
300 Background: Accurate radiation therapy (RT) targeting of hepatic tumors is critically dependent on organ and tumor motion assessment, most commonly performed with 4DCT. Since 4DCT captures only a snapshot of tumor motion in time and is prone to artifacts and irregular breathing, it is unclear how reliable 4DCT is in determining intra-fraction tumor motion. CineMRI allows for prolonged real-time organ and tumor motion assessment with no radiation exposure. We compared the extent of tumor motion between 4DCT and cineMRI in patients with hepatic tumors treated with RT. Methods: Sixteen patients with hepatocellular carcinoma (n=11), cholangiocarcinoma (n=3), and liver metastasis (n=2) underwent 4DCT and 2D biplanar cineMRI scans during simulation to determine the extent of target motion in the superior/inferior (S/I), anterior/posterior (A/P) and lateral directions. Biplanar cineMRI was performed over 5 minutes. Tumor motion from MRI was determined by tracking the centroid position of the gross tumor volume (GTV) using deformable image registration. Margins were determined by using histograms of 90% confidence interval of GTV motion in each direction. Motion estimates from 4DCT were performed by evaluation of the marker positions in each phase of the CT. We compared the extent of GTV motion and resulting margin size between cineMRI and 4DCT. Results: 4DCT underestimated the S/I margin in 50% of patients by a mean of 3.4 mm (range: 1.5-7 mm), the A/P margin in 44% of patients by a mean of 2.8 mm (range: 1-5.5 mm), and the lateral margin in 63% of patients by a mean of 1.6 mm (range: 0.2-4.5 mm). The average inferior motion (median to 10th percentile) was of greater magnitude (5.0 mm vs. 3.5 mm) compared to the average superior motion (median to 90th percentile). Superior, inferior, lateral, anterior, and posterior margins of 6, 8, 5, 6, and 4 mm respectively would be needed to cover 90% of the intra-fraction GTV motion as defined by cineMRI. Conclusions: CineMRI frequently detects larger differences in hepatic intra-fraction tumor motion when compared to 4DCT, most notably in the S/I direction, and may be useful when treating without respiratory management, particularly in patients with unreliable 4DCT imaging.
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Affiliation(s)
| | | | - Yingshu Lin
- University of Pennsylvania, Philadelphia, PA
| | | | | | - James M. Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - Kevin Teo
- University of Pennsylvania, Philadelphia, PA
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Brousmiche S, Seabra J, Labarbe R, Vila Oliva M, Rit S, Wikler D, Lee J, Teo K, Orban de Xivry J, Macq B. PO-0783: Design of cone-beam CT for proton therapy gantry. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30901-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fernandes A, Whaley J, Teo K, Plastaras J, Metz J, Perini R, Pryma D, Apisarnthanarax S. Predicting Outcomes in Locally-Advanced Rectal Cancer Using Pretreatment FDG-PET Imaging. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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