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Harrison NE, Ehrman R, Collins S, Desai AA, Duggan NM, Ferre R, Gargani L, Goldsmith A, Kapur T, Lane K, Levy P, Li X, Noble VE, Russell FM, Pang P. The prognostic value of improving congestion on lung ultrasound during treatment for acute heart failure differs based on patient characteristics at admission. J Cardiol 2024; 83:121-129. [PMID: 37579872 PMCID: PMC10859542 DOI: 10.1016/j.jjcc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Lung ultrasound congestion scoring (LUS-CS) is a congestion severity biomarker. The BLUSHED-AHF trial demonstrated feasibility for LUS-CS-guided therapy in acute heart failure (AHF). We investigated two questions: 1) does change (∆) in LUS-CS from emergency department (ED) to hospital-discharge predict patient outcomes, and 2) is the relationship between in-hospital decongestion and adverse events moderated by baseline risk-factors at admission? METHODS We performed a secondary analysis of 933 observations/128 patients from 5 hospitals in the BLUSHED-AHF trial receiving daily LUS. ∆LUS-CS from ED arrival to inpatient discharge (scale -160 to +160, where negative = improving congestion) was compared to a primary outcome of 30-day death/AHF-rehospitalization. Cox regression was used to adjust for mortality risk at admission [Get-With-The-Guidelines HF risk score (GWTG-RS)] and the discharge LUS-CS. An interaction between ∆LUS-CS and GWTG-RS was included, under the hypothesis that the association between decongestion intensity (by ∆LUS-CS) and adverse outcomes would be stronger in admitted patients with low-mortality risk but high baseline congestion. RESULTS Median age was 65 years, GWTG-RS 36, left ventricular ejection fraction 36 %, and ∆LUS-CS -20. In the multivariable analysis ∆LUS-CS was associated with event-free survival (HR = 0.61; 95 % CI: 0.38-0.97), while discharge LUS-CS (HR = 1.00; 95%CI: 0.54-1.84) did not add incremental prognostic value to ∆LUS-CS alone. As GWTG-RS rose, benefits of LUS-CS reduction attenuated (interaction p < 0.05). ∆LUS-CS and event-free survival were most strongly correlated in patients without tachycardia, tachypnea, hypotension, hyponatremia, uremia, advanced age, or history of myocardial infarction at ED/baseline, and those with low daily loop diuretic requirements. CONCLUSIONS Reduction in ∆LUS-CS during AHF treatment was most associated with improved readmission-free survival in heavily congested patients with otherwise reassuring features at admission. ∆LUS-CS may be most useful as a measure to ensure adequate decongestion prior to discharge, to prevent early readmission, rather than modify survival.
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Affiliation(s)
- Nicholas E Harrison
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA.
| | - Robert Ehrman
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI, USA
| | - Sean Collins
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, TN, USA
| | - Ankit A Desai
- Indiana University School of Medicine, Department of Medicine, Division of Cardiology, Indianapolis, IN, USA
| | - Nicole M Duggan
- Brigham and Womens Hospital, Department of Emergency Medicine, Boston, MA, USA
| | - Rob Ferre
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
| | - Luna Gargani
- University of Pisa, Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, Italy
| | - Andrew Goldsmith
- Brigham and Womens Hospital, Department of Emergency Medicine, Boston, MA, USA
| | - Tina Kapur
- Brigham and Womens Hospital, Department of Radiology, Boston, MA, USA
| | - Katie Lane
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Phillip Levy
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, MI, USA
| | - Xiaochun Li
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Vicki E Noble
- Case Western Reserve University, Department of Emergency Medicine, Cleveland, OH, USA
| | - Frances M Russell
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
| | - Peter Pang
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, IN, USA
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Harrison NE, Ehrman R, Pang P, Armitage S, Abidov A, Perkins D, Peacock J, Montelauro N, Gupta S, Favot MJ, Levy P. The significance of historical troponin elevation in acute heart failure: Not as reassuring as previously assumed. Acad Emerg Med 2023; 30:1223-1236. [PMID: 37641846 PMCID: PMC10863562 DOI: 10.1111/acem.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Historical cardiac troponin (cTn) elevation is commonly interpreted as lessening the significance of current cTn elevations at presentation for acute heart failure (AHF). Evidence for this practice is lacking. Our objective was to determine the incremental prognostic significance of historical cTn elevation compared to cTn elevation and ischemic heart disease (IHD) history at presentation for AHF. METHODS A total of 341 AHF patients were prospectively enrolled at five sites. The composite primary outcome was death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/emergent dialysis, and/or acute myocardial infarction (AMI)/percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) at 90 days. Secondary outcomes were 30-day AMI/PCI/CABG and in-hospital AMI. Logistic regression compared outcomes versus initial emergency department (ED) cTn, the most recent electronic medical record cTn, estimated glomerular filtration rate, age, left ventricular ejection fraction, and IHD history (positive, negative by prior coronary workup, or unknown/no prior workup). RESULTS Elevated cTn occurred in 163 (49%) patients, 80 (23%) experienced the primary outcome, and 29 had AMI (9%). cTn elevation at ED presentation, adjusted for historical cTn and other covariates, was associated with the primary outcome (adjusted odds ratio [aOR] 2.39, 95% confidence interval [CI] 1.30-4.38), 30-day AMI/PCI/CABG, and in-hospital AMI. Historical cTn elevation was associated with greater odds of the primary outcome when IHD history was unknown at ED presentation (aOR 5.27, 95% CI 1.24-21.40) and did not alter odds of the outcome with known positive (aOR 0.74, 95% CI 0.33-1.70) or negative IHD history (aOR 0.79, 95% CI 0.26-2.40). Nevertheless, patients with elevated ED cTn were more likely to be discharged if historical cTn was also elevated (78% vs. 32%, p = 0.025). CONCLUSIONS Historical cTn elevation in AHF patients is a harbinger of worse outcomes for patients who have not had a prior IHD workup and should prompt evaluation for underlying ischemia rather than reassurance for discharge. With known IHD history, historical cTn elevation was neither reassuring nor detrimental, failing to add incremental prognostic value to current cTn elevation alone.
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Affiliation(s)
| | - Robert Ehrman
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Peter Pang
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Sarah Armitage
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Aiden Abidov
- Wayne State University School of Medicine, Department of Medicine, Division of Cardiology
| | - Daniel Perkins
- Indiana University School of Medicine, Department of Emergency Medicine
| | - Johnathon Peacock
- Indiana University School of Medicine, Department of Emergency Medicine
| | | | - Sushane Gupta
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Mark J Favot
- Wayne State University School of Medicine, Department of Emergency Medicine
| | - Phillip Levy
- Wayne State University School of Medicine, Department of Emergency Medicine
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Li J, Huang RP, Pang P, Guo X, Wang YH, Guo LC, Huang S. [Perivascular epithelioid cell tumor of the lung: a clinicopathological analysis of eight cases]. Zhonghua Bing Li Xue Za Zhi 2023; 52:1126-1131. [PMID: 37899318 DOI: 10.3760/cma.j.cn112151-20230504-00304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objective: To investigate the clinicopathological features of perivascular epithelioid cell tumor (PEComa) of the lung. Methods: Eight PEComa cases of the lung diagnosed at the First Affiliated Hospital of Soochow University, Suzhou, China from July 2008 to December 2021 were collected and subject to immunohistochemical staining, fluorescence in situ hybridization and next generation sequencing. The relevant literature was reviewed and the clinicopathological features were analyzed. Results: There were 5 males and 3 females, aged from 18 to 70 years (mean 39 years). There were 3 cases of the right upper lung, 3 cases of the left lower lung, 1 case of the left upper lung and 1 case of the right middle lung. Seven cases were solitary and 1 case was multifocal (4 lesions). Seven cases were benign while one was malignant. The tumors were all located in the peripheral part of the lung, with a maximum diameter of 0.2-4.0 cm. Grossly, they were oval and well circumscribed. Microscopically, the tumor cells were oval, short spindle-shaped, arranged in solid nests, acinar or hemangiopericytoma-like patterns, with clear or eosinophilic cytoplasm. The stroma was rich in blood vessels with hyalinization. Coagulated necrosis and high-grade nuclei were seen in the malignant case, and calcification was seen in 2 cases. Immunohistochemically, the tumor cells were positive for Melan A (8/8), HMB45 (7/8), CD34 (6/8), TFE3 (4/7), and SMA (3/8). All cases were negative for CKpan and S-100. TFE3 (Xp11.2) gene fusion was examined using the TFE3 break-apart fluorescence in situ hybridization in 5 cases, in which only the malignant case was positive. The next generation sequencing revealed the SFPQ-TFE3 [t(X;1)(p11.2;p34)] fusion. Follow-up of the patients ranged from 12 to 173 months while one patient was lost to the follow-up. The malignant case had tumor metastasis to the brain 4 years after the operation and then received radiotherapy. Other 6 cases had no recurrence and metastasis, and all the 7 patients survived. Conclusions: Most of the PEComas of the lung are benign. When there are malignant morphological features such as necrosis, high-grade nuclei or SFPQ-TFE3 gene fusion, close follow-up seems necessary.
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Affiliation(s)
- J Li
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - R P Huang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - P Pang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - X Guo
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Y H Wang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - L C Guo
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - S Huang
- Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
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Goldsmith AJ, Jin M, Lucassen R, Duggan NM, Harrison NE, Wells W, Ehrman RR, Ferre R, Gargani L, Noble V, Levy P, Lane K, Li X, Collins S, Pang P, Kapur T, Russell FM. Comparison of pulmonary congestion severity using artificial intelligence-assisted scoring versus clinical experts: A secondary analysis of BLUSHED-AHF. Eur J Heart Fail 2023; 25:1166-1169. [PMID: 37218619 DOI: 10.1002/ejhf.2881] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
AIM Acute decompensated heart failure (ADHF) is the leading cause of cardiovascular hospitalizations in the United States. Detecting B-lines through lung ultrasound (LUS) can enhance clinicians' prognostic and diagnostic capabilities. Artificial intelligence/machine learning (AI/ML)-based automated guidance systems may allow novice users to apply LUS to clinical care. We investigated whether an AI/ML automated LUS congestion score correlates with expert's interpretations of B-line quantification from an external patient dataset. METHODS AND RESULTS This was a secondary analysis from the BLUSHED-AHF study which investigated the effect of LUS-guided therapy on patients with ADHF. In BLUSHED-AHF, LUS was performed and B-lines were quantified by ultrasound operators. Two experts then separately quantified the number of B-lines per ultrasound video clip recorded. Here, an AI/ML-based lung congestion score (LCS) was calculated for all LUS clips from BLUSHED-AHF. Spearman correlation was computed between LCS and counts from each of the original three raters. A total of 3858 LUS clips were analysed on 130 patients. The LCS demonstrated good agreement with the two experts' B-line quantification score (r = 0.894, 0.882). Both experts' B-line quantification scores had significantly better agreement with the LCS than they did with the ultrasound operator's score (p < 0.005, p < 0.001). CONCLUSION Artificial intelligence/machine learning-based LCS correlated with expert-level B-line quantification. Future studies are needed to determine whether automated tools may assist novice users in LUS interpretation.
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Affiliation(s)
- Andrew J Goldsmith
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mike Jin
- Centaur Labs, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruben Lucassen
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas E Harrison
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William Wells
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robinson Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Emergency Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Phil Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Katie Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xiaochun Li
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Basiliya K, Pang P, Honing J, di Pietro M, Varghese S, Gbegli E, Corbett G, Carroll NR, Godfrey EM. What can the Interventional Endoscopist Offer in the Management of Upper Gastrointestinal Malignancies? Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00183-8. [PMID: 37253647 DOI: 10.1016/j.clon.2023.05.004] [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: 02/19/2023] [Revised: 04/10/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
The therapeutic possibilities of endoscopy have rapidly increased in the last decades and now allow organ-sparing treatment of early upper gastrointestinal malignancy as well as an increasing number of options for symptom palliation. This review contains an overview of the interventional endoscopic procedures in upper gastrointestinal malignancies. It describes endoscopic treatment of early oesophageal and gastric cancers, and the palliative options in managing dysphagia and gastric outlet obstruction. It also provides an overview of the therapeutic possibilities of biliary endoscopy, such as retrograde stenting and radiofrequency biliary ablation. Endoscopic ultrasound-guided therapeutic options are discussed, including biliary drainage, gastrojejunostomy and coeliac axis block. To aid in clinical decision making, the procedures are described in the context of their indication, efficacy, risks and limitations.
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Affiliation(s)
- K Basiliya
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
| | - P Pang
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - J Honing
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - M di Pietro
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - S Varghese
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - E Gbegli
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - G Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - N R Carroll
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - E M Godfrey
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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Harrison N, Gupta S, Armitage S, Peacock J, Perkins D, Montelauro N, Abidov A, Ehrman R, Favot M, Pang P, Levy P. 145 External Validation of the Non-Ischemic Troponin Rule Out in Acute Heart Failure (NITRO-AHF) Decision Instrument for Acute Myocardial Infarction or Revascularization. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldsmith A, Duggan N, Jin M, Lucassen R, Fischetti C, Ferre R, Boyer E, Kapur T, Pang P, Russell F. 197 Deep Learning-Based Scoring of Pulmonary Congestion for BLUSHED AHF Trial. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fermann GJ, Schrock JW, Levy PD, Pang P, Butler J, Chang AM, Char D, Diercks D, Han JH, Hiestand B, Hogan C, Jenkins CA, Kampe C, Khan Y, Kumar VA, Lee S, Lindenfeld J, Liu D, Miller KF, Peacock WF, Reilly CM, Robichaux C, Rothman RL, Self WH, Singer AJ, Sterling SA, Storrow AB, Stubblefield WB, Walsh C, Wilburn J, Collins SP. Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12695. [PMID: 35434709 PMCID: PMC8994616 DOI: 10.1002/emp2.12695] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. Objective Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED. Methods This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED‐HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional troponin not due to acute coronary syndrome (ACS) were included. Our primary outcome was a composite endpoint: time to 30‐day cardiovascular death and/or heart failure‐related events. Results Of the 491 subjects included in the GUIDED‐HF trial, 418 had troponin measured during the ED evaluation and 66 (16%) had troponin values above the 99th percentile. Median age was 63 years (interquartile range, 54‐70), 62% (n = 261) were male, 63% (n = 265) were Black, and 16% (n = 67) experienced our primary outcome. There were no differences in our primary outcome between those with and without troponin elevation (12/66, 18.1% vs 55/352, 15.6%; P = 0.60). This effect was maintained regardless of assignment to usual care or the intervention arm. In multivariable regression analysis, there was no association between our primary outcome and elevated troponin (hazard ratio, 1.00; 95% confidence interval, 0.49–2.01, P = 0.994) Conclusion If confirmed in a larger cohort, these findings may facilitate safe ED discharge for a group of patients with AHF without ACS when an elevated troponin is the primary reason for admission.
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Affiliation(s)
- Gregory J. Fermann
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Jon W. Schrock
- Department of Emergency Medicine Metro Health Cleveland Ohio USA
| | - Phillip D. Levy
- Department of Emergency Medicine Wayne State University Detroit Michigan USA
| | - Peter Pang
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Javed Butler
- Division of Cardiovascular Medicine Stony Brook University Stony Brook New York USA
| | - Anna Marie Chang
- Department of Emergency Medicine Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Douglas Char
- Division of Emergency Medicine Washington University St. Louis Missouri USA
| | - Deborah Diercks
- Department of Emergency Medicine University of Texas‐Southwestern Dallas Texas USA
| | - Jin H. Han
- Department of Emergency Medicine Metro Health Cleveland Ohio USA
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - Brian Hiestand
- Department of Emergency Medicine Wake Forest University Winston‐Salem North Carolina USA
| | - Chris Hogan
- Department of Emergency Medicine Virginia Commonwealth University Richmond Virginia USA
| | - Cathy A. Jenkins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - Christy Kampe
- Department of Biostatistics Vanderbilt University Nashville Tennessee USA
| | - Yosef Khan
- American Heart Association/American Stroke Association Dallas Texas USA
| | - Vijaya A. Kumar
- Department of Emergency Medicine Wayne State University Detroit Michigan USA
| | - Sangil Lee
- Department of Emergency Medicine University of Iowa Iowa City Iowa USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Disease Vanderbilt University Medical Center Nashville Tennessee USA
| | - Dandan Liu
- Department of Biostatistics Vanderbilt University Nashville Tennessee USA
| | - Karen F. Miller
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - W. Frank Peacock
- Department of Emergency Medicine Baylor College of Medicine Houston Texas USA
| | - Carolyn M. Reilly
- Department of Emergency Medicine Emory University Atlanta Georgia USA
| | - Chad Robichaux
- Department of Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Russell L. Rothman
- Department of Internal Medicine Pediatrics & Health Policy Vanderbilt University Nashville Tennessee USA
| | - Wesley H. Self
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - Adam J. Singer
- Department of Emergency Medicine Renaissance School of Medicine at Stony Brook University Stony Brook New York USA
| | - Sarah A. Sterling
- Department of Emergency Medicine University of Mississippi Medical Center Jackson Mississippi USA
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - William B. Stubblefield
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
| | - Cheryl Walsh
- Geriatric Research Education and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USA
| | - John Wilburn
- Department of Emergency Medicine Wayne State University Detroit Michigan USA
| | - Sean P. Collins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USA
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Harrison NE, Meram S, Li X, White MB, Henry S, Gupta S, Zhu D, Pang P, Levy P. Hemodynamic profiles by non-invasive monitoring of cardiac index and vascular tone in acute heart failure patients in the emergency department: External validation and clinical outcomes. PLoS One 2022; 17:e0265895. [PMID: 35358231 PMCID: PMC8970400 DOI: 10.1371/journal.pone.0265895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Non-invasive finger-cuff monitors measuring cardiac index and vascular tone (SVRI) classify emergency department (ED) patients with acute heart failure (AHF) into three otherwise-indistinguishable subgroups. Our goals were to validate these “hemodynamic profiles” in an external cohort and assess their association with clinical outcomes. Methods AHF patients (n = 257) from five EDs were prospectively enrolled in the validation cohort (VC). Cardiac index and SVRI were measured with a ClearSight finger-cuff monitor (formerly NexFin, Edwards Lifesciences) as in a previous study (derivation cohort, DC, n = 127). A control cohort (CC, n = 127) of ED patients with sepsis was drawn from the same study as the DC. K-means cluster analysis previously derived two-dimensional (cardiac index and SVRI) hemodynamic profiles in the DC and CC (k = 3 profiles each). The VC was subgrouped de novo into three analogous profiles by unsupervised K-means consensus clustering. PERMANOVA tested whether VC profiles 1–3 differed from profiles 1–3 in the DC and CC, by multivariate group composition of cardiac index and vascular tone. Profiles in the VC were compared by a primary outcome of 90-day mortality and a 30-day ranked composite secondary outcome (death, mechanical cardiac support, intubation, new/emergent dialysis, coronary intervention/surgery) as time-to-event (survival analysis) and binary events (odds ratio, OR). Descriptive statistics were used to compare profiles by two validated risk scores for the primary outcome, and one validated score for the secondary outcome. Results The VC had median age 60 years (interquartile range {49–67}), and was 45% (n = 116) female. Multivariate profile composition by cardiac index and vascular tone differed significantly between VC profiles 1–3 and CC profiles 1–3 (p = 0.001, R2 = 0.159). A difference was not detected between profiles in the VC vs. the DC (p = 0.59, R2 = 0.016). VC profile 3 had worse 90-day survival than profiles 1 or 2 (HR = 4.8, 95%CI 1.4–17.1). The ranked secondary outcome was more likely in profile 1 (OR = 10.0, 1.2–81.2) and profile 3 (12.8, 1.7–97.9) compared to profile 2. Diabetes prevalence and blood urea nitrogen were lower in the high-risk profile 3 (p<0.05). No significant differences between profiles were observed for other clinical variables or the 3 clinical risk scores. Conclusions Hemodynamic profiles in ED patients with AHF, by non-invasive finger-cuff monitoring of cardiac index and vascular tone, were replicated de novo in an external cohort. Profiles showed significantly different risks of clinically-important adverse patient outcomes.
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Affiliation(s)
- Nicholas Eric Harrison
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
| | - Sarah Meram
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Xiangrui Li
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Morgan B. White
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sarah Henry
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Sushane Gupta
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Dongxiao Zhu
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Phillip Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
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Matsue Y, Sama IE, Postmus D, Metra M, Greenberg BH, Cotter G, Davison BA, Felker GM, Filippatos G, Pang P, Ponikowski P, Severin T, Gimpelewicz C, Voors AA, Teerlink JR. Association of Early Blood Pressure Decrease and Renal Function With Prognosis in Acute Heart Failure. JACC Heart Fail 2021; 9:890-903. [PMID: 34627724 DOI: 10.1016/j.jchf.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between systolic blood pressure (SBP) drop, worsening renal function (WRF), and prognosis in patients with acute heart failure (AHF). BACKGROUND A large drop in SBP early after hospital admission for AHF might be associated with increased risk for WRF and prognosis. However, there is a paucity of data regarding the interaction between WRF and a drop in SBP on clinical outcomes. METHODS A post hoc analysis among 6,544 patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure-2) trial was performed. Blood pressure was uniformly and repetitively measured. Peak SBP drop was defined as the difference between baseline SBP and lowest SBP documented during the first 48 hours. WRF was defined by an increase in serum creatinine of ≥0.3 mg/dL from baseline to day 5. RESULTS Peak SBP drop was independently associated with a higher risk for WRF (HR: 1.11 per 10 mm Hg SBP drop; P < 0.001), 5-day worsening heart failure (HR: 1.12 per 10 mm Hg SBP drop; P = 0.006), and 180-day cardiovascular death (HR: 1.09 per 10 mm Hg SBP drop; P = 0.026) after adjustment for potential confounders including baseline SBP. There was no interaction between the prognostic value of early SBP drop according to the presence or absence of WRF. CONCLUSIONS In patients hospitalized for AHF, a greater early drop in SBP was associated with a higher incidence of WRF, worsening heart failure, and an increased risk for 180-day cardiovascular death. However, the association between SBP drop and prognosis was not influenced by WRF. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778).
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Affiliation(s)
- Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iziah E Sama
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Douwe Postmus
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Metra
- Cardiology, ASST Civil Hospitals, and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Barry H Greenberg
- Division of Cardiology, University of California-San Diego, San Diego, California, USA
| | - Gad Cotter
- Momentum Research, Durham, North Carolina, USA; Inserm U-942 MASCOT, Paris, France
| | - Beth A Davison
- Momentum Research, Durham, North Carolina, USA; Inserm U-942 MASCOT, Paris, France
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, Indiana, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | | | | | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California, USA
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11
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Kuang Y, Luo Y, Yi X, Wang Q, Wang C, Shen M, Fu Y, Shu G, Li R, Zhu L, Pang P, Zhang Y, Zhu W, Chen X, Chen BT. Prevalence and risk factors for cognitive impairment in patients with psoriasis. J Eur Acad Dermatol Venereol 2021; 36:e152-e155. [PMID: 34582578 DOI: 10.1111/jdv.17707] [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: 05/03/2021] [Accepted: 09/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Y Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Y Luo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - X Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Q Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - C Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - M Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Y Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - G Shu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - R Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - L Zhu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - P Pang
- GE Healthcare, Hangzhou, China
| | - Y Zhang
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - W Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - X Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - B T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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12
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Harrison N, Ehrman R, Pang P, Collins S, Levy P. IS SYSTOLIC BLOOD PRESSURE AN APPROPRIATE ENTRY CRITERIA FOR VASODILATOR CLINICAL TRIALS IN ACUTE HEART FAILURE? J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Harrison N, Ehrman R, Pang P, Collins S, Levy P. ACUTE HEART FAILURE VASODILATOR TRIALS REQUIRE HIGHER ENROLLMENT BLOOD PRESSURES TO IDENTIFY THOSE WHO MAY BENEFIT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Abstract
PURPOSE OF REVIEW To review the key clinical and research questions regarding blood pressure (BP) reduction with vasodilators in the early management of hypertensive acute heart failure (H-AHF). RECENT FINDINGS Despite numerous AHF vasodilator clinical trials in the past two decades, virtually none has studied a population where vasoconstriction is the predominant physiology, and with the agents and doses most commonly used in contemporary practice. AHF patients are remarkably heterogenous by vascular tone, and this heterogeneity is not always discernible through BP or clinical exam. Emerging data suggest that diastolic BP may be a stronger correlate of vascular tone in AHF than systolic BP, despite the latter historically serving as a key inclusion criterion for vasodilator clinical trials. Existing data are limited. A clinical trial that evaluates vasodilators in a manner of use consistent with contemporary practice, specifically within the subpopulation of patients with true H-AHF, is greatly needed. Until then, observational data supports long-standing vasodilators such as nitroglycerin, administered by IV bolus, and with goal reduction of SBP ≤25% as a safe first-line approach for patients with severe H-AHF presentations.
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Affiliation(s)
| | - Peter Pang
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean Collins
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Phillip Levy
- Wayne State University School of Medicine, Detroit, MI, USA
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15
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Song LY, Li YJ, Pang P, Xiao HY, Dou JT. [Insulin autoimmune syndrome caused by proton pump inhibitors: a case report]. Zhonghua Nei Ke Za Zhi 2021; 60:58-60. [PMID: 33397024 DOI: 10.3760/cma.j.cn112138-20200217-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- L Y Song
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Y J Li
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - P Pang
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - H Y Xiao
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - J T Dou
- Department of Endocrinology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
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16
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Ma Q, Feng L, Wang T, Li Y, Li Z, Zhao B, Qin X, Li Q, Wu S, Sun H, Yuan J, Chu L, Wu J, Gu Y, Pang P, Chen Z, Fan D. 2020 expert consensus statement on neuro-protection after cardiac arrest in China. Ann Transl Med 2021; 9:175. [PMID: 33569477 PMCID: PMC7867902 DOI: 10.21037/atm-20-7853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Qingbian Ma
- Emergency Department, Peking University Third Hospital, Beijing, China
| | - Liqun Feng
- Neurology Department, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Neurosurgery Department, Peking University Third Hospital, Beijing, China
| | - Yongqiu Li
- Neurology Department, Tangshan Gongren Hospital, Tangshan, China
| | - Zhenzhong Li
- Neurology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Zhao
- Emergency Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiuchuan Qin
- Emergency Department, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingxi Li
- Neurosurgery Department, Dandong Central Hospital, Dandong, China
| | - Shizheng Wu
- Neurology Department, Qinghai Provincial People's Hospital, Xining, China
| | - Hongbin Sun
- Neurology Department, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jun Yuan
- Neurology Department, Inner Mongolia People's Hospital, Hohhot, China
| | - Lan Chu
- Neurology Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jian Wu
- Neurology Department, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yuxiang Gu
- Neurosurgery Department, Fudan University Huashan Hospital, Shanghai, China
| | - Peter Pang
- Accident and Emergency Department, Yan Chai Hospital, Hong Kong, China
| | - Zhi Chen
- Beijing Emergency Medical Center, Beijing, China
| | - Dongsheng Fan
- Neurology Department, Peking University Third Hospital, Beijing, China
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17
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Pugliese N, Frassi F, Frumento P, Poggianti E, Mazzola M, De Biase N, Landi P, Masi S, Taddei S, Pang P, Sicari R, Gargani L. Prognostic value of integrated cardiopulmonary ultrasound in inpatients with acute heart failure with preserved and reduced ejection fraction and without heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To assess the prognostic value of B-lines integrated with echocardiography in patients admitted to a Cardiology Department, with and without acute heart failure (AHF).
Background
Lung-ultrasound (LUS) B-lines are sonographic signs of pulmonary congestion and can be used in the differential diagnosis of dyspnea to rule in or rule out AHF. Their prognostic value at admission is less established, as well as the different role in AHF with reduced and preserved ejection fraction (HFrEF and HFpEF), or patients admitted for cardiac conditions but without overt signs and symptoms of AHF.
Methods
A total of 1021 consecutive in-patients (69±12 years) admitted for various cardiac conditions were enrolled. Patients were classified into three groups: 1) acute HFrEF; 2) acute HFpEF; 3) no AHF. All patients underwent on the admission an echocardiogram coupled with LUS, according to standardised protocols.
Results
Patients were followed-up for a median of 14.4 months (interquartile range: 4.6–24.3) for death and HF readmission (composite endpoint). During the follow-up, 126 events occurred. Kaplan-Meier survival analyses showed admission B-lines >30 identified patients with worse outcome at follow-up in the overall population and each of the three groups (Figure). At multivariable analysis (Table), admission B-lines >30, EF <50%, tricuspid regurgitation velocity >2.8 m/s and tricuspid annular plane systolic excursion (TAPSE) <17 mm resulted in independent predictors of the composite endpoint. B-lines >30 had a strong predictive value in HFpEF and non-AHF, but not in HFrEF.
Conclusions
Ultrasound B-lines can detect subclinical pulmonary interstitial edema in patients thought to be free of congestion, and provide useful information not only for the diagnosis but also for the prognosis in different cardiac conditions. Their added prognostic value among standard echocardiographic parameters is stronger in patients with HFpEF compared to HFrEF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N.R Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Frassi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - E Poggianti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Landi
- National Council of Research, Pisa, Italy
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Pang
- Indiana University School of Medicine, Indianapolis, United States of America
| | - R Sicari
- National Council of Research, Pisa, Italy
| | - L Gargani
- National Council of Research, Pisa, Italy
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18
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Feng S, Janwanishstaporn S, Teerlink JR, Metra M, Cotter G, Davison B, Felker GM, Filippatos G, Pang P, Ponikowski P, Sama IE, Voors AA, Greenberg B. Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study. Eur J Heart Fail 2020; 23:58-67. [PMID: 32964537 DOI: 10.1002/ejhf.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/12/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Whether risk of worsening renal function (WRF) during acute heart failure (AHF) hospitalization or the association between in-hospital WRF and post-discharge outcomes vary according to left ventricular ejection fraction (LVEF) is uncertain. We assessed incidence of WRF, factors related to its development and impact of WRF on post-discharge outcomes across the spectrum of LVEF in patients enrolled in RELAX-AHF-2. METHODS AND RESULTS A total of 6112 patients who had LVEF measured on admission and renal function determined prospectively during hospitalization were included. WRF, defined as a rise in serum creatinine ≥0.3 mg/dL from baseline through day 5, occurred in 1722 patients (28.2%). Incidence increased progressively from lowest to highest LVEF quartile (P < 0.001). After baseline adjustment, WRF risk in Q4 (LVEF >50%) remained significantly greater than in Q1 (LVEF ≤29%; hazard ratio 1.2, 95% confidence interval 1-1.43; P = 0.050). Age and comorbidity burden including chronic kidney disease increased as LVEF increased. Neither admission haemodynamic abnormalities, extent of diuresis during hospitalization nor residual congestion explained the increased incidence of WRF in patients with higher LVEF. Serelaxin treatment and diuretic responsiveness were associated with reduced risk of WRF in all LVEF quartiles. WRF in patients in the upper three LVEF quartiles increased risk of post-discharge events. CONCLUSIONS Worsening renal function incidence during AHF hospitalization increases progressively with LVEF. Greater susceptibility of patients with higher LVEF to WRF appears more related to their advanced age and worse underlying kidney function rather than haemodynamic or treatment effects. WRF is associated with increased risk of post-discharge events except in patients in the lowest LVEF quartile.
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Affiliation(s)
- Siting Feng
- Division of Cardiology, University of California, San Diego, CA, USA.,Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Satit Janwanishstaporn
- Division of Cardiology, University of California, San Diego, CA, USA.,Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Gerasimos Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus.,National and Kapidistrian University of Athens, School of Medicine, Athens, Greece
| | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wrocław, Poland
| | - Iziah E Sama
- University of Groningen, Groningen, The Netherlands
| | | | - Barry Greenberg
- Division of Cardiology, University of California, San Diego, CA, USA
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19
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Janwanishstaporn S, Feng S, Teerlink J, Metra M, Cotter G, Davison BA, Felker GM, Filippatos G, Pang P, Ponikowski P, Severin T, Gimpelewicz C, Holbro T, Chen CW, Sama I, Voors AA, Greenberg BH. Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX‐AHF‐2 trial. Eur J Heart Fail 2020; 22:726-738. [DOI: 10.1002/ejhf.1772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Satit Janwanishstaporn
- Division of Cardiology University of California San Diego CA USA
- Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
| | - Siting Feng
- Division of Cardiology University of California San Diego CA USA
- Beijing Anzhen Hospital Capital Medical University Beijing China
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine University of California San Francisco CA USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health University of Brescia Brescia Italy
| | | | | | - G. Michael Felker
- Division of Cardiology Duke University School of Medicine Durham NC USA
| | | | - Peter Pang
- Department of Emergency Medicine Indiana University School of Medicine, and the Regenstrief Institute Indianapolis IN USA
| | - Piotr Ponikowski
- Department of Heart Diseases Medical University, Military Hospital Wrocław Poland
| | | | | | | | | | - Iziah Sama
- Department of Cardiology University of Groningen Groningen The Netherlands
| | - Adriaan A. Voors
- Department of Cardiology University of Groningen Groningen The Netherlands
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20
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Cotter O, Davison BA, Koch G, Senger S, Metra M, Voors AA, Mebazza A, Nielsen OW, Chioncel O, Pang P, Greenberg BH, Maggioni A, Sato N, Teerlink JR, Cotter G. 4329Mega-studies in heart failure, effect dilution in examination of new therapies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
All phase 3 studies in patients with acute heart failure (AHF) and HF with preserved ejection fraction (HFpEF) have failed in the last decades. We explore the likelihood that the negative results are due to chance and/or to study size and dilution of statistical power.
Methods and results
First, using simulations, we examined the probability that a positive finding in phase 2 would result in studying truly effective drugs in phase 3. We simulated phase 2 studies under six scenarios where the range of true relative risk (RR) for an outcome of interest varied from 0.5 (major benefit) to 1.15 (some harm). The proportion of simulated studies where the RR <0.8 (we assumed that a 20% or greater risk reduction reflects an effective drug) ranged from 6% to 42% across the six scenarios studied. To further simulate “real life” clinical research, we simulated a continuous surrogate outcome that was linearly related to the true RR in each simulation of each scenario. Regardless of criteria considered for a positive phase 2 trial, results suggest that even in our worst-case scenario, where overall only 6% of drugs taken into phase 2 are effective, roughly 20% of phase 3 studies, if appropriately powered, should have yielded positive results. Given this, we then explored study size in AHF research, as a potential explanation for the high failure rate in these studies. Comparison of published phase 2 and 3 clinical trials with registries in AHF suggest that populations in both large and small trials differ from “real life”. Meta-regression models suggest that both control event rates, and in the serelaxin program as an example, treatment effects, decline with increasing study size greatly reducing power (figure). This effect dilution might be explained by an increasing proportion of patients enrolled in studies who cannot benefit from the study drug.
Figure 1. Power at two-sided 0.05 significance level to detect an effect size of hazard ratio of 0.65 (left) or 0.8 (right) with a placebo event rate of 10% (top) and 20% (bottom) at N=100 at various treatment effect dilutions with increasing sample size.
Conclusion
These data suggest that it is unlikely that the very high rate of negative AHF phase III trials can be explained by chance alone. Potentially, our tendency to increase sample size does not necessarily increase statistical power, due to more heterogenous populations leading to reduced event rates and treatment effects.
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Affiliation(s)
- O Cotter
- Momentum Research Inc., Durham, United States of America
| | - B A Davison
- Momentum Research Inc., Durham, United States of America
| | - G Koch
- UNC, Chapel-Hill, United States of America
| | - S Senger
- Momentum Research Inc., Durham, United States of America
| | - M Metra
- Civil Hospital of Brescia, Cardiology, Brescia, Italy
| | - A A Voors
- University Medical Center Groningen, Cardiology, Groningen, Netherlands (The)
| | - A Mebazza
- Saint Louis Lariboisière University Hospitals, Department of Anesthesiology and Critical Care Medicine, AP-HP, Paris, France
| | - O W Nielsen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - O Chioncel
- Carol Davila Emergency Clinical Military Hospital, Bucharest, Romania
| | - P Pang
- Indiana University School of Medicine, Indianapolis, United States of America
| | - B H Greenberg
- University of California San Diego, San Diego, United States of America
| | - A Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - N Sato
- Nippon Medical School, Musashi-Kosugi Hospital, Cardiology and Intensive Care Unit, Kawasaki, Japan
| | - J R Teerlink
- University of California San Francisco, San Francisco, United States of America
| | - G Cotter
- Momentum Research Inc., Durham, United States of America
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21
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Yang Y, Xie Z, Pang P, Wang N, Liang H, Zhao L. EP1.14-43 The Safety of First-line and Subsequent Monotherapy of PD-1/PD-L1 Inhibitors in NSCLC: A Meta Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Weng Q, Zhou L, Wang H, Hui J, Chen M, Pang P, Zheng L, Xu M, Wang Z, Ji J. A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules. Clin Radiol 2019; 74:933-943. [PMID: 31521324 DOI: 10.1016/j.crad.2019.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Abstract
AIM A nomogram model was developed to predict the histological subtypes of lung invasive adenocarcinomas (IAs) and minimally invasive adenocarcinomas (MIAs) that manifest as part-solid ground-glass nodules (GGNs). MATERIALS AND METHODS This retrospective study enrolled 119 patients with histopathologically confirmed part-solid GGNs assigned to the training (n=83) or testing cohorts (n=36). Radiomic features were extracted based on the unenhanced computed tomography (CT) images. R software was applied to process the qualitative and quantitative data. The CT features model, radiomic signature model, and combined prediction model were constructed and compared. RESULTS A total of 396 radiomic features were extracted from the preoperative CT images, four features including MaxIntensity, RMS, ZonePercentage, and LongRunEmphasis_angle0_offset7 were indicated to be the best discriminators to establish the radiomic signature model. The performance of the model was satisfactory in both the training and testing set with areas under the curve (AUCs) of 0.854 (95% confidence interval [CI]: 0.774 to 0.934) and 0.813 (95% CI: 0.670 to 0.955), respectively. The CT morphology of the lesion shape and diameter of the solid component were confirmed to be a significant feature for building the CT features model, which had an AUC of 0.755 (95% CI: 0.648 to 0.843). A nomogram that integrated lesion shape and radiomic signature was constructed, which contributed an AUC of 0.888 (95% CI: 0.82 to 0.955). CONCLUSIONS The radiomic signature could provide an important reference for differentiating IAs from MIAs, and could be significantly enhanced by the addition of CT morphology. The nomogram may be highly informative for making clinical decisions.
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Affiliation(s)
- Q Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - L Zhou
- Department of Radiology, Lishui People's Hospital, Lishui, 323000, China
| | - H Wang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - J Hui
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - M Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - P Pang
- GE Healthcare, Hangzhou 310000, China
| | - L Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - M Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Z Wang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - J Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, 323000, China.
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Pang P, Sun C, Duan W, Liu S, Bai S, Ma Y, Li R, Liu F. A review on global head and neck tuberculosis cases from 980 papers and 5881 patients. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu M, Wu H, Wang S, Pang P, Jin S, Sun C, Liu F. MIR-1275 promotes cell migration, invasion and proliferation in squamous cell carcinoma of head and neck via up-regulating igf-1R and CCR7. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pang P, Sun C, Duan W, Liu S, Bai S, Ma Y, Li R, Liu F. A review on global head and neck tuberculosis cases from 980 papers and 5881 patients. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pang P, Ng YS, Sidhu J, Kok M. Epidemiology of Inflammatory Bowel Disease in Southern Peninsular Malaysia. Med J Malaysia 2018; 73:86-89. [PMID: 29703871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To record the incidence and prevalence of inflammatory bowel disease (IBD), its social demographics, clinical characteristics and treatment, in the state of Johor, Malaysia. METHODS Hospital Sultanah Aminah, Johor Bahru, is the only public hospital in Johor with a Gastroenterology service. Data on all existing and new IBD patients managed by the Gastroenterology Unit in 2016 were collected. Incidence and prevalence of IBD in 2016 were then calculated based on the estimated population of Johor and Johor Bahru. RESULTS Twenty-five new cases of IBD were diagnosed in 2016. Among the 25 cases, 13 cases were Crohn's disease (CD), 10 were ulcerative colitis (UC) and two were IBD Unclassified (IBDU). The crude incidence of IBD, CD, UC and IBDU were 0.68, 0.36, 0.27, and 0.05 per 100,000 population respectively. Ethnic Indians had the highest incidence of IBD at 4.21 followed by Malays and Chinese at 0.56 and 0.18 per 100,000 population respectively. A total of 156 IBD cases were captured. Amongst them, 85 cases were UC, 68 cases were CD and three cases were IBDU, hence the prevalence of IBD, UC, CD and IBDU were 4.27, 2.33, 1.86 and 0.08 per 100,000 population respectively. Similarly, Indians had the highest prevalence at 16.84, followed by Chinese at 4.06 and Malays at 3.44 per 100,000 population. CONCLUSIONS The incidence of IBD in Johor is comparable to that of a previous study in northern Peninsular Malaysia. The ethnicity preponderance is similar to the previous studies conducted in Malaysia.
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Affiliation(s)
- P Pang
- Hospital Sultanah Aminah Johor Bahru, Department of Medicine, Gastroenterology Unit, Malaysia.
| | - Y S Ng
- Hospital Sultanah Aminah Johor Bahru, Department of Medicine, Gastroenterology Unit, Malaysia
| | - J Sidhu
- Hospital Sultanah Aminah Johor Bahru, Department of Medicine, Gastroenterology Unit, Malaysia
| | - M Kok
- Hospital Sultanah Aminah Johor Bahru, Department of Medicine, Gastroenterology Unit, Malaysia
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Pare J, Pang P, Noble V, Moore C, Sam F. 104EMF Can Corrected Flow Time Detect Changes in Patients Undergoing Heart Failure Treatment? Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jung M, Pressler SJ, Newhouse RP, Lake KR, Smith M, O'Donnell D, Arkins T, Bakoyannis G, Cook R, Pang P, Gradus-Pizlo I. Emergency Medical Services Activation for Heart Failure Patients: A Methodological Pilot Study. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gimpelewicz C, Metra M, Cleland JG, Szecsödy P, Chang Wun CC, Boer-Martins L, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Pang P, Ponikowski P, Severin T, Voors AA, Teerlink JR. Effects of serelaxin on the outcome of patients with or without substantial peripheral edema: A subgroup analysis from the RELAX-AHF trial. Am Heart J 2017; 190:113-122. [PMID: 28760204 DOI: 10.1016/j.ahj.2017.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/24/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute heart failure (AHF) is a heterogeneous disorder, with most of the patients presenting with breathlessness along with varying degrees of peripheral edema. The presence of peripheral edema suggests that volume overload is the cause of decompensation leading to AHF, whereas breathlessness in the absence of edema may reflect a "vascular phenotype." This analysis investigated the characteristics, therapeutic response, and outcome of patients with AHF, with and without overt peripheral edema in the RELAX-AHF trial. METHODS Physician-assessed edema scores at baseline were used to categorize the population into those with no/mild edema (score 0 or 1+) and moderate/severe edema (score 2+ or 3+). The effect of serelaxin vs placebo was assessed within each subgroup. RESULTS Patients with moderate/severe edema (n = 583; 50.5%) were more likely to have severe dyspnea, orthopnea (>30°), rales (≥1/3), and elevated jugular venous pressure (>6 cm) than the patients with little or no peripheral edema (n=571; 49.5%). The relative benefits of serelaxin in terms of reduction in breathlessness, lower diuretic requirements, decreased length of initial hospital stay and days in intensive care unit/cardiac care unit, and improved prognosis (180-day cardiovascular and all-cause mortality) were generally similar for patients with or without peripheral edema. However, because patients with moderate/severe peripheral edema had worse outcomes, the absolute benefit was generally greater than in patients with no/mild edema. CONCLUSIONS Overall, patients with AHF and moderate/severe peripheral edema have a worse prognosis but appear to receive similar relative benefit and perhaps greater absolute benefit from serelaxin administration.
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Fermann GJ, Levy PD, Pang P, Butler J, Ayaz SI, Char D, Dunn P, Jenkins CA, Kampe C, Khan Y, Kumar VA, Lindenfeld J, Liu D, Miller K, Peacock WF, Rizk S, Robichaux C, Rothman RL, Schrock J, Singer A, Sterling SA, Storrow AB, Walsh C, Wilburn J, Collins SP. Design and Rationale of a Randomized Trial of a Care Transition Strategy in Patients With Acute Heart Failure Discharged From the Emergency Department: GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure). Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003581. [PMID: 28188268 DOI: 10.1161/circheartfailure.116.003581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/18/2017] [Indexed: 11/16/2022]
Abstract
GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure) is a multicenter randomized trial of a patient-centered transitional care intervention in patients with acute heart failure (AHF) who are discharged either directly from the emergency department (ED) or after a brief period of ED-based observation. To optimize care and reduce ED and hospital revisits, there has been significant emphasis on improving transitions at the time of hospital discharge for patients with HF. Such efforts have been almost exclusively directed at hospitalized patients; individuals with AHF who are discharged from the ED or ED-based observation are not included in these transitional care initiatives. Patients with AHF discharged directly from the ED or after a brief period of ED-based observation are randomly assigned to our transition GUIDED-HF strategy or standard ED discharge. Patients in the GUIDED arm receive a tailored discharge plan via the study team, based on their identified barriers to outpatient management and associated guideline-based interventions. This plan includes conducting a home visit soon after ED discharge combined with close outpatient follow-up and subsequent coaching calls to improve postdischarge care and avoid subsequent ED revisits and inpatient admissions. Up to 700 patients at 11 sites will be enrolled over 3 years of the study. GUIDED-HF will test a novel approach to AHF management strategy that includes tailored transitional care for patients discharged from the ED or ED-based observation. If successful, this program may significantly alter the current paradigm of AHF patient care. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519283.
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Affiliation(s)
- Gregory J Fermann
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Phillip D Levy
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Peter Pang
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Javed Butler
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - S Imran Ayaz
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Douglas Char
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Patrick Dunn
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Cathy A Jenkins
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Christy Kampe
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Yosef Khan
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Vijaya A Kumar
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - JoAnn Lindenfeld
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Dandan Liu
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Karen Miller
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - W Frank Peacock
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Samaa Rizk
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Chad Robichaux
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Russell L Rothman
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Jon Schrock
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Adam Singer
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Sarah A Sterling
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Alan B Storrow
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Cheryl Walsh
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - John Wilburn
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.)
| | - Sean P Collins
- From the Department of Emergency Medicine, University of Cincinnati, OH (G.J.F.); Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L., S.I.A., V.A.K., S.R., J.W.); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.P.); Division of Cardiovascular Medicine (J.B.) and Department of Emergency Medicine (A.S.), Stony Brook University, NY; Division of Emergency Medicine, Washington University, St. Louis, MO (D.C.); American Heart Association/American Stroke Association, Dallas, TX (P.D., Y.K.); Department of Biostatistics (C.A.J., D.L.), Department of Emergency Medicine (C.K., K.M., A.B.S., C.W., S.P.C.), Division of Cardiovascular Disease (J.L.), and Department of Internal Medicine, Pediatrics and Health Policy (R.L.R.), Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.R.); Department of Emergency Medicine, Metro Health, Cleveland, OH (J.S.); and Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (S.A.S.).
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Abstract
Porcine circovirus type 2 (PCV2) has been known as a causative agent of reproductive failure in the sow. In the present study mouse model was used to investigate PCV2 infection. In order to investigate whether PCV2 can induce lesions of spermatocytes and oocytes, 6 male and 6 female mice were each inoculated intraperitoneally with PCV2b, and 3 male and 3 female mice mock-infected with cell culture supernatant served as controls. Samples of testes and ovaries from PCV2b-inoculated and mock-infected mice were investigated using PCR, histopathological, ultrastructural and immunofluorescent histochemical methods at 14 and 21 day post infection (dpi). The study revealed that in the virus-inoculated mice leydig cells in testes and granulosa cells in ovaries were degenerated, and a small number of spermatocytes and oocytes showed apoptosis. Positive PCV2b antigen signals were also observed in these apoptotic cells. It can be suggested that PCV2 can cause lesions of spermatocyte and oocyte prior to zygotes formation in its host.
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Bao SD, Pang P, Zang L, Chen K, Gu WJ, Yang GQ, Du J, Tian W, Luo YK, Lü ZH, Dou JT, Mu YM. [Predictive value of sonographic features in preoperative evaluation of medullary thyroid carcinoma]. Zhonghua Yi Xue Za Zhi 2017; 96:2482-6. [PMID: 27562047 DOI: 10.3760/cma.j.issn.0376-2491.2016.31.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To summarize ultrasound features associated with medullary thyroid carcinoma (MTC) and investigate the predictive value of ultrasonography in preoperative diagnosis of MTC. METHODS The sonographic and clinical data were studied in a series of nodules histologically proven as MTC collected from January 1993 to January 2013. RESULTS A total of 86 patients (92 nodules proven as MTC) were enrolled in the study with an average age of (47±12) years.Among the MTCs, 21.7%(20/92) were excluded because of missing data and the remained 78.3%(72/92) had complete data with the average diameter of (2.1±1.3) cm.The common US findings for MTC were solid, hypoechogenicity, regular sharp, well-defined margin, AP/ TR<1 and calcification (mostly microcalcification). Calcification and vascularization were more common in MTC nodules(48.6% vs 5.6%, P=0.001). Nodules with enlargement of cervical lymph node tended to be undergone FNAB(76.0% vs 55.3%, P=0.084), and ill-defined margin was more common in MTC nodules with cervical lymph node metastasis(36.4% vs 12.8%, P=0.009). CONCLUSION Despite having a few US features closely linked to the malignant nodules such as solid, hypoechogenicity and with microcalcification, the MTC nodules also have specific US imaging characteristics as regular sharp, well-defined margin and AP/ TR<1.
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Affiliation(s)
- S D Bao
- Department of Endocrinology, People's Liberation Army General Hospital, Beijing 100853, China
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Darling CE, Sun JE, Goldberg J, Pang P, Baugh CW, Lessard D, McManus DD. A Historical Perspective on Presentations of Hypertensive Acute Heart Failure. J Cardiovasc Dis Diagn 2017; 5. [PMID: 28824930 PMCID: PMC5560164 DOI: 10.4172/2329-9517.1000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- Corresponding authors: Chad E Darling, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North Worcester, MA, 01655, USA, Tel: 5084211464;
| | - Jiaoyuan Elisabeth Sun
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jordan Goldberg
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Peter Pang
- Department of Emergency Medicine, University of Indiana, Indianapolis, IN, USA
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
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Ng S, Fong S, Chan C, Fung F, Pang P, Tsang N, Yeung C, Kwong P, Tse M, Tam E. Floor transfer test for assessing people with chronic stroke. J Rehabil Med 2015; 47:489-94. [DOI: 10.2340/16501977-1958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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AbouEzzeddine O, Lala A, Wong YW, Mentz R, Khazanie P, McNulty S, Anstrom K, Hernandez A, Pang P, Shah M, Givertz M, Anand I, Butler J, Semigran M, Braunwald E, Stevenson L, Redfield M. THE WORST SYMPTOM VISUAL ANALOGUE SCALE: A PROSPECTIVE ANCILLARY STUDY FROM THE RENAL OPTIMIZATION STRATEGIES EVALUATION IN ACUTE HEART FAILURE (ROSE-AHF) TRIAL. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60752-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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AbouEzzeddine O, Wong YW, Lala A, Mentz R, Khazanie P, McNulty S, Anstrom K, Hernandez A, Pang P, Shah M, Givertz M, Anand I, Butler J, Semigran M, Stevenson L, Braunwald E, Redfield M. RELIABLE EVALUATION OF DYSPNEA (RED-ROSE): A PROSPECTIVE ANCILLARY STUDY FROM THE RENAL OPTIMIZATION STRATEGIES EVALUATION IN ACUTE HEART FAILURE (ROSE-AHF) TRIAL. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60751-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chiu LHS, Yau WH, Leung LP, Pang P, Tsui CT, Wan KA, Au TTS, Fong WC, Chung SHJ. Short-Term Prognosis of Transient Ischemic Attack and Predictive Value of the ABCD(2) Score in Hong Kong Chinese. Cerebrovasc Dis Extra 2014; 4:40-51. [PMID: 24715897 PMCID: PMC3975175 DOI: 10.1159/000360074] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Literature on prognosis of transient ischemic attack (TIA) in Chinese is scarce. The short-term prognosis of TIA and the predictive value of the ABCD(2) score in Hong Kong Chinese patients attending the emergency department (ED) were studied to provide reference for TIA patient management in our ED. METHODS A cohort of TIA patients admitted through the ED to 13 acute public hospitals in 2006 was recruited through the centralized electronic database by the Hong Kong Hospital Authority (HA). All inpatients were e-coded by the HA according to the International Classification of Diseases, Ninth Revision (ICD9). Electronic records and hard copies were studied up to 90 days after a TIA. The stroke risk of a separate TIA cohort diagnosed by the ED was compared. RESULTS In the 1,000 recruited patients, the stroke risk after a TIA at days 2, 7, 30, and 90 was 0.2, 1.4, 2.9, and 4.4%, respectively. Antiplatelet agents were prescribed in 89%, warfarin in 6.9%, statin in 28.6%, antihypertensives in 39.3%, and antidiabetics in 11.9% of patients after hospitalization. Before the index TIA, the prescribed medications were 27.6, 3.7, 11.3, 27.1, and 9.7%, respectively. The accuracy of the ABCD(2) score in predicting stroke risk was 0.607 at 7 days, 0.607 at 30 days, and 0.574 at 90 days. At 30 days, the p for trend across ABCD(2) score levels was 0.038 (OR for every score point = 1.36, p = 0.040). Diabetes mellitus, previous stroke and carotid bruit were associated with stroke within 90 days (p = 0.038, 0.045, 0.030, respectively). A total of 45.4% of CTs of the brain showed lacunar infarcts or small vessel disease. There was an increased stroke risk at 90 days in patients with old or new infarcts on CT or MRI. Patients with carotid stenosis ≥70% had an increased stroke risk within 30 (OR = 6.335, p = 0.013) and 90 days (OR = 3.623, p = 0.050). Stroke risks at days 2, 7, 30, and 90 in the 289 TIA patients diagnosed by the ED were 0.35, 2.4, 5.2, and 6.2%, respectively. CONCLUSION The short-term stroke risk in Hong Kong Chinese TIA patients is low. The administered nonurgent treatment cannot solely explain the favorable outcome, the lower risk can be due to the different pathophysiological mechanisms of stroke between Caucasians and Chinese. The predictive value of the ABCD(2) score is low in our population.
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Affiliation(s)
- Lai Hong Simon Chiu
- Accident and Emergency Department at Princess Margret Hospital, Hong Kong, SAR, PR China
| | - Wah Hon Yau
- Accident and Emergency Department at Queen Elizabeth Hospital, Hong Kong, SAR, PR China
| | - Ling Pong Leung
- Accident and Emergency Department at Queen Mary Hospital, Hong Kong, SAR, PR China
| | - Peter Pang
- Accident and Emergency Department at Yan Chai Hospital, Hong Kong, SAR, PR China
| | - Chee Tat Tsui
- Accident and Emergency Department at Princess Margret Hospital, Hong Kong, SAR, PR China
| | - Kuang An Wan
- Accident and Emergency Department at Ruttongie and Tang Siu Kin Hospital, Hong Kong, SAR, PR China
| | - Thomas Tak-Shun Au
- Accident and Emergency Department at Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, PR China
| | - Wing Chi Fong
- Department of Medicine and Geriatrics, Queen Elizabeth Hospital, Hong Kong, SAR, PR China
| | - Shun Hang Joseph Chung
- Accident and Emergency Department at Tuen Mun Hospital, Queen Elizabeth Hospital, Hong Kong, SAR, PR China
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Pang P. Psychiatry with a scalpel — making smiles, changing lives. Interviewed by Winnie Sung and Clara Tsui. Hong Kong Med J 2014; 20:84-85. [PMID: 24620379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Collins S, Levy P, Pang P, Gheorghiade M. Reply to letter to the editor by Shiraishi and colleagues. Am Heart J 2013; 166:e47. [PMID: 24268224 DOI: 10.1016/j.ahj.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ojaghi-Haghighi Z, Mostafavi A, Moladoust H, Noohi F, Maleki M, Esmaeilzadeh M, Samiei N, Hosseini S, Jasaityte R, Teske A, Claus P, Verheyden B, Rademakers F, D'hooge J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Maniatakis P, Parthenakis F, Vardas P, Hilde JM, Skjoerten I, Humerfelt S, Hansteen V, Melsom M, Hisdal J, Steine K, Ippolito R, Gripari P, Muraru D, Esposito R, Kocabay G, Tamborini G, Galderisi M, Maffessanti F, Badano L, Pepi M, Yurdakul S, Oner F, Sahin T, Avci B, Tayyareci Y, Direskeneli H, Aytekin S, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Andova V, Georgievska-Ismail L, Srbinovska-Kostovska E, Gardinger Y, Joanna Hlebowicz J, Ola Bjorgell O, Magnus Dencker M, Liao MT, Tsai CT, Lin JL, Piestrzeniewicz K, Luczak K, Maciejewski M, Komorowski J, Jankiewicz-Wika J, Drozdz J, Ismail MF, Alasfar A, Elassal M, El-Sayed S, Ibraheim M, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Santos Furtado M, Nogueira K, Arruda A, Rodrigues AC, Carvalho F, Silva M, Cardoso A, Lira-Filho E, Pinheiro J, Andrade JL, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Taha N, Zagari D, Oteri A, Quattrone A, Boretti I, Carerj S, Obremska O, Boratynska B, Poczatek P, Zon Z, Magott M, Klinger K, Szenczi O, Szelid Z, Soos P, Bagyura Z, Edes E, Jozan P, Merkely B, Ahn J, Kim D, Jeon D, Kim I, Baeza Garzon F, Delgado M, Mesa D, Ruiz M, De Lezo JS, Pan M, Leon C, Castillo F, Morenate M, Toledano F, Zhong L, Lim E, Shanmugam N, Law S, Ong B, Katwadi K, Tan R, Chua Y, Liew R, Ding Z, Von Bibra H, Leclerque C, Schuster T, Schumm-Draeger PM, Bonios M, Kaladaridou A, Papadopoulou O, Tasoulis A, Pamboucas C, Ntalianis A, Nanas J, Toumanidis S, Silva D, Cortez-Dias N, Carrilho-Ferreira P, Placido R, Jorge C, Calisto C, Robalo Martins S, Carvalho De Sousa J, Pinto F, Nunes Diogo A, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Moral Torres S, Rodriguez-Palomares J, Pineda V, Gruosso D, Evangelista A, Garcia-Dorado D, Figueras J, Cambronero E, Corbi MJ, Valle A, Cordoba J, Llanos C, Fernandez M, Lopez I, Hidalgo V, Barambio M, Jimenez J, D'andrea A, Riegler L, Cocchia R, Russo M, Bossone E, Calabro R, Iniesta Manjavacas A, Valbuena Lopez S, Lopez Fernandez T, Garcia-Blas S, De Torres Alba F, De Diego JG, Ramirez Valdiris U, Mesa Garcia J, Moreno Yanguela M, Lopez-Sendon J, Logstrup B, Andersen H, Thuesen L, Christiansen E, Terp K, Klaaborg K, Poulsen S, Cacicedo A, Velasco S, Aguirre U, Onaindia J, Rodriguez I, Oria G, Subinas A, Zugazabeitia G, Romero A, Laraudogoitia Zaldumbide E, Weisz S, Magne J, Dulgheru R, Rosca M, Pierard L, Lancellotti P, Auffret V, Donal E, Bedossa M, Boulmier D, Laurent M, Verhoye J, Le Breton H, Van Hall S, Herbrand T, Ketterer U, Keymel S, Boering Y, Rassaf T, Meyer C, Zeus T, Kelm M, Balzer J, Floria M, Seldrum S, Mariciuc M, Laurence G, Buche M, Eucher P, Louagie Y, Jamart J, Marchandise B, Schroeder E, Venkatesh A, Sahlen A, Johnson J, Brodin L, Winter R, Shahgaldi K, Manouras A, Maffessanti F, Tamborini G, Fusini L, Gripari P, Muratori M, Alamanni F, Bartorelli A, Ferrari C, Caiani E, Pepi M, Yaroslavskaya E, Kuznetsov V, Pushkarev G, Krinochkin D, Zyrianov I, Ciobotaru C, Kobayashi Y, Yamamoto K, Kobayashi Y, Hirose E, Hirohata A, Ohe T, Jhund P, Cunningham T, Murday V, Findlay I, Sonecki P, Rangel I, Sousa C, Goncalves A, Correia A, Vigario A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lovric D, Samardzic J, Milicic D, Reskovic V, Baricevic Z, Ivanac I, Separovic Hanzevacki J, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Iorio A, Pinamonti B, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra G, Heggemann F, Hamm K, Streitner F, Sueselbeck T, Papavassiliu T, Borggrefe M, Haghi D, Ferreira F, Galrinho A, Soares R, Branco L, Abreu J, Feliciano J, Papoila A, Alves M, Leal A, Ferreira R, Reynaud A, Donal E, Lund LH, Oger E, Drouet E, Hage C, Bauer F, Linde C, Daubert J, Schnell F, Donal E, Lentz P, Kervio G, Leurent G, Mabo P, Carre F, Rodrigues A, Roque M, Arruda A, Becker D, Barros S, Kay F, Emerick T, Pinheiro J, Sampaio-Barros P, Andrade J, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Mincu R, Magda S, Dumitrache Rujinski S, Constantinescu T, Mihaila S, Ciobanu A, Florescu M, Vinereanu D, Ashcheulova T, Kovalyova O, Ardeleanu E, Gurgus D, Gruici A, Suciu R, Ana I, Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew M, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs S, Caiani E, Massabuau P, Weinert L, Lairez O, Berry M, Sotaquira M, Vaida P, Lang R, Khan I, Waterhouse D, Asegdom S, Alqaseer M, Foley D, Mcadam B, Colonna P, Michelotto E, Genco W, Rubino M, Pugliese S, Belfiore A, Sorino M, Trisorio Liuzzi M, Antonelli G, Palasciano G, Duszanska A, Skoczylas I, Streb W, Kukulski T, Polonski L, Kalarus Z, Fleig A, Seitz K, Secades S, Martin M, Corros C, Rodriguez M, De La Hera J, Garcia A, Velasco E, Fernandez E, Barriales V, Lambert J, Zwas DR, Hoss S, Leibowitz D, Beeri R, Lotan C, Gilon D, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Chrzanowski L, Lipiec P, Kasprzak J, Wita K, Mizia-Stec K, Wrobel W, Plonska-Gosciniak E, Goncalves A, Sousa C, Rangel I, Pinho T, Wang Y, Houle H, Madureira AJ, Macedo F, Zamorano J, Maciel MJ, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Calabro' R, Cadenas Chamorro R, Lopez T, Gomez J, Moreno M, Salinas P, Jimenez Rubio C, Valbuena S, Manjavacas A, De Torres F, Lopez-Sendon J, Vaugrenard T, Huttin O, Rouge A, Schwartz J, Zinzius P, Popovic B, Sellal J, Aliot E, Juilliere Y, Selton-Suty C, Looi J, Lee A, Hsiung M, Song W, Wong R, Underwood MJ, Fang F, Lin Q, Lam Y, Yu C, Vitarelli A, Nguyen B, Capotosto L, D-Alessandro G, D-Ascanio M, Rafique A, Gang E, Barilla F, Siegel R, Kydd A, Khan F, Watson W, Mccormick L, Virdee M, Dutka D, Ranjbar S, Karvandi M, Hassantash S, Grapsa J, Efthimiadis I, Pakrashi T, Dawson D, Punjabi P, Nihoyannopoulos P, Jasaityte R, D'hooge J, Rademakers F, Claus P, Henein M, Soderberg S, Tossavainen E, Henein M, Lindqvist P, Bellsham-Revell H, Bell A, Miller O, Simpson J, Altekin E, Kucuk M, Yanikoglu A, Karakas S, Er A, Ozel D, Ermis C, Demir I, Henein M, Soderberg S, Henein M, Lindqvist P, Bajraktari G, Di Salvo G, Baldini L, Del Gaizo F, Rea A, Pergola V, Caso P, Pacileo G, Fadel B, Calabro R, Russo M, Seo JS, Choi GN, Jin HY, Seol SH, Jang JS, Yang TH, Kim DK, Kim DS, Papadopoulou E, Kaladaridou A, Hatzidou S, Agrios J, Pamboukas C, Antoniou A, Toumanidis S, Gargiulo P, Dellegrottaglie S, Bruzzese D, Scala O, D'amore C, Ruggiero D, Marciano C, Vassallo E, Pirozzi E, Perrone Filardi P, Mor-Avi V, Kachenoura N, Lodato J, Port S, Chandra S, Freed B, Bhave N, Newby B, Lang R, Patel A, Dwivedi G, Alam M, Boczar K, Chow B, Staskiewicz G, Czekajska-Chehab E, Uhlig S, Tomaszewski A, Przegalinski J, Maciejewski R, Drop A, Di Giammarco G, Canosa C, Foschi M, Liberti G, Bedir M, Marinelli D, Masuyama S, Rabozzi R, Vijayan S, Miller H, Muthusamy R, Smith S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Mizia-Stec K, Chmiel A, Mizia M, Haberka M, Gieszczyk K, Sikora - Puz A, Lasota B, Trojnarska O, Grajek S, Gasior Z, Koumoulidis A, Vlasseros I, Tousoulis D, Katsi V, Avgeropoulou A, Divani M, Stefanadis C, Kallikazaros I. Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tiwari A, Yuk H, Pang P, Fong DYT, Yuen F, Humphreys J, Bullock L. Telephone intervention to improve the mental health of community-dwelling women abused by their intimate partners: a randomised controlled trial. Hong Kong Med J 2012; 18 Suppl 6:14-17. [PMID: 23249846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- A Tiwari
- Department of Nursing Studies, The University of Hong Kong, Hong Kong SAR, China.
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Abstract
Carbon nanotubes (CNTs) are well known as materials for nanoelectronics and show great potential to be used as the sensing elements in chemical and biological sensors. Recently, CNTs have been shown to be effective nanofluidic channels and the transport of substances through small diameter CNTs is intrinsically fast, selective, and operates at the single molecule level. It has been shown that the transport characteristics of semiconducting single-walled CNT (SWCNT) field effect transistors (FETs) are sensitive to internal water wetting. We report here that the characteristics of semiconducting SWCNT FETs are also sensitive to the concentration, pH and ion type of the ionic solution when the electrolyte is inside the CNT. Such sensitivity is not observed at the outside surface of a semiconducting SWCNT. This opens a new avenue for building new types of CNT sensor devices in which the SWCNT concurrently functions as a nanochannel and an electronic detector.
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Affiliation(s)
- D Cao
- Department of Physics, Arizona State University, Tempe, AZ 85287, USA
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Kenny C, Adhya S, Dworakowski R, Brickham B, Maccarthy P, Monaghan M, Guzzo A, Innocenti F, Vicidomini S, Lazzeretti D, Squarciotta S, De Villa E, Donnini C, Bulletti F, Guerrini E, Pini R, Bendjelid K, Viale J, Duperret S, Piriou V, Jacques D, Shahgaldi K, Silva C, Pedro F, Deister L, Brodin LA, Sahlen A, Manouras A, Winter R, Berjeb N, Cimadevilla C, Dreyfus J, Cueff C, Malanca M, Chiampan A, Vahanian A, Messika-Zeitoun D, Muraru D, Peluso D, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Almuntaser I, King G, Norris S, Daly C, Ellis E, Murphy R, Erdei T, Denes M, Kardos A, Foldesi C, Temesvari A, Lengyel M, Bouzas Mosquera A, Broullon F, Alvarez-Garcia N, Peteiro J, Barge-Caballero G, Lopez-Perez M, Lopez-Sainz A, Castro-Beiras A, Luotolahti M, Luotolahti H, Kantola I, Viikari J, Andersen M, Ersboell M, Bro-Jeppesen J, Gustafsson F, Koeber L, Hassager C, Moller J, Coisne D, Diakov C, Vallet F, Lequeux B, Blouin P, Christiaens L, Esposito R, Santoro A, Schiano Lomoriello V, Raia R, Santoro C, De Simone G, Galderisi M, Sahlen A, Abdula G, Winter R, Kosmala W, Szczepanik-Osadnik H, Przewlocka-Kosmala M, Mysiak A, O' Moore-Sullivan T, Marwick T, Tan YT, Wenzelburger F, Leyva F, Sanderson J, Pichler P, Syeda B, Hoefer P, Zuckermann A, Binder T, Fijalkowski M, Koprowski A, Galaska R, Blaut K, Sworczak K, Rynkiewicz A, Lee S, Kim W, Jung L, Yun H, Song M, Ko J, Khalifa EA, Szymanski P, Lipczynska M, Klisieiwcz A, Hoffman P, Jorge C, Silva Marques J, Robalo Martins S, Calisto C, Mieiro M, Vieira S, Correia M, Carvalho De Sousa J, Almeida A, Nunes Diogo A, Park C, March K, Tillin T, Mayet J, Chaturvedi N, Hughes A, Di Bello V, Giannini C, Delle Donne M, De Sanctis F, Spontoni P, Cucco C, Corciu A, Grigoratos C, Bogazzi F, Balbarini A, Enescu O, Suran B, Florescu M, Cinteza M, Vinereanu D, Higuchi Y, Iwakura K, Okamura A, Date M, Fujii K, Jorge C, Cortez-Dias N, Silva D, Carrilho-Ferreira P, Silva Marques J, Magalhaes A, Ribeiro S, Goncalves S, Fiuza M, Pinto F, Jorge C, Cortez-Dias N, Silva D, Silva Marques J, Carrilho-Ferreira P, Placido R, Bordalo A, Goncalves S, Fiuza M, Pinto F, Grzywocz P, Mizia-Stec K, Chudek J, Gasior Z, Maceira Gonzalez AM, Cosin Sales J, Dalli E, Igual B, Diago J, Aguilar J, Ruvira J, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Boccalini F, Mattatelli A, Hiramoto Y, Iacoboni C, Agati L, Trifunovic D, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Boricic-Kostic M, Draganic G, Tesic M, Petrovic M, Gavina C, Lopes R, Lourenco A, Almeida J, Rodrigues J, Pinho P, Zamorano J, Leite-Moreira A, Rocha-Goncalves F, Clavel MA, Capoulade R, Dumesnil J, Mathieu P, Despres JP, Pibarot P, Bull S, Pitcher A, Augustine D, D'arcy J, Karamitsos T, Rai A, Prendergast B, Becher H, Neubauer S, Myerson S, Magne J, Donal E, Davin L, O'connor K, Pirlet C, Rosca M, Szymanski C, Cosyns B, Pierard L, Lancellotti P, Calin A, Rosca M, Popescu B, Beladan C, Enache R, Lupascu L, Sandu C, Lancellotti P, Pierard L, Ginghina C, Kamperidis V, Hadjimiltiadis S, Sianos G, Anastasiadis K, Grosomanidis V, Efthimiadis G, Karvounis H, Parharidis G, Styliadis I, Gonzalez Canovas C, Munoz-Esparza C, Bonaque Gonzalez J, Fernandez A, Salar Alcaraz M, Saura Espin D, Pinar Bermudez E, Oliva-Sandoval M, De La Morena Valenzuela G, Valdes Chavarri M, Dreyfus J, Brochet E, Lepage L, Attias D, Cueff C, Detaint D, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Pirat B, Little S, Chang S, Tiller L, Kumar R, Zoghbi W, Lee APW, Hsiung M, Wan S, Wong R, Luo F, Fang F, Xie J, Underwood M, Sun J, Yu C, Jansen R, Tietge W, Sijbrandij K, Cramer M, De Heer L, Kluin J, Chamuleau SAJ, Oliveras Vila T, Ferrer Sistach E, Delgado Ramis L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Garcia Alonso C, Teis Soley A, Ruyra Baliarda X, Bayes Genis A, Negrea S, Alexandrescu C, Bourlon F, Civaia F, Dreyfus G, Paetzold S, Luha O, Hoedl R, Stoschitzky G, Pfeiffer K, Zweiker D, Pieske B, Maier R, Sevilla T, Revilla A, Lopez J, Vilacosta I, Arnold R, Gomez I, San Roman J, Nikcevic G, Djordjevic Dikic A, Djordjevic S, Raspopovic S, Jovanovic V, Kircanski B, Pavlovic S, Milasinovic G, Ruiz-Zamora I, Cabrera Bueno F, Molina M, Fernandez-Pastor J, Pena J, Linde A, Barrera A, Alzueta J, Bremont C, Bensaid A, Alonso H, Zaghden O, Nahum J, Dubois-Rande J, Gueret P, Lim P, Lee SP, Park K, Kim HR, Lee JH, Ahn HS, Kim JH, Kim HK, Kim YJ, Sohn DW, Niemann M, Herrmann S, Hu K, Liu D, Beer M, Ertl G, Wanner C, Takenaka T, Tei C, Weidemann F, Silva D, Madeira H, Mendes Pedro M, Nunes Diogo A, Brito D, Schiano Lomoriello V, Ippolito R, Santoro A, Esposito R, Raia R, De Palma D, Galderisi M, Gati S, Oxborough D, Reed M, Zaidi A, Ghani S, Sheikh N, Papadakis M, Sharma S, Chow V, Ng A, Pasqualon T, Zhao W, Hanzek D, Chung T, Yeoh T, Kritharides L, Florescu M, Magda L, Enescu O, Mihalcea D, Suran B, Jinga D, Mincu R, Cinteza M, Vinereanu D, Ferrazzi E, Segato G, Folino F, Famoso G, Senzolo M, Bellu R, Corbetti F, Iliceto S, Tona F, Azevedo O, Quelhas I, Guardado J, Fernandes M, Pereira V, Medeiros R, Lourenco A, Sousa P, Santos W, Pereira S, Marques N, Mimoso J, Marques V, Jesus I, Rustad L, Nytroen K, Gullestad L, Amundsen B, Aakhus S, Linhartova K, Sterbakova G, Necas J, Kovalova S, Cerbak R, Nelassov N, Korotkijan N, Shishkina A, Gagieva B, Nagaplev M, Eroshenko O, Morgunov M, Parmon S, Velthuis S, Van Gent M, Post M, Westermann C, Mager J, Snijder R, Koyalakonda SP, Anderson M, Burgess M, Bergenzaun L, Chew M, Ohlin H, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Rutz T, Kuehn A, Petzuch K, Pekala M, Elmenhorst J, Fratz S, Mueller J, Hager A, Hess J, Vogt M, Van Der Linde D, Van De Laar I, Wessels M, Bekkers J, Moelker A, Tanghe H, Van Kooten F, Oldenburg R, Bertoli-Avella A, Roos-Hesselink J, Cresti A, Fontani L, Calabria P, Capati E, Severi S, Lynch M, Saraf S, Sandler B, Yoon S, Kim S, Ko C, Ryu S, Byun Y, Seo H, Ciampi Q, Rigo F, Pratali L, Gherardi S, Villari B, Picano E, Sicari R, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Sinicyna J, Gruodyte G, Janonyte K, Laucevicius A, O'driscoll J, Schmid K, Marciniak A, Saha A, Gupta S, Smith R, Sharma R, Bouzas Mosquera A, Alvarez Garcia N, Peteiro J, Broullon F, Prada O, Rodriguez Vilela A, Barge Caballero G, Lopez Perez M, Lopez Sainz A, Castro Beiras A, Kochanowski J, Scislo P, Piatkowski R, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Van De Heyning CM, Magne J, O'connor K, Mahjoub H, Pibarot P, Pirlet C, Pierard L, Lancellotti P, Clausen H, Basaggianis C, Newton J, Del Pasqua A, Carotti A, Di Carlo D, Cetrano E, Toscano A, Iacobelli R, Esposito C, Chinali M, Pongiglione G, Rinelli G, Larsson M, Larsson M, Bjallmark A, Winter R, Caidahl K, Brodin L, Velthuis S, Van Gent M, Mager J, Westermann C, Snijder R, Post M, Gao H, Coisne D, Lugiez M, Guivier C, Rieu R, D'hooge J, Lugiez M, Hang G, D'hooge J, Guerin C, Christiaens L, Menard M, Voigt JU, Coisne D, Dungu J, Campos G, Jaffarulla R, Gomes-Pereira S, Sutaria N, Baker C, Nihoyannopoulos P, Bellamy M, Adhya S, Harries D, Walker N, Pearson P, Reiken J, Batteson J, Kamdar R, Murgatroyd F, Monaghan M, D'andrea A, Riegler L, Scarafile R, Pezzullo E, Salerno G, Bossone E, Limongelli G, Russo M, Pacileo G, Calabro' R, Kang Y, Cui J, Chen H, Pan C, Shu X, Kiotsekoglou A, Saha S, Toole R, Govind S, Gopal A, Crispi F, Bijnens B, Sepulveda-Swatson E, Rojas-Benavente J, Dominguez J, Illa M, Eixarch E, Sitges M, Gratacos E, Prinz C, Faludi R, Walker A, Amzulescu M, Gao H, Uejima T, Fraser A, Voigt J, Esmaeilzadeh M, Maleki M, Amin A, Vakilian F, Noohi F, Ojaghi Haghighi Z, Nakhostin Davari P, Bakhshandeh Abkenar H, Rimbas R, Dulgheru R, Margulescu A, Florescu M, Vinereanu D, Toscano A, Chinali M, D' Asaro M, Iacobelli R, Del Pasqua A, Esposito C, Mizzon C, Parisi F, Pongiglione G, Rinelli G, Jung BC, Lee BY, Kang HJ, Kim S, Kim M, Kim Y, Cho D, Park S, Hong S, Lim D, Shim W, Bellsham-Revell H, Tibby S, Bell AJ, Miller OI, Greil G, Simpson JM, Providencia RA, Trigo J, Botelho A, Gomes P, Seca L, Barra S, Faustino A, Costa G, Quintal N, Leitao-Marques A, Nestaas E, Stoylen A, Fugelseth D, Mornos C, Ionac A, Petrescu L, Cozma D, Dragulescu D, Mornos A, Pescariu S, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Laser K, Faber L, Fischer M, Koerperich H, Kececioglu D, Elnoamany MF, Dawood A, Elhabashy M, Khalil Y, Fontana A, Abbate M, Cazzaniga M, Giannattasio C, Trocino G, Piriou N, Warin-Fresse K, Caza M, Fau G, Crochet D, Xhabija N, Allajbeu I, Petrela E, Heba M, Barreiro Perez M, Martin Fernandez M, Renilla Gonzalez A, Florez Munoz J, Fernandez Cimadevilla O, Alvarez Pichel I, Velasco Alonso E, Leon Duran D, Benito Martin E, Secades Gonzalez S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Silva Ferreira A, Bettencourt N, Matos P, Oliveira L, Almeida A, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Lopez Lereu M, Monmeneu J, Estornell J, Tsverava M, Tsverava D, Varela A, Salagianni M, Galani I, Andreakos E, Davos C, Ikonomidis I, Lekakis J, Tritakis V, Kadoglou N, Papadakis J, Trivilou P, Tzortzis S, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Kim G, Youn H, Park C, Ibrahimi P, Bajraktari G, Jashari F, Ahmeti A, Poniku A, Haliti E, Henein M, Pezo Nikolic B, Jurin H, Lovric D, Baricevic Z, Ivanac Vranesic I, Lovric Bencic M, Ernst A, Separovic Hanzevacki J. Poster Session 3: Friday 9 December 2011, 08:30-12:30 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Collins S, Storrow A, Miller K, Roll S, Fermann G, Pang P, Gheorghiade M, Lindsell C, Sawyer D, Weintraub N. Changing Clinical Profiles and Timing of Enrollment in Acute Heart Failure Syndromes Clinical Trials. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Periyanayagam U, Pang P, Collins S, Hollander J, Nowak R, Storrow A, Miller C, Kirk J, Peacock W, Gheorghiade M. 187: The Effects of Standard Therapy on Dyspnea In Acute Heart Failure Syndromes: Results From the URGENT International Dyspnea Study. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pang P, Chen FY, Tang J, Ma LF, Wang JC, Zheng SJ. Avian leukosis virus p27 inhibits tumor necrosis factor alpha expression in RAW264.7 macrophages after stimulation with lipopolysaccharide. Acta Virol 2010; 54:119-24. [PMID: 20545441 DOI: 10.4149/av_2010_02_119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Avian leukosis is a widely distributed disease caused by Avian leukosis virus (ALV). ALV p27 is a capsid protein and group specific antigen, whose role in host immune response is poorly understood. To explore ALV p27, we developed a RAW264.7 macrophage cell line stably expressing p27-GFP fusion protein. The cells of this line and control cell line expressing GFP protein only were compared in production of tumor necrosis factor alpha (TNF-alpha), interleukins IL-1beta, IL-6, IL-12, and in proliferative activity stimulated by the lipopolysaccharide (LPS). It was found that the ALV p27 expression markedly reduced the production of TNF-alpha, but did not affect the production of IL-1beta, IL-6, and 12, and cell proliferative activity. These results demonstrate that ALV p27 specifically inhibits TNF-alpha expression in the macrophages stimulated by LPS, suggesting a possible contribution of ALV p27 to immunosuppression detected in ALV-infected hosts. KEYWORDS Avian leukosis virus; p27; tumor necrosis factor alpha; interleukins; macrophages; lipopolysaccharide.
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Affiliation(s)
- P Pang
- State Key Laboratory of Agrobiotechnology, Beijing 100193, PR, China
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Sauser K, Pang P, Courtney DM, Hollander J, Collins SP, Storrow A, Nowak RM, Tavares M, Mebazaa A, Gheorghiade M. Relationship between Symptomatic Dyspnea and Renal Function in Patients With Acute Heart Failure Syndromes: Results from the URGENT-Dyspnoea Study (Ularitide Global Evaluation in Acute Decompensated Heart Failure). J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pang P. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies. World J Emerg Med 2010; 1:6-11. [PMID: 25214934 PMCID: PMC4129759] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 05/20/2010] [Indexed: 06/03/2023] Open
Abstract
To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies.
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Affiliation(s)
- Peter Pang
- Founding Chairman of EBMSubcommittee, Hong Kong College of Emergency Medicine, Hong Kong, China
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Abstract
OBJECTIVES This study was conducted to test out-of-hospital performance of a noninvasive radial artery tonometry device to assess blood pressure (BP), providing readings every 10-12 seconds. The primary objective was to determine the correlation between noninvasive BPs calculated with radial artery tonometry and standard oscillometric cuff methods. The secondary objective was to determine whether the difference observed between the two techniques was consistent over the range of BPs measured. METHODS This prospective trial enrolled adults transported by helicopter (n = 9 patients), fixed-wing airplane (n = 1), or ground vehicle (n = 10) of a single transport service. Patients had BP assessed simultaneously, by both standard automatic cuff and radial artery tonometry device, every 5 minutes. Data were assessed with correlation coefficients, and Bland-Altman techniques were utilized to assess for bias over the range of mean arterial pressures (MAPs) encountered. For all tests, p was set at 0.05. RESULTS No major problem with radial artery tonometry device field performance was noted. There were 139 pairs of MAP assessments in 20 patients. The correlation coefficient for the two assessment modalities was 0.96. Bland-Altman bias plot and Pitman's test (p = 0.11) revealed good correlation between the two assessment mechanisms over the entire range of MAPs (42 to 163 mm Hg) encountered in the study. CONCLUSION The radial artery tonometry device provided MAP assessments that were highly correlated with readings from a standard oscillometric device. The radial artery tonometry device performed well in a variety of patient types and in multiple transport vehicles, and there was no sign that its performance was adversely affected by the out-of-hospital setting.
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Tavares M, Pang P, Laribi S, Mebazaa A, Gheorghiade M. Time course of dyspnea evolution in the emergency department: results from the URGENT dyspnea survey. Crit Care 2009. [PMCID: PMC4083887 DOI: 10.1186/cc7165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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