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Anthony P, Barat S, Ahmadi N, Morris DL. The CEA/PCI ratio is a superior prognosticator than mCOREP for colorectal cancer patients with peritoneal carcinomatosis. Surg Open Sci 2024; 19:28-31. [PMID: 38585035 PMCID: PMC10995861 DOI: 10.1016/j.sopen.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024] Open
Abstract
Background The CEA/PCI ratio, which evaluates tumour marker and burden, has been demonstrated as a prognosticator for patients with colorectal cancer with peritoneal carcinomatosis. The aim of this study was to compare the CEA/PCI ratio with the Modified Colorectal Peritoneal Score (mCOREP) for overall survival (OS) and recurrence free survival (RFS). There is no literature currently comparing both markers for RFS. Methods Data was collected retrospectively for patients undergoing CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) at the Peritonectomy Unit at St. George Hospital, NSW from January 2015 to December 2021. Results From 187 patients, an increase in CEA/PCI ratio was associated with reduced OS (p < 0.01) and RFS (p < 0.01), whereas mCOREP score did not demonstrate such association with OS (p = 0.5) nor RFS (p = 0.4). However, CEA/PCI ratio greater than the median of 0.63 was correlated with an increased OS (p = 0.01), whereas the mCOREP greater than the median of 4 correlated with reduced OS (p < 0.01). Median mCOREP also demonstrated association with reduced RFS in patients with PCI <15 (p = 0.03), whereas CEA/PCI ratio above 0.63 demonstrated association with reduced RFS in patients with PCI ≥ 15 (p = 0.02). Conclusion The CEA/PCI ratio is more associated with OS and RFS in patients with colorectal cancer with peritoneal carcinomatosis, when compared with mCOREP. CEA/PCI ratio above 0.63 was correlated with increased OS, whereas mCOREP above 4 is correlated with reduced OS. CEA/PCI ratio above 0.63 demonstrated reduced RFS for patients with higher PCIs. By contrast, mCOREP >4 illustrated reduced RFS in patients with lower PCIs.
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Affiliation(s)
- Phelopatir Anthony
- South Eastern Sydney Local Health District, Australia
- University of New South Wales, NSW, Australia
| | - Shoma Barat
- South Eastern Sydney Local Health District, Australia
| | - Nima Ahmadi
- South Eastern Sydney Local Health District, Australia
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Sarofim M, Wijayawardana R, Ahmadi N, Barat S, Liauw W, Morris DL. Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery. World J Surg Oncol 2024; 22:103. [PMID: 38637820 PMCID: PMC11025186 DOI: 10.1186/s12957-024-03392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Colorectal peritoneal metastases (CRPM) affects 15% of patients at initial colorectal cancer diagnosis. Neoadjuvant chemotherapy (NAC) prior to cytoreductive surgery (CRS) has been demonstrated to be a safe and feasible option, however there is limited data describing its efficacy in advanced peritoneal disease. This study evaluated the effect of NAC on survival in patients with high volume CRPM undergoing CRS with or without HIPEC. METHODS A retrospective review of all patients who underwent CRS with or without HIPEC for CRPM from 2004 to 2019 at our institution was performed. The cohort was divided based on peritoneal carcinomatosis index (PCI) at surgery: Low Volume (PCI ≤ 16) and High Volume (PCI > 16). RESULTS A total of 326 patients underwent CRS with HIPEC for CRPM. There were 39 patients (12%) with High Volume disease, and 15 of these (38%) received NAC. Patients with High Volume disease had significantly longer operating time, lower likelihood of complete macroscopic cytoreduction (CC-0 score), longer intensive care unit length of stay and longer hospital stay compared to Low Volume disease. In High Volume disease, the NAC group had a significantly shorter median survival of 14.4 months compared to 23.8 months in the non-NAC group (p = 0.046). CONCLUSION Patients with High Volume CRPM achieved good median survival following CRS with HIPEC, which challenges the current PCI threshold for offering CRS. The use of NAC in this cohort did not increase perioperative morbidity but was associated with significantly shorter median survival compared to upfront surgery.
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Affiliation(s)
- Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Sydney, NSW, Australia.
- School of Medicine, University of New South Wales, Sydney, Australia.
- School of Medicine, University of Sydney, Sydney, Australia.
| | - Ruwanthi Wijayawardana
- Liver and Peritonectomy Unit, St George Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Nima Ahmadi
- Liver and Peritonectomy Unit, St George Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Shoma Barat
- Liver and Peritonectomy Unit, St George Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Winston Liauw
- School of Medicine, University of New South Wales, Sydney, Australia
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
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3
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Sarofim M, Wijayawardana R, Ahmadi N, Morris DL. Repeat cytoreductive surgery with HIPEC for colorectal peritoneal metastases: a systematic review. World J Surg Oncol 2024; 22:99. [PMID: 38627808 PMCID: PMC11022433 DOI: 10.1186/s12957-024-03386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Colorectal peritoneal metastases (CRPM) are present in 10-20% of patients at the time of their initial cancer diagnosis, and affects over 20% of those who develop colorectal cancer recurrence. Cytoreductive surgery (CRS) with HIPEC is firmly established as the optimal surgical treatment, but there is very little known about the benefit of repeat or iterative CRS. The aim of this review is to provide a systematic evaluation of the perioperative complications, survival outcomes and quality of life in patients undergoing repeat CRS with HIPEC for CRPM. METHODS A systematic review of PubMed, Ovid MEDLINE, EMBASE, Scopus and Cochrane databases was performed to identify all studies that reported outcomes for repeat CRS with or without HIPEC for CRPM. RESULTS Four hundred and ninety-three manuscripts were screened, and 15 retrospective studies were suitable for inclusion. Sample sizes ranged from 2 to 30 participants and comprised a total of 229 patients. HIPEC was used in all studies, but exact rates were not consistently stated. Perioperative morbidity was reported in four studies, between 16.7% and 37.5%. Nine studies reported mortality rate which was consistently 0%. The median overall survival after repeat CRS ranged from 20 to 62.6 months. No studies provided quality of life metrics. CONCLUSION Repeat CRS for CRPM has perioperative morbidity and mortality rates comparable to initial CRS, and offers a potential survival benefit in selected patients. There is however limited high-quality data in the literature.
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Affiliation(s)
- Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia.
- School of Medicine, University of New South Wales, Sydney, NSW, Australia.
- School of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Ruwanthi Wijayawardana
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nima Ahmadi
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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Steffens D, Ansari N, Koh C, Ahmadi N, Solomon MJ, Hogan S, Karunaratne S, Anderson T, Harvey K, McBride K, Moran B. Complexity of surgery and treatment burden in patients with peritoneal malignancy is not determined by addition of hyperthermic intraperitoneal chemotherapy. ANZ J Surg 2024; 94:628-633. [PMID: 38450829 DOI: 10.1111/ans.18933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND This study describes surgical and quality of life outcomes in patients with peritoneal malignancy treated by cytoreductive surgery (CRS) alone compared with a subgroup treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS Peritoneal malignancy patients undergoing surgery between 2017 and 2023 were included. The cohort was divided into patients treated by CRS and HIPEC and those treated by CRS without HIPEC (including CRS only or maximal tumour debulking (MTB)). Main outcomes included surgical outcomes, survival, and quality of life. Groups were compared using non-parametric tests and log-rank test was used to compare survival curves. RESULTS 403 had CRS and HIPEC, 25 CRS only and 15 MTB. CRS and HIPEC patients had a lower peritoneal carcinomatosis index (12.0 vs. 17.0 vs. 35.0; P < 0.001) and longer surgical operative time (9.3 vs. 8.3 vs. 5.2 h; P < 0.001), when compared to CRS only and MTB, respectively. No other significant difference between groups was observed. CONCLUSIONS The optimal management of selected patients with resectable peritoneal malignancy incorporates a combined strategy of CRS and HIPEC. When HIPEC is not utilized, due to significant residual disease or comorbidity precluding safe delivery, CRS alone is associated with good outcomes. Hospital stay and complications are acceptable but not significantly different to the CRS and HIPEC group. CRS alone is a complex intervention requiring comparable resources with good outcomes. In view of our findings 'intention to treat' with CRS and HIPEC should be the basis for resource allocation and funding.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nima Ahmadi
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sophie Hogan
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Teresa Anderson
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kiel Harvey
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kate McBride
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute Basingstoke, Basingstoke, United Kingdom
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Brown KGM, Ng KS, Solomon MJ, Chapuis PH, Koh CE, Ahmadi N, Austin KKS. Complete mesocolic excision for colon cancer: current status and controversies. ANZ J Surg 2024; 94:309-319. [PMID: 37850417 DOI: 10.1111/ans.18741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
According to Hohenberger's original description, complete mesocolic excision for colon cancer involves precise dissection of the avascular embryonic plane between the parietal retroperitoneum and visceral peritoneum of the mesocolon. This ensures mesocolic integrity, access to high ligation of the supplying vessels at their origin and an associated extended lymphadenectomy. Results from centres which have adopted this approach routinely have demonstrated that oncological outcomes can be improved by the rigorous implementation of established principles of cancer surgery. Meticulous anatomical dissection along embryonic planes is a well-established principle of precision cancer surgery used routinely by the specialist colorectal surgeon. Therefore, the real question concerns the need for true central vascular ligation and associated extended (D3) lymphadenectomy or otherwise, particularly along the superior mesenteric vessels when performing a right colectomy. Whether this approach results in improved overall or disease-free survival remains unclear and its role remains controversial particularly given the potential for significant morbidity associated with a more extensive central vascular dissection. Current literature is limited by considerable bias, as well as inconsistent and variable terminology, and the results of established randomized trials are awaited. As a result of the current state of equipoise, various national guidelines have disparate recommendations as to when complete mesocolic excision should be performed if at all. This article aims to review the rationale for and technical aspects of complete mesocolic excision, summarize available short and long term outcome data and address current controversies.
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Affiliation(s)
- Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pierre H Chapuis
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nima Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Kirk K S Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
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Ahmadi N, Sasangohar F, Yang J, Yu D, Danesh V, Klahn S, Masud F. Quantifying Workload and Stress in Intensive Care Unit Nurses: Preliminary Evaluation Using Continuous Eye-Tracking. Hum Factors 2024; 66:714-728. [PMID: 35511206 DOI: 10.1177/00187208221085335] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE (1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU. BACKGROUND Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses' workload. This is the first naturalistic attempt to explore nurses' mental workload using eye movement data. METHODS Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes. RESULTS While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter. CONCLUSION Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development.
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Affiliation(s)
- Nima Ahmadi
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA and Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Jing Yang
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Valerie Danesh
- Baylor Scott & White Health, Center for Applied Health Research, Dallas, TX, USA and University of Texas at Austin, School of Nursing, Austin, TX, USA
| | - Steven Klahn
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Masud
- Center for Critical Care, Houston Methodist Hospital, Houston, TX, USA
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Siu A, Steffens D, Ansari N, Karunaratne S, Solanki H, Ahmadi N, Solomon M, Moran B, Koh C. Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Tech Coloproctol 2024; 28:35. [PMID: 38376623 PMCID: PMC10879398 DOI: 10.1007/s10151-024-02911-9] [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: 12/13/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Rural Australians typically encounter disparities in healthcare access leading to adverse health outcomes, delayed diagnosis and reduced quality of life (QoL) parameters. These disparities may be exacerbated in advanced malignancies, where treatment is only available at highly specialised centres with appropriate multidisciplinary expertise. Thus, this study aims to determine the association between patient residence on oncological, surgical and QoL outcomes following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC). METHODS A retrospective analysis was conducted on consecutive patients undergoing CRS and HIPEC at Royal Prince Alfred Hospital from January 2017 to March 2022. On the basis of their postcode of residence, patients were stratified into metropolitan and regional groups. Data encompassing demographics, oncological, surgical and QoL outcomes were compared. Statistical analysis included chi-square test, t-tests and Kaplan-Meier survival curves. RESULTS Among the 317 patients, 228 (72%) were categorised as metropolitan and 89 (28%) as regional. Metropolitan patients presented higher rates of recurrence (61.8% versus 40.0%, p = 0.014) and shorter overall mean survival [3.8 years (95% CI: 3.44-4.09) versus 4.2 years (95% CI: 3.76-4.63), p = 0.019] compared with regional patients. No other statistically significant differences were observed in oncological, surgical and QoL outcomes. CONCLUSIONS Most oncological, surgical and QoL parameters did not differ by geographical location of patients undergoing CRS and HIPEC for peritoneal malignancies at a high-volume quaternary referral centre. Observed differences in recurrence and survival may be attributed to the selective nature of surgical referrals and variable follow-up patterns. Future research should focus on characterising referral pathways and its influence on post-operative outcomes.
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Affiliation(s)
- Adrian Siu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Henna Solanki
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
| | - Nima Ahmadi
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, North Hampshire Foundation Trust, Basingstoke, UK
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, C/O Royal Prince Alfred Hospital, Missenden Road, PO Box M 157, Camperdown, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Gao Y, Lodh SP, Ahmadi N. Pelvic arteriovenous malformation causing per rectal haemorrhage - A case report. Int J Surg Case Rep 2024; 115:109291. [PMID: 38280343 PMCID: PMC10839948 DOI: 10.1016/j.ijscr.2024.109291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE We present the case of a 17 years old girl with per rectal haemorrhage secondary to pelvic arteriovenous malformations (AVM) and potentially haemorrhoids. Pelvic AVMs are rare and extremely variable in their clinical presentation, size and location and pose a therapeutic challenge. Focus has turned towards interventional radiological procedures with angioembolisation as the main treatment form for pelvic AVMs. CASE PRESENTATION A 17 years old girl presented to a rural hospital with significant per rectal bleeding requiring transfer to a tertiary centre with interventional radiology capabilities. Diagnostic imaging determined the presence of a pelvic AVM as well as haemorrhoid. She had no prior history of haemorrhoids, per rectal bleeding or per vaginal bleeding. Further diagnostic imaging including a digital subtraction angiography and MRI pelvis was performed and her case was discussed at a multidisciplinary meeting where the decision was made for angioembolisation of a large right rectal AVM as well as precautionary banding of haemorrhoids that had developed secondary to outflow obstruction. A repeat CT mesenteric angiogram a month later demonstrated diminished appearances of the rectal AVM. CLINICAL DISCUSSION Pelvic AVMs are a rare entity and are not a common cause for per rectal bleeding. There is currently no direct consensus on the optimum management of complex pelvic AVMs particularly those that present with a second pathology such as haemorrhoids. Surgical management often results in recurrence or rapid progression of the AVM lesion and recruitment of new blood supply further complicates the problem. Selective embolisation allows for control of haemorrhage and utilises chemical agents as well as detachable coils and balloons. However, postoperative pain and swelling can still be expected and multiple transcatheter embolisations may be required. CONCLUSION The treatment of symptomatic pelvic AVMs is complex and requires a multidisciplinary approach with careful radiological planning prior to embolisation. Angioembolisation is becoming increasingly prevalent and multiple embolisation procedures may be required to reach the desired therapeutic effect.
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Affiliation(s)
- Yijun Gao
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia; University of New South Wales, St George & Sutherland Clinical School, Sydney, NSW 2217, Australia.
| | - Suhrid P Lodh
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia
| | - Nima Ahmadi
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia
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Sarofim M, Ahmadi N, Morris DL. Shifting the paradigm of long-term total parenteral nutrition: Lessons from renal dialysis. JPEN J Parenter Enteral Nutr 2024. [PMID: 38297819 DOI: 10.1002/jpen.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Mina Sarofim
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Nima Ahmadi
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David L Morris
- Liver and Peritonectomy Unit, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Ahmadi N, Tsang MY, Gu AN, Tsang TSM, Abolmaesumi P. Transformer-Based Spatio-Temporal Analysis for Classification of Aortic Stenosis Severity From Echocardiography Cine Series. IEEE Trans Med Imaging 2024; 43:366-376. [PMID: 37581960 DOI: 10.1109/tmi.2023.3305384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Aortic stenosis (AS) is characterized by restricted motion and calcification of the aortic valve and is the deadliest valvular cardiac disease. Assessment of AS severity is typically done by expert cardiologists using Doppler measurements of valvular flow from echocardiography. However, this limits the assessment of AS to hospitals staffed with experts to provide comprehensive echocardiography service. As accurate Doppler acquisition requires significant clinical training, in this paper, we present a deep learning framework to determine the feasibility of AS detection and severity classification based only on two-dimensional echocardiographic data. We demonstrate that our proposed spatio-temporal architecture effectively and efficiently combines both anatomical features and motion of the aortic valve for AS severity classification. Our model can process cardiac echo cine series of varying length and can identify, without explicit supervision, the frames that are most informative towards the AS diagnosis. We present an empirical study on how the model learns phases of the heart cycle without any supervision and frame-level annotations. Our architecture outperforms state-of-the-art results on a private and a public dataset, achieving 95.2% and 91.5% in AS detection, and 78.1% and 83.8% in AS severity classification on the private and public datasets, respectively. Notably, due to the lack of a large public video dataset for AS, we made slight adjustments to our architecture for the public dataset. Furthermore, our method addresses common problems in training deep networks with clinical ultrasound data, such as a low signal-to-noise ratio and frequently uninformative frames. Our source code is available at: https://github.com/neda77aa/FTC.git.
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Mohaghegh S, Alirezaei F, Ahmadi N, Kouhestani F, Motamedian SR. Application of chemical factors for acceleration of consolidation phase of the distraction osteogenesis: a scoping review. Oral Maxillofac Surg 2023; 27:559-579. [PMID: 35852720 DOI: 10.1007/s10006-022-01097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to analyze the effect of injecting chemical factors compared to conventional distraction osteogenesis (DO) treatment on the bone formation of the distracted area of the maxillofacial region in human and animal studies. METHOD Electronic search was done in PubMed, Scopus, Embase, and Cochrane database for studies published until September 2021. The studies' risk of bias (ROB) was assessed using the Cochrane Collaborations and NIH quality assessment tools. Meta-analyses were performed to assess the difference in the amount of bone formation and maximal load tolerance. RESULTS Among a total of 58 included studies, eight studies analyzed the bone formation rate of the distracted area in human models and others in animal models. Results of the human studies showed acceptable outcomes in the case of using bone morphogenic protein-2 (BMP-2), autologous bone-platelet gel, and calcium sulfate. However, using platelet reach plasma does not increase the rate of bone formation significantly. Quantitative analyses showed that both BMP-2 (SMD = 26.57; 95% CI = 18.86 to 34.28) and neuron growth factor (NGF) (SMD = 16.19; 95% CI = 9.64 to 22.75) increase the amount of bone formation. Besides, NGF increased the amount of load tolerance significantly (SMD = 30.03; 95% CI = 19.91 to 40.16). Additionally, BMP-2 has no significant impact on the post-treatment maxillary length (SMD = 9.19; 95% CI = - 2.35 to 20.73). CONCLUSION Limited number of human studies with low quality used chemical factors to enhance osteogenesis and showed acceptable results. However, more studies with higher quality are required.
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Affiliation(s)
- Sadra Mohaghegh
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Fatemeh Alirezaei
- Department of Orthodontics, School of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Nima Ahmadi
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Farnaz Kouhestani
- Department of Periodontics, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran.
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Karpes JB, Shamavonian R, Dewhurst S, Cheng E, Wijayawardana R, Ahmadi N, Morris DL. Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions. Cancers (Basel) 2023; 15:4704. [PMID: 37835398 PMCID: PMC10571654 DOI: 10.3390/cancers15194704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.
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Affiliation(s)
- Josh B. Karpes
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Raphael Shamavonian
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Suzannah Dewhurst
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Ernest Cheng
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Ru Wijayawardana
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Nima Ahmadi
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - David L. Morris
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
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Ahmadi N, Ahmadi N, Ravindran P, Kim TJ, Byrne CM, Young CJ. Acute diverticulitis in immunosuppressed patients: a 12-year management experience. ANZ J Surg 2023; 93:2161-2165. [PMID: 37079781 DOI: 10.1111/ans.18370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis. METHOD A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018. RESULT A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001). CONCLUSION Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.
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Affiliation(s)
- Navid Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nima Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Colorectal Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Tae Jun Kim
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Ahmadi N, Niazmand M, Ghasemi A, Mohaghegh S, Motamedian SR. Applications of Machine Learning in Facial Cosmetic Surgeries: A Scoping Review. Aesthetic Plast Surg 2023; 47:1377-1393. [PMID: 37277660 DOI: 10.1007/s00266-023-03379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/23/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To review the application of machine learning (ML) in the facial cosmetic surgeries and procedures METHODS AND MATERIALS: Electronic search was conducted in PubMed, Scopus, Embase, Web of Science, ArXiv and Cochrane databases for the studies published until August 2022. Studies that reported the application of ML in various fields of facial cosmetic surgeries were included. The studies' risk of bias (ROB) was assessed using the QUADAS-2 tool and NIH tool for before and after studies. RESULTS From 848 studies, a total of 29 studies were included and categorized in five groups based on the aim of the studies: outcome evaluation (n = 8), face recognition (n = 7), outcome prediction (n = 7), patient concern evaluation (n = 4) and diagnosis (n = 3). Total of 16 studies used public data sets. ROB assessment using QUADAS-2 tool revealed that six studies were at low ROB, five studies were at high ROB, and others had moderate ROB. All studies assessed with NIH tool showed fair quality. In general, all studies showed that using ML in the facial cosmetic surgeries is accurate enough to benefit both surgeons and patients. CONCLUSION Using ML in the field of facial cosmetic surgery is a novel method and needs further studies, especially in the fields of diagnosis and treatment planning. Due to the small number of articles and the qualitative analysis conducted, we cannot draw a general conclusion about the impact of ML in the sphere of facial cosmetic surgery. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nima Ahmadi
- Student research committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maral Niazmand
- Student research committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ghasemi
- Student research committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadra Mohaghegh
- Student research committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran.
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Motamedian SR, Ahmadi N, Ghaffari S, Niazmand M, Mohaghegh S, Morice A, Khonsari RH. Effects of distraction osteogenesis with Le Fort osteotomies on upper airway volumes: a systematic review and meta-analyses. J Stomatol Oral Maxillofac Surg 2023:101553. [PMID: 37422264 DOI: 10.1016/j.jormas.2023.101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Distraction osteogenesis is one of the treatment options in patients with severe maxillomandibular abnormalities to treat morphological and respiratory problems (obstructive sleep apnea syndrome). The study aimed to evaluate the effect of Le Fort I, II and III distraction osteogenesis (DO) on upper airway dimensions and respiratory function. METHODS Electronic search was performed in PubMed, Scopus, Embase, Google Scholar and Cochrane databases. Studies that only involved two dimensional analyses were excluded. Besides, studies that performed DO in conjunction with orthognathic surgery were not considered. NIH quality assessment tool was used to evaluate the risk of bias. Meta-analyses were performed to assess sleep apnea indices and the mean differences in the airway dimensions before and after DO. Gradings of Recommendations, Assessment, Development and Evaluation were used to analyze the evidence level. RESULTS Among the 114 studies that went under full-text analyses, 11 articles met the inclusion criteria. Results of the quantitative analyses showed that maxillary Le Fort III DO significantly increased the amounts of oropharyngeal, pharyngeal and upper airway volumes. However, apnea-hypopnea index (AHI) showed a non-significant improvement after this procedure. Besides, the dimensions of the airways increased with Le Fort I and II DO, according to a qualitative analysis. Considering the design of the included studies, our results had a low level of evidence. CONCLUSION Maxillary Le Fort DO does not significantly impact AHI, while it significantly increases the airway dimensions. Meanwhile, multicentric studies with standardized evaluation are still required to confirm the effects of maxillary Le Fort DO on airway obstruction.
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Affiliation(s)
- Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Ahmadi
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Ghaffari
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maral Niazmand
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadra Mohaghegh
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anne Morice
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université Paris Cité; Paris, France
| | - Roman Hossein Khonsari
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université Paris Cité; Paris, France.
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Cheng E, Shamavonian R, Mui J, Hayler R, Karpes J, Wijayawardana R, Barat S, Ahmadi N, Morris DL. Overall survival and morbidity are not associated with advanced age for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Pleura Peritoneum 2023; 8:83-90. [PMID: 37304160 PMCID: PMC10249755 DOI: 10.1515/pp-2022-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has enabled better prognosis for patients with peritoneal surface malignancies. However, in older age groups, short -and long-term outcomes are still perceived as poor. We evaluated patients aged 70 and over and determine if age is a predictor of morbidity, mortality and overall survival (OS). Methods A retrospective cohort analysis was performed on CRS/HIPEC patients and categorised by age. The primary outcome was overall survival. Secondary outcomes included morbidity, mortality, hospital and incentive care unit (ICU) stay and early postoperative intraperitoneal chemotherapy (EPIC). Results A total of 1,129 patients were identified with 134 aged 70+ and 935 under 70. There was no difference in OS (p=0.175) or major morbidity (p=0.051). Advanced age was associated with higher mortality (4.48 vs. 1.11 %, p=0.010), longer ICU stay (p<0.001) and longer hospitalisation (p<0.001). The older group was less likely to achieve complete cytoreduction (61.2 vs. 73 %, p=0.004) and receive EPIC (23.9 vs. 32.7 %, p=0.040). Conclusions In patients undergoing CRS/HIPEC, age of 70 and above does not impact OS or major morbidity but is associated with increased mortality. Age alone should not be a limiting factor in selecting CRS/HIPEC patients. Careful multi-disciplinary approach is needed when considering those of advanced age.
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Affiliation(s)
- Ernest Cheng
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raphael Shamavonian
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Jasmine Mui
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Josh Karpes
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Ruwanthi Wijayawardana
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Shoma Barat
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Nima Ahmadi
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - David L. Morris
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
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Hayler R, Lockhart K, Barat S, Cheng E, Mui J, Shamavonian R, Ahmadi N, Alzahrani N, Liauw W, Morris D. Survival benefits with EPIC in addition to HIPEC for low grade appendiceal neoplasms with pseudomyxoma peritonei: a propensity score matched study. Pleura Peritoneum 2023; 8:27-35. [PMID: 37020474 PMCID: PMC10067551 DOI: 10.1515/pp-2022-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
Abstract
Objectives
Appendiceal cancer is a rare malignancy, occurring in roughly 1.2 per 100,000 per year. Low grade appendiceal neoplasams (LAMN) in particular can lead to pseudomyxoma peritonei (PMP), and respond poorly to systemic chemotherapy. Standard treatment includes cytoreduction surgery (CRS) with addition of heated intraoperative peritoneal chemotherapy (HIPEC). Several centres include early postoperative intraperitoneal chemotherapy (EPIC) however; the literature is mixed on the benefits. We aim to examine the benefits of additional EPIC through a propensity-matched analysis.
Methods
Patients with LAMN with PMP who underwent cytoreductive surgery at St George hospital between 1996 and 2020 were included in this retrospective analysis. Propensity score matching was performed with the following used to identify matched controls; sex, age, American Society of Anesthesiologists (ASA) grade, peritoneal cancer index (PCI) and morbidity grade. Outcomes measured included length of stay and survival.
Results
A total of 224 patients were identified of which 52 received HIPEC alone. Propensity matching was performed to identify 52 matched patients who received HIPEC + EPIC. Those receiving HIPEC + EPIC were younger at 54.3 vs. 58.4 years (p=0.044). There was a median survival benefit of 34.3 months for HIPEC + EPIC (127.3 vs. 93.0 months, p=0.02). Median length of stay was higher in those who received EPIC (25.0 vs. 23.5 days, p=0.028).
Conclusions
In LAMN with PMP, the addition of EPIC to HIPEC with CRS improves overall survival in propensity score matched cases but results in prolonged hospitalisation. The use of EPIC should still be considered in selected patients.
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Affiliation(s)
- Raymond Hayler
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
- Faculty of Medicine and Health , Macquarie University , Sydney , Australia
| | - Kathleen Lockhart
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Shoma Barat
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Ernest Cheng
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Jasmine Mui
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Raphael Shamavonian
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Nima Ahmadi
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Nayef Alzahrani
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- College of Medicine , Imam Muhammad Ibn Saud Islamic University , Riyadh , Kingdom of Saudi Arabia
| | - Winston Liauw
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
- Department of Medical Oncology , St George Hospital , NSW , Sydney , Australia
| | - David Morris
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
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Mercado M, Shamavonian R, Cheng E, Ahmadi N, Morris DL. Comparing Survival Outcomes and Impact of EPIC in Patients Undergoing CRS/HIPEC for Mucinous Appendiceal Neoplasm. Anticancer Res 2023; 43:817-822. [PMID: 36697077 DOI: 10.21873/anticanres.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM This study sought to investigate the difference in survival outcomes in patients with complete cytoreduction (CC)-0 or CC-1 mucinous appendiceal cancer undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). It also investigated what effect early postoperative intraperitoneal chemotherapy (EPIC) may have on survival based on CC score and histology. PATIENTS AND METHODS This was a retrospective single centre study of patients that underwent CRS/HIPEC +/- EPIC for mucinous appendiceal neoplasms from June 2003 to February 2022. RESULTS A total of 545 patients were identified. Although there was a survival difference between CC-0 and CC-1 on univariate analyses, this was not statistically significant on multivariate analysis. Histology, peritoneal cancer index, and EPIC status were demonstrated to be independent factors that affected overall survival (OS) on multivariate analysis. Patients with CC-1 that received EPIC had significantly improved OS (mean OS 14 years) when compared to patients that did not receive EPIC (mean OS 6 years). In CC-1, OS was significantly improved in patients that received EPIC in both low-grade (p<0.001) and high-grade (p=0.012) disease. OS for patients that received EPIC at 1, 5, and 10 years was 95%, 80%, and 59%, respectively. OS for patients that did not receive EPIC at 1, 5, and 10 years was 84%, 49%, and 30%, respectively. CONCLUSION There was no difference in OS between CC-0 and CC-1. The implementation of EPIC in patients with CC-1 significantly improved OS in both low-grade and high-grade disease and thus we recommend its addition in CC-1 disease to achieve optimal survival outcome.
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Affiliation(s)
- Melanie Mercado
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Raphael Shamavonian
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Ernest Cheng
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Nima Ahmadi
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - David L Morris
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia; .,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
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Mortazavi H, Nobar BR, Shafiei S, Moslemi H, Ahmadi N, Hazrati P. Oral fixed drug eruption: Analyses of reported cases in the literature. J Stomatol Oral Maxillofac Surg 2022; 123:e355-e363. [PMID: 35443214 DOI: 10.1016/j.jormas.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This analytic study aimed to summarize the data regarding OFDEs manifestations and characteristics available up to date. MATERIALS AND METHODS We searched online databases for relevant articles and summarized their data regarding age, gender, Main drug classification and name, additional drugs, dosages, primary disorders, OFDE presentation and location, extra-oral presentation and location, follow-up, and treatment. RESULTS The mean age of OFDE-affected patients was 38.9. Most of the reported cases were between 30 and 60 years of age. The female/male ratio was 1.12/1. Three drug classifications, which were mainly associated with OFDEs, were analgesics (27.8%), antibiotics (22.2%), and antifungals (11.1%). The most common additional drugs were oral contraceptives and corticosteroids. The three most prevalent disorders or conditions were infectious disease (23.7%), pain (13.2%) and auto-immune disease (10.5%). Erythematous lesions without blister (38.9%), lichenoid drug eruptions (16.7%), blisters/vesicles (13.9%) and ulcers (13.9%) were the most common manifestations of OFDEs. The rarest manifestation of OFDE was pigmentation. Lips, tongue, buccal mucosa, palate and gingiva were the sites in which OFDEs occurred in the included studies. Similar to OFDEs, erythematous lesions without blisters and lichenoid drug eruptions were the most prevalent extra-oral manifestations. The most common time for OFDE manifestations was one to three days after taking the drug. CONCLUSIONS Due to the similarities between the reported cases of OFDEs, clinicians should familiarize themselves with OFDE cases in order to screen suspected patients effectively.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrad Rahbani Nobar
- Dentistry Student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shafiei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Moslemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Ahmadi
- Dentistry Student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Hazrati
- Dentistry Student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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20
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Hasegawa H, Denton RE, Nakamura TKM, Genestreti KJ, Phan TD, Nakamura R, Hwang K, Ahmadi N, Shi QQ, Hesse M, Burch JL, Webster JM, Torbert RB, Giles BL, Gershman DJ, Russell CT, Strangeway RJ, Wei HY, Lindqvist P, Khotyaintsev YV, Ergun RE, Saito Y. Magnetic Field Annihilation in a Magnetotail Electron Diffusion Region With Electron-Scale Magnetic Island. J Geophys Res Space Phys 2022; 127:e2022JA030408. [PMID: 36248013 PMCID: PMC9541864 DOI: 10.1029/2022ja030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 06/16/2023]
Abstract
We present observations in Earth's magnetotail by the Magnetospheric Multiscale spacecraft that are consistent with magnetic field annihilation, rather than magnetic topology change, causing fast magnetic-to-electron energy conversion in an electron-scale current sheet. Multi-spacecraft analysis for the magnetic field reconstruction shows that an electron-scale magnetic island was embedded in the observed electron diffusion region (EDR), suggesting an elongated shape of the EDR. Evidence for the annihilation was revealed in the form of the island growing at a rate much lower than expected for the standard X-type geometry of the EDR, which indicates that magnetic flux injected into the EDR was not ejected from the X-point or accumulated in the island, but was dissipated in the EDR. This energy conversion process is in contrast to that in the standard EDR of a reconnecting current sheet where the energy of antiparallel magnetic fields is mostly converted to electron bulk-flow energy. Fully kinetic simulation also demonstrates that an elongated EDR is subject to the formation of electron-scale magnetic islands in which fast but transient annihilation can occur. Consistent with the observations and simulation, theoretical analysis shows that fast magnetic diffusion can occur in an elongated EDR in the presence of nongyrotropic electron effects. We suggest that the annihilation in elongated EDRs may contribute to the dissipation of magnetic energy in a turbulent collisionless plasma.
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Affiliation(s)
- H. Hasegawa
- Institute of Space and Astronautical ScienceJapan Aerospace Exploration AgencySagamiharaJapan
| | - R. E. Denton
- Department of Physics and AstronomyDartmouth CollegeHanoverNHUSA
| | - T. K. M. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
- Institute of PhysicsUniversity of GrazGrazAustria
| | | | - T. D. Phan
- Space Sciences LaboratoryUniversity of CaliforniaBerkeleyCAUSA
| | - R. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
| | - K.‐J. Hwang
- Southwest Research InstituteSan AntonioTXUSA
| | - N. Ahmadi
- Laboratory for Atmospheric and Space PhysicsUniversity of ColoradoBoulderCOUSA
| | - Q. Q. Shi
- Shandong Provincial Key Laboratory of Optical Astronomy and Solar‐Terrestrial EnvironmentInstitute of Space SciencesShandong UniversityWeihaiChina
| | - M. Hesse
- NASA Ames Research CenterMoffett FieldCAUSA
| | - J. L. Burch
- Southwest Research InstituteSan AntonioTXUSA
| | | | - R. B. Torbert
- Institute of PhysicsUniversity of GrazGrazAustria
- Physics DepartmentUniversity of New HampshireDurhamNHUSA
| | - B. L. Giles
- NASA Goddard Space Flight CenterGreenbeltMDUSA
| | | | - C. T. Russell
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - R. J. Strangeway
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - H. Y. Wei
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | | | | | - R. E. Ergun
- Department of Astrophysical and Planetary SciencesUniversity of ColoradoBoulderCOUSA
| | - Y. Saito
- Institute of Space and Astronautical ScienceJapan Aerospace Exploration AgencySagamiharaJapan
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21
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Shamavonian R, Cheng E, Karpes JB, Barat S, Ahmadi N, Morris DL. Cytoreductive Surgery and HIPEC for Malignant Peritoneal Mesothelioma: Outcomes and Survival From an Australian Centre. Anticancer Res 2022; 42:2939-2944. [PMID: 35641285 DOI: 10.21873/anticanres.15776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the study was to determine outcomes and overall survival (OS) in patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for malignant peritoneal mesothelioma (MPM). PATIENTS AND METHODS This was a retrospective cohort study from a prospectively maintained database of patients that underwent CRS/HIPEC for MPM from April 1999 to December 2021. RESULTS A total of 81 patients were identified with MPM. Median OS was 53 months with a 1-, 3- and 5-year OS of 76%, 55% and 49% respectively. Multivariate analysis identified lymph node status, PCI and CC score as statistically significant prognostic factors that impact survival. Median OS for PCI 0-20 was 103 months vs. 33 months for PCI 21-39 (p=0.005). Median OS for CC0, CC1 and CC2 were 104, 30 and 2.7 months respectively (p<0.001). Hazard ratio for node-positive disease over node-negative was 2.14 (95% CI=1.07-4.31, p<0.033). Grade III/IV complication rate was 43.2% and mortality 4.9%. CONCLUSION CRS/HIPEC remains the gold standard for treating patients with MPM with excellent patient OS. Lymph node status, PCI and CC score were independent prognostic factors that affect OS.
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Affiliation(s)
- Raphael Shamavonian
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Ernest Cheng
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Josh B Karpes
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Shoma Barat
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Nima Ahmadi
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - David L Morris
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St. George Hospital, Kogarah, NSW, Australia; .,St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
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22
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Haidari S, Tröltzsch M, Fliefel R, Jungbluth AA, Otto S, Fegg F, Liokatis P, Ahmadi N, Eberl M, Probst FA, Knösel T. Cancer testis antigen (PRAME) as an independent marker for survival in oral squamous cell carcinoma (OSCC). J Oral Pathol Med 2022; 51:421-428. [PMID: 35430758 DOI: 10.1111/jop.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective was to assess the expression patterns of the cancer testis antigen PRAME, NY-ESO1, and SSX2 in oral squamous cell carcinoma (OSSC) and to correlate the expression with clinical and histopathological parameters including progression-free survival analysis. METHODS The study variables of this retrospective cohort study (n = 83) included demographic data, histopathological data, and information on progression-free survival. PRAME expression patterns were rated based on immunohistochemistry on tissue microarrays (TMA). The survival rate was assessed by Kaplan-Meier method and Cox regression model. The primary predictor variable was defined as the expression of PRAME and the outcome variable was progression-free survival. RESULTS Analysis of progression-free survival using Kaplan-Meier method showed that patients with positive expression of PRAME had lower probabilities of progression-free survival (p < 0.001). According to the Cox regression model, the level of PRAME expression had a considerable and significant independent influence on progression-free survival (positive PRAME expression increasing the hazards for a negative outcome by 285% in our sample; HR = 3.85, 95% CI: 1.45-10.2, p = 0.007). The expression of SSX2 (n = 1) and NY-ESO-1 (n = 5) in our samples was rare. CONCLUSION PRAME is expressed in OSCC and appears to be a suitable marker of progression-free survival, correlates with severe course, and may allow identification of high-risk patients with aggressive progression.
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Affiliation(s)
- Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,Department of Oral and Maxillofacial Surgery, Alexandria-University, Alexandria, Egypt.,Experimental Surgery and Regenerative Medicine (ExperiMed), LMU, Planegg, Germany
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center (MSKCC), New York City, New York, USA
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,Experimental Surgery and Regenerative Medicine (ExperiMed), LMU, Planegg, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Nima Ahmadi
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Marian Eberl
- Department of Sport and Health Sciences, Chair of Epidemiology, Technical University of Munich, Munich, Germany
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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23
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Ahmadi N, Romoser M, Salmon C. Improving the tactical scanning of student pilots: A gaze-based training intervention for transition from visual flight into instrument meteorological conditions. Appl Ergon 2022; 100:103642. [PMID: 34871832 DOI: 10.1016/j.apergo.2021.103642] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Eye tracking has been applied to train novice drivers and clinicians; however, such applications in aviation are limited. This study develops a gaze-based intervention using video-based, expert commentary, and 3M (Mistake, Mitigation, Mastery) training to instruct visual flight rule student pilots on an instrument cross-check to mitigate the risk of losing aircraft control when they inadvertently enter instrument meteorological conditions (IMC). Twenty general aviation student pilots were randomized into control and experimental groups. Dwell time, return time, entropy, Kullback-Leibler divergence, and deviations from flight paths were compared before and after training to straight-and-level-flight (LF) and standard left level turn (LT) scenarios. After the training, the experimental pilots significantly increased dwell time on primary instruments (PIs), reduced randomness in visual search, and fixated on the PIs in shorter times (in the scenario of LT). In terms of piloting, all experimental pilots successfully kept the aircraft control while five control pilots lost control in IMC; significant differences in altitude and rate of climb deviations were observed between groups (in the scenario of LF).
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Affiliation(s)
- Nima Ahmadi
- Western New England University, Department of Industrial Engineering and Engineering Management, Springfield, MA, 01119-2684, USA.
| | - Matthew Romoser
- Western New England University, Department of Industrial Engineering and Engineering Management, Springfield, MA, 01119-2684, USA.
| | - Christian Salmon
- Western New England University, Department of Industrial Engineering and Engineering Management, Springfield, MA, 01119-2684, USA.
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24
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Motamedian SR, Mohaghegh S, Lakmazaheri E, Ahmadi N, Kouhestani F. Efficacy of regenerative medicine for alveolar cleft reconstruction: A systematic review and meta-analysis. Curr Stem Cell Res Ther 2022; 17:446-465. [DOI: 10.2174/1574888x17666220204145347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/05/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
Objective:
Objective: To analyze the efficacy and complications of regenerative medicine compared to autogenous bone graft for alveolar cleft reconstruction.
Method:
Method: Electronic search was done in PubMed, Scopus, Embase and Cochrane database for studies published until May 2021. No limitations were considered for the type of the included studies. The risk of bias (ROB) of the studies was assessed using the Cochrane Collaborations and NIH quality assessment tool. Meta-analyses were performed to assess the difference in the amount of bone formation and rate of complications. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for analyzing the level of the evidence.
Results:
Results: Among a total of 42 included studies, 21 studies used growth factors, 16 studies delivered cells, and five studies used biomaterials for bone regeneration of the alveolar cleft. Results showed no significant difference in the amount of bone formation between bone morphogenic protein-2 and iliac graft treated patients after six months (P=0.44) and 12 months (P=0.17) follow-up. Besides, higher swelling (OR=9.46,P<0.01) and less infection (OR=0.19,P=0.01) observed in BMP treated patients. Using stem cells can reduce the post-treatment pain (OR=0.04,P=0.01) but it has no significant impact on other complications (P>0.05). Using tissue engineering methods reduced the operation time (SD=1.06,P<0.01). GRADE assessment showed that results regarding the amount of bone formation volume after six and 12 months have low level of evidence.
Conclusion:
Conclusion: Tissue engineering methods can provide a comparable amount of bone formation as of the autogenous graft and reduce some of the complications, operation time and hospitalization duration.
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Affiliation(s)
| | - Sadra Mohaghegh
- Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Ehsan Lakmazaheri
- Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Nima Ahmadi
- University of Medical Sciences, Tehran 1983963113, Iran
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25
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Ahmadi N, Sasangohar F, Nisar T, Danesh V, Larsen E, Sultana I, Bosetti R. Quantifying Occupational Stress in Intensive Care Unit Nurses: An Applied Naturalistic Study of Correlations Among Stress, Heart Rate, Electrodermal Activity, and Skin Temperature. Hum Factors 2022; 64:159-172. [PMID: 34478340 DOI: 10.1177/00187208211040889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify physiological correlates to stress in intensive care unit nurses. BACKGROUND Most research on stress correlates are done in laboratory environments; naturalistic investigation of stress remains a general gap. METHOD Electrodermal activity, heart rate, and skin temperatures were recorded continuously for 12-hr nursing shifts (23 participants) using a wrist-worn wearable technology (Empatica E4). RESULTS Positive correlations included stress and heart rate (ρ = .35, p < .001), stress and skin temperature (ρ = .49, p < .05), and heart rate and skin temperatures (ρ = .54, p = .0008). DISCUSSION The presence and direction of some correlations found in this study differ from those anticipated from prior literature, illustrating the importance of complementing laboratory research with naturalistic studies. Further work is warranted to recognize nursing activities associated with a high level of stress and the underlying reasons associated with changes in physiological responses. APPLICATION Heart rate and skin temperature may be used for real-time detection of stress, but more work is needed to validate such surrogate measures.
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Affiliation(s)
- Nima Ahmadi
- 23534 Houston Methodist Hospital, Texas, USA
| | - Farzan Sasangohar
- 23534 Houston Methodist Hospital, Texas, USA
- 2655 Texas A&M University, College Station, USA
| | - Tariq Nisar
- 23534 Houston Methodist Hospital, Texas, USA
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26
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McClintock G, Makary J, Broe M, Leslie S, Ahmadi N, Thanigasalam R. Robotic radical prostatectomy following renal transplant. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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27
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Ahmadi N, Steinberg A, Pynoos R, Mizutani S, Kashiwazaki H, Ni J, Wu Z. GSK3β is involved in promoting Alzheimer's disease pathologies following chronic systemic exposure to Porphyromonas gingivalis lipopolysaccharide in amyloid precursor protein NL-F/NL-F knock-in mice. Brain Behav Immun 2021; 98:1-12. [PMID: 34391814 PMCID: PMC8849844 DOI: 10.1016/j.bbi.2021.08.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022] Open
Abstract
In line with the strong association between periodontitis and Alzheimer's disease (AD) clinically, preclinical studies have shown that systemic exposure to Porphyromonas gingivalis (Pg) initiates AD pathologies. However, the involvement of periodontitis in promoting AD pathologies is unclear. In the present study, we provided evidence that chronic systemic exposure to lipopolysaccharide derived from Pg (PgLPS, 1 mg/kg, daily, intraperitoneally) prompted neuroinflammation and tau hyperphosphorylation in 10-month-old of amyloid precursor protein (APP) knock-in mice, a model of AD, carrying the Swedish and Beyreuther/Iberian mutation (APPNL-F/NL-F). The learning and memory function were assessed using the passive avoidance test. The production of APP, Amyloid (A)β1-42, cytokines, synaptic proteins and the activation of glycogen synthase kinase (GSK)-3β as well as phosphorylation of tau were analyzed by immunohistochemistry, Western blotting or an enzyme-linked immunosorbent assay (ELISA) in the cortex of APPNL-F/NL-F mice. We found that systemic exposure of PgLPS for three consecutive weeks induced learning and memory deficits with significantly reduced postsynaptic density protein (PSD95). Increased hyperphosphorylation of tau in multiple residues, including Ser202, Thr231 and Ser396, but not the accumulation of Aβ1-42 was detected in the neurons of APPNL-F/NL-F mice. Furthermore, PgLPS increased the GSK3β activity by reducing its phosphorylation of the serine residue at position 9 (Ser9) and promoted neuroinflammation by increasing the expression of interleukin-1β (IL-1β) and tumor necrosis factor (TNF-α) while decreasing that of interleukin-10 (IL-10) and transforming growth factor (TGFβ) in the cortex of APPNL-F/NL-F mice. Moreover, the PgLPS-increased GSK3β activity was detected in both microglia and neurons, while the PgLPS-increased TNF-α expression was mainly detected in the microglia in the cortex of APPNL-F/NL-F mice. In in vitro studies, PgLPS (1 µg/ml) stimulation increased the mRNA and protein level of TNF-α in MG6 microglia, which were significantly inhibited by the GSK3β-specific inhibitor TWS119. In contrast, the tau hyperphosphorylation and activation of GSK3β in N2a neurons were enhanced after treatment with conditioned medium from PgLPS-stimulated microglia, which was attenuated after pre-treatment with TNF-α inhibitor. Taken together, these findings indicate that GSK3β is involved in prompting microglia (TNF-α)-dependent tau hyperphosphorylation in neurons, resulting in learning and memory deficits in APPNL-F/NL-F mice without changes in the Aβ expression during chronic systemic exposure to PgLPS. We propose that dampening GSK3β activation may help delay the periodontitis-promoted pathological progression of AD.
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Affiliation(s)
| | | | | | - Shinsuke Mizutani
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Haruhiko Kashiwazaki
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Junjun Ni
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China.
| | - Zhou Wu
- Department of Aging Science and Pharmacology, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan; OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan.
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28
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Ahmadi N, Preston S, Barbar J, Aresu G, Peryt A, Mahadeva R, Coonar A. 485 Unexpected Pathological Findings In 189 LVRS Patients: Clinical Relevance. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
LVRS improves survival and quality of life in selected patients with emphysema. In view of the great improvement in the detailed information available from CT, it is important to evaluate the benefit of routine pathological assessment of the resected specimen. We reviewed the histopathological findings in our contemporary LVRS series to determine the rate of pathological findings in addition to emphysema.
Method
Prospectively collected data from a specialised higher volume LVRS centre. The CT and histopathology reports of 189 consecutive LVRS procedures were reviewed. One underwent thoracotomy, 188 were by VATS, of which one was converted to thoracotomy and of which 22 were by a subxiphoid approach. The target reduction volume was 30-50% of the lung.
Results
All patients were reported to have emphysematous changes in both CT and histology. Ten patients, all with radiographic evidence of a lesion preoperatively, had squamous carcinoma (x2), adenocarcinoma, atypical adenomatous hyperplasia (AAH) (x2), squamous metaplasia (x2), carcinoid tumourlet, chondroid hamartoma, and DIPNECH. There were 39 neoplastic histological findings which were not radiologically reported; these were adenocarcinoma (1), AAH (10), squamous metaplasia (7), carcinoid tumourlet (5), squamous dysplasia (3), neuroendocrine hyperplasia (2), and chemodectoma. In addition, 21 inflammatory/infective cases were also reported.
Conclusions
Our systemic retrospective CT and histopathology review of LVRS operations shows that the rate of additional findings is 32%. Of these 83% were not reported on the pre-operative review of the CT. This supports the value of systematic pathological assessment of resected samples.
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Affiliation(s)
- N Ahmadi
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - S Preston
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - J Barbar
- Cambridge Hospital, Cambridge, United Kingdom
| | - G Aresu
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - A Peryt
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - R Mahadeva
- Cambridge Hospital, Cambridge, United Kingdom
| | - A Coonar
- Royal Papworth Hospital, Cambridge, United Kingdom
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29
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Mortazavi H, Nobar BR, Shafiei S, Ahmadi N. Drug-related cancers: Analyses of head and neck cases reported in the literature. Dent Med Probl 2021; 58:267-280. [PMID: 34176247 DOI: 10.17219/dmp/131116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent advances have attributed carcinogenic potential to pharmacotherapy. Cancers of the head and neck region are no exception. OBJECTIVES This descriptive investigation aimed to identify studies reporting on drugs that have contributed to cancer development in the head and neck region. MATERIAL AND METHODS Online databases were searched for relevant articles and their data were summarized, including age, gender, main drug classification and name, additional drugs, primary disorders, drug-related cancers, and the site of each drug-related cancer. RESULTS The mean age of the patients included in this analysis was 52.9 years. However, drug-related head and neck cancers (DR HNCs) were most prevalent in persons over 60 years of age. Overall, these cancers were more prevalent in females than in males (1.33/1). The HNC-related drugs could mainly be categorized into 3 groups, namely, immunomodulatory/immunosuppressive, chemotherapeutic and chemoprotective drugs, while the most frequently used additional drugs across the studies were corticosteroids. The 5 most prevalent primary conditions for which the patients had received pharmacotherapy were organ transplantations, lymphoproliferative disorders (LPD), rheumatoid arthritis (RA), Epstein-Barr virus (EBV) infection, and bone sarcoma. The most prevalent HNCs were squamous cell carcinoma (SCCs), thyroid cancers (including papillary and follicular thyroid carcinomas), LPD, and mucoepidermoid/acinic cell carcinomas, which occurred mostly in the oral cavity, neck, salivary glands, pharynx/larynx, and head/face. CONCLUSIONS This study was the first of its kind to analyze and discuss the aforementioned findings regarding the head and neck region in depth. Clinicians should familiarize themselves with DR HNC cases to effectively screen suspected patients.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrad Rahbani Nobar
- Dentistry student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shafiei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Ahmadi
- Dentistry student, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ahmadi N, Mor I, Warner R. Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies. J Robot Surg 2021; 16:429-436. [PMID: 34081291 DOI: 10.1007/s11701-021-01246-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
To compare the outcomes of patients undergoing right hemicolectomy using laparoscopic or robotic approaches and perform a cost analysis. Retrospective review of all patients undergoing elective laparoscopic and robotic right hemicolectomies at a public and private hospital in NSW/QLD from January 2015 to June 2018. Cost analysis was calculated using actual and estimated costs by the local health district. A total of 101 patients were identified. 59 (58%) had Robotic resection, of which 44 (75%) had an intra-corporeal anastomosis. There were no demographic or oncological differences between the two groups. The robotic group had a significantly earlier time to bowels opening (2 vs 4 days, p < 0.001) and shorter length of stay (3 vs 5 days, p < 0.001). The robotic group had a lower rate of ileus (2% vs 14%, p = 0.02) and complications (5% vs 33%, p = 0.006). The mean lymph node harvest was higher in the robotic group (18 vs 14, p = 0.001). The operative time was longer in the robotic group (110 vs 97 min, p = 0.021). The total instrument costs of robotic surgery were A$2565.37 compared with $1507.50 for laparoscopic surgery. The cost of bed days was A$1167.00/day. The average difference in cost of care was calculated as A$1276.13 and A$464.43 less in the robotic with intra-corporeal and extra-corporeal anastomosis, respectively. Patients have significantly faster return to bowel function and shorter length of stay after Robotic vs laparoscopic right hemicolectomy and experience fewer complications. This difference in length of stay may make robotic right hemicolectomies more cost effective.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia
| | - Isabella Mor
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia.,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia
| | - Ross Warner
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia. .,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia.
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Ahmadi N, Moran BJ. ASO Author Reflections: Managing Recurrent Pseudomyxoma Peritonei in 430 Patients After Complete Cytoreduction and HIPEC. Ann Surg Oncol 2021; 28:7821-7822. [PMID: 34041627 DOI: 10.1245/s10434-021-10179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Nima Ahmadi
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan J Moran
- Department of Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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Ahmadi N, Kostadinov D, Sakata S, Ball WR, Gandhi J, Carr NJ, Tzivanakis A, Dayal SP, Mohamed F, Cecil TD, Moran BJ. Managing Recurrent Pseudomyxoma Peritonei in 430 Patients After Complete Cytoreduction and HIPEC: A Dilemma for Patients and Surgeons. Ann Surg Oncol 2021; 28:7809-7820. [PMID: 34041626 DOI: 10.1245/s10434-021-10093-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Epithelial appendiceal neoplasms are uncommon peritoneal malignancies causing a spectrum of disease including pseudomyxoma peritonei (PMP). The optimal management is cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Despite complete CRS (CCRS), recurrence develops in almost 45% of patients. No consensus exists for the optimal treatment of recurrent disease, with treatment strategies including repeat CRS, watch-and-wait, and palliative chemotherapy. This report aims to describe evolving management strategies for a large cohort with recurrence after CCRS. METHODS This retrospective study analyzed a prospective database of patients with recurrence after CCRS for appendiceal neoplasms from 1994 to 2017 who had long-term follow-up evaluation with tumor markers and computed tomography (CT). RESULTS Overall, 430 (37.6%) of 1145 PMP patients experienced recurrence at a median of 19 months. Of these 430 patients 145 (33.7%) underwent repeat CRS, 119 (27.7%) had a watch-and-wait approach, and 119 (27.7%) had palliative chemotherapy. The patients with recurrence had a median overall survival (OS) of 39 months, a 3-year survival of 74.6%, a 5-year survival of 57.4%, and a 10-year survival of 36.5%. In the multivariate analysis, the patients who had recurrence within 1 year after primary CRS (hazard ratio [HR], 3.55), symptoms at recurrence (HR, 3.08), a high grade of disease or adenocarcinoma pathology (HR, 2.94), signet ring cells (HR, 1.91), extraperitoneal metastatic disease (HR, 1.71), or male gender (HR, 1.61) had worse OS. The OS was longer for the patients who had repeat CRS (HR, 0.41). The patients who underwent repeat CCRS had a 3-year OS of 87.5%, a 5-year OS of 78.1%, and a 10-year OS of 67.9%. CONCLUSIONS Dilemmas persist around the optimal management of patients with recurrence after CRS and HIPEC for appendiceal tumors. Selected patients benefit from repeat CRS, particularly those with favorable tumor biology and focal disease.
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Affiliation(s)
- Nima Ahmadi
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - Shinichiro Sakata
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - William Robert Ball
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jamish Gandhi
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Norman John Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Alexios Tzivanakis
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sanjeev Paul Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Thomas Desmond Cecil
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan John Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK. .,Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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Sakata S, Rees H, Parke S, Carr NJ, Kostadinov D, Ahmadi N, Tzivanakis A, Mohamed F, Cecil TD, Moran BJ, Dayal SP. Complete pathological response after ceritinib for anaplastic lymphoma kinase-rearranged epithelioid peritoneal mesothelioma. ANZ J Surg 2021; 91:475-476. [PMID: 33740310 DOI: 10.1111/ans.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Shinichiro Sakata
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Helen Rees
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Simon Parke
- Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Norman J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Danko Kostadinov
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Nima Ahmadi
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Alexios Tzivanakis
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Tom D Cecil
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Brendan J Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
| | - Sanjeev P Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, UK
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Sakata S, Tan TG, Kostadinov D, Ahmadi N, Dayal SP, Tzivanakis A, Mohamed F, Carr NJ, Cecil TD, Moran BJ. Patients undergoing cytoreductive surgery for peritoneal malignancy of appendiceal origin should be consented for umbilical excision as 30% have umbilical infiltration. Colorectal Dis 2021; 23:1153-1157. [PMID: 33544973 DOI: 10.1111/codi.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
AIM Cytoreductive surgery (CRS) for peritoneal malignancy has traditionally included umbilical excision with no published evidence on the incidence of umbilical involvement. The primary aim of this work was to determine the incidence of umbilical involvement in patients undergoing CRS for peritoneal malignancy of appendiceal origin. The secondary aim was to investigate the relationship of umbilical involvement with prior surgery affecting the umbilicus, such as diagnostic laparoscopy and midline laparotomy. METHOD This study is from a national referral centre in the United Kingdom for appendiceal tumours and peritoneal malignancy. It is a retrospective analysis from a dedicated prospective database. We evaluated the most recent 200 consecutive patients who underwent CRS for peritoneal malignancy of appendiceal origin where all pathology specimens were reported by a recognized expert pathologist in appendiceal tumours and peritoneal malignancy. RESULTS From June 2016 to September 2019, 200 consecutive patients had CRS and 178 had umbilical excision. Of these 54/178 (30.3%) had disease involving the umbilicus. The pathological findings in the 178 patients were low-grade mucinous carcinoma peritonei in 90/178 (50.6%), high-grade mucinous carcinoma peritonei in 31/178 (17.4%), metastatic appendiceal adenocarcinoma in 29/178 (16.4%) and diffuse acellular mucin in 28/178 (15.7%). Umbilical involvement was found in 25/90 (27.8%) with low-grade, 11/31 (35.5%) with high-grade, 8/29 (27.6%) with adenocarcinoma and 10/28 (35.7%) of patients with acellular mucin. In the 54 patients with umbilical disease, 30/54 (55.6%) had previous diagnostic surgery affecting the umbilicus. In the 124 patients without umbilical disease, 76/124 (61.2%) had prior surgery involving the umbilicus. The difference between the groups was not significant (p = 0.24). CONCLUSION In patients with peritoneal malignancy of appendiceal origin, approximately 30% have umbilical involvement, irrespective of the primary appendiceal pathology. Umbilical involvement was not associated with prior surgery involving the umbilicus. This is the first report to document the incidence of umbilical pathology and supports consideration of routine umbilical excision in CRS for peritoneal malignancy.
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Affiliation(s)
- Shinichiro Sakata
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Tun G Tan
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Danko Kostadinov
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Nima Ahmadi
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Sanjeev P Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Alexios Tzivanakis
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Norman J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Tom D Cecil
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
| | - Brendan J Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, UK
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Amanollahi R, Asasi K, Abdi-Hachesoo B, Ahmadi N, Mohammadi A. Effect of infectious bronchitis and Newcastle disease vaccines on experimental avian influenza infection (H9N2) in broiler chickens. BJVM 2021. [DOI: 10.15547/bjvm.2267] [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: 11/12/2022] Open
Abstract
Despite the fact that H9N2 avian influenza virus (AIV) is considered a low-pathogenic agent, frequent outbreaks of this subtype have caused high mortality and economic losses in poultry farms around the world including Iran. Coinfection with a respiratory pathogen or environmental factors may explain the exacerbation of H9N2 AIV infection. In this study, the role of infectious bronchitis (IB) vaccines (H120 and 4/91) and Newcastle disease (ND) vaccines (B1 and LaSota) on experimental H9N2 AIV infection was investigated in 180 broiler chickens allotted into 6 groups (n=30). At the age of 18 days, groups 3 and 4 received H120 and 4/91 infectious bronchitis live vaccines (IBLVs) and groups 5 and 6 received B1 and LaSota Newcastle disease live vaccines (NDLVs), respectively. At the age of 20 days, all birds in the experimental groups except the negative control group (group 1), were inoculated intra-nasally with H9N2 AIV. After the inoculation, clinical signs, gross and microscopic lesions, and viral detection were examined. The results of this study revealed that clinical signs, gross and microscopic lesions were more severe in the AIV challenged groups which had been previously vaccinated with IB vaccines. In addition, AI viral RNA from tracheal and faecal samples in IB vaccinated birds were recovered at a higher rate. Moreover, in the 4/91 IB vaccinated group, the AI virus shedding period was longer than the other challenged groups. In conclusion, infectious bronchitis live vaccines (IBLVs) exacerbated the H9N2 AIV infection; also, 4/91 IBLV extended AI virus shedding period and increased the recovery rate of AI virus from feaces. However, the coinfection of Newcastle disease live vaccines (NDLVs) had no considerable adverse effects on AIV infection in broiler chickens.
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Affiliation(s)
- R. Amanollahi
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - K. Asasi
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - B. Abdi-Hachesoo
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - N. Ahmadi
- Department of Pathobiology; School of Veterinary Medicine, Shiraz Uni-versity, Shiraz, Iran
| | - A. Mohammadi
- Department of Pathobiology; School of Veterinary Medicine, Shiraz Uni-versity, Shiraz, Iran
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Ramezani S, Abbasi A, Sobhanverdi S, Shojaeiyan A, Ahmadi N. The effects of water deficit on the expression of monoterpene synthases and essential oils composition in Salvia ecotypes. Physiol Mol Biol Plants 2020; 26:2199-2207. [PMID: 33268923 PMCID: PMC7688846 DOI: 10.1007/s12298-020-00892-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 05/17/2023]
Abstract
The medicinal sage plant (Salvia spp.), belonging to Lamiaceae family, is one of the most important medicinal and aromatic plants. The members of this genus are globally known due to its antimicrobial, antioxidant, astringent, spasmolytic, antihidrotic and specific sensorial properties. In this study, we investigated the potential impact of water deficit on transcript abundance, and essential oil composition of five major metabolites, i.e. 1-8 cineole, α-β-thujone, camphor, and borneol in three genotypes of Salvia spp. Results showed that relative expression of three genes and their corresponding metabolites increased together at three stages under drought condition, but the CS gene transcript decreased independently from 1,8-cineole in garden sage. Furthermore, borneol changed differently compared to the BS gene expression in control and drought treatment plants of S. reuterana (Yasuj). The competitive synthesis of ß-thujone, and α-thujone by SS gene were demonstrated in S. officinalis and Yasuj ecotype of S. reuterana; whereas, no change was observed for Urmia ecotype of S. reuterana. There was no precursor shortage to synthesis of borneol and camphor in garden sage; however increasing the BS led to high production of borneol and low camphor in S. reuterana under drought stress. As a mechanism, secondary metabolites enable the plants to cope with unfavorable conditions, but genetic differences might affect the quantity and quality of these compounds.
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Affiliation(s)
| | - Alireza Abbasi
- Department of Agronomy and Plant Breeding, University of Tehran, Karaj, Iran
| | - Sajjad Sobhanverdi
- Department of Agronomy and Plant Breeding, University of Tehran, Karaj, Iran
| | | | - Nima Ahmadi
- Sistan and Baluchestan University, Zahedan, Iran
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Sasangohar F, Dhala A, Zheng F, Ahmadi N, Kash B, Masud F. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Qual Saf 2020; 30:715-721. [PMID: 33028659 PMCID: PMC8380894 DOI: 10.1136/bmjqs-2020-011604] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 05/21/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND When the COVID-19 pandemic restricted visitation between intensive care unit patients and their families, the virtual intensive care unit (vICU) in our large tertiary hospital was adapted to facilitate virtual family visitation. The objective of this paper is to document findings from interviews conducted with family members on three categories: (1) feelings experienced during the visit, (2) barriers, challenges or concerns faced using this service, and (3) opportunities for improvements. METHODS Family members were interviewed postvisit via phone. For category 1 (feelings), automated analysis in Python using the Valence Aware Dictionary for sentiment Reasoner package produced weighted valence (extent of positive, negative or neutral emotive connotations) of the interviewees' word choices. Outputs were compared with a manual coder's valence ratings to assess reliability. Two raters conducted inductive thematic analysis on the notes from these interviews to analyse categories 2 (barriers) and 3 (opportunities). RESULTS Valence-based and manual sentiment analysis of 230 comments received on feelings showed over 86% positive sentiments (88.2% and 86.8%, respectively) with some neutral (7.3% and 6.8%) and negative (4.5% and 6.4%) sentiments. The qualitative analysis of data from 57 participants who commented on barriers showed four primary concerns: inability to communicate due to patient status (44% of respondents); technical difficulties (35%); lack of touch and physical presence (11%); and frequency and clarity of communications with the care team (11%). Suggested improvements from 59 participants included: on demand access (51%); improved communication with the care team (17%); improved scheduling processes (10%); and improved system feedback and technical capabilities (17%). CONCLUSIONS Use of vICU for remote family visitations evoked happiness, joy, gratitude and relief and a sense of closure for those who lost loved ones. Identified areas for concern and improvement should be addressed in future implementations of telecritical care for this purpose.
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Affiliation(s)
- Farzan Sasangohar
- Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA .,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Feibi Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Nima Ahmadi
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA.,School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Faisal Masud
- Center for Critical Care, Houston Methodist Hospital, Houston, Texas, USA
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Dhala A, Sasangohar F, Kash B, Ahmadi N, Masud F. Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study. J Med Internet Res 2020; 22:e20143. [PMID: 32795997 PMCID: PMC7473763 DOI: 10.2196/20143] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/19/2020] [Accepted: 08/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. OBJECTIVE The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients' families during the pandemic. METHODS The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non-COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non-COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. RESULTS Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. CONCLUSIONS Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.
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Affiliation(s)
- Atiya Dhala
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States.,School of Public Health, Texas A&M University, College Station, TX, United States
| | - Nima Ahmadi
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Faisal Masud
- Departments of Anesthesiology and Critical Care, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
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39
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Mardani R, Alamdary A, Mousavi Nasab SD, Gholami R, Ahmadi N, Gholami A. Association of vitamin D with the modulation of the disease severity in COVID-19. Virus Res 2020; 289:198148. [PMID: 32866536 PMCID: PMC7455115 DOI: 10.1016/j.virusres.2020.198148] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/15/2023]
Abstract
Insufficient levels of Vitamin D could be seen in COVID-19 patients. Increase in the ACE could be seen in COVID-19 patients with higher quantities in the individuals who died from the COVID-19. The Neutrophil to Lymphocyte ratio (NLR) is higher in COVID-19 than the control group. Serum levels of vitamin D and ACE are associated with the progression and severity of the COVID-19.
In late 2019, SARS-CoV-2 started to spread throughout the world causing the COVID-19 that has taken a considerable number of lives. Results obtained from several investigations have explained the virus origin, pathogenicity, and transmission. Similar to SARS coronavirus, the pulmonary angiotensin converting enzyme (ACE) 2 was introduced as the virus receptor for entering the cell. An increased body of epidemiological and clinical evidences has shown modulating effects of vitamin D in lung injuries through several mechanisms. Several clinical symptoms as well as molecular factors have shown to be related to the disease transmission and severity. In this study, vitamin D, ACE concentrations, and neutrophil to lymphocyte ratio (NLR) were measured in patients with confirmed COVID-19 in comparison with control group. Results demonstrated significant alterations in vitamin D and ACE levels as well as NLR in the patients’ group. Contribution of those factors with the prognosis and severity of the disease has been shown.
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Affiliation(s)
- R Mardani
- Viral Vaccines Production Unit, Pasteur Institute of Iran Production Complex, Tehran, Iran
| | - A Alamdary
- Viral Vaccines Production Unit, Pasteur Institute of Iran Production Complex, Tehran, Iran
| | - S D Mousavi Nasab
- Rotavaccine Research Lab, Pasteur Institute of Iran Production Complex, Tehran, Iran
| | - R Gholami
- Shoushtar University of Medical Sciences, Shoushtar, Iran
| | - N Ahmadi
- Proteomics Research Center, Department of Medical Lab Technology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - A Gholami
- Viral Vaccines Production Unit, Pasteur Institute of Iran Production Complex, Tehran, Iran.
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40
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Ahmadi N, Ravindran P, Kim T, Ayoubi SE, Byrne CM, Young CJ. C-reactive protein trajectory in the first 48 hours predicts the need for intervention in conservative management of acute diverticulitis. ANZ J Surg 2020; 90:2036-2040. [PMID: 32755032 DOI: 10.1111/ans.16176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND C-reactive protein (CRP) is a useful marker for monitoring response to treatment in sepsis. The aim of this study was to examine the use of CRP trajectory in predicting the need for intervention in conservatively managed patients with acute diverticulitis (AD). METHODS A retrospective review of patients with AD who were managed conservatively was performed. They were divided into four groups based on CRP relative to the median at day 0 and 2: 'Low rise' (levels below median at day 0 and 2), 'High rise' (levels above median at day 0 and 2), 'Rapid rise' (levels below median at day 0 but above median at day 2) and 'Decline' (levels above median at day 0 but below median at day 2). RESULTS Intervention was required in 64 of 456 (14%) with 30 (48%) of these performed after day 2 of admission. There were 150 patients (54%) in the 'Low rise', 76 (27%) in the 'Decline', 26 patients (9%) in the 'Rapid rise' and 25 patients (9%) in the 'High rise' groups. Within these groups 5%, 8%, 19% and 32% of patients required intervention (P = 0.001). On multivariate analysis, patients with a pelvic abscess were more likely to need intervention (odds ratio 19.1 (confidence interval 6.2-59.4), P < 0.0001). CONCLUSION The CRP trajectory during the initial 48 h of admission can predict the need for intervention in AD patients being managed conservatively. Patients with a 'Rapid rise' or 'High rise' in CRP from day 0 to 2 are more likely to need intervention.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Taejun Kim
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Salah E Ayoubi
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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41
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Ghodsi Z, Moghaddam SS, Vezvaei P, Yoosefi M, Rezaei N, Saadat S, Sheidaei A, Sharif-Alhoseini M, Sadeghian F, Ahmadi N, Jazayeri SB, Salamati P, Khosravi A, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. The mortality rate from self-harm in Iran. Public Health 2020; 186:44-51. [PMID: 32768623 DOI: 10.1016/j.puhe.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years. METHODS The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults. RESULTS Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period. CONCLUSION Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions.
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Affiliation(s)
- Z Ghodsi
- Department of Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Iran.
| | - S S Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - P Vezvaei
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Yoosefi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - N Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - M Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - F Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - N Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - S B Jazayeri
- Department of Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA.
| | - P Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - A Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran.
| | - M Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - A H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Washington, USA.
| | - G O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - V Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Ahmadi N, Brown KGM, Lee P, Quinn M, Austin KKS, Solomon MJ. Is neoadjuvant chemoradiotherapy sufficient in patients with advanced rectal malignancy and positive extra-mesorectal lateral lymph nodes? Colorectal Dis 2020; 22:689-693. [PMID: 31909851 DOI: 10.1111/codi.14950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
AIM There is current debate about the optimal management of lateral pelvic lymph nodes (LPLNs) in rectal cancer between Western and Eastern centres. This paper aims to report the rate of histologically proven positive LPLNs in a group of patients undergoing the conventional Western approach to primary and recurrent rectal cancer. METHOD A retrospective cohort review of all patients who underwent LPLN dissection at Royal Prince Alfred Hospital in Sydney, Australia. This included patients who underwent pelvic exenteration who had LPLNs excised either en bloc for laterally invasive or recurrent tumours or as part of selective node dissection for suspicious lymph nodes on preoperative imaging. Histopathological results for these patients were compared with node status at preoperative imaging. RESULTS Seventy-one patients satisfied the inclusion criteria. Of those patients with positive nodes on histology, 27% (9/33) with radiologically positive LPLNs were treated with preoperative radiotherapy and 75% (9/12) with radiologically positive LPLNs were not treated with preoperative radiotherapy (P = 0.004). None of the 12 patients with radiologically negative nodes treated with radiotherapy had positive nodes; 25% (3/12) of the patients with radiologically negative nodes who were not treated with radiotherapy had positive nodes. Fifty-three per cent of patients developed postoperative complications. CONCLUSION Our study suggests that in patients with radiologically positive LPLNs chemoradiotherapy may not be enough to sterilize these extra-mesorectal lymph nodes as a large proportion (27%) will have residual viable adenocarcinoma cells. In patients with radiologically negative LPLNs, however, the addition of chemoradiotherapy may serve to adequately sterilize these lymph nodes without the need for prophylactic LPLN dissection.
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Affiliation(s)
- N Ahmadi
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney Local Health District, Newtown, New South Wales, Australia
| | - P Lee
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Quinn
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - K K S Austin
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The Institute of Academic Surgery at RPA, Sydney Local Health District, Newtown, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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43
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Khotyaintsev YV, Graham DB, Steinvall K, Alm L, Vaivads A, Johlander A, Norgren C, Li W, Divin A, Fu HS, Hwang KJ, Burch JL, Ahmadi N, Le Contel O, Gershman DJ, Russell CT, Torbert RB. Electron Heating by Debye-Scale Turbulence in Guide-Field Reconnection. Phys Rev Lett 2020; 124:045101. [PMID: 32058767 DOI: 10.1103/physrevlett.124.045101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/22/2019] [Indexed: 06/10/2023]
Abstract
We report electrostatic Debye-scale turbulence developing within the diffusion region of asymmetric magnetopause reconnection with a moderate guide field using observations by the Magnetospheric Multiscale mission. We show that Buneman waves and beam modes cause efficient and fast thermalization of the reconnection electron jet by irreversible phase mixing, during which the jet kinetic energy is transferred into thermal energy. Our results show that the reconnection diffusion region in the presence of a moderate guide field is highly turbulent, and that electrostatic turbulence plays an important role in electron heating.
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Affiliation(s)
| | - D B Graham
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | - K Steinvall
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | - L Alm
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | - A Vaivads
- Department of Space and Plasma Physics, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm 11428, Sweden
| | - A Johlander
- Department of Physics, University of Helsinki, Helsinki 00014, Finland
| | - C Norgren
- University of Bergen, Bergen 5007, Norway
| | - W Li
- State Key Laboratory of Space Weather, National Space Science Center, Chinese Academy of Sciences, Beijing 100190, China
| | - A Divin
- Earth Physics Department, St. Petersburg State University, St. Petersburg 198504, Russia
| | - H S Fu
- School of Space and Environment, Beihang University, Beijing 100083, China
| | - K-J Hwang
- Southwest Research Institute, San Antonio, Texas 78228, USA
| | - J L Burch
- Southwest Research Institute, San Antonio, Texas 78228, USA
| | - N Ahmadi
- Laboratory of Atmospheric and Space Physics, University of Colorado, Boulder, Colorado 80303, USA
| | - O Le Contel
- Laboratoire de Physique des Plasmas, CNRS, Ecole Polytechnique, Sorbonne Université, Université Paris-Sud, and Observatoire de Paris, Paris, F-75252 Paris Cedex 05, France
| | - D J Gershman
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - C T Russell
- University of California, Los Angeles, California 90095, USA
| | - R B Torbert
- University of New Hampshire, Durham, New Hampshire 03824, USA
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44
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Kavaz E, Armoosh S, Perişanoğlu U, Ahmadi N, Oltulu M. Gamma ray shielding effectiveness of the Portland cement pastes doped with brass-copper: An experimental study. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cacciamani GE, Shakir A, Tafuri A, Gill K, Han J, Ahmadi N, Hueber PA, Gallucci M, Simone G, Campi R, Vignolini G, Huang WC, Taylor J, Becher E, Van Leeuwen FWB, Van Der Poel HG, Velet LP, Hemal AK, Breda A, Autorino R, Sotelo R, Aron M, Desai MM, De Castro Abreu AL. Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus. World J Urol 2019; 38:883-896. [PMID: 31286194 DOI: 10.1007/s00345-019-02870-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/03/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The aim of the present study is to investigate the impact of the near-infrared (NIRF) technology with indocyanine green (ICG) in robotic urologic surgery by performing a systematic literature review and to provide evidence-based expert recommendations on best practices in this field. METHODS All English language publications on NIRF/ICG-guided robotic urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus® and Web of Science™ databases (up to April 2019). Experts in the field provided detailed pictures and intraoperative video-clips of different NIRF/ICG-guided robotic surgeries with recommendations for each procedure. A unique QRcode was generated and linked to each underlying video-clip. This new exclusive feature makes the present the first "dynamic paper" that merges text and figure description with their own video providing readers an innovative, immersive, high-quality and user-friendly experience. RESULTS Our electronic search identified a total of 576 papers. Of these, 36 studies included in the present systematic review reporting the use of NIRF/ICG in robotic partial nephrectomy (n = 13), robotic radical prostatectomy and lymphadenectomy (n = 7), robotic ureteral re-implantation and reconstruction (n = 5), robotic adrenalectomy (n = 4), robotic radical cystectomy (n = 3), penectomy and robotic inguinal lymphadenectomy (n = 2), robotic simple prostatectomy (n = 1), robotic kidney transplantation (n = 1) and robotic sacrocolpopexy (n = 1). CONCLUSION NIRF/ICG technology has now emerged as a safe, feasible and useful tool that may facilitate urologic robotic surgery. It has been shown to improve the identification of key anatomical landmarks and pathological structures for oncological and non-oncological procedures. Level of evidence is predominantly low. Larger series with longer follow-up are needed, especially in assessing the quality of the nodal dissection and the feasibility of the identification of sentinel nodes and the impact of these novel technologies on long-term oncological and functional outcomes.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - A Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Tafuri
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - K Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Han
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - N Ahmadi
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Uro-Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - P A Hueber
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Gallucci
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - G Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - R Campi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Vignolini
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - W C Huang
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - J Taylor
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - E Becher
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York, USA
| | - F W B Van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Interventional Molecular Imaging Laboratory, Leiden University Medical center, Leiden, The Netherlands.,Orsi Academy, Melle, Belgium
| | - H G Van Der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L P Velet
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | - A K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | - A Breda
- Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain
| | - R Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - R Sotelo
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Aron
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M M Desai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A L De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ahmadi N, Howden WB, Ahmadi N, Byrne CM, Young CJ. Increasing primary anastomosis rate over time for the operative management of acute diverticulitis. ANZ J Surg 2019; 89:1080-1084. [PMID: 31272133 DOI: 10.1111/ans.15321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the past two decades, there has been mounting evidence that primary anastomosis (PA) is a safe alternative to Hartmann's procedure (HP) in acute diverticulitis. In addition, specialized colorectal surgeons are more likely to perform PA. This study aimed to analyse if this evidence has led to an increase in the rate of PA in a major tertiary institution over time. METHODS A retrospective observational study of patients requiring operative management of acute diverticulitis from 1 January 2001 to 31 December 2015 at a tertiary teaching hospital. RESULTS One hundred and eighteen patients underwent surgery for acute diverticulitis. Patients who failed initial conservative management were more likely to have PA (43% versus 21%, P = 0.044). There was no difference in medical or surgical complications, readmission rate or mortality between patients who had a PA compared with HP. Patients were more likely to have a PA if a colorectal surgeon was operating compared with a colorectal surgery fellow or general surgeon (36% versus 19% versus 10%, P = 0.039). In patients with modified Hinchey 0-2, there was an increased PA rate within the study period, 21%, 43%, 63% to 57% from the first to the fourth quartile of patients (P = 0.038). CONCLUSIONS The mounting evidence for the safety of performing PA has led to an increase in the PA rates for acute diverticulitis. Patients who were operated by a colorectal surgeon were more likely to have a PA. The morbidity and mortality were similar in patients who had PA compared with HP.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - William B Howden
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nazanin Ahmadi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Cozzani G, Retinò A, Califano F, Alexandrova A, Le Contel O, Khotyaintsev Y, Vaivads A, Fu HS, Catapano F, Breuillard H, Ahmadi N, Lindqvist PA, Ergun RE, Torbert RB, Giles BL, Russell CT, Nakamura R, Fuselier S, Mauk BH, Moore T, Burch JL. In situ spacecraft observations of a structured electron diffusion region during magnetopause reconnection. Phys Rev E 2019; 99:043204. [PMID: 31108651 DOI: 10.1103/physreve.99.043204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/07/2022]
Abstract
The electron diffusion region (EDR) is the region where magnetic reconnection is initiated and electrons are energized. Because of experimental difficulties, the structure of the EDR is still poorly understood. A key question is whether the EDR has a homogeneous or patchy structure. Here we report Magnetospheric Multiscale (MMS) spacecraft observations providing evidence of inhomogeneous current densities and energy conversion over a few electron inertial lengths within an EDR at the terrestrial magnetopause, suggesting that the EDR can be rather structured. These inhomogenenities are revealed through multipoint measurements because the spacecraft separation is comparable to a few electron inertial lengths, allowing the entire MMS tetrahedron to be within the EDR most of the time. These observations are consistent with recent high-resolution and low-noise kinetic simulations.
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Affiliation(s)
- Giulia Cozzani
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Dipartimento di Fisica "E. Fermi", Università di Pisa, I-56127 Pisa, Italy
| | - A Retinò
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - F Califano
- Dipartimento di Fisica "E. Fermi", Università di Pisa, I-56127 Pisa, Italy
| | - A Alexandrova
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - O Le Contel
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - Y Khotyaintsev
- Swedish Institute of Space Physics, SE-75121 Uppsala, Sweden
| | - A Vaivads
- Swedish Institute of Space Physics, SE-75121 Uppsala, Sweden
| | - H S Fu
- School of Space and Environment, Beihang University, Beijing, 100083, P.R. China
| | - F Catapano
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Dipartimento di Fisica, Università della Calabria, I-87036, Arcavacata di Rende (CS), Italy
| | - H Breuillard
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Laboratoire de Physique et Chimie de l'Environnement et de l'Espace, CNRS-Université d'Orléans, UMR 7328, 45071 Orléans, France
| | - N Ahmadi
- Laboratory of Atmospheric and Space Physics, University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - P-A Lindqvist
- KTH Royal Institute of Technology, SE-10044, Stockholm, Sweden
| | - R E Ergun
- Laboratory of Atmospheric and Space Physics, University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - R B Torbert
- Space Science Center, University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B L Giles
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - C T Russell
- Department of Earth and Space Sciences, University of California, Los Angeles, California 90095, USA
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, 8042 Graz, Austria
| | - S Fuselier
- Southwest Research Institute, San Antonio, Texas 78238, USA.,University of Texas at San Antonio, San Antonio, Texas 78238, USA
| | - B H Mauk
- The Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland 20723, USA
| | - T Moore
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - J L Burch
- Southwest Research Institute, San Antonio, Texas 78238, USA
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48
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Ahmadi N, Ahmadi A, Kheirali E, Hossein Yadegari M, Bayat M, Shajiei A, Amini AA, Ashrafi S, Abolhassani M, Faezi S, Yazdanparast SA, Mahdavi M. Systemic infection with Candida albicans in breast tumor bearing mice: Cytokines dysregulation and induction of regulatory T cells. J Mycol Med 2019; 29:49-55. [DOI: 10.1016/j.mycmed.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
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49
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Samanipour H, Ahmadi N, Mirzaee I, Abbasalizade M. The Study of Cylindrical Polymer Fuel Cell's Performance and the Investigation of Gradual Geometry Changes' Effect on Its Performance. Period Polytech Chem Eng 2019. [DOI: 10.3311/ppch.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To achieve an optimal perception of cardinal processes and prior to prototype fabrication to fuel cell optimization, modeling is extensively used in industrial researches and applications to transfer mass and heat into small-sized channels. In the current study, Computational Fluid Dynamics is presented to cylindrical polymer fuel cell with circular and elliptical cross-section. Concurrently, the design of fractured electrode-membrane assembly is introduced. The simulations explicitly demonstrate comparing to Base case production, the fractured case of the Electrode Membrane Assembly produces more current. Likewise, a new design for cylindrical polymer fuel cell is illustrated. In the cylindrical design, both the effect of gradual geometric changes on the performance including radius changes and the transformation of cross-section from circle to ellipse has been investigated and compared to Base case. The obtained results displays the cylindrical fuel cell’s better performance compared to Base case. Accordingly, establishing wider passage, in same volume for reactive gases toward reaction areas, results in sharp increase in the performance. Finally, validating simulation with valid laboratory results, proper correspondence is achieved.
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50
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Torbert RB, Burch JL, Phan TD, Hesse M, Argall MR, Shuster J, Ergun RE, Alm L, Nakamura R, Genestreti KJ, Gershman DJ, Paterson WR, Turner DL, Cohen I, Giles BL, Pollock CJ, Wang S, Chen LJ, Stawarz JE, Eastwood JP, Hwang KJ, Farrugia C, Dors I, Vaith H, Mouikis C, Ardakani A, Mauk BH, Fuselier SA, Russell CT, Strangeway RJ, Moore TE, Drake JF, Shay MA, Khotyaintsev YV, Lindqvist PA, Baumjohann W, Wilder FD, Ahmadi N, Dorelli JC, Avanov LA, Oka M, Baker DN, Fennell JF, Blake JB, Jaynes AN, Le Contel O, Petrinec SM, Lavraud B, Saito Y. Electron-scale dynamics of the diffusion region during symmetric magnetic reconnection in space. Science 2018; 362:1391-1395. [PMID: 30442767 DOI: 10.1126/science.aat2998] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 11/06/2018] [Indexed: 11/02/2022]
Abstract
Magnetic reconnection is an energy conversion process that occurs in many astrophysical contexts including Earth's magnetosphere, where the process can be investigated in situ by spacecraft. On 11 July 2017, the four Magnetospheric Multiscale spacecraft encountered a reconnection site in Earth's magnetotail, where reconnection involves symmetric inflow conditions. The electron-scale plasma measurements revealed (i) super-Alfvénic electron jets reaching 15,000 kilometers per second; (ii) electron meandering motion and acceleration by the electric field, producing multiple crescent-shaped structures in the velocity distributions; and (iii) the spatial dimensions of the electron diffusion region with an aspect ratio of 0.1 to 0.2, consistent with fast reconnection. The well-structured multiple layers of electron populations indicate that the dominant electron dynamics are mostly laminar, despite the presence of turbulence near the reconnection site.
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Affiliation(s)
- R B Torbert
- University of New Hampshire, Durham, NH, USA. .,Southwest Research Institute (SwRI), San Antonio, TX, USA
| | - J L Burch
- Southwest Research Institute (SwRI), San Antonio, TX, USA
| | - T D Phan
- University of California, Berkeley, CA, USA
| | - M Hesse
- Southwest Research Institute (SwRI), San Antonio, TX, USA.,University of Bergen, Bergen, Norway
| | - M R Argall
- University of New Hampshire, Durham, NH, USA
| | - J Shuster
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - R E Ergun
- University of Colorado Laboratory for Atmospheric and Space Physics, Boulder, CO, USA
| | - L Alm
- Swedish Institute of Space Physics, Uppsala, Sweden
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - K J Genestreti
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - D J Gershman
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - W R Paterson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - D L Turner
- Aerospace Corporation, El Segundo, CA, USA
| | - I Cohen
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - B L Giles
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - C J Pollock
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Wang
- University of Maryland, College Park, MD, USA
| | - L-J Chen
- NASA Goddard Space Flight Center, Greenbelt, MD, USA.,University of Maryland, College Park, MD, USA
| | - J E Stawarz
- Blackett Laboratory, Imperial College London, London, UK
| | - J P Eastwood
- Blackett Laboratory, Imperial College London, London, UK
| | - K J Hwang
- Southwest Research Institute (SwRI), San Antonio, TX, USA
| | - C Farrugia
- University of New Hampshire, Durham, NH, USA
| | - I Dors
- University of New Hampshire, Durham, NH, USA
| | - H Vaith
- University of New Hampshire, Durham, NH, USA
| | - C Mouikis
- University of New Hampshire, Durham, NH, USA
| | - A Ardakani
- University of New Hampshire, Durham, NH, USA
| | - B H Mauk
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - S A Fuselier
- Southwest Research Institute (SwRI), San Antonio, TX, USA.,University of Texas, San Antonio, TX, USA
| | - C T Russell
- University of California, Los Angeles, CA, USA
| | | | - T E Moore
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J F Drake
- University of Maryland, College Park, MD, USA
| | - M A Shay
- University of Delaware, Newark, DE, USA
| | | | | | - W Baumjohann
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - F D Wilder
- University of Colorado Laboratory for Atmospheric and Space Physics, Boulder, CO, USA
| | - N Ahmadi
- University of Colorado Laboratory for Atmospheric and Space Physics, Boulder, CO, USA
| | - J C Dorelli
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - L A Avanov
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Oka
- University of California, Berkeley, CA, USA
| | - D N Baker
- University of Colorado Laboratory for Atmospheric and Space Physics, Boulder, CO, USA
| | | | - J B Blake
- Aerospace Corporation, El Segundo, CA, USA
| | | | - O Le Contel
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université/Univ. Paris Sud/Observatoire de Paris, Paris, France
| | - S M Petrinec
- Lockheed Martin Advanced Technology Center, Palo Alto, CA, USA
| | - B Lavraud
- Institut de Recherche en Astrophysique et Planétologie, CNRS, Centre National d'Etudes Spatiales, Université de Toulouse, Toulouse, France
| | - Y Saito
- Institute for Space and Astronautical Sciences, Sagamihara, Japan
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