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Day TG, Matthew J, Budd SF, Venturini L, Wright R, Farruggia A, Vigneswaran TV, Zidere V, Hajnal JV, Razavi R, Simpson JM, Kainz B. Interaction between clinicians and artificial intelligence to detect fetal atrioventricular septal defects on ultrasound: how can we optimize collaborative performance? Ultrasound Obstet Gynecol 2024. [PMID: 38197584 DOI: 10.1002/uog.27577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Artificial intelligence (AI) has shown promise in improving the performance of fetal ultrasound screening in detecting congenital heart disease (CHD). The effect of giving AI advice to human operators has not been studied in this context. Giving additional information about AI model workings, such as confidence scores for AI predictions, may be a way of improving performance further. Our aims were to investigate whether AI advice improved overall diagnostic accuracy (using a single CHD lesion as an exemplar), and to see what, if any, additional information given to clinicians optimized the overall performance of the clinician-AI team. METHODS An AI model was trained to classify a single fetal CHD lesion (atrioventricular septal defect, AVSD), using a retrospective cohort of 121,130 cardiac four chamber images extracted from 173 ultrasound scan videos (98 with normal hearts, 75 with AVSD). A ResNet50 model architecture was used. Temperature scaling of model prediction probability was performed on a validation set, and gradient-weighted class activation maps (grad-CAMs) produced. Ten clinicians (two consultant fetal cardiologists, three trainees in pediatric cardiology, and five fetal cardiac sonographers) were recruited from a center of fetal cardiology to participate. Each participant was shown 2000 fetal four chamber images in a random order (1,000 normal and 1,000 AVSD). The dataset was comprised of 500 images, each shown in four conditions: 1) image alone without AI output; 2) image with binary AI classification; 3) image with AI model confidence; 4) image with gradient-weighted class activation map image overlays. The clinicians were asked to classify each image as normal or AVSD. RESULTS 20,000 image classifications were recorded from 10 clinicians. The AI model alone achieved an accuracy of 0.798 (95% CI 0.760 - 0.832), sensitivity of 0.868 (95% CI 0.834 - 0.902) and specificity of 0.728 (95% CI 0.702 - 0.754, and the clinicians without AI achieved an accuracy of 0.844 (95% CI 0.834 - 0.854), sensitivity of 0.827 (95% CI 0.795 - 0.858) and specificity of 0.861 (95% CI 0.828 - 0.895). Showing a binary (normal or AVSD) AI model output resulted in significant improvement in accuracy to 0.865 (p <0.001). This effect was seen in both experienced and less experienced participants. Giving incorrect AI advice resulted in significant deterioration in overall accuracy from 0.761 to 0.693 (p <0.001), which was driven by an increase in both type I and type II error by the clinicians. This effect was worsened by showing model confidence (accuracy 0.649, p <0.001) or grad-CAM (accuracy 0.644, p <0.001). CONCLUSIONS AI has the potential to improve performance when used in collaboration with clinicians, even if the model performance does not reach expert level. Giving additional information about model workings such as model confidence and class activation map image overlays did not improve overall performance, and actually worsened performance for images where the AI model was incorrect. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- T G Day
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Matthew
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S F Budd
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - L Venturini
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Wright
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Farruggia
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - T V Vigneswaran
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - V Zidere
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Harris Birthright Centre, King's College London NHS Foundation Trust, London, UK
| | - J V Hajnal
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - R Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M Simpson
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - B Kainz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
- Department of Computing, Faculty of Engineering, Imperial College London, London, UK
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Cook E, Wright R. A feasibility study into the effectiveness of a cue intervention, to increase physical activity levels in ambulatory chronic stroke. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.090] [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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Naylor JM, Frost S, Farrugia M, Pavlovic N, Ogul S, Hackett D, Gray L, Wright R, van Smeden M, Harris IA. Patient factors associated with referral to inpatient rehabilitation following knee or hip arthroplasty in a public sector cohort: A prognostic factor study. J Eval Clin Pract 2021; 27:809-816. [PMID: 32930469 DOI: 10.1111/jep.13479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 01/23/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Inpatient rehabilitation following total knee or hip arthroplasty (TKA, THA) is resource intensive and expensive. Understanding who is referred is integral to the discourse concerning service and cost reform. This study aimed to determine patient prognostic factors associated with referral to inpatient rehabilitation following TKA or THA in a public sector setting. In this setting, surgeon or patient choice does not drive referral. METHOD Prognostic factor research based on secondary analysis of prospectively collected data. Consecutive people undergo elective, primary TKA, or THA at a high-volume public hospital. The outcome was referral to inpatient rehabilitation after acute care. Patient variables including sociodemographic, comorbidity, and complication details were used in multivariable logistic regression to determine the prognostic factors associated with referral. RESULTS Five hundred twenty people were included; 9.2% experienced the outcome. In the multivariable model, acute complications (OR 3.6, 95% CI 1.6-7.8), TKA surgery (OR 3.1, 95% CI 1.0-9.4), renal disease (OR 4.4, 95% CI 1.4-13.3), and higher body mass index (OR 1.1, 95% CI 1.0-1.2) were associated with referral; unilateral surgery (OR 0.1 (95% CI 0.01-0.2) and previous arthroplasty (OR 0.3 (95% CI 0.1-0.8) were protective. There were no significant associations found for sociodemographic factors (such as gender and residential status) in the multivariable model. CONCLUSION In the absence of choice, physical impairment and health factors are associated with referral to inpatient rehabilitation following TKA or THA.
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Affiliation(s)
- Justine M Naylor
- Whitlam Orthopaedic Research Centre, SWSLHD, Liverpool, New South Wales, Australia
| | - Steve Frost
- Centre for Applied Nursing Research, SWSLHD, Liverpool, New South Wales, Australia
| | - Melissa Farrugia
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Natalie Pavlovic
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Shaniya Ogul
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Danella Hackett
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Leeanne Gray
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Rachael Wright
- Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, SWSLHD, Liverpool, New South Wales, Australia
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Elshibly M, Kanagala P, Budgeon C, Wright R, Jerosch-Herold M, Gulsin GS, Squire IB, Ng LL, Mccann GP, Arnold JR. Prognostic value of pulmonary transit time by cardiac magnetic resonance in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre
Background
Quantifying pulmonary transit time (PTT) from cardiac magnetic resonance (CMR) first pass perfusion imaging is a novel technique for the evaluation of haemodynamic congestion in heart failure. Previous studies have demonstrated that PTT is prolonged in patients with heart failure with reduced ejection fraction (HFrEF) and that it provides independent prognostic information in this patient group. However, the potential diagnostic and prognostic roles of PTT assessment in patients with heart failure with preserved ejection fraction (HFpEF) remain to be established.
Aim
To compare PTT in healthy controls and in patients with HFpEF, and to determine the prognostic value of PTT in HFpEF.
Methods
In a prospective, observational study, HFpEF and age-matched control subjects underwent multi-parametric CMR at 3-Tesla, comprising quantitative left ventricular volumetric assessment using a standard steady-state free precession (SSFP) pulse sequence, and first-pass perfusion imaging at rest using a T1-weighted segmented inversion recovery gradient echo sequence (following injection of 0.04mmol/kg of contrast). PTT was calculated as the time interval between the peaks of signal intensity curves in the right and left ventricular blood pools (defined on the basal slice of the rest perfusion images). The primary endpoint was the composite of death or hospitalisation with heart failure.
Results
88 HFpEF patients (age 73 ± 9 years, 51% male, EF 56.4 ± 5.6%) and 40 controls (age 73 ± 5 years, 43% male, EF 58.5 ± 4.7%) were studied. PTT was comparable in HFpEF patients (7.7 ± 3.8s) and in healthy controls (7.5 ± 1.8, p = 0.69). Normalised to cardiac cycle lengths, PTT remained comparable in HFpEF patients and healthy controls (8.5 ± 4.0 cardiac cycles versus 7.8 ± 1.6 cardiac cycles, respectively, p = 0.19). In the HFpEF group, during median follow-up of 3.4 years, there were 38 events (25 hospitalisations with heart failure, 13 deaths); a significant relationship between survival and PTT was not demonstrated (HR 1.06 [0.99,1.14] for a one-unit increase, p = 0.098).
Conclusion
In HFpEF, PTT is not prolonged compared with PTT in healthy subjects. Unlike in HFrEF, PTT does not appear to be diagnostically or prognostically significant in HFpEF.
Figure 1: Graph showing signal intensity curves in the right (red) and left (green) ventricular blood pools
Figure 2: Kaplan-Meier plot showing comparable rates of the composite endpoint in patients with PTT greater/less than median PTT (8 cardiac cycles)
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Affiliation(s)
- M Elshibly
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - P Kanagala
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - C Budgeon
- University of Western Australia, Perth, Australia
| | - R Wright
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | | | - GS Gulsin
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - IB Squire
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - LL Ng
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - GP Mccann
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - JR Arnold
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
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Johnstone-Burt A, Giles S, Wright R. P111. 'Attend anywhere': A virtual success? Patient feedback from breast nurse specialists using 'attend anywhere' technology during the COVID-19 pandemic. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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de Albuquerque D, Goffinet J, Wright R, Pearson J. Deep Generative Analysis for Task-Based Functional MRI Experiments. Proc Mach Learn Res 2021; 149:146-175. [PMID: 35224507 PMCID: PMC8871581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While functional magnetic resonance imaging (fMRI) remains one of the most widespread and important methods in basic and clinical neuroscience, the data it produces-time series of brain volumes-continue to pose daunting analysis challenges. The current standard ("mass univariate") approach involves constructing a matrix of task regressors, fitting a separate general linear model at each volume pixel ("voxel"), computing test statistics for each model, and correcting for false positives post hoc using bootstrap or other resampling methods. Despite its simplicity, this approach has enjoyed great success over the last two decades due to: 1) its ability to produce effect maps highlighting brain regions whose activity significantly correlates with a given variable of interest; and 2) its modeling of experimental effects as separable and thus easily interpretable. However, this approach suffers from several well-known drawbacks, namely: inaccurate assumptions of linearity and noise Gaussianity; a limited ability to capture individual effects and variability; and difficulties in performing proper statistical testing secondary to independently fitting voxels. In this work, we adopt a different approach, modeling entire volumes directly in a manner that increases model flexibility while preserving interpretability. Specifically, we use a generalized additive model (GAM) in which the effects of each regressor remain separable, the product of a spatial map produced by a variational autoencoder and a (potentially nonlinear) gain modeled by a covariate-specific Gaussian Process. The result is a model that yields group-level effect maps comparable or superior to the ones obtained with standard fMRI analysis software while also producing single-subject effect maps capturing individual differences. This suggests that generative models with a decomposable structure might offer a more flexible alternative for the analysis of task-based fMRI data.
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Affiliation(s)
- Daniela de Albuquerque
- Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA
| | - Jack Goffinet
- Department of Computer Science, Duke University, Durham, NC 27708, USA
| | - Rachael Wright
- Center for Cognitive Neuroscience, Duke University, Durham, NC 27708, USA
| | - John Pearson
- Department of Biostatistics & Bioinformatics, Department of Electrical and Computer Engineering, Center for Cognitive Neuroscience, Duke University, Durham, NC 27708, USA
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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McKnight JA, Ochs A, Mair C, McKnight O, Wright R, Gibb FW, Cunningham SG, Strachan M, Ritchie S, McGurnaghan SJ, Colhoun HM. The effect of DAFNE education, continuous subcutaneous insulin infusion, or both in a population with type 1 diabetes in Scotland. Diabet Med 2020; 37:1016-1022. [PMID: 31872473 DOI: 10.1111/dme.14223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the effect of DAFNE and continuous subcutaneous insulin infusion in clinical practice. METHODS Within NHS Lothian, continuous subcutaneous insulin infusion started in 2004 and DAFNE education began in 2006. We extracted anonymized data from the national database for all those aged > 18 years with type 1 diabetes having a Dose Adjustment For Normal Eating course or continuous subcutaneous insulin infusion start date (n = 4617). RESULTS In total, 956 persons received DAFNE education, and 505 had received an insulin pump, 208 of whom had DAFNE education followed by insulin pump. Mean (SD) HbA1c before DAFNE education was 68 (15) mmol/mol (8.4% [1.4%]) and 66 (13) mmol/mol (8.2% [1.2%]) before continuous subcutaneous insulin infusion. In the year following DAFNE education, the mean fall in within-person HbA1c was 3.8 mmol/mol (95% CI 4.0 to 3.4; 0.3% [0.4% to 0.3%]). Those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]) experienced the largest decline (15.7 mmol/mol [1.4%]). Those in the lowest HbA1c band at initiation (< 53 mmol/mmol [7.0%]) experienced a rise. In the year following continuous subcutaneous insulin infusion initiation there was a mean fall in within-person HbA1c of 6.6 mmol/mol (6.8 to 6.4; 0.6% [0.6% to 0.6%]). In those with the poorest control (HbA1c ≥ 85 mmol/mol [9.9%]), the mean fall in HbA1c was 22.2 mmol/mol (23 to 21; 2.0% [2.1% to 1.9%]). Continuous subcutaneous insulin infusion effectiveness was not different with or without DAFNE education. The effects of both interventions were sustained over 5 years. CONCLUSIONS Both DAFNE education and insulin pump therapy had the greatest effect on HbA1c in those with higher baseline values. There was little difference to attained HbA1c when Dose Adjustment For Normal Eating education was introduced before insulin pump therapy.
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Affiliation(s)
- J A McKnight
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - A Ochs
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Mair
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - O McKnight
- Forth Valley Royal Hospital, NHS Forth Valley, Scotland
| | - R Wright
- Department of Diabetes, St John's Hospital, Livingston, UK
| | - F W Gibb
- Edinburgh Centre for Diabetes and Endocrinology, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S G Cunningham
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - M Strachan
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S Ritchie
- Edinburgh Centre for Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - S J McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - H M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Department of Public Health, NHS Fife, Kirkcaldy, UK
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Pinto R, Wright R, Ghosh S. Nasal fractures: a dedicated clinic providing reduction under local anaesthesia improves time to manipulation. Ann R Coll Surg Engl 2020; 102:418-421. [PMID: 32326744 DOI: 10.1308/rcsann.2019.0185] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes. MATERIALS AND METHODS A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. A dedicated nasal fracture clinic providing manipulation under local anaesthesia was implemented followed by a prospective study of all patients presenting to the clinic between February and November 2017. Main outcome measures included time from injury to otolaryngology assessment, time from injury to manipulation and incidence of secondary septorhinoplasty. RESULTS The retrospective series involved 525 patients including 381 males (72.6%) and 144 females (27.4%). Mean time from injury to assessment was 10 days. Mean time from injury to surgery was 14.5 days. Mean time from assessment to surgery was five days. The incidence of septorhinoplasty was 2.3%. The prospective series involved 119 patients including 78 males (65.5%) and 41 females (34.5%). Following implementation of a nasal fracture clinic, mean time from injury to assessment and manipulation was 6.1 days and 5.4% of patients underwent septorhinoplasty for secondary deformity. DISCUSSION Implementation of a nasal fracture clinic providing reduction under local anaesthesia reduced the time to assessment and manipulation. The incidence of septorhinoplasty is low following reduction under general or local anaesthesia. Assessment earlier than seven days is feasible and advice for referral can be changed accordingly.
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Affiliation(s)
- R Pinto
- Alder Hey Children's Hospital, Liverpool, UK
| | - R Wright
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Ghosh
- Pennine Acute Hospitals NHS Trust, Manchester, UK
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Wu W, Zhang Y, Jiang J, Lucas MV, Fonzo GA, Rolle CE, Cooper C, Chin-Fatt C, Krepel N, Cornelssen CA, Wright R, Toll RT, Trivedi HM, Monuszko K, Caudle TL, Sarhadi K, Jha MK, Trombello JM, Deckersbach T, Adams P, McGrath PJ, Weissman MM, Fava M, Pizzagalli DA, Arns M, Trivedi MH, Etkin A. An electroencephalographic signature predicts antidepressant response in major depression. Nat Biotechnol 2020; 38:439-447. [PMID: 32042166 PMCID: PMC7145761 DOI: 10.1038/s41587-019-0397-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [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: 12/08/2018] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
Antidepressants are widely prescribed, but their efficacy relative to placebo is modest, in part because the clinical diagnosis of major depression encompasses biologically heterogeneous conditions. Here, we sought to identify a neurobiological signature of response to antidepressant treatment as compared to placebo. We designed a latent-space machine-learning algorithm tailored for resting-state electroencephalography (EEG) and applied it to data from the largest imaging-coupled, placebo-controlled antidepressant study (n = 309). Symptom improvement was robustly predicted in a manner both specific for the antidepressant sertraline (versus placebo) and generalizable across different study sites and EEG equipment. This sertraline-predictive EEG signature generalized to two depression samples, wherein it reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation treatment outcome. Furthermore, we found that the sertraline resting-state EEG signature indexed prefrontal neural responsivity, as measured by concurrent transcranial magnetic stimulation and EEG. Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression.
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Affiliation(s)
- Wei Wu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Yu Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Jing Jiang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Molly V. Lucas
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Gregory A. Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Camarin E. Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Crystal Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cherise Chin-Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Noralie Krepel
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478
| | - Carena A. Cornelssen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Rachael Wright
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Russell T. Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Hersh M. Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Karen Monuszko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Trevor L. Caudle
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Kamron Sarhadi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joseph M. Trombello
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thilo Deckersbach
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Patrick J. McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Myrna M. Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Maurizio Fava
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Diego A. Pizzagalli
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Martijn Arns
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478
- Department of Experimental Psychology, Utrecht University, Utrecht, the Netherlands
- neuroCare Group Netherlands, Nijmegen, the Netherlands
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
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Toll RT, Wu W, Naparstek S, Zhang Y, Narayan M, Patenaude B, De Los Angeles C, Sarhadi K, Anicetti N, Longwell P, Shpigel E, Wright R, Newman J, Gonzalez B, Hart R, Mann S, Abu-Amara D, Sarhadi K, Cornelssen C, Marmar C, Etkin A. An Electroencephalography Connectomic Profile of Posttraumatic Stress Disorder. Am J Psychiatry 2020; 177:233-243. [PMID: 31964161 DOI: 10.1176/appi.ajp.2019.18080911] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to identify brain regions whose frequency-specific, orthogonalized resting-state EEG power envelope connectivity differs between combat veterans with posttraumatic stress disorder (PTSD) and healthy combat-exposed veterans, and to determine the behavioral correlates of connectomic differences. METHODS The authors first conducted a connectivity method validation study in healthy control subjects (N=36). They then conducted a two-site case-control study of veterans with and without PTSD who were deployed to Iraq and/or Afghanistan. Healthy individuals (N=95) and those meeting full or subthreshold criteria for PTSD (N=106) underwent 64-channel resting EEG (eyes open and closed), which was then source-localized and orthogonalized to mitigate effects of volume conduction. Correlation coefficients between band-limited source-space power envelopes of different regions of interest were then calculated and corrected for multiple comparisons. Post hoc correlations of connectomic abnormalities with clinical features and performance on cognitive tasks were conducted to investigate the relevance of the dysconnectivity findings. RESULTS Seventy-four brain region connections were significantly reduced in PTSD (all in the eyes-open condition and predominantly using the theta carrier frequency). Underconnectivity of the orbital and anterior middle frontal gyri were most prominent. Performance differences in the digit span task mapped onto connectivity between 25 of the 74 brain region pairs, including within-network connections in the dorsal attention, frontoparietal control, and ventral attention networks. CONCLUSIONS Robust PTSD-related abnormalities were evident in theta-band source-space orthogonalized power envelope connectivity, which furthermore related to cognitive deficits in these patients. These findings establish a clinically relevant connectomic profile of PTSD using a tool that facilitates the lower-cost clinical translation of network connectivity research.
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Affiliation(s)
- Russell T Toll
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Wei Wu
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Sharon Naparstek
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Yu Zhang
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Manjari Narayan
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Brian Patenaude
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Carlo De Los Angeles
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Kasra Sarhadi
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Nicole Anicetti
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Parker Longwell
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Emmanuel Shpigel
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Rachael Wright
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Jennifer Newman
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Bryan Gonzalez
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Roland Hart
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Silas Mann
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Duna Abu-Amara
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Kamron Sarhadi
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Carena Cornelssen
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Charles Marmar
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
| | - Amit Etkin
- Department of Bioengineering (Toll), Department of Psychiatry and Behavioral Sciences (Toll, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), and the Wu Tsai Neurosciences Institute (Toll, Wu, Naparstek, Zhang, Narayan, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin), Stanford University, Stanford, Calif.; Veterans Affairs Palo Alto Health Care System, and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif. (Toll, Wu, Naparstek, Zhang, Patenaude, De Los Angeles, Kasra Sarhadi, Anicetti, Longwell, Shpigel, Wright, Kamron Sarhadi, Cornelssen, Etkin); Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York (Wu, Naparstek, Narayan, Patenaude, De Los Angeles, Longwell, Shpigel, Newman, Gonzalez, Hart, Mann, Abu-Amara, Cornelssen, Marmar, Etkin); School of Automation Science and Engineering, South China University of Technology, Guangzhou, China (Wu); and Department of Psychiatry, New York University Langone School of Medicine, New York (Newman, Gonzalez, Hart, Mann, Abu-Amara, Marmar)
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Faul A, D’Ambrosio J, Yankeelov P, Cotton S, Furman C, Hall-Faul M, Gordon B, Wright R. HUMAN FLOURISHING AS AN OUTCOME OF INTEGRATED PRIMARY CARE AND COMMUNITY BASED MODELS OF CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Faul
- Institute for Sustainable Health & Optimal Aging, Louisville, KY
| | - J D’Ambrosio
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - P Yankeelov
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - S Cotton
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - C Furman
- Institute for Sustainable Health & Optimal Aging, University of Louisville
| | - M Hall-Faul
- KIPDA Area Agency on Aging and Independent Living
| | - B Gordon
- KIPDA Area Agency on Aging and Independent Living
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Valle L, Deig C, Wright R, High W. 394 An advanced case of extramammary pagets disease: Safe and effective treatment in an inoperable elderly patient using extensive en face electron irradiation. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Harding G, Klein E, Pass T, Wright R, Million C. Endotoxin and Bacterial Contamination of Dialysis Center Water and Dialysate; a Cross Sectional Survey. Int J Artif Organs 2018. [DOI: 10.1177/039139889001300107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The bacterial and endotoxin levels of purified water and effluent dialysate were examined in a cross section of dialysis centers in the central United States. All samples were collected within a four-hour drive of the University of Louisville and were collected, processed and analyzed by our personnel, to eliminate variability in sample handling. A medium capable of higher bacteria recovery from aqueous environments than those ordinarily employed in clinical assays was used. Endotoxins were determined by a quantitative colorimetric assay. By the more sensitive bacterial assay 53% of the centers had bacterial counts above the AAMI standard of 200 colony-forming units per ml (CFU/ml) for water and 35% of the centers had bacterial counts above the 2000 CFU/ml standard for dialysate in at least one sampling period. The samples showed 35% and 19% of water and dialysate above the standards, respectively. While there are no standards for endotoxin concentrations in water used to prepare dialysate, 2% of the centers had endotoxin levels in their water above five endotoxin units per ml (5 EU/ml = 1 ng/ml in our assay kit), the limit set by the AAMI standards for reprocessor water. Both bacterial and endotoxin levels tended to be elevated in dialysate, with the highest levels of endotoxin in dialysates posing an obvious potential risk when high-flux dialyzers are used.
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Affiliation(s)
- G.B. Harding
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - E. Klein
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - T. Pass
- Water Testing Laboratory, Morehead State University, Morehead, Kentucky - USA
| | - R. Wright
- Water Testing Laboratory, Morehead State University, Morehead, Kentucky - USA
| | - C. Million
- Department of Medicine, University of Louisville, Louisville, Kentucky
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Jones P, Martin S, Bays H, Mancini G, Averna M, Sposito A, Koren M, Samuel R, Letierce A, Baccara-Dinet M, Wright R. ALIROCUMAB EFFICACY AND SAFETY IN PATIENTS WITH HYPERCHOLESTEROLEMIA AND WITH OR WITHOUT CLINICAL ATHEROSCLEROTIC CARDIOVASCULAR DISEASE: POOLED ANALYSIS OF 10 ODYSSEY RANDOMIZED TRIALS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wright R, Born DE, D'Souza N, Hurd L, Gill R, Wright D. Pain and compression neuropathy in primary inguinal hernia. Hernia 2017; 21:715-722. [PMID: 28819736 DOI: 10.1007/s10029-017-1641-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Enlargement of the ilioinguinal nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical nerve constriction sites and is associated with enlargement of the peripheral nerve accompanied by sensory changes. METHODS In this prospective study, Carolina Comfort Scale (CCS) questionnaire data was collected for 35 primary hernia repairs. Each patient underwent primary inguinal herniorrhaphy that included ilioinguinal neurectomy. All nerves were sampled proximal to the external inguinal ring. Any nerves with grossly increased overall diameter to any degree distal to the external ring were additionally sampled in the thickened portions. A neuropathologist performed histologic evaluation of the H&E-stained cross sections. RESULTS Paired comparison of proximal and distal nerves revealed a greater overall diameter and greater measured nerve-specific diameter in distal nerve segments. Nerves with increased overall diameter were also found to have a statistically significant positive correlation with four of eight pain measures. Additionally, increased nerve-specific diameter correlates with increased pain on four of eight pain values, but age effect on nerve diameter blunts this finding. CONCLUSIONS Increased preoperative CCS pain values in primary open inguinal hernia are significantly correlated with gross enlargement of the overall diameter and nerve-specific diameter of the ilioinguinal nerve beyond the external inguinal ring. This is consistent with a compression neuropathy.
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Affiliation(s)
- R Wright
- Cascade Hernia Institute, 208 17th Ave SE Suite 201, Puyallup, WA, 98372, USA.
| | - D E Born
- Department of Pathology, Stanford University, 300 Pasteur Dr., Stanford, CA, 94305, USA
| | - N D'Souza
- Pacific Northwest University of Health Sciences, Yakima, USA
| | - L Hurd
- Pacific Northwest University of Health Sciences, Yakima, USA
| | - R Gill
- Creighton University, Omaha, USA
| | - D Wright
- University of Denver, Denver, USA
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Affiliation(s)
- D. Swindle
- University of Arkansas, Department of Chemistry Fayetteville, Arkansas 72701
| | - R. Wright
- University of Arkansas, Department of Chemistry Fayetteville, Arkansas 72701
| | - K. Takahashi
- University of Arkansas, Department of Chemistry Fayetteville, Arkansas 72701
| | - W. H. Rivera
- University of Arkansas, Department of Chemistry Fayetteville, Arkansas 72701
| | - J. L. Meason
- University of Arkansas, Department of Chemistry Fayetteville, Arkansas 72701
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Buhagiar MA, Naylor JM, Harris IA, Xuan W, Kohler F, Wright R, Fortunato R. Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial. JAMA 2017; 317:1037-1046. [PMID: 28291891 DOI: 10.1001/jama.2017.1224] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Formal rehabilitation programs, including inpatient programs, are often assumed to optimize recovery among patients after undergoing total knee arthroplasty. However, these programs have not been compared with any outpatient or home-based programs. OBJECTIVE To determine whether 10 days of inpatient rehabilitation followed by a monitored home-based program after total knee arthroplasty provided greater improvements than a monitored home-based program alone in mobility, function, and quality of life. DESIGN, SETTING, AND PARTICIPANTS In this 2-group, parallel, randomized clinical trial, including a nonrandomized observational group, conducted at 2 public, high-volume arthroplasty hospitals in Sydney, Australia (July 2012-December 2015), 940 patients with osteoarthritis undergoing primary total knee arthroplasty were screened for eligibility. Of the 525 eligible patients consecutively invited to participate, 165 were randomized either to receive inpatient hospital rehabilitation and home-based rehabilitation or to receive home-based rehabilitation alone, and 87 patients enrolled in the observation group. INTERVENTIONS Eighty-one patients were randomized to receive 10 days of hospital inpatient rehabilitation followed by an 8-week clinician-monitored home-based program, 84 were randomized to receive the home-based program alone, and 87 agreed to be in the observational group, which included only the home-based program. MAIN OUTCOMES AND MEASURES Mobility at 26 weeks after surgery, measured with the 6-minute walk test. Secondary outcomes included the Oxford Knee Score, which ranges from 0 (worst) to 48 (best) and has a minimal clinically important difference of 5 points; and EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) visual analog scale, which ranges from 0 (worst) to 100 (best), and has a minimal clinically important difference of 23 points. RESULTS Among the 165 randomized participants, 68% were women, and the cohort had a mean age, 66.9 years (SD, 8.4 years). There was no significant difference in the 6-minute walk test between the inpatient rehabilitation and either of the 2 home program groups (mean difference, -1.01; 95% CI, -25.56 to 23.55), nor in patient-reported pain and function (knee score mean difference, 2.06; 95% CI, -0.59 to 4.71), or quality of life (EQ-5D visual analog scale mean difference, 1.41; 95% CI, -6.42 to 3.60). The number of postdischarge complications for the inpatient group was 12 vs 9 among the home group, and there were no adverse events reported that were a result of trial participation. CONCLUSIONS AND RELEVANCE Among adults undergoing uncomplicated total knee arthroplasty, the use of inpatient rehabilitation compared with a monitored home-based program did not improve mobility at 26 weeks after surgery. These findings do not support inpatient rehabilitation for this group of patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01583153.
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Affiliation(s)
- Mark A Buhagiar
- Braeside Hospital, HammondCare, Australia2South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia
| | - Justine M Naylor
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia3South West Sydney Local Health District, Liverpool 2170, NSW, Australia4Whitlam Orthopaedic Research Centre, Australia5Ingham Institute of Applied Medical Research, Liverpool 2170, NSW, Australia
| | - Ian A Harris
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia3South West Sydney Local Health District, Liverpool 2170, NSW, Australia4Whitlam Orthopaedic Research Centre, Australia5Ingham Institute of Applied Medical Research, Liverpool 2170, NSW, Australia
| | - Wei Xuan
- South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia5Ingham Institute of Applied Medical Research, Liverpool 2170, NSW, Australia
| | - Friedbert Kohler
- Braeside Hospital, HammondCare, Australia2South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool NSW 2170, Australia3South West Sydney Local Health District, Liverpool 2170, NSW, Australia
| | - Rachael Wright
- South West Sydney Local Health District, Liverpool 2170, NSW, Australia
| | - Renee Fortunato
- South West Sydney Local Health District, Liverpool 2170, NSW, Australia
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Naylor JM, Mills K, Buhagiar M, Fortunato R, Wright R. Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods. BMC Musculoskelet Disord 2016; 17:390. [PMID: 27624720 PMCID: PMC5022203 DOI: 10.1186/s12891-016-1249-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/09/2016] [Indexed: 01/28/2023] Open
Abstract
Background The 6-minute walk test (6MWT) is a commonly used metric for measuring change in mobility after knee arthroplasty, however, what is considered an improvement after surgery has not been defined. The determination of important change in an outcome assessment tool is controversial and may require more than one approach. This study, nested within a combined randomised and observational trial, aimed to define a minimal important improvement threshold for the 6MWT in a knee arthroplasty cohort through a triangulation of methods including patient-perceived anchor-based thresholds and distribution-based thresholds. Methods Individuals with osteoarthritis performed a 6MWT pre-arthroplasty then at 10 and 26 weeks post-surgery. Each rated their perceived improvement in mobility post-surgery on a 7-point transition scale anchored from “much better” to “much worse”. Based on these responses the cohort was dichotomised into ‘improved’ and ‘not improved’. The thresholds for patient-perceived improvements were then identified using two receiver operating curve methods producing sensitivity and specificity indices. Distribution-based change thresholds were determined using two methods utilising effect size (ES). Agreement between the anchor- and distribution-based methods was assessed using kappa. Results One hundred fifty-eight from 166 participants in the randomised cohort and 222 from 243 in the combined randomised and observational cohort were included at 10 and 26 weeks, respectively. The slightly or more patient-perceived improvement threshold at 26 weeks (an absolute improvement of 26 m) was the only one to demonstrate sensitivity and specificity results both better than chance. At 10- and 26-weeks, the ES based on the mean change score divided by the baseline standard deviation (SD), was an absolute change of 24.5 and 37.9 m, respectively. The threshold based on a moderate ES (a 0.5 SD of the baseline score) was a change of 55.0 and 55.4 m at 10- and 26-weeks, respectively. The level of agreement between the 26-week anchor-based and distribution-based minimal absolute changes was very good (k = 0.88 (95 % CI 0.81 0.95)). Conclusion A valid threshold of improvement for the 6MWT can only be proposed for changes identified from baseline to 26 weeks post-surgery. The level of agreement between anchor- and distribution-based methods indicates that a true minimal or more threshold of meaningful improvement following surgery is likely within the ranges proposed by the triangulation of all four methods, that is, 26 to 55 m.
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Affiliation(s)
- J M Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, 1871, Sydney, NSW, Australia. .,South West Sydney Clinical School, UNSW, Sydney, Australia. .,Ingham Institute of Applied Medical Health Research, Sydney, Australia.
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - M Buhagiar
- South West Sydney Clinical School, UNSW, Sydney, Australia.,Ingham Institute of Applied Medical Health Research, Sydney, Australia.,Braeside Hospital, Hammondcare Group, Sydney, Australia
| | - R Fortunato
- Physiotherapy Department, Campbelltown Hospital, Sydney, Australia
| | - R Wright
- Occupational Therapy Department, Fairfield Hospital, Sydney, Australia
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Affiliation(s)
- R Wright
- Nuffield Department of Clinical Medicine, The Radcliffe Infirmary, Oxford
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Modabbernia A, Velthorst E, Gennings C, De Haan L, Austin C, Sutterland A, Mollon J, Frangou S, Wright R, Arora M, Reichenberg A. Early-life metal exposure and schizophrenia: A proof-of-concept study using novel tooth-matrix biomarkers. Eur Psychiatry 2016; 36:1-6. [PMID: 27311101 DOI: 10.1016/j.eurpsy.2016.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 02/01/2016] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite evidence for the effects of metals on neurodevelopment, the long-term effects on mental health remain unclear due to methodological limitations. Our objective was to determine the feasibility of studying metal exposure during critical neurodevelopmental periods and to explore the association between early-life metal exposure and adult schizophrenia. METHODS We analyzed childhood-shed teeth from nine individuals with schizophrenia and five healthy controls. We investigated the association between exposure to lead (Pb(2+)), manganese (Mn(2+)), cadmium (Cd(2+)), copper (Cu(2+)), magnesium (Mg(2+)), and zinc (Zn(2+)), and schizophrenia, psychotic experiences, and intelligence quotient (IQ). We reconstructed the dose and timing of early-life metal exposures using laser ablation inductively coupled plasma mass spectrometry. RESULTS We found higher early-life Pb(2+) exposure among patients with schizophrenia than controls. The differences in log Mn(2+) and log Cu(2+) changed relatively linearly over time to postnatal negative values. There was a positive correlation between early-life Pb(2+) levels and psychotic experiences in adulthood. Moreover, we found a negative correlation between Pb(2+) levels and adult IQ. CONCLUSIONS In our proof-of-concept study, using tooth-matrix biomarker that provides direct measurement of exposure in the fetus and newborn, we provide support for the role of metal exposure during critical neurodevelopmental periods in psychosis.
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Affiliation(s)
- A Modabbernia
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - E Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Gennings
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - L De Haan
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Austin
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - A Sutterland
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Mollon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England, United Kingdom
| | - S Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Psychosis Research Program, Icahn School of Medicine at Mount Sinai, New York, United States
| | - R Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - M Arora
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - A Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States; Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, United States
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Irwin S, Midgley A, Wright R, Peak M, Beresford M. FRI0007 Effect of Type 1 and 2 Interferons on Neutrophil Apoptosis in naÏve and TNF Alpha Primed Neutrophils. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jackson M, Austin D, Hall J, Wright R, Sutton A, Muir D, Swanson N, Carter J, Williams P, de Belder M. 30 Do PRAMI and CVLPRIT represent real-life experiences of culprit-only PPCI? - a single centre observational study. Heart 2016. [DOI: 10.1136/heartjnl-2016-309588.30] [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: 11/04/2022]
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Castelijns B, Ponten JEH, Van de Poll MCG, Nienhuijs SW, Smulders JF, Hu ZW, Wu JM, Wang ZG, Idani H, Asami S, Nakano K, Miyake S, Harano M, Miyoshi H, Araki H, Ogawa T, Takahashi K, Shiozaki S, Ninomiya M, Prasad A, Todkar J, Asti E, Lovece A, Sironi A, Bonavina L, Wright R, Wurst H, Zhang C, Li HL, Ke LM, Loi K, Hua R, Yao QY, Chen H, Okinyi W, Odende K, Ndungu B, Ndonga A, Kiragu P, Kelimu A, Alimujiang M, Tian W, Bing M. Hiatal Hernia. Hernia 2015; 19 Suppl 1:S13-7. [PMID: 26518789 DOI: 10.1007/bf03355320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | - J M Wu
- Gastroesophageal Reflux Disease Department, Second Artillery General Hospital PLA, 2. Xuanwu Hospital, Capital Medic, Beijing, China
| | | | - H Idani
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - S Asami
- Fukuyama City Hospital, Fukuyama, Japan
| | - K Nakano
- Fukuyama City Hospital, Fukuyama, Japan
| | - S Miyake
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - M Harano
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - H Miyoshi
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - H Araki
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - T Ogawa
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - K Takahashi
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - S Shiozaki
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - M Ninomiya
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - A Prasad
- Apollo Hospital, New Delhi, India
| | - J Todkar
- Hiranandani Hospital, Mumbai, India
| | - E Asti
- IRCCS Policlinico San Donato, Milan, Italy
| | - A Lovece
- IRCCS Policlinico San Donato, Milan, Italy
| | - A Sironi
- IRCCS Policlinico San Donato, Milan, Italy
| | - L Bonavina
- IRCCS Policlinico San Donato, Milan, Italy
| | - R Wright
- Cascade Hernia Institute, Puyallup, USA
| | - H Wurst
- Meridian Surgery Center, Puyallup, USA
| | - C Zhang
- Department of Minimally Invasive Surgery, Xinjiang people Hospital, Urumqi, China
| | | | | | - K Loi
- St George Private Hospital, Sydney, Australia
| | | | - Q Y Yao
- Department of General Surgery, Hernia Center, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - W Okinyi
- The University of Nairobi, Nairobi, Kenya
| | - K Odende
- Kenyatta National Hospital, Nairobi, Kenya
| | - B Ndungu
- The University of Nairobi, Nairobi, Kenya
| | - A Ndonga
- The Mater Hospital, Nairobi, Kenya
| | - P Kiragu
- Maralal County Hospital, Maralal, Kenya
| | - A Kelimu
- Department of Minimally Invasive Surgery, hernias and abdominal wall surgery, People's Hospital of Xinjiang Uyghur Auton, Urumqi, China
| | | | - W Tian
- Department of General Surgery, 1st affiliated hospital of PLA general hospital, Beijing, China
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Wright R, Makropoulos A, Kyriakopoulou V, Patkee PA, Koch LM, Rutherford MA, Hajnal JV, Rueckert D, Aljabar P. Construction of a fetal spatio-temporal cortical surface atlas from in utero MRI: Application of spectral surface matching. Neuroimage 2015; 120:467-80. [PMID: 26070259 DOI: 10.1016/j.neuroimage.2015.05.087] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 02/01/2023] Open
Abstract
In this study, we construct a spatio-temporal surface atlas of the developing cerebral cortex, which is an important tool for analysing and understanding normal and abnormal cortical development. In utero Magnetic Resonance Imaging (MRI) of 80 healthy fetuses was performed, with a gestational age range of 21.7 to 38.9 weeks. Topologically correct cortical surface models were extracted from reconstructed 3D MRI volumes. Accurate correspondences were obtained by applying a joint spectral analysis to cortices for sets of subjects close to a specific age. Sulcal alignment was found to be accurate in comparison to spherical demons, a state of the art registration technique for aligning 2D cortical representations (average Fréchet distance≈0.4 mm at 30 weeks). We construct consistent, unbiased average cortical surface templates, for each week of gestation, from age-matched groups of surfaces by applying kernel regression in the spectral domain. These were found to accurately capture the average cortical shape of individuals within the cohort, suggesting a good alignment of cortical geometry. Each spectral embedding and its corresponding cortical surface template provide a dual reference space where cortical geometry is aligned and a vertex-wise morphometric analysis can be undertaken.
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Affiliation(s)
- R Wright
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK.
| | - A Makropoulos
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - V Kyriakopoulou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - P A Patkee
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - L M Koch
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - M A Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - J V Hajnal
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
| | - D Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK
| | - P Aljabar
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London SW7 2AZ, UK; Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
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Wright R, Herrera M, Parpas P, Stoianov I. Hydraulic Resilience Index for the Critical Link Analysis of Multi-feed Water Distribution Networks. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.proeng.2015.08.987] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wright R, Kyriakopoulou V, Ledig C, Rutherford M, Hajnal J, Rueckert D, Aljabar P. Automatic quantification of normal cortical folding patterns from fetal brain MRI. Neuroimage 2014; 91:21-32. [PMID: 24473102 DOI: 10.1016/j.neuroimage.2014.01.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/13/2014] [Accepted: 01/21/2014] [Indexed: 01/18/2023] Open
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Zorrilla CD, Wright R, Osiyemi OO, Yasin S, Baugh B, Brown K, Coate B, Verboven P, Mrus J, Falcon R, Kakuda TN. Total and unbound darunavir pharmacokinetics in pregnant women infected with HIV-1: results of a study of darunavir/ritonavir 600/100 mg administered twice daily. HIV Med 2013; 15:50-6. [PMID: 23731450 PMCID: PMC4231999 DOI: 10.1111/hiv.12047] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Abstract
Objectives Antiretroviral therapy during pregnancy is recommended to reduce the risk of mother-to-child transmission of HIV and for maternal care management. Physiological changes during pregnancy can affect pharmacokinetics, potentially altering pharmacological activity. We therefore evaluated the pharmacokinetics of twice-daily (bid) darunavir in HIV-1-infected pregnant women. Methods HIV-1-infected pregnant women receiving an antiretroviral regimen containing darunavir/ritonavir 600/100 mg bid were enrolled in this study. Total and unbound darunavir and total ritonavir plasma concentrations were obtained over 12 h during the second and third trimesters and postpartum. Total darunavir and ritonavir plasma concentrations were determined using a validated high-performance liquid chromatography tandem mass spectrometry assay and unbound darunavir was determined using 14C-darunavir-fortified plasma. Pharmacokinetic parameters were derived using noncompartmental analysis. Results Data were available for 14 women. The area under the plasma concentration–time curve from 0 to 12 h (AUC12h) for total darunavir was 17–24% lower during pregnancy than postpartum. The AUC12h for unbound darunavir was minimally reduced during pregnancy vs. postpartum. The minimum plasma concentration (Cmin) of total and unbound darunavir was on average 43–86% and 10–14% higher, respectively, during pregnancy vs. postpartum. The antiviral response (< 50 HIV-1 RNA copies/mL) was 33% at baseline and increased to 73–90% during treatment; the percentage CD4 count increased over time. One serious adverse event was reported (increased transaminase). All 12 infants born to women remaining in the study at delivery were HIV-1-negative; four of these infants were premature. Conclusions Total darunavir exposure decreased during pregnancy. No clinically relevant change in unbound (active) darunavir occurred during pregnancy, suggesting that no dose adjustment is required for darunavir/ritonavir 600/100 mg bid in pregnant women.
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Affiliation(s)
- C D Zorrilla
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Lewis JW, Morley NJ, Ahmad M, Challis GL, Wright R, Bicker R, Morritt D. Structural changes in freshwater fish and chironomids exposed to bacterial exotoxins. Ecotoxicol Environ Saf 2012; 80:37-44. [PMID: 22381615 DOI: 10.1016/j.ecoenv.2012.02.006] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 05/31/2023]
Abstract
Mass fish mortalities have been reported in the past decade from British waters, often coinciding with blooms of filamentous actinobacteria, particularly strains of Streptomyces griseus. The present study has shown that some fractions of the exudate of S. griseus, prepared after a series of high pressure liquid chromatography (HPLC) separations, and analysed with liquid chromatography mass spectrometry (LC-MS), induced pathological changes to the gills of carp and/or tench fry following exposure under laboratory conditions up to 96 h Similar changes were induced by streptomycin, a secondary metabolite of S. griseus, and these included loss of microridging and fusion of secondary lamellae, with carp fry in the case of the exudate of S. griseus being more sensitive than tench fry, especially with exposure to fraction 9 and selected sub-fractions of 9. Some deformities using a severity index were also observed in the head capsule of larvae of the non-biting midge Chironomus riparius, including loss and splitting of teeth on the mentum. The results are discussed in relation to further identification of metabolites derived from samples of the organic filtrate of S. griseus and implications for the functioning of freshwater ecosystems.
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Affiliation(s)
- J W Lewis
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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Khan S, Saidmeerasah A, Hunjan R, Wright R, Swanson N, Sutton A, Muir D, Carter J, Hall J, de Belder M. 029 Management and outcomes of patients following out-of-hospital cardiac arrest. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.29] [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: 11/04/2022]
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Calvo O, Matzen T, Wright R, Gutiérrez A. SU-E-T-213: Preliminary Testing of a 2-D Fluence Measurement Prototype Device (Delta4-AT) for In-Vivo Patient Verification Dosimetry. Med Phys 2011. [DOI: 10.1118/1.3612163] [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: 11/07/2022] Open
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Ren C, Baccarelli A, Wilker E, Suh H, Sparrow D, Vokonas P, Wright R, Schwartz J. Lipid and endothelium-related genes, ambient particulate matter, and heart rate variability--the VA Normative Aging Study. J Epidemiol Community Health 2011; 64:49-56. [PMID: 19602472 DOI: 10.1136/jech.2008.083295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many studies have shown that exposures to air pollution are associated with cardiovascular events, although the mechanism remains to be clarified. To identify whether exposures to ambient particles act on autonomic function via the lipid/endothelial metabolism pathway, whether effects of particulate matter <2.5 mum in aerodynamic diameter (PM(2.5)) on heart rate variability (HRV) were modified by gene polymorphisms related to those pathways were evaluated. METHODS HRV and gene data from the Normative Aging Study and PM(2.5) from a monitor located a kilometre from the examination site were used. A mixed model was fitted to investigate the associations between PM(2.5) and repeated measurements of HRV by gene polymorphisms of apolipoprotein E (APOE), lipoprotein lipase (LPL) and vascular endothelial growth factor (VEGF) adjusting for potential confounders chosen a priori. RESULTS A 10 microg/m(3) increase in PM(2.5) in the 2 days before the examination was associated with 3.8% (95% CI 0.2% to 7.4%), 7.8% (95 CI 0.4% to 15.3%) and 10.6% (95% CI 1.8% to 19.4%) decreases of the standard deviation of normal-to-normal intervals, the low frequency and the high frequency, respectively. Overall, carriers of wild-type APOE, LPL and VEGF genes had stronger effects of particles on HRV than those with hetero- or homozygous types. Variations of LPL-N291S, LPL-D9N and APOE-G113C significantly modified effects of PM(2.5) on HRV. CONCLUSION Associations between PM(2.5) and HRV were modified by gene polymorphisms of APOE, LPL and VEGF; the biological metabolism remains to be identified.
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Affiliation(s)
- C Ren
- Exposure, Epidemiology, and Risk Program, Harvard School of Public Health, Landmark Center West, Suite 415, 401 Park Dr, Boston, MA 02215, USA.
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Hsü KJ, He Q, McKenzie JA, Weissert H, Perch-Nielsen K, Oberhänsli H, Kelts K, Labrecque J, Tauxe L, Krähenbühl U, Percival SF, Wright R, Karpoff AM, Petersen N, Tucker P, Poore RZ, Gombos AM, Pisciotto K, Carman MF, Schreiber E. Mass mortality and its environmental and evolutionary consequences. Science 2010; 216:249-56. [PMID: 17832725 DOI: 10.1126/science.216.4543.249] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The latest Mesozoic and earliest Tertiary sediments at Deep Sea Drilling Project site 524 provide an amplified record of environmental and biostratographic changes at the end of Cretaceous. Closely spaced samples, representing time intervals as short as 10(2) or 10(3) years, were analyzed for their bulk carbonate and trace-metal compositions, and for oxygen and carbon isotopic compositions. The data indicate that at the end of Cretaceous, when a high proportion of the ocean's planktic organisms were eliminated, an associated reduction in productivity led to a partial transfer of dissolved carbon dioxide from the oceans to the atmosphere. This resulted in a large increase of the atmospheric carbon dioxide during the next 50,000 years, which is believed to have caused a temperature rise revealed by the oxygen-isotope data. The lowermost Tertiary sediments at site 524 include fossils with Cretaceous affinities, which may include both reworked individuals and some forms that survived for a while after the catastrophe. Our data indicate that many of the Cretaceous pelagic organisms became extinct over a period of a few tens of thousands of years, and do not contradict the scenario of cometary impact as a cause of mass mortality in the oceans, as suggested by an iridium anomaly at the Cretaceous-Tertiary boundary.
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Wright R, Brandt S, Allan K. 143 THORACIC RADIOFREQUENCY MEDIAL BRANCH ABLATION: DESCRIPTION OF A NOVEL DEVICE, NOVEL TECHNIQUE, AND IN VIVO THERMAL MAPPING SAFETY STUDY. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R. Wright
- Denver Pain Management, Greenwood Village, Colorado, United States
| | - S. Brandt
- Denver Pain Management, Greenwood Village, Colorado, United States
| | - K. Allan
- Denver Pain Management, Greenwood Village, Colorado, United States
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Pfund C, Miller S, Brenner K, Bruns P, Chang A, Ebert-May D, Fagen AP, Gentile J, Gossens S, Khan IM, Labov JB, Pribbenow CM, Susman M, Tong L, Wright R, Yuan RT, Wood WB, Handelsman J. Summer Institute to Improve University Science Teaching. Science 2009; 324:470-1. [DOI: 10.1126/science.1170015] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lewis JW, Morley NJ, Drinkall J, Jamieson BJ, Wright R, Parry JD. Toxic effects of Streptomyces griseus spores and exudate on gill pathology of freshwater fish. Ecotoxicol Environ Saf 2009; 72:173-181. [PMID: 18755510 DOI: 10.1016/j.ecoenv.2008.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 07/07/2008] [Accepted: 07/13/2008] [Indexed: 05/26/2023]
Abstract
Many unexplained fish-kills in British waters are considered microbial in origin and a large proportion of field sites contains elevated concentrations of filamentous actinobacteria. The present study has shown that a strain of Streptomyces griseus, isolated from field sites, elicits pathological changes to the gills of fish under laboratory conditions which mirror those found in situ. These changes include hyperplasia leading to fusion of the secondary lamellae and loss of microridging on the filamental epithelium of the primary lamellae. Juveniles of up to six fish species were exposed to spore suspensions or exudate of S. griseus in the range of 1 x 10(2)-1 x 10(6)spores ml(-1) for up to 96 h. The exudate was more potent than the spores and there was a positive correlation between exudate concentration and the rate and extent of fish gill pathology with bream and rainbow trout being more sensitive than carp, tench and roach. The results are discussed in the context of recognising and managing potential fish mortalities caused by microbial toxins.
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Affiliation(s)
- J W Lewis
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey TW20 OEX, UK
| | - N J Morley
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey TW20 OEX, UK.
| | - J Drinkall
- Division of Biomedical and Life Sciences, School of Health and Medicine, Lancaster University, Lancaster LA1 4YQ, UK
| | - B J Jamieson
- Ecology and Soils, Science, Environment Agency, Howbery Park, Wallingford OX10 8BD, UK
| | - R Wright
- Environment Agency, Rivers House, Inworth Road, Feering, Essex CO5 1UD, UK
| | - J D Parry
- Division of Biomedical and Life Sciences, School of Health and Medicine, Lancaster University, Lancaster LA1 4YQ, UK
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Eade OE, Grice D, Krawitt EL, Trowell J, Albertini R, Festenstein H, Wright R. HLA A and B locus antigens in patients with unexplained hepatitis following halothane anaesthesia. Tissue Antigens 2008; 17:428-32. [PMID: 7330846 DOI: 10.1111/j.1399-0039.1981.tb00724.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
HLA A and B locus antigens were determined in 17 patients who had recovered from unexplained hepatitis following halothane anaesthesia. The greatest deviations from expected frequencies were observed with A1, A11 and BW22, but these differences were not statistically significant when the P values were corrected for the number of antigens tested. Although a larger series might show such deviations to be significantly different, HLA typing is of no predictive value in determining those at risk to hepatitis following repeated halothane exposure.
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Wright R, Hughes M, Tanner P, Hughes K, Gasworth L, Peklo D, Gill J. 273: Is Whole Body Computed Tomography Imaging Necessary to Identify “Clinically Significant” Injuries in Low Risk Blunt Trauma Patients? Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brown C, McNicholl B, Wright R. Ultrasound simulator for venous access. Emerg Med J 2008; 25:122. [PMID: 18212166 DOI: 10.1136/emj.2007.051151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Faber J, Krivtsov A, Stubbs M, Wright R, van den Heuvel-Eibrink M, Kung A, Zwaan C, Armstrong S. Suppression of HOX A cluster genes inhibits proliferation and induces cell death in human mixed-lineage leukemias. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14020 Background: Leukemias harboring translocations of the mixed lineage leukemia locus (MLL) are generally associated with poor clinical prognosis. Using gene expression profiling we and others have previously shown that Homeobox (HOX) A cluster genes are highly expressed in leukemias with MLL rearrangements. Methods: Here we studied the role of aberrant HOXA9 expression in human MLL- rearranged and non-rearranged leukemias utilizing an shRNA mediated knockdown approach. Results: Three different shRNA constructs targeting human HOXA9 were synthesized and stably introduced into t(9;11) MOLM14 cells utilizing a lentiviral vector system. 75–80% HOXA9 RNA knockdown was confirmed by quantitative PCR and Western Blot analysis. In a panel of 17 AML/ALL cell lines (7 MLL rearranged, 10 non rearranged), HOXA9 directed shRNA inhibited cell proliferation starting as early as 48h after transduction, and induced apoptosis beginning at 72h. Interestingly, impaired cell proliferation and induction of apoptosis was significantly higher in the MLL rearranged cell lines (mean viability: 51.88%) than in the non-rearranged cells (mean viability: 90.98%; p=0.007) and also significantly correlated with the baseline HOXA9 mRNA expression before knockdown (R= 0.8, p=0.00017). We then further analyzed the effect of HOXA9 knockdown in MLL rearranged and non-rearranged primary human AML cells. Similar to our findings in cell lines, a marked induction of cell death was observed, which was significantly higher in leukemias with an MLL translocation (p=0.005) and also significantly correlated with the baseline HOXA9 mRNA expression (R= 0.8, p=0.001). Next, the in vivo effect of HOXA9 knockdown was assessed by transplanting luciferase-expressing SEMK2 (t4;11) cells into SCID-beige mice followed by in vivo bioluminescent imaging. Leukemia burden was significantly reduced in HOXA9 shRNA treated mice (n=10) with a peak difference at day 15 (p=0.000059) shortly before mice of the control group (n=10) succumbed from overt leukemia. At this point all mice of the HOXA9 shRNA treated group were still healthy with no signs of leukemia. Conclusions: Taken together our data implicates that depletion of HOXA9 might be a novel approach for targeted therapy in human MLL rearranged leukemias. No significant financial relationships to disclose.
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Affiliation(s)
- J. Faber
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - A. Krivtsov
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - M. Stubbs
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - R. Wright
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - M. van den Heuvel-Eibrink
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - A. Kung
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - C. Zwaan
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
| | - S. Armstrong
- Children’s Hospital of Boston, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Erasmus Medical Center, Rotterdam, The Netherlands
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McQueen A, Wright R, Krauss B. Post-discharge Adverse Behavioral Events in Children Receiving Fentanyl/Midazolam Versus Ketamine in a Pediatric Emergency Department. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.957] [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: 11/10/2022]
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Abstract
Tarsometatarsal joint dislocations and fracture-dislocations are uncommon injuries most frequently resulting from high-energy trauma as encountered in crush injuries, falls, and motor vehicle accidents. Although less common in athletes, this injury is being recognized with greater frequency and may carry a poor prognosis for return to high levels of competition. These injuries present a considerable challenge to orthopedic surgeons caring for athletes because of the prolonged period of recovery often required [ 1,2,5,6,12]. The literature contains descriptions of this injury in football players, gymnasts, tennis players, and track and field athletes [2,5,9]. To our knowledge, no report of such a Lisfranc injury to a hockey player has been described. This is a case report of a National Hockey League player that sustained a Lisfranc injury requiring surgical stabilization, but was able to return to elite hockey play.
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Affiliation(s)
- D Patillo
- Department of Orthopaedics, Washington University School of Medicine, St. Louis, MO 63110, USA
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47
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Hopkins M, Hernandez-Avila M, Tellez-Rojo M, Bellinger D, Hu H, Wright R. Genetic Predictors of Blood and Bone Lead Levels in Women and Children. Epidemiology 2006. [DOI: 10.1097/00001648-200611001-00912] [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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48
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Becker C, Wright R, Satchi-Fainaro R, Funakoshi T, Folkman J, Kung A, D'Amato R. Nicht-invasive Überwachung des Effekts antiangiogener Therapie in einem neuartigen transgenen Mausmodell für Endometriose. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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49
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Rajan P, Kelsey K, Schwartz J, Bellinger D, Sparrow D, Spiro III A, Smith T, Wright R, Nieh H, Hu H. Prospective Study of Lead and Psychiatric Symptoms and the Modifying Influence of the δ-Aminolevulinic Acid Dehydratase (ALAD) Polymorphism: The Normative Aging Study. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s238-b] [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: 11/12/2022] Open
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50
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Abstract
A study was made of the relative sensitivity and specificity of presumptive and confirmatory media for the most probable number enumeration of enterococci in frozen vegetables. Azide dextrose broth yielded the highest numbers of confirmable enterococci and its sensitivity was shown to be comparable to nonselective media. The use of ethyl violet azide broth as a confirmatory medium resulted in a significant number of false positive tests. Growth in broth containing 6.5% sodium chloride incubated at 45 C for 2 days was found to be a more specific confirmatory test for enterococci.
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Affiliation(s)
- D F Splittstoesser
- New York State Agricultural Experiment Station, Cornell University, Geneva, New York
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