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Chuangsuwanich T, Tun TA, Braeu FA, Wang X, Chin ZY, Panda SK, Buist M, Milea D, Strouthidis N, Perera S, Nongpiur ME, Aung T, Girard MJA. Adduction induces large optic nerve head deformations in subjects with normal-tension glaucoma. Br J Ophthalmol 2024; 108:522-529. [PMID: 37011991 DOI: 10.1136/bjo-2022-322461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To assess intraocular pressure (IOP)-induced and gaze-induced optic nerve head (ONH) strains in subjects with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). DESIGN Clinic-based cross-sectional study. METHODS The ONH from one eye of 228 subjects (114 subjects with HTG (pre-treatment IOP≥21 mm Hg) and 114 with NTG (pre-treatment IOP<21 mm Hg)) was imaged with optical coherence tomography (OCT) under the following conditions: (1) OCT primary gaze, (2) 20° adduction from OCT primary gaze, (3) 20° abduction from OCT primary gaze and (4) OCT primary gaze with acute IOP elevation (to approximately 33 mm Hg). We then performed digital volume correlation analysis to quantify IOP-induced and gaze-induced ONH tissue deformations and strains. RESULTS Across all subjects, adduction generated high effective strain (4.4%±2.3%) in the LC tissue with no significant difference (p>0.05) with those induced by IOP elevation (4.5%±2.4%); while abduction generated significantly lower (p=0.01) effective strain (3.1%±1.9%). The lamina cribrosa (LC) of HTG subjects exhibited significantly higher effective strain than those of NTG subjects under IOP elevation (HTG: 4.6%±1.7% vs NTG: 4.1%±1.5%, p<0.05). Conversely, the LC of NTG subjects exhibited significantly higher effective strain than those of HTG subjects under adduction (NTG: 4.9%±1.9% vs HTG: 4.0%±1.4%, p<0.05). CONCLUSION We found that NTG subjects experienced higher strains due to adduction than HTG subjects, while HTG subjects experienced higher strain due to IOP elevation than NTG subjects-and that these differences were most pronounced in the LC tissue.
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Affiliation(s)
- Thanadet Chuangsuwanich
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Fabian A Braeu
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Singapore-MIT Alliance for Research and Technology, Singapore
| | - Xiaofei Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zhi Yun Chin
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Satish K Panda
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Martin Buist
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Michael J A Girard
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
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Fenwick EK, Man REK, Lim B, Baskaran M, Nongpiur M, Sng CCA, Iyer JV, Husain R, Perera S, Wong T, Low JR, Huang OS, Lun K, Loe BS, Aung T, Lamoureux EL. Efficiency, Precision, Validity, and Reliability of GlauCAT-Asian Computerized Adaptive Tests in Measuring Glaucoma-Related Quality of Life. Transl Vis Sci Technol 2024; 13:6. [PMID: 38329749 PMCID: PMC10860685 DOI: 10.1167/tvst.13.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To determine the efficiency, precision, and agreement of GlauCAT-Asian and its corresponding validity and reliability. Methods In this cross-sectional study, 219 participants (mean ± standard deviation age, 66.59 ± 8.61 years; 34% female) across the spectrum of glaucoma severity and 50 glaucoma suspects were recruited from glaucoma clinics in Singapore. Participants answered seven computerized adaptive testing (CAT) evaluations (Ocular Comfort, Activity Limitation, Lighting, Mobility, Concerns, Psychosocial, Glaucoma Management) and underwent eye examinations. Efficiency (mean number of items required for each CAT and time taken for CAT versus full item banks [IBs]), agreement (concordance between CATs and full IB person measures, henceforth referred to as scores), and precision (standard error of measurement [SE]) were evaluated. Other validity and reliability metrics were also assessed. Results The mean number of items administered ranged from 9 (Mobility/Glaucoma Management) to 12 (Ocular Comfort). Compared to answering the full IBs, CATs provided an average time saving of 38.3% (range, 10% to 70.6% for Lighting and Activity Limitation, respectively). Agreement between scores obtained by CAT versus full IB was high (intracorrelation coefficient ≥0.75), as was precision of score estimates (mean SE range: 0.35 for Psychosocial to 0.29 for Mobility). Scores from Activity Limitation, Mobility, Lighting, and Concerns decreased significantly as glaucoma severity increased (criterion validity; P-trend <0.05). All tests displayed good convergent/divergent validity and test-retest reliability. Conclusions GlauCAT-Asian provides efficient, precise, accurate, valid, and reliable measurement of the patient-centered impact of glaucoma. Translational Relevance GlauCAT-Asian may provide a valuable clinical tool for ophthalmologists to monitor impact of disease progression and the effectiveness of therapies.
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Affiliation(s)
- Eva K. Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ryan E. K. Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Belicia Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Monisha Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chelvin C. A. Sng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | | | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Tina Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jin Rong Low
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Olivia Shimin Huang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Katherine Lun
- National University Health System, Singapore, Singapore
| | - Bao Sheng Loe
- School of Psychology, University of Cambridge, Cambridge, UK
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National University of Singapore, Singapore, Singapore
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke–NUS Medical School, National University of Singapore, Singapore, Singapore
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Braeu FA, Chuangsuwanich T, Tun TA, Perera S, Husain R, Thiery AH, Aung T, Barbastathis G, Girard MJA. AI-based clinical assessment of optic nerve head robustness superseding biomechanical testing. Br J Ophthalmol 2024; 108:223-231. [PMID: 36627175 DOI: 10.1136/bjo-2022-322374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS To use artificial intelligence (AI) to: (1) exploit biomechanical knowledge of the optic nerve head (ONH) from a relatively large population; (2) assess ONH robustness (ie, sensitivity of the ONH to changes in intraocular pressure (IOP)) from a single optical coherence tomography (OCT) volume scan of the ONH without the need for biomechanical testing and (3) identify what critical three-dimensional (3D) structural features dictate ONH robustness. METHODS 316 subjects had their ONHs imaged with OCT before and after acute IOP elevation through ophthalmo-dynamometry. IOP-induced lamina cribrosa (LC) deformations were then mapped in 3D and used to classify ONHs. Those with an average effective LC strain superior to 4% were considered fragile, while those with a strain inferior to 4% robust. Learning from these data, we compared three AI algorithms to predict ONH robustness strictly from a baseline (undeformed) OCT volume: (1) a random forest classifier; (2) an autoencoder and (3) a dynamic graph convolutional neural network (DGCNN). The latter algorithm also allowed us to identify what critical 3D structural features make a given ONH robust. RESULTS All three methods were able to predict ONH robustness from a single OCT volume scan alone and without the need to perform biomechanical testing. The DGCNN (area under the curve (AUC): 0.76±0.08) outperformed the autoencoder (AUC: 0.72±0.09) and the random forest classifier (AUC: 0.69±0.05). Interestingly, to assess ONH robustness, the DGCNN mainly used information from the scleral canal and the LC insertion sites. CONCLUSIONS We propose an AI-driven approach that can assess the robustness of a given ONH solely from a single OCT volume scan of the ONH, and without the need to perform biomechanical testing. Longitudinal studies should establish whether ONH robustness could help us identify fast visual field loss progressors. PRECIS Using geometric deep learning, we can assess optic nerve head robustness (ie, sensitivity to a change in IOP) from a standard OCT scan that might help to identify fast visual field loss progressors.
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Affiliation(s)
- Fabian A Braeu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore-MIT Alliance for Research and Technology, Singapore
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore
| | - Thanadet Chuangsuwanich
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
| | - Alexandre H Thiery
- Statistics and Applied Probability, National University of Singapore, Singapore
| | - Tin Aung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - George Barbastathis
- Singapore-MIT Alliance for Research and Technology, Singapore
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland
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Tran L, Vo J, Bell K, Perera S, Crowston J. Does Bevacizumab Improve Outcomes following Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A meta-analysis. J Glaucoma 2024:00061198-990000000-00337. [PMID: 38194278 DOI: 10.1097/ijg.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
PRCIS Mean IOP, complete and overall success, mean IOP-lowering medications, incidence of hypertensive phase and complications were found to be comparable between patients undergoing Ahmed Glaucoma Valve implantation (AGVI) with adjunctive bevacizumab versus AGVI alone. PURPOSE This meta-analysis aims to assess how adjunctive bevacizumab impacts the surgical outcomes of Ahmed glaucoma valve implantation (AGVI) compared to AGVI alone in all subtypes of refractory glaucoma. METHODS A systematic search of databases for relevant randomised controlled trials (RCTs) was performed in March 2023. Primary outcomes included mean intraocular pressure (IOP) and success rates. Secondary outcomes were mean IOP-lowering medications, incidence of hypertensive phase, and complications. Qualitative assessment, meta-analysis, subgroup analyses, and sensitivity analysis were performed. RESULTS Five RCTs comprising 203 eyes were included in the quantitative analysis. Initial meta-analysis showed a strong yet non-significant trend (all P>0.05) favouring adjunctive bevacizumab in all outcomes of interest. Significant heterogeneity was observed for mean IOP and success outcomes at all timepoints (all I2>50%). Subgroup analysis of administration route revealed a reduced incidence of hyphaema in the intravitreal bevacizumab (IVB) subgroup (OR, 0.10; 95% CI, 0.02-0.59; P=0.01) with significant heterogeneity persisting in the IVB subgroup for all measures (all I2>50%). Post hoc sensitivity analysis of studies without concurrent PRP for mean IOP and success outcomes demonstrated more conservative effect sizes with a corresponding decrease in heterogeneity for all measures (all I2<30%). CONCLUSION Published studies investigating the role of adjunctive bevacizumab show a strong trend to improved outcomes but contain a relatively small number of participants. This analysis underpins the need for an adequately powered RCT to explore the role of anti-VEGF agents in AGVI surgery.
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Affiliation(s)
- Luke Tran
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales Australia
| | - Joanne Vo
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, Queensland Australia
| | - Katharina Bell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales Australia
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Jonathan Crowston
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales Australia
- Save Sight Institute, Sydney, New South Wales Australia
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Ramadasa U, Silva S, Udumulla U, Perera S, Lekamwasam S. Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index - Sinhala version. BMC Palliat Care 2023; 22:172. [PMID: 37924086 PMCID: PMC10625189 DOI: 10.1186/s12904-023-01270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Care givers of Palliated patients are at risk of adverse physical, psychosocial and emotional sequelae in varied nature. Efficient and valid assessment tools facilitate early detection to take corrective measures. The Modified Caregiver Strain Index (MCSI), composed of domains associated with caregiver strain is a simple and brief tool that can be used in both clinical and field settings. This study aimed to adapt and validate this in order to cater effective palliative care services in Sri Lanka. METHODS After cross-cultural adaptation, 200 primary caregivers in 3 teaching hospitals were recruited. The internal consistency, item-total correlations, of the 13-item S-MCSI were performed. The criterion validity was assessed by Pearson correlation between the total scores of S-MCSI, the Karnofky Performance Scale and the Barthel index. Construct validity was determined by the principal component analysis keeping the Varimax with Keiser normalization as the rotation method. The Kaiser-Meyer-Olkin test (KMO) and Bartlett's test of sphericity statistics were also performed to determine the adequacy of the sample and correlations between items, respectively. The number of factors was determined by the Scree plot, percentage of variance explained by each component and number of Eigen values over 01 (Kaiser-Guttman rule). RESULTS The total MCSI score ranged 0 to 26. The overall Cronbach's alpha of the 13-item questionnaire was 0.80 while item-total corrections ranged 0.34 to 0.62, exception of one item (0.11). Inverse correlations were demonstrated in total scores of MCSI and Karnofky Performance Scale (r =- 0.32, p < 0.001) and Barthel index (r =-0.34, P < 0.001). A Kaiser-Meyer-Olkin value of 0.79 (p < 0.001) for Bartlett's test indicated adequate sampling and nonlinearity of factors. The Scree plot showed a three-factor structure explaining 57% of the variation. Items regarding personal wellbeing of caregiver loaded together while the effects on the family loaded separately. Adjustment of personal concerns and family issues along with time alteration grouped as the third factor. CONCLUSIONS The study showed that the Sinhala version of MCSI has adequate psychometric properties and reliability to be used as a validated tool to estimate the caregiver burden within a short time period for any health care workers.
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Affiliation(s)
- U Ramadasa
- Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
| | - S Silva
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - U Udumulla
- Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Ratnapura, Sri Lanka
| | - S Perera
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - S Lekamwasam
- Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Vuković F, Garcia NA, Perera S, Turchi M, Andersson MP, Solvang M, Raiteri P, Walsh TR. Atomistic simulations of calcium aluminosilicate interfaced with liquid water. J Chem Phys 2023; 159:104704. [PMID: 37694746 DOI: 10.1063/5.0164817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
The dissolution behavior of calcium aluminosilicate based glass fibers, such as stone wool fibers, is an important consideration in mineral wool applications for both the longevity of the mineral wool products in humid environments and limiting the health impacts of released and inhaled fibers from the mineral wool product. Balancing these factors requires a molecular-level understanding of calcium aluminosilicate glass dissolution mechanisms, details that are challenging to resolve with experiment alone. Molecular dynamics simulations are a powerful tool capable of providing complementary atomistic insights regarding dissolution; however, they require force fields capable of describing not-only the calcium aluminosilicate surface structure but also the interactions relevant to dissolution phenomena. Here, a new force field capable of describing amorphous calcium aluminosilicate surfaces interfaced with liquid water is developed by fitting parameters to experimental and first principles simulation data of the relevant oxide-water interfaces, including ab initio molecular dynamics simulations performed for this work for the wüstite and periclase interfaces. Simulations of a calcium aluminosilicate surface interfaced with liquid water were used to test this new force field, suggesting moderate ingress of water into the porous glass interface. This design of the force field opens a new avenue for the further study of calcium and network-modifier dissolution phenomena in calcium aluminosilicate glasses and stone wool fibers at liquid water interfaces.
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Affiliation(s)
- F Vuković
- Institute for Frontier Materials, Deakin University, Geelong, VIC 3216, Australia
| | - N A Garcia
- Institute for Frontier Materials, Deakin University, Geelong, VIC 3216, Australia
| | - S Perera
- Institute for Frontier Materials, Deakin University, Geelong, VIC 3216, Australia
| | - M Turchi
- Department of Chemical and Biochemical Engineering, Technical University of Denmark, Kgs. Lyngby 2800, Denmark
| | - M P Andersson
- Department of Chemical and Biochemical Engineering, Technical University of Denmark, Kgs. Lyngby 2800, Denmark
| | - M Solvang
- Group Research and Development, ROCKWOOL A/S, 2640 Hedehusene, Denmark
| | - P Raiteri
- Curtin Institute for Computation/The Institute for Geoscience Research (TIGeR), School of Molecular and Life Sciences, Curtin University, Perth, Western Australia 6845, Australia
| | - T R Walsh
- Institute for Frontier Materials, Deakin University, Geelong, VIC 3216, Australia
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Fenwick EK, Lim B, Man REK, Baskaran M, Nongpiur M, Sng CCA, Iyer JV, Husain R, Perera S, Wong T, Low JR, Loe BS, Huang OS, Lun K, Aung T, Lamoureux EL. Measuring glaucoma quality of life in an Asian population using item banking: psychometric evaluation and computerized adaptive testing simulations. Qual Life Res 2023; 32:2667-2679. [PMID: 37118365 PMCID: PMC10147351 DOI: 10.1007/s11136-023-03428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To assess the psychometric properties of glaucoma-specific health-related quality of life (HRQoL) item banks (IBs), and explore their efficiency using computerized adaptive testing (CAT) simulations. METHODS In this cross-sectional, clinical study, 300 Asian glaucoma patients answered 221 items within seven IBs: Ocular Comfort Symptoms (OS); Activity Limitation (AL); Lighting (LT); Mobility (MB); Glaucoma Management (GM); Psychosocial (PSY); and Work (WK). Rasch analysis was conducted to assess each IB's psychometric properties (e.g., item "fit" to the construct; unidimensionality) and a set of analytic performance criteria guiding decision making relating to retaining or dropping domains and items was employed. CAT simulations determined the mean number of items for 'high' and 'moderate' measurement precision (stopping rule: SEM 0.3 and 0.387, respectively). RESULTS Participants' mean age was 67.2 ± 9.2 years (62% male; 87% Chinese). LT, MB, and GM displayed good psychometric properties overall. To optimize AL's psychometric properties, 16 items were deleted due to poor "fit", high missing data, item bias, low discrimination and/or a low clinical/patient importance rating. To resolve multidimensionality in PSY, we rehomed 16 items into a "Concern (CN)" domain. PSY and CN required further amendment, including collapsing of response categories, and removal of poorly functioning items (N = 7). Due to poor measurement precision, low applicability and high ceiling effect, low test information indices, and low item separation index the WK IB was not considered further. In CAT simulations on the final seven IBs (n = 182 items total), an average of 12.1 and 15.7 items per IB were required for moderate and high precision measurement, respectively. CONCLUSIONS After reengineering our seven IBs, they displayed robust psychometric properties and good efficiency in CAT simulations. Once finalized, GlauCAT™-Asian may enable comprehensive assessment of the HRQoL impact of glaucoma and associated treatments.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Belicia Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Monisha Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Chelvin C A Sng
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- School of Psychology, University of Cambridge, Cambridge, UK
| | - Jayant Venkatramani Iyer
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Tina Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jin Rong Low
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Bao Sheng Loe
- School of Psychology, University of Cambridge, Cambridge, UK
| | - Olivia Shimin Huang
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Katherine Lun
- National University Health System, Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- School of Psychology, University of Cambridge, Cambridge, UK
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
- Department of Ophthalmology, National University of Singapore, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
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8
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Finkelstein MT, Nongpiur ME, Husain R, Perera S, Baskaran M, Wong TT, Aung T, Milea D, Najjar RP. Handheld chromatic pupillometry can reliably detect functional glaucomatous damage in eyes with high myopia. Br J Ophthalmol 2023:bjo-2023-323878. [PMID: 37524446 DOI: 10.1136/bjo-2023-323878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND/AIMS To assess pupillary light responses (PLRs) in eyes with high myopia (HM) and evaluate the ability of handheld chromatic pupillometry (HCP) to identify glaucomatous functional loss in eyes with HM. METHODS This prospective, cross-sectional study included 28 emmetropes (EM), 24 high myopes without glaucoma (HM) and 17 high myopes with confirmed glaucoma (HMG), recruited at the Singapore National Eye Center. Monocular PLRs were evaluated using a custom-built handheld pupillometer that recorded changes in horizontal pupil radius in response to 9 s of exponentially increasing blue (469.1 nm) and red (640.1 nm) lights. Fifteen pupillometric features were compared between groups. A logistic regression model (LRM) was used to distinguish HMG eyes from non-glaucomatous eyes (EM and HM). RESULTS All pupillometric features were similar between EM and HM groups. Phasic constriction to blue (p<0.001) and red (p=0.006) lights, and maximum constriction to blue light (p<0.001) were reduced in HMG compared with EM and HM. Pupillometric features of melanopsin function (postillumination pupillary response, PIPR area under the curve (AUC) 0-12 s (p<0.001) and PIPR 6 s (p=0.01) to blue light) were reduced in HMG. Using only three pupillometric features, the LRM could classify glaucomatous from non-glaucomatous eyes with an AUC of 0.89 (95% CI 0.77 to 1.00), sensitivity 94.1% (95% CI 82.4% to 100.0%) and specificity 78.8% (95% CI 67.3% to 90.4%). CONCLUSION PLRs to ramping-up light stimuli are unaltered in highly myopic eyes without other diagnosed ocular conditions. Conversely, HCP can distinguish glaucomatous functional loss in eyes with HM and can be a useful tool to detect/confirm the presence of glaucoma in patients with HM.
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Affiliation(s)
| | - Monisha Esther Nongpiur
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
| | - Shamira Perera
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
| | - Mani Baskaran
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
| | - Tina T Wong
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
- Ocular Therapeutics & Drug Delivery, Singapore Eye Research Institute, Singapore
| | - Tin Aung
- Glaucoma, Singapore Eye Research Institute, Singapore
- Glaucoma, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
| | - Dan Milea
- Visual Neurosciences, Singapore Eye Research Institute, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
- Neuro-ophthalmology, Singapore National Eye Centre, Singapore
| | - Raymond P Najjar
- Visual Neurosciences, Singapore Eye Research Institute, Singapore
- Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
- Ophthalmology, National University of Singapore, Singapore
- Biomedical Engineering, National University of Singapore, Singapore
- Center for Innovation & Precision Eye Health, National University of Singapore, Singapore
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9
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Herath N, Gunatatne L, Rajakrishna P, Perera S. WCN23-0500 PERITONEAL DIALYSIS ASSOCIATED PERITONITIS, A SINGLE CENTER EXPERIENCE. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.780] [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: 03/22/2023] Open
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10
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Chuangsuwanich T, Tun TA, Braeu FA, Wang X, Chin ZY, Panda SK, Buist M, Strouthidis N, Perera S, Nongpiur M, Aung T, Girard MJA. Differing Associations between Optic Nerve Head Strains and Visual Field Loss in Patients with Normal- and High-Tension Glaucoma. Ophthalmology 2023; 130:99-110. [PMID: 35964710 DOI: 10.1016/j.ophtha.2022.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in patients with glaucoma. DESIGN Clinic-based cross-sectional study. PARTICIPANTS Two hundred twenty-nine patients with primary open-angle glaucoma (subdivided into 115 patients with high-tension glaucoma [HTG] and 114 patients with normal-tension glaucoma [NTG]). METHODS For 1 eye of each patient, we imaged the ONH using spectral-domain OCT under the following conditions: (1) primary gaze and (2) primary gaze with acute IOP elevation (to approximately 35 mmHg) achieved through ophthalmodynamometry. A 3-dimensional strain-mapping algorithm was applied to quantify IOP-induced ONH tissue strain (i.e., deformation) in each ONH. Strains in the prelaminar tissue (PLT), the retina, the choroid, the sclera, and the lamina cribrosa (LC) were associated (using linear regression) with measures of retinal sensitivity from the 24-2 Humphrey visual field test (Carl Zeiss Meditec). This was performed globally, then locally according to a previously published regionalization scheme. MAIN OUTCOME MEASURES Associations between ONH strains and values of retinal sensitivity from visual field testing. RESULTS For patients with HTG, we found (1) significant negative linear associations between ONH strains and retinal sensitivity (P < 0.001; on average, a 1% increase in ONH strains corresponded to a decrease in retinal sensitivity of 1.1 decibels [dB]), (2) that high-strain regions colocalized with anatomically mapped regions of high visual field loss, and (3) that the strongest negative associations were observed in the superior region and in the PLT. In contrast, for patients with NTG, no significant associations between strains and retinal sensitivity were observed except in the superotemporal region of the LC. CONCLUSIONS We found significant negative associations between IOP-induced ONH strains and retinal sensitivity in a relatively large glaucoma cohort. Specifically, patients with HTG who experienced higher ONH strains were more likely to exhibit lower retinal sensitivities. Interestingly, this trend in general was less pronounced in patients with NTG, which could suggest a distinct pathophysiologic relationship between the two glaucoma subtypes.
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Affiliation(s)
- Thanadet Chuangsuwanich
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore.
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Fabian A Braeu
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Xiaofei Wang
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Zhi Yun Chin
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Satish Kumar Panda
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Martin Buist
- Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Nicholas Strouthidis
- National Institute of Health Research, Biomedical Sciences Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Monisha Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore; Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland.
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11
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Haeri NS, Perera S, Greenspan SL. The Association of Bone Turnover Markers with Muscle Function, Falls, and Frailty in Older Women in Long-Term Care. J Frailty Aging 2023; 12:284-290. [PMID: 38008978 DOI: 10.14283/jfa.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Osteoporosis and sarcopenia commonly coexist in older adults. There is strong evidence that bone and muscle impact each other through mechanical and biochemical cross-talk. OBJECTIVES We sought to investigate the relationship between the markers of bone remodeling including the C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N propeptide (P1NP) with muscle function, falls, and frailty in older women residing in long-term care (LTC) facilities. DESIGN A secondary analysis of a randomized controlled trial. SETTING Residents of LTC. PARTICIPANTS One hundred seventy-eight older women with osteoporosis. MEASUREMENTS We measured and analyzed baseline CTX, P1NP, gait speed, sit to stand time, history of falls, and frailty index. RESULTS Participants had a mean age of 86.7 years and BMI of 27.6 kg/m2. The correlation (r) of CTX with gait speed and sit to stand test, as indices for muscle function, were -0.193 (p=0.0163) and 0.152 (p=0.0507), respectively. Additionally, CTX level was significantly associated with history of falls (p=0.0068), recurrent falls (p=0.0260), and frail phenotype (p=0.0126). P1NP did not have a significant association with gait speed, sit to stand test, and history of falls; however, it was associated with frail phenotype (p=0.0137). Most findings persisted after adjusting for age. CONCLUSIONS In older women residing in LTC facilities, CTX was associated with gait speed, falls history, and frail phenotype, whereas P1NP was only associated with frail phenotype. These findings suggest a relationship between bone remodeling and muscle function.
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Affiliation(s)
- N S Haeri
- Nami Safai Haeri, MD, 3471 Fifth Ave, Suite 1110, Pittsburgh, PA, USA 15213, Telephone: (412) 692-2472,
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12
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Bagga S, Perera S, Bagga SK, Seyan K. An evaluation of remote algorithm-assisted consultations for the safe prescribing of progesterone-only pills in a digital setting. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Introduction
This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice.
Aim
To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement.
Methods
A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation.
Results
Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing.
Discussion/Conclusion
Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.
References
1. Faculty of Sexual & Reproductive Healthcare (FSRH). Clinical Effectiveness Unit. FSRH Guidance – Progesterone-only pills. March 2015. Amended April 2019. Royal College of Obstetricians & Gynaecologists Website www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015 Accessed May 2022
2. Faculty of Sexual & Reproductive Healthcare (FSRH). UK Medical Eligibility Criteria (UKMEC) Summery sheets for contraceptive use. April 2016. Amended September 2019. Website www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets Accessed May 2022
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Affiliation(s)
- S Bagga
- Lloyds Pharmacy Online Doctor , London
| | - S Perera
- Lloyds Pharmacy Online Doctor , London
| | - S K Bagga
- Lloyds Pharmacy Online Doctor , London
| | - K Seyan
- Lloyds Pharmacy Online Doctor , London
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13
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Bajpai J, Mailankody S, Budukh A, Swaminathan R, Dikshit R, Perera S, Dhimal M, Tshomo U, Bagal S, Bhise M, Banavali S, Gupta S, Chaturvedi P, Badwe R, Trama A. 1336P Epidemiology of rare cancers in South Asian Association for Regional Cooperation (SAARC) countries: Remembering the forgotten. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1468] [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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14
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Ribbands A, Perera S, D'Estrube T, Bailey A, Luke E, Feng Wang P. 644P Treatment patterns, outcomes, and physician decision-making in multiple myeloma: A real-world European study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.770] [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: 11/27/2022] Open
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15
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Panda SK, Cheong H, Tun TA, Devella SK, Senthil V, Krishnadas R, Buist ML, Perera S, Cheng CY, Aung T, Thiéry AH, Girard MJ. Describing the Structural Phenotype of the Glaucomatous Optic Nerve Head Using Artificial Intelligence. Am J Ophthalmol 2022; 236:172-182. [PMID: 34157276 DOI: 10.1016/j.ajo.2021.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To develop a novel deep-learning approach that can describe the structural phenotype of the glaucomatous optic nerve head (ONH) and can be used as a robust glaucoma diagnosis tool. DESIGN Retrospective, deep-learning approach diagnosis study. METHOD We trained a deep-learning network to segment 3 neural-tissue and 4 connective-tissue layers of the ONH. The segmented optical coherence tomography images were then processed by a customized autoencoder network with an additional parallel branch for binary classification. The encoder part of the autoencoder reduced the segmented optical coherence tomography images into a low-dimensional latent space (LS), whereas the decoder and the classification branches reconstructed the images and classified them as glaucoma or nonglaucoma, respectively. We performed principal component analysis on the latent parameters and identified the principal components (PCs). Subsequently, the magnitude of each PC was altered in steps and reported how it impacted the morphology of the ONH. RESULTS The image reconstruction quality and diagnostic accuracy increased with the size of the LS. With 54 parameters in the LS, the diagnostic accuracy was 92.0 ± 2.3% with a sensitivity of 90.0 ± 2.4% (at 95% specificity), and the corresponding Dice coefficient for the reconstructed images was 0.86 ± 0.04. By changing the magnitudes of PC in steps, we were able to reveal how the morphology of the ONH changes as one transitions from a "nonglaucoma" to a "glaucoma" condition. CONCLUSIONS Our network was able to identify novel biomarkers of the ONH for glaucoma diagnosis. Specifically, the structural features identified by our algorithm were found to be related to clinical observations of glaucoma.
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16
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Panda SK, Cheong H, Tun TA, Chuangsuwanich T, Kadziauskiene A, Senthil V, Krishnadas R, Buist ML, Perera S, Cheng CY, Aung T, Thiery AH, Girard MJ. The three-dimensional structural configuration of the central retinal vessel trunk and branches as a glaucoma biomarker. Am J Ophthalmol 2022; 240:205-216. [PMID: 35247336 DOI: 10.1016/j.ajo.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess whether the 3-dimensional (3D) structural configuration of the central retinal vessel trunk and its branches (CRVT&B) could be used as a diagnostic marker for glaucoma. DESIGN Retrospective, deep-learning approach diagnosis study. METHODS We trained a deep learning network to automatically segment the CRVT&B from the B-scans of the optical coherence tomography (OCT) volume of the optic nerve head. Subsequently, 2 different approaches were used for glaucoma diagnosis using the structural configuration of the CRVT&B as extracted from the OCT volumes. In the first approach, we aimed to provide a diagnosis using only 3D convolutional neural networks and the 3D structure of the CRVT&B. For the second approach, we projected the 3D structure of the CRVT&B orthographically onto sagittal, frontal, and transverse planes to obtain 3 two-dimensional (2D) images, and then a 2D convolutional neural network was used for diagnosis. The segmentation accuracy was evaluated using the Dice coefficient, whereas the diagnostic accuracy was assessed using the area under the receiver operating characteristic curves (AUCs). The diagnostic performance of the CRVT&B was also compared with that of retinal nerve fiber layer (RNFL) thickness (calculated in the same cohorts). RESULTS Our segmentation network was able to efficiently segment retinal blood vessels from OCT scans. On a test set, we achieved a Dice coefficient of 0.81 ± 0.07. The 3D and 2D diagnostic networks were able to differentiate glaucoma from nonglaucoma subjects with accuracies of 82.7% and 83.3%, respectively. The corresponding AUCs for the CRVT&B were 0.89 and 0.90, higher than those obtained with RNFL thickness alone (AUCs ranging from 0.74 to 0.80). CONCLUSIONS Our work demonstrated that the diagnostic power of the CRVT&B is superior to that of a gold-standard glaucoma parameter, that is, RNFL thickness. Our work also suggested that the major retinal blood vessels form a "skeleton"-the configuration of which may be representative of major optic nerve head structural changes as typically observed with the development and progression of glaucoma.
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17
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Churilla BM, Perera S, Greenspan SL, Resnick NM, Kotlarczyk MP. Zoledronic acid and bone health in older adults with cognitive impairment. Osteoporos Int 2022; 33:293-298. [PMID: 34341833 PMCID: PMC8758516 DOI: 10.1007/s00198-021-06063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED Fracture prevention in cognitively impaired individuals is lacking. This work highlights the benefits of zoledronic acid on bone health in cognitively impaired older adults. Demonstrating benefits of therapy may increase treatment uptake and reduce fracture risk in this group. INTRODUCTION Osteoporosis has detrimental consequences for frail older adults. The effects on those with both osteoporosis and cognitive impairment are compounded due to increased risk of falls and changes in mobility, both of which can lead to fracture. However, there are limited data on treatment benefits for osteoporotic individuals with cognitive impairment. METHODS This post hoc, secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of single-dose zoledronic acid included 179 women age ≥ 65 years residing in assisted living facilities or nursing homes, 43 of whom had mild to severe cognitive impairment. We assessed bone mineral density (BMD) of the total hip, femoral neck, and lumbar spine by dual-energy x-ray absorptiometry and serum bone turnover markers (C-terminal telopeptide of type I collagen and procollagen type I N propeptide) at 6 and 12 months. RESULTS In participants with cognitive impairment, those who received zoledronic acid had 4.3% greater BMD at the total hip (p=.005) and 5.3% greater BMD at the femoral neck (p<.001) after 12 months compared to those in the placebo group. Bone turnover markers demonstrated significant decreases at 6 months in those with cognitive impairment who received active treatment compared to the placebo group. Improvements in bone health measures with zoledronic acid were similar to those seen in participants without cognitive impairment. CONCLUSION Zoledronic acid improves bone health in frail older women with cognitive impairment similar to those without impairment. Further studies are warranted to assess the benefit for fracture reduction in this undertreated population.
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Affiliation(s)
- B M Churilla
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - S L Greenspan
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - N M Resnick
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M P Kotlarczyk
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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18
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Haeri N, Perera S, Greenspan S. Does Zoledronic Acid Improve Appendicular Lean Mass in Older Women with Osteoporosis? A Sub-Analysis of a Randomized Clinical Trial. J Frailty Aging 2022; 11:420-425. [PMID: 36346729 PMCID: PMC9851771 DOI: 10.14283/jfa.2022.54] [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: 01/21/2023]
Abstract
BACKGROUND Coexistence of osteoporosis and sarcopenia (osteosarcopenia), is associated with increased risk for fractures, falls, and mortality. Although there are multiple medications for management of osteoporosis, there are no approved pharmacotherapy for sarcopenia. OBJECTIVES We examined the effect of zoledronic acid on muscle mass indices including ALM (Appendicular Lean Mass) and ALM/Height2 in a cohort of older women with osteoporosis who were residents of Long-Term Care Communities (LTCCs). DESIGN A secondary analysis of a 2-year double-blind, randomized, placebo-controlled clinical trial. SETTING Residents of LTCCs. PARTICIPANTS Sixty-two postmenopausal women with osteoporosis. INTERVENTION Participants either received 5 mg infusion of zoledronic acid or placebo, once at the start of the study. MEASUREMENTS Participant's ALM/Height2, ALM, total hip BMD (Bone Mineral Density) and spine BMD were measured in 6, 12 and 24 months. RESULTS On average, participants were 86.7 years old and had a BMI of 27.4 kg/m2. There was no significant difference in change from baseline (mean ± SE) between the treatment group and the placebo group in ALM/Height2: (-0.15 vs -0.02, p = 0.541) and (-0.17 vs 0.001, p = 0.315) and (-0.29 vs -0.19, p = 0.646) or ALM: (-0.38 vs -0.09, p = 0.455) and (-0.45 vs -0.005, p = 0.216) and (-0.70 vs -0.48, p = 0.553) at 6, 12, and 24 months respectively. In addition, after adjusting for a possible confounding, the ALM/Height2 or ALM did not have significant improvements from baseline at 6 months, 12 months, and 24 months either in the treatment group or in the placebo group. However, there were significant improvements in the BMD at the total hip and the spine in the treatment group compared with the placebo group at all three time points. CONCLUSIONS Among older women residing in LTCCs, a single dose of zoledronic acid did not increase ALM/Height2 and ALM, despite improving the BMD at the total hip and the spine at the 2-year follow-up.
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Affiliation(s)
- N.S. Haeri
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - S. Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - S.L. Greenspan
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Najjar RP, Rukmini AV, Finkelstein MT, Nusinovici S, Mani B, Nongpiur ME, Perera S, Husain R, Aung T, Milea D. Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma. Br J Ophthalmol 2021; 107:663-670. [PMID: 34853018 PMCID: PMC10176376 DOI: 10.1136/bjophthalmol-2021-319938] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Early detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma. METHODS In this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF). RESULTS Pupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT. CONCLUSION HCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.
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Affiliation(s)
- Raymond P Najjar
- Visual Neurosciences Research Group, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - A V Rukmini
- Visual Neurosciences Research Group, Singapore Eye Research Institute, Singapore
| | | | - Simon Nusinovici
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Baskaran Mani
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Glaucoma Department, Singapore National Eye Centre, Singapore.,Glaucoma Research Group, Singapore Eye Research Institute, Singapore
| | - Monisha Esther Nongpiur
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Glaucoma Department, Singapore National Eye Centre, Singapore.,Glaucoma Research Group, Singapore Eye Research Institute, Singapore
| | - Shamira Perera
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Glaucoma Department, Singapore National Eye Centre, Singapore
| | - Rahat Husain
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Glaucoma Department, Singapore National Eye Centre, Singapore
| | - Tin Aung
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Glaucoma Department, Singapore National Eye Centre, Singapore.,Glaucoma Research Group, Singapore Eye Research Institute, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dan Milea
- Visual Neurosciences Research Group, Singapore Eye Research Institute, Singapore .,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Neuro-Ophthalmology Department, Singapore National Eye Center, Singapore
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Lim XH, Nongpiur ME, Najjar RP, Hoang QV, Milea D, Wong CW, Husain R, Htoon HM, Aung T, Perera S, Wong TTL. Steady-State Pattern Electroretinography in Eyes with Glaucoma and High Myopia. Clin Ophthalmol 2021; 15:4455-4465. [PMID: 34819717 PMCID: PMC8607345 DOI: 10.2147/opth.s336903] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate features of the steady-state pattern electroretinogram (ssPERG) in subjects with glaucoma (G), high myopia (HM; spherical equivalent ≤-6D) and glaucoma with high myopia (GHM). Patients and Methods Our study included 48 participants divided into 3 groups (G, HM, and GHM) who each underwent monocular ssPERG testing with Diopsys NOVA PERG protocols. The ConStim protocol detects distinct topographic patterns of dysfunction 16° and 24° around the central macula. MagD is the amplitude of the average signal and MagD/Mag ratio indicates the consistency of the response. ssPERG indices were compared between groups and correlated with functional (ie, visual field mean deviation (VFMD)) and structural (ie, average retinal nerve fibre layer (RNFL) thickness; Cirrus optical coherence tomography) features. Results Participants had an average age of 59.4±7.6 years. Mean Humphrey VFMD was -14.22 ± 2.88dB, -2.62 ± 1.18dB and -12.80 ± 2.60dB for G, HM and GHM groups, respectively. Mean RNFL thickness was 63.0 ± 8.20μm, 69.5 ± 15.7μm and 60.6 ± 5.0μm for G, HM and GHM groups, respectively. For the 24° setting, no significant differences were noted for any of the parameters. For the 16° setting, MagD was lower in the GHM group compared to the HM group (0.29µV vs 0.52µV; p = 0.02). Significant differences were noted for the MagD/Mag ratio between HM and G groups (0.58 vs 0.40; p = 0.02) and between HM and GHM groups (0.58 vs 0.35; p = 0.002). There were positive correlations between both MagD 16° and MagD/Mag ratio 16° with VFMD (correlation coefficient [r]=0.37, p = 0.009; and r = 0.44, p = 0.002, respectively) and RNFL (r = 0.43, p = 0.002; and r = 0.48, p = 0.001, respectively). Conclusion MagD/Mag ratio at 16° was significantly lower in glaucomatous eyes (with or without high myopia) compared to those with high myopia without glaucoma, suggesting that glaucoma has a distinct impact on MagD/Mag ratio at 16° irrespective of the presence of myopia.
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Affiliation(s)
| | - Monisha Esther Nongpiur
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Dan Milea
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Hla Myint Htoon
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tin Aung
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shamira Perera
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tina Tzee Ling Wong
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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21
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Bingaman C, Wang R, Haut A, Hester J, Perera S, Goldberg E, Ranney M. 3 MyCOVIDrisk: User Experience Study Of COVID-19 Risk Assessment and Mitigation Application. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Yao X, Tan B, Ho Y, Liu X, Wong D, Chua J, Wong TT, Perera S, Ang M, Werkmeister RM, Schmetterer L. Full circumferential morphological analysis of Schlemm's canal in human eyes using megahertz swept source OCT. Biomed Opt Express 2021; 12:3865-3877. [PMID: 34457385 PMCID: PMC8367246 DOI: 10.1364/boe.426218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 05/16/2023]
Abstract
We performed full circumferential imaging of the Schlemm's canal (SC) of two human eyes using a Fourier domain mode-lock laser (FDML) based 1.66-MHz SS-OCT prototype at 1060 nm. Eight volumes with overlapping margins were acquired around the limbal area with customized raster scanning patterns designed to fully cover the SC while minimizing motion artifacts. The SC was segmented from the volumes using a semi-automated active contour segmentation algorithm, whose mean dice similarity coefficient was 0.76 compared to the manual segmentation results. We also reconstructed three-dimensional (3D) renderings of the 360° SC by stitching the segmented SCs from the volumetric datasets. Quantitative metrics of the full circumferential SC were provided, including the mean and standard deviation (SD) of the cross-sectional area (CSA), the maximum CSA, the minimum and maximum SC opening width, and the number of collector channels (CC) stemming from the SC.
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Affiliation(s)
- Xinwen Yao
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yijie Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xinyu Liu
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tina T. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - René M. Werkmeister
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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23
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Abstract
Background Emerging cross-sectional reports find that the COVID-19 pandemic and related social restrictions negatively affect lifestyle behaviours and mental health in general populations. Aims To study the longitudinal impact of COVID-19 on work practices, lifestyle and well-being among desk workers during shelter-at-home restrictions. Methods We added follow-up after completion of a clinical trial among desk workers to longitudinally measure sedentary behaviour, physical activity, sleep, diet, mood, quality of life and work-related health using validated questionnaires and surveys. We compared outcomes assessed before and during COVID-19 shelter-at-home restrictions. We assessed whether changes in outcomes differed by remote working status (always, changed to or never remote) using analysis of covariance (ANCOVA). Results Participants (N = 112; 69% female; mean (SD) age = 45.4 (12.3) years; follow-up = 13.5 (6.8) months) had substantial changes to work practices, including 72% changing to remote work. Deleterious changes from before to during shelter-at-home included: 1.3 (3.5)-h increase in non-workday sedentary behaviour; 0.7 (2.8)-point worsening of sleep quality; 8.5 (21.2)-point increase in mood disturbance; reductions in five of eight quality of life subscales; 0.5 (1.1)-point decrease in work-related health (P < 0.05). Other outcomes, including diet, physical activity and workday sedentary behaviour, remained stable (P ≥ 0.05). Workers who were remote before and during the pandemic had greater increases in non-workday sedentary behaviour and stress, with greater declines in physical functioning. Wake time was delayed overall by 41 (61) min, and more so in workers who changed to remote. Conclusions Employers should consider supporting healthy lifestyle and well-being among desk workers during pandemic-related social restrictions, regardless of remote working status.
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Affiliation(s)
- B Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - C E Kline
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - K A Huber
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - J L Paley
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Perera
- Departments of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
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24
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Porporato N, Tun TA, Baskaran M, Wong DWK, Husain R, Fu H, Sultana R, Perera S, Schmetterer L, Aung T. Towards 'automated gonioscopy': a deep learning algorithm for 360° angle assessment by swept-source optical coherence tomography. Br J Ophthalmol 2021; 106:1387-1392. [PMID: 33846160 DOI: 10.1136/bjophthalmol-2020-318275] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/05/2021] [Accepted: 03/28/2021] [Indexed: 11/03/2022]
Abstract
AIMS To validate a deep learning (DL) algorithm (DLA) for 360° angle assessment on swept-source optical coherence tomography (SS-OCT) (CASIA SS-1000, Tomey Corporation, Nagoya, Japan). METHODS This was a reliability analysis from a cross-sectional study. An independent test set of 39 936 SS-OCT scans from 312 phakic subjects (128 SS-OCT meridional scans per eye) was analysed. Participants above 50 years with no previous history of intraocular surgery were consecutively recruited from glaucoma clinics. Indentation gonioscopy and dark room SS-OCT were performed. Gonioscopic angle closure was defined as non-visibility of the posterior trabecular meshwork in ≥180° of the angle. For each subject, all images were analysed by a DL-based network based on the VGG-16 architecture, for gonioscopic angle-closure detection. Area under receiver operating characteristic curves (AUCs) and other diagnostic performance indicators were calculated for the DLA (index test) against gonioscopy (reference standard). RESULTS Approximately 80% of the participants were Chinese, and more than half were women (57.4%). The prevalence of gonioscopic angle closure in this hospital-based sample was 20.2%. After analysing a total of 39 936 SS-OCT scans, the AUC of the DLA was 0.85 (95% CI:0.80 to 0.90, with sensitivity of 83% and a specificity of 87%) to classify gonioscopic angle closure with the optimal cut-off value of >35% of circumferential angle closure. CONCLUSIONS The DLA exhibited good diagnostic performance for detection of gonioscopic angle closure on 360° SS-OCT scans in a glaucoma clinic setting. Such an algorithm, independent of the identification of the scleral spur, may be the foundation for a non-contact, fast and reproducible 'automated gonioscopy' in future.
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Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Damon W K Wong
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Huazhu Fu
- Inception Institute of Artificial Intelligence, Abu Dhabi, UAE
| | | | - Shamira Perera
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Austria, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, Austria
| | - Tin Aung
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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25
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Stirling R, Perera S, Martin C, Brand M, Zalcberg J. P09.05 Surveillance, Patterns of Recurrence and Survivorship in Early Stage Lung Cancer Patients Following Curative Intent Treatment. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.433] [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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26
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Perera S, Kelly D, O'Kane GM. Non-immunotherapy options for the first-line management of hepatocellular carcinoma: exploring the evolving role of sorafenib and lenvatinib in advanced disease. Curr Oncol 2020; 27:S165-S172. [PMID: 33343210 DOI: 10.3747/co.27.7159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The results of the sharp trial established sorafenib, a tyrosine kinase inhibitor (tki), as the sole first-line treatment option in advanced hepatocellular carcinoma (hcc) for more than a decade. In 2020, there has been a surge in new therapies for hcc, including immunotherapeutic strategies and the approval of a number of novel tkis. In addition to sorafenib, lenvatinib and combination atezolizumab-bevacizumab now represent standard first-line treatment options. As those systemic therapy options begin to be better utilized, assurance of adequate liver function and optimal timing are required to improve patient outcomes. Furthermore, sequencing of the agents will have to be carefully tailored, given the increasing armamentarium of choices. Here, we discuss the role of lenvatinib and sorafenib in the first-line management of hcc.
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Affiliation(s)
- S Perera
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
| | - D Kelly
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
| | - G M O'Kane
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON
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27
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Devalla SK, Pham TH, Panda SK, Zhang L, Subramanian G, Swaminathan A, Yun CZ, Rajan M, Mohan S, Krishnadas R, Senthil V, De Leon JMS, Tun TA, Cheng CY, Schmetterer L, Perera S, Aung T, Thiéry AH, Girard MJA. Towards label-free 3D segmentation of optical coherence tomography images of the optic nerve head using deep learning. Biomed Opt Express 2020; 11:6356-6378. [PMID: 33282495 PMCID: PMC7687952 DOI: 10.1364/boe.395934] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 05/06/2023]
Abstract
Recently proposed deep learning (DL) algorithms for the segmentation of optical coherence tomography (OCT) images to quantify the morphological changes to the optic nerve head (ONH) tissues during glaucoma have limited clinical adoption due to their device specific nature and the difficulty in preparing manual segmentations (training data). We propose a DL-based 3D segmentation framework that is easily translatable across OCT devices in a label-free manner (i.e. without the need to manually re-segment data for each device). Specifically, we developed 2 sets of DL networks: the 'enhancer' (enhance OCT image quality and harmonize image characteristics from 3 devices) and the 'ONH-Net' (3D segmentation of 6 ONH tissues). We found that only when the 'enhancer' was used to preprocess the OCT images, the 'ONH-Net' trained on any of the 3 devices successfully segmented ONH tissues from the other two unseen devices with high performance (Dice coefficients > 0.92). We demonstrate that is possible to automatically segment OCT images from new devices without ever needing manual segmentation data from them.
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Affiliation(s)
- Sripad Krishna Devalla
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Tan Hung Pham
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Satish Kumar Panda
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Liang Zhang
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Giridhar Subramanian
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Anirudh Swaminathan
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Chin Zhi Yun
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | | | | | | | | | - John Mark S De Leon
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Philippines
| | - Tin A Tun
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Clinical and Molecular Ophthalmology, Basel, Switzerland
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Alexandre H Thiéry
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Michaël J A Girard
- Ophthalmic Engineering and Innovation Laboratory (OEIL), Singapore Eye Research Institute, 20 College Road, Singapore 169856, Singapore
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28
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Vernet-Tomas M, Perera S, Castellà J, Fabregó B, Argudo N, Jiménez M, Segura M, Alcantara R, Pitarch M, Arenas N, Plancarte F, Vázquez I, Comerma L, Nicolau P. Clinical, imaging and pathology factors related to residual axillary disease after neoadjuvant treatment. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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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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Perera S, Krafcsik D, Rutherford P. OP0319-PARE SEE ME HEAR ME: AN ANCA-ASSOCIATED VASCULITIS PATIENT CO-CREATION INITIATIVE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:ANCA-associated Vasculitis (AAV) is a rare, severe small vessel vasculitis that affects multiple organs with a high acute mortality risk. As every patient presents differently, diagnosis is often delayed. Although treatments exist, responses vary, and remission is often not achieved or sustained. From the time of initial diagnosis onwards, patients suffer from an impaired quality of life. Coping with pain, fatigue, ongoing symptoms and combating challenges becomes a complex task and patients may be challenged in how best to communicate these emotions with health care professionals. We aimed to develop an initiative with Art and Voice, that would seek to empower people living with AAV and their carers in feeling understood, seen and heard in a meaningful way. This would invite a collective understanding of ‘how people make sense of key life experiences and what it means to them’ by creating a common language to address poorly addressed issues.Objectives:This project aims to provide a voice to patients to express personal experiences and complexity of everyday living and empower people to feel in control of their own health through an online platform. It should also allow practitioners to gain new awareness about issues faced by their patients, to better understand the relationships between caring and curing, hearing and listening.Methods:We collaborated with 10 patient association groups representatives, 17 AAV patients and 9 of their carers across 7 European countries. A series of workshops were set up to discuss issues faced and aid the subsequent production of a range of materials designed to provide clear, comprehensive content that would help individuals cope with the physical and emotional impact of AAV from diagnosis to living with it. This work was supported by a digital artist who is a rheumatologist living with vasculitis.Results:The co-creation of patient information materials featuring real life patients was successful and led to the development of a creative initiative called SEE ME.HEAR ME with an online platformwww.myancavasculitis.com. This includes: (1) an awareness programme featuring artwork created by the digital artist and advised by the patients which captures the essence of AAV from the patients view (see Figure). (2) a series of first-hand patient and carer stories capturing their authentic voice on ‘what it is like to live with the disease’. (3) extensive written content designed to fill information gaps around AAV diagnosis, investigations and treatment and what to expect during clinical follow up. The platform supports patients in asking questions and seeking information while signposting them to their own healthcare professional for advice and their local country patient association for support.Table 1.Sensitivities and specificities of examinations in gout and calcium pyrophosphate deposition diseaseConclusion:People with AAV need support throughout life, the profound psychosocial influence from illness makes the lived experience, challenging. SEE ME. HEAR ME online patient platform aims to generate awareness around AAV, improve physician and patient dialog, and enhance people’s experiences of living and coping with the disease. In addition it provides support for carers and giving valuable insights to friends, family and the general public about what the lived experience with AAV looks like.Acknowledgments:We wish to thank all European patients and patient association leads who worked on this projectDisclosure of Interests:Shanali Perera Consultant of: Vifor Pharma, Dijana krafcsik Employee of: Vifor Pharma, Peter Rutherford Shareholder of: Vifor Pharma, Employee of: Vifor Pharma, Baxter Healthcare
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Perera S, Seyan K. P-06-8 Digital Healthcare Access and Use by Transgender Individuals. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cheong H, Devalla SK, Pham TH, Zhang L, Tun TA, Wang X, Perera S, Schmetterer L, Aung T, Boote C, Thiery A, Girard MJA. DeshadowGAN: A Deep Learning Approach to Remove Shadows from Optical Coherence Tomography Images. Transl Vis Sci Technol 2020; 9:23. [PMID: 32818084 PMCID: PMC7396186 DOI: 10.1167/tvst.9.2.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/13/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose To remove blood vessel shadows from optical coherence tomography (OCT) images of the optic nerve head (ONH). Methods Volume scans consisting of 97 horizontal B-scans were acquired through the center of the ONH using a commercial OCT device for both eyes of 13 subjects. A custom generative adversarial network (named DeshadowGAN) was designed and trained with 2328 B-scans in order to remove blood vessel shadows in unseen B-scans. Image quality was assessed qualitatively (for artifacts) and quantitatively using the intralayer contrast—a measure of shadow visibility ranging from 0 (shadow-free) to 1 (strong shadow). This was computed in the retinal nerve fiber layer (RNFL), the inner plexiform layer (IPL), the photoreceptor (PR) layer, and the retinal pigment epithelium (RPE) layer. The performance of DeshadowGAN was also compared with that of compensation, the standard for shadow removal. Results DeshadowGAN decreased the intralayer contrast in all tissue layers. On average, the intralayer contrast decreased by 33.7 ± 6.81%, 28.8 ± 10.4%, 35.9 ± 13.0%, and 43.0 ± 19.5% for the RNFL, IPL, PR layer, and RPE layer, respectively, indicating successful shadow removal across all depths. Output images were also free from artifacts commonly observed with compensation. Conclusions DeshadowGAN significantly corrected blood vessel shadows in OCT images of the ONH. Our algorithm may be considered as a preprocessing step to improve the performance of a wide range of algorithms including those currently being used for OCT segmentation, denoising, and classification. Translational Relevance DeshadowGAN could be integrated to existing OCT devices to improve the diagnosis and prognosis of ocular pathologies.
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Affiliation(s)
- Haris Cheong
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Sripad Krishna Devalla
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Tan Hung Pham
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Liang Zhang
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Tin Aung Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Xiaofei Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology Department. Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology Department. Duke-NUS Medical School, Singapore
| | - Tin Aung
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Craig Boote
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore.,School of Optometry & Vision Sciences, Cardiff University, UK.,Newcastle Research & Innovation Institute, Singapore
| | - Alexandre Thiery
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Michaël J A Girard
- Ophthalmic Engineering and Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Guralnik J, Bandeen-Roche K, Bhasin SAR, Eremenco S, Landi F, Muscedere J, Perera S, Reginster JY, Woodhouse L, Vellas B. Clinically Meaningful Change for Physical Performance: Perspectives of the ICFSR Task Force. J Frailty Aging 2020; 9:9-13. [PMID: 32150208 PMCID: PMC7286121 DOI: 10.14283/jfa.2019.33] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
For clinical studies of sarcopenia and frailty, clinically meaningful outcome measures are needed to monitor disease progression, evaluate efficacy of interventions, and plan clinical trials. Physical performance measures including measures of gait speed and other aspects of mobility and strength have been used in many studies, although a definition of clinically meaningful change in performance has remained unclear. The International Conference on Frailty and Sarcopenia Research Task Force (ICFSR-TF), a group of academic and industry scientists investigating frailty and sarcopenia, met in Miami Beach, Florida, USA in February 2019 to explore approaches for establishing clinical meaningfulness in a manner aligned with regulatory authorities. They concluded that clinical meaningful change is contextually dependent, and that both anchor-based and distribution-based methods of quantifying physical function are informative and should be evaluated relative to patient-reported outcomes. In addition, they identified additional research needed to enable setting criteria for clinical meaningful change in trials.
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Affiliation(s)
- J Guralnik
- Jack Guralnik, University of Maryland School of Medicine, Baltimore, MD, USA,
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34
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Porporato N, Baskaran M, Perera S, Tun TA, Sultana R, Tan M, Quah JH, Allen JC, Friedman D, Cheng CY, Aung T. Evaluation of meridional scans for angle closure assessment with anterior segment swept-source optical coherence tomography. Br J Ophthalmol 2020; 105:131-134. [DOI: 10.1136/bjophthalmol-2019-315461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/28/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022]
Abstract
Background/aimsAs swept-source optical coherence tomography (SS-OCT) simultaneously obtains 128 meridional scans, it is important to identify which scans are playing the main role in classifying gonioscopic angle closure to simplify the analysis. We aimed to evaluate the diagnostic performance of every meridional scan in its ability to detect gonioscopic angle closure.MethodsObservational study with 2027 phakic subjects consecutively recruited from a community polyclinic. Gonioscopy and SS-OCT were performed. Gonioscopic angle closure was defined as non-visibility of the posterior trabecular meshwork in ≥180° of the angle, while SS-OCT was defined as iridotrabecular contact anterior to the scleral spur. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic performance of each single scan, the sequential anticlockwise cumulative effect of those single scans and different combinations of them.ResultsThe AUCs of each scan ranged from 0.73 to 0.82. The single scan at 80°–260° had the highest AUC (0.82, 95% CI 0.79 to 0.84) and performed significantly better than most of the temporonasal scans (from 0° to 52° and from 153° to 179°). The superoinferior scans achieved higher AUCs compared with the temporonasal ones. When assessing the cumulative effect of adding individual scans consecutively, the peak AUC (0.80) was obtained when considering the superoinferior scans closer to 80°–85°, but no further positive cumulative effect was seen when adding the rest of the temporonasal scans of the circumference.ConclusionsIn conclusion, the single SS-OCT scan at 80°–260° had the highest diagnostic performance. Our study suggests that the 360° evaluation may not translate to better clinical utility for detection of gonioscopic angle closure.
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Perera S, Aslam A, Castles A, Beale A, Segan L, Gutman S, Leet A, Mukherjee S, Burgess S, Zaman S. 550 Sex Differences in Perception Towards Pursuing Cardiology as a Career. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Aslam A, Perera S, Beale A, Segan L, Gutman S, Leet A, Mukherjee S, Zaman S. 530 Perceptions of Cardiology as a Future Career Among Australian Medical Students. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Porporato N, Baskaran M, Tun TA, Sultana R, Tan M, Quah JH, Allen JC, Perera S, Friedman DS, Cheng CY, Aung T. Understanding diagnostic disagreement in angle closure assessment between anterior segment optical coherence tomography and gonioscopy. Br J Ophthalmol 2019; 104:795-799. [PMID: 31492674 DOI: 10.1136/bjophthalmol-2019-314672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/02/2019] [Accepted: 08/27/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Although being a more objective tool for assessment and follow-up of angle closure, reliability studies have reported a moderate diagnostic performance for anterior segment optical coherence tomography (OCT) technologies when comparing with gonioscopy as the reference standard. We aim to determine factors associated with diagnostic disagreement in angle closure when assessed by anterior segment swept source OCT (SS-OCT, CASIA SS-1000; Tomey, Nagoya, Japan) and gonioscopy. METHODS Cross-sectional study. A total of 2027 phakic subjects aged ≥50 years, with no relevant previous ophthalmic history, were consecutively recruited from a community polyclinic in Singapore. Gonioscopy and SS-OCT (128 radial scans) for the entire circumference of the angle were performed for each subject. A two-quadrant closed gonioscopic definition was used. On SS-OCT images, angle closure was defined as iridotrabecular contact (ITC) to the extent of ≥35%, ≥50% and ≥75% of the circumferential angle. Diagnostic disagreements between both methods, that is, false positives or overcalls and false negatives or undercalls were defined, respectively, as gonioscopic open/closed angles inversely assessed as closed/open by SS-OCT. RESULTS Two hundred and seventy-two (14.7%) resulted in overcall results (false positives) when ≥50% of the angle circumference was closed using SS-OCT. These eyes had significantly wider (anterior chamber width, 11.7 vs 11.6 mm, p<0.001) and deeper (anterior chamber depth (ACD), 2.4 vs 2.2 mm, p<0.001) anterior chambers than eyes assessed by both methods as closed (true positives). Deeper ACD (OR 9.31) and lower lens vault (LV) (OR 0.04) were significantly associated with a false positive diagnosis in the multivariate analysis. Most of these cases had short (52.6%) or irregular (39%) ITC in SS-OCT images. CONCLUSIONS We found that anterior chamber dimensions, determined by ACD and LV, were factors significantly associated with diagnostic disagreement between anterior segment SS-OCT and gonioscopy in angle closure assessment.
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Affiliation(s)
- Natalia Porporato
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Mani Baskaran
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Tin A Tun
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Marcus Tan
- Ophthalmology, National University Hospital, Singapore
| | | | - John C Allen
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Shamira Perera
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - David S Friedman
- Glaucoma, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Ching Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
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DE SILVA S, Perera S, Anuruddhika D, Dassanayake R, Niriella M. SAT-232 HEPATITIS B AND HEPATITIS C VIRUS INFECTIONS AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE FROM TWO PRESUMED HIGH-RISK CENTERS IN SRI LANKA. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.268] [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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39
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Perera S, Hetrick S, Cotton S, Parker A, Rickwood D, Davenport T, Hickie IB, Herrman H, McGorry P. Awareness of headspace youth mental health service centres across Australian communities between 2008 and 2015. J Ment Health 2019; 29:410-417. [DOI: 10.1080/09638237.2019.1630718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Perera
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S. Hetrick
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A. Parker
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - D. Rickwood
- Faculty of Health, University of Canberra, Canberra, Australia
- Headspace, National Youth Mental Health Foundation, Melbourne, Australia
| | - T. Davenport
- Brain and Mind Centre, University of Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - H. Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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40
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Nace D, Nace D, Perera S, Schweon S, Drinka P, Crnich C, Anderson G, Saracco S, Mulligan M, Hanlon J. Impact of a Multifaceted Strategy to Reduce Inappropriate Antibiotic Prescribing for Uncomplicated Cystitis in Nursing Home Residents as Assessed Using the Medication Appropriateness Index. J Am Med Dir Assoc 2019. [DOI: 10.1016/j.jamda.2019.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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41
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Garner-Purkis A, Hine P, Gamage A, Perera S, Gulliford MC. Tuberculosis screening for prospective migrants to high-income countries: systematic review of policies. Public Health 2019; 168:142-147. [PMID: 30771630 DOI: 10.1016/j.puhe.2018.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/15/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare predeparture tuberculosis (TB) screening policies, including screening criteria and screening tests, and visa requirements for prospective migrants to high-income countries that have low to intermediate TB incidence and high immigration. STUDY DESIGN Systematic review of policy documents. METHODS We systematically identified high-income, high net-migration countries with an estimated TB incidence of <30 per 100,000. After initial selection, this yielded 15 countries which potentially had TB screening policies. We performed a systematic search of governmental and official visa services' websites for these countries to identify visa information and policy documents for prospective migrants. Results were summarized, tabulated, and compared. RESULTS Programs to screen for active TB were identified in all 15 countries, but screening criteria and screening tests varied substantially between countries. Prospective migrants' country of origin represented an initial assessment criterion which generally focused on elevated TB incidence based on World Health Organization data but also focused on the countries of origin that sent the most migrants, and this varied between destination countries. Specific categories of migrants represented a second assessment criterion that focused on duration of stay and reasons for migration; the focus of which showed variation between the destination countries. Specific screening tests including medical examination and chest X-rays were used as the final stage of assessment, and there were differences between which tests were used between the destination countries. CONCLUSIONS Current approaches to migrant TB screening are inconsistent in their approach and implementation. While this variation might reflect adaptation to local public health situations, it could also indicate uncertainty concerning optimal strategies. Comparative research studies are needed to define the most effective and efficient methods for TB screening of migrants.
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Affiliation(s)
- A Garner-Purkis
- King's College London, School of Population Health and Environmental Sciences, London, UK.
| | - P Hine
- Liverpool School of Tropical Medicine, Clinical Sciences Department, Liverpool, UK
| | - A Gamage
- Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka, Management Development and Planning Unit, Colombo, Sri Lanka
| | - S Perera
- Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka, Management Development and Planning Unit, Colombo, Sri Lanka
| | - M C Gulliford
- King's College London, School of Population Health and Environmental Sciences, London, UK
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42
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Nadkarni N, Snitz B, Perera S, Cohen A, Lopresti B, Barinas-Mitchell E, Klunk W, Lopez O. MOBILITY, BRAIN BLOOD FLOW, SYSTEMIC INFLAMMATION AND, CARDIAC AND ARTERIAL STIFFNESS IN COGNITIVELY NORMAL ELDERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1350] [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)
| | - B Snitz
- University of Pittsburgh, Pittsburgh, PA, USA
| | - S Perera
- University of Pittsburgh, Pittsburgh, PA, USA
| | - A Cohen
- University of Pittsburgh, Pittsburgh, PA
| | - B Lopresti
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - W Klunk
- University of Pittsburgh, Pittsburgh, PA, USA
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43
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Dixit A, Ramaswamy KK, Perera S, Sukumar V, Frerk C. Impact of change in head and neck position on ultrasound localisation of the cricothyroid membrane: an observational study. Anaesthesia 2018; 74:29-32. [DOI: 10.1111/anae.14445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 12/15/2022]
Affiliation(s)
- A. Dixit
- Northampton General Hospital; Northampton UK
| | | | - S. Perera
- Northampton General Hospital; Northampton UK
| | - V. Sukumar
- Northampton General Hospital; Northampton UK
| | - C. Frerk
- Northampton General Hospital; Northampton UK
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44
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Vithana P, Perera S, Dheerasinghe D, Handagiripathira H, Mery L, Bray F. Trends in Incidence and Mortality of Female Cancers Among Sri Lankan Women 1995-2010. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.39800] [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
Background: Sri Lanka is facing epidemiologic transition from communicable diseases to noncommunicable diseases in recent decades. Aim: This study analyses the trends in incidence and mortality of all cancers, breast cancer, cervical, ovarian and uterine cancers among Sri Lankan females over 1995-2010. Methods: Cancer incidence was obtained from the published national hospital based cancer registries, Sri Lanka for 1995-2010. Cancer mortality was abstracted from World Health Organization (WHO) database for 1996-2003 and 2006 and Department of Census and Statistics Sri Lanka for 1995 and 2004-2010 where WHO data were not available. Number of new cases and deaths were obtained by five-year age group for all cancers by sex and breast, cervical, ovarian and uterine cancers for females. Particular cancer specific incidence and mortality rates were directly age-standardized to the world population and age standardized rates were calculated for all ages, 20-34, 35-64 and over 64 years. Results: Female, age-standardized rates (ASR) for incidence for all cancers rose from 63.3 to 87.5 per 100 000 population during 1995-2010 and morality increased from 44.5 to 53.5 per 100 000 population over 1995-2010. In spite of having basically similar trends in both sexes, female incidence remained higher and mortality lower than males. Breast cancer was the commonest cancer among females with its incidence and mortality increasing through-out. Cervical cancer incidence increased during 1995- 2000, declined slightly in 2005 and remained stable over 2006-2010. Cervical cancer mortality remained stable over 1995-1999, declined in 1999-2003, increased in a lesser extend throughout 2003-2006 and remained stable during 2007-2010. Ovarian cancer incidence remained stable over 1995-2010 with 35-64 years being highest. Its mortality remained stable over 1995-2000 and declined slightly during 2000-2003 and increased in 2003-2010 with over 64 years being highest. Uterine cancer incidence and mortality increased steadily throughout 1995-2010. For all above mentioned cancers, incidence and mortality in 0-34 years remained low. Conclusion: Increasing trend of cancer incidence and mortality among females over 1995-2010, directs the need of revisiting breast cancer and cervical cancer control program in the country and strengthening awareness and early diagnosis and timely treatment of the other gynecologic cancers.
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Affiliation(s)
| | - S. Perera
- Ministry of Health, Colombo, Sri Lanka
| | | | | | - L. Mery
- Ministry of Health, Colombo, Sri Lanka
| | - F. Bray
- Ministry of Health, Colombo, Sri Lanka
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45
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Vithana P, Bandarage V, Dheerasinghe D, Perera S, Samarakoon P, Amaradasa U, Naseemdeen S, Banneheke D, Peiris C, Fernando E, Paranagama N, Mery L, Bray F. Survival of the Patients Diagnosed With Cervical Cancer and Associated Prognostic Factors in the Western Province of Sri Lanka. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.36400] [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
Background: Cervical cancer is the second commonest cancer among Sri Lankan females with an age-standardized incidence rate of 8.6 per 100,000 in 2008. Aim: Present study assessed the five-year survival of cervical cancer patients diagnosed in 2008 in the western province of Sri Lanka and the associated prognostic factors. Methods: A descriptive cross sectional study was conducted to assess five-year survival among cervical cancer patients of the western province, diagnosed in 2008, from hospital based cancer registry. Ethical clearance was from Ethical Review Committee of Faculty of Medicine, University of Colombo. Study sample consisted of 177 patients who were eligible. Two pretested data records sheets were used. Patient contact details, incident date, clinical stage, histology treatment details, last contact date and survival status at the last contact date were abstracted from the hospital records. Data abstraction from the hospital records were conducted by medical officers. Patients were followed-up at the field by the public health nursing sisters to assess survival-status and associated prognostic factors in 2014. Statistical analysis was conducted using Stata-12. Observed survival rates were calculated using Kaplan-Meier product-limit method. Survival time was limited only for the five years from the incidence date. Survival at 1, 3 and 5 years were calculated. Log-rank test was used in univariate analysis to identify. Potentially important prognostic variables were identified using log-rank test in univariate analysis. Cox-proportional hazards model was used in multivariate analysis using covariates found to be with probability of 0.2 or below in log-rank test. Results: Mean age of the total of 177 eligible patients was 56.3 years (SD=12.4). Majority 79 (44.6%) were from Colombo district. Sixty one (34.5%) and thirty seven (20.9%) were from Gampaha and Kalutata districts respectively. Seventy (56.0%) were in stage IIIA and B. Most 42 (31.8%) had radiotherapy as first treatment while 24 (18.2%) had chemo-radiation, 17 (12.9%) had chemotherapy and 17 (12.9%) had surgery. Thirty-four (24.2%) had other options as first line. Forty-one (23.1%) had experienced the death within the five-year period from the incidence-date. One, three and five year survivals were 86.0%, 70.0% and 62.5% respectively. District, clinical stage, undergone surgery were statistically significant in univariate analysis ( P < 0.05). Only clinical stage was found to be significant in multiple cox- regression( P < 0.05). Women in stage III & IV were 3.5 times more likely to die compared with those in stage I and II at diagnosis. Conclusion: Cervical cancer patients had fairly good five-year survival (62.5%). Late clinical stage being poor prognostic factor reflects the need of strengthening prevention, screening and palliative care.
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Affiliation(s)
| | | | | | - S. Perera
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
| | | | | | | | - D. Banneheke
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
| | - C. Peiris
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
| | - E. Fernando
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
| | | | - L. Mery
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
| | - F. Bray
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
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46
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Devalla SK, Renukanand PK, Sreedhar BK, Subramanian G, Zhang L, Perera S, Mari JM, Chin KS, Tun TA, Strouthidis NG, Aung T, Thiéry AH, Girard MJA. DRUNET: a dilated-residual U-Net deep learning network to segment optic nerve head tissues in optical coherence tomography images. Biomed Opt Express 2018; 9:3244-3265. [PMID: 29984096 PMCID: PMC6033560 DOI: 10.1364/boe.9.003244] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 05/18/2023]
Abstract
Given that the neural and connective tissues of the optic nerve head (ONH) exhibit complex morphological changes with the development and progression of glaucoma, their simultaneous isolation from optical coherence tomography (OCT) images may be of great interest for the clinical diagnosis and management of this pathology. A deep learning algorithm (custom U-NET) was designed and trained to segment 6 ONH tissue layers by capturing both the local (tissue texture) and contextual information (spatial arrangement of tissues). The overall Dice coefficient (mean of all tissues) was 0.91 ± 0.05 when assessed against manual segmentations performed by an expert observer. Further, we automatically extracted six clinically relevant neural and connective tissue structural parameters from the segmented tissues. We offer here a robust segmentation framework that could also be extended to the 3D segmentation of the ONH tissues.
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Affiliation(s)
- Sripad Krishna Devalla
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Prajwal K Renukanand
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Bharathwaj K Sreedhar
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Giridhar Subramanian
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Liang Zhang
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Shamira Perera
- Duke-NUS, Graduate Medical School, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jean-Martial Mari
- GePaSud, Université de la Polynésie française, Tahiti, French Polynesia
| | - Khai Sing Chin
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Tin A Tun
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nicholas G Strouthidis
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Alexandre H Thiéry
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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47
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Shiga Y, Akiyama M, Nishiguchi KM, Sato K, Shimozawa N, Takahashi A, Momozawa Y, Hirata M, Matsuda K, Yamaji T, Iwasaki M, Tsugane S, Oze I, Mikami H, Naito M, Wakai K, Yoshikawa M, Miyake M, Yamashiro K, Kashiwagi K, Iwata T, Mabuchi F, Takamoto M, Ozaki M, Kawase K, Aihara M, Araie M, Yamamoto T, Kiuchi Y, Nakamura M, Ikeda Y, Sonoda KH, Ishibashi T, Nitta K, Iwase A, Shirato S, Oka Y, Satoh M, Sasaki M, Fuse N, Suzuki Y, Cheng CY, Khor CC, Baskaran M, Perera S, Aung T, Vithana EN, Cooke Bailey JN, Kang JH, Pasquale LR, Haines JL, Wiggs JL, Burdon KP, Gharahkhani P, Hewitt AW, Mackey DA, MacGregor S, Craig JE, Allingham RR, Hauser M, Ashaye A, Budenz DL, Akafo S, Williams SEI, Kamatani Y, Nakazawa T, Kubo M. Genome-wide association study identifies seven novel susceptibility loci for primary open-angle glaucoma. Hum Mol Genet 2018; 27:1486-1496. [PMID: 29452408 PMCID: PMC6251544 DOI: 10.1093/hmg/ddy053] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/12/2022] Open
Abstract
Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness worldwide for which 15 disease-associated loci had been discovered. Among them, only 5 loci have been associated with POAG in Asians. We carried out a genome-wide association study and a replication study that included a total of 7378 POAG cases and 36 385 controls from a Japanese population. After combining the genome-wide association study and the two replication sets, we identified 11 POAG-associated loci, including 4 known (CDKN2B-AS1, ABCA1, SIX6 and AFAP1) and 7 novel loci (FNDC3B, ANKRD55-MAP3K1, LMX1B, LHPP, HMGA2, MEIS2 and LOXL1) at a genome-wide significance level (P < 5.0×10-8), bringing the total number of POAG-susceptibility loci to 22. The 7 novel variants were subsequently evaluated in a multiethnic population comprising non-Japanese East Asians (1008 cases, 591 controls), Europeans (5008 cases, 35 472 controls) and Africans (2341 cases, 2037 controls). The candidate genes located within the new loci were related to ocular development (LMX1B, HMGA2 and MAP3K1) and glaucoma-related phenotypes (FNDC3B, LMX1B and LOXL1). Pathway analysis suggested epidermal growth factor receptor signaling might be involved in POAG pathogenesis. Genetic correlation analysis revealed the relationships between POAG and systemic diseases, including type 2 diabetes and cardiovascular diseases. These results improve our understanding of the genetic factors that affect the risk of developing POAG and provide new insight into the genetic architecture of POAG in Asians.
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Affiliation(s)
- Yukihiro Shiga
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masato Akiyama
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kota Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Nobuhiro Shimozawa
- Tsukuba Primate Research Center, National Institutes of Biomedical Innovation, Health and Nutrition, Ibaraki, Japan
| | - Atsushi Takahashi
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Omics Research Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Makoto Hirata
- Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koichi Matsuda
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Taiki Yamaji
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Isao Oze
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Munemitsu Yoshikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan
| | | | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takeshi Iwata
- Division of Molecular and Cellular Biology, National Institute of Sensory Organs, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan
| | - Fumihiko Mabuchi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | | | - Mineo Ozaki
- Ozaki Eye Hospital, Hyuga, Miyazaki, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuhide Kawase
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuhiro Ikeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Nitta
- Fukuiken Saiseikai Hospital, Fukui, Japan
| | | | | | | | - Mamoru Satoh
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Makoto Sasaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Nobuo Fuse
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Miyagi, Japan
| | - Yoichi Suzuki
- Department of Education and Training, Tohoku Medical Megabank Organization, Miyagi, Japan
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eranga N Vithana
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jessica N Cooke Bailey
- Department of Population and Quantitative Health Sciences, Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jae H Kang
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Puya Gharahkhani
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - David A Mackey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, WA, Australia
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | | | | | - Adeyinka Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, USA
| | - Stephan Akafo
- University of Ghana School of Medicine and Dentistry, Ghana
| | - Susan E I Williams
- Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, South Africa
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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48
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Perera S, Warner A, Almotasen R, Boldt G, Matsuoka H, Yan B, Sey M, Rahman A, Palma DA, Asfaha S. A95 THE EFFICACY OF SURVEILLANCE COLONOSCOPY ON SURVIVAL IN INFLAMMATORY BOWEL DISEASE ASSOCIATED COLORECTAL CANCER: A SYSTEMATIC REVIEW & META-ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Perera
- Gastroenterology, Western University, London, ON, Canada
| | - A Warner
- Department of Radiation Oncology, London, ON, Canada
| | - R Almotasen
- Gastroenterology, Western University, London, ON, Canada
| | - G Boldt
- London Health Sciences Centre, London, ON, Canada
| | - H Matsuoka
- Nishiwaki Municipal Hospital, Nishiwaki, Japan
| | - B Yan
- Gastroenterology, Western University, London, ON, Canada
| | - M Sey
- Gastroenterology, Western University, London, ON, Canada
| | - A Rahman
- Gastroenterology, Western University, London, ON, Canada
| | - D A Palma
- Department of Radiation Oncology, London, ON, Canada
| | - S Asfaha
- Gastroenterology, Western University, London, ON, Canada
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49
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Greenspan SL, Vujevich K, Britton C, Herradura A, Gruen G, Tarkin I, Siska P, Hamlin B, Perera S. Teriparatide for treatment of patients with bisphosphonate-associated atypical fracture of the femur. Osteoporos Int 2018; 29:501-506. [PMID: 29085957 PMCID: PMC6468986 DOI: 10.1007/s00198-017-4286-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED The Fracture Improvement with Teriparatide (Fix-IT) study randomized 13 women with an atypical femur fracture to immediate vs delayed teriparatide therapy; all were followed for 12 months. Results suggested a trend for superior healing and lesser bone mineral density declines in the immediate vs delayed group with no differences in adverse events. PURPOSE Little clinical data are available on the use of teriparatide for the treatment of bisphosphonate-associated atypical femur fractures (AFF). The goal of the Fix-IT study was to determine if immediate therapy with teriparatide was superior for fracture healing after an AFF compared to a 6-month delay in teriparatide therapy. METHODS This randomized pilot clinical trial included 13 women with an AFF who were randomized to immediate teriparatide vs a delay of 6 months. All were followed for 12 months on teriparatide. The primary outcomes included individual and composite measures of radiologic bone healing (scored 1 point [no healing] to 4 points [complete healing]) at 6 and 12 months. Secondary outcomes included bone mineral density of the unfractured contralateral hip, spine, 1/3 distal radius, and adverse events. RESULTS We found there was a trend for superior healing with the composite score (12.6 vs 11.2 at 6 months and 15.4 vs 13.2 at 12 months), and lesser bone mineral density declines at the 1/3 distal radius (12-month change - 1.9 vs - 6.1%) in the immediate vs the delayed group. There were no differences in adverse events. There was one implant failure in the delayed group. CONCLUSIONS There is a preliminary signal for greater improvements with immediate teriparatide therapy vs delayed therapy. However, because an AFF is a rare event, and only a small number of patients were included, the results must be interpreted with caution.
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Affiliation(s)
- S L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1110 Kaufmann Medical Building, Pittsburgh, PA, 15213, USA.
| | - K Vujevich
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1110 Kaufmann Medical Building, Pittsburgh, PA, 15213, USA
| | - C Britton
- Department of Radiology, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - A Herradura
- Department of Radiology, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - G Gruen
- Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - I Tarkin
- Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - P Siska
- Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - B Hamlin
- Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - S Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 1110 Kaufmann Medical Building, Pittsburgh, PA, 15213, USA
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50
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Nongpiur ME, Cheng CY, Duvesh R, Vijayan S, Baskaran M, Khor CC, Allen J, Kavitha S, Venkatesh R, Goh D, Husain R, Boey PY, Quek D, Ho CL, Wong TT, Perera S, Wong TY, Krishnadas SR, Sundaresan P, Aung T, Vithana EN. Evaluation of Primary Angle-Closure Glaucoma Susceptibility Loci in Patients with Early Stages of Angle-Closure Disease. Ophthalmology 2018; 125:664-670. [PMID: 29310965 DOI: 10.1016/j.ophtha.2017.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/07/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate whether newly identified genetic loci for primary angle-closure glaucoma (PACG) are associated with early stage angle-closure disease defined as primary angle closure suspect (PACS). DESIGN Case-control study. PARTICIPANTS A total of 1397 PACS patients and 943 controls of Chinese ethnicity from Singapore and 604 PACS patients and 287 controls of Indian ethnicity. METHODS The 8 PACG single nucleotide polymorphisms (SNPs; rs11024102 at PLEKHA7, rs3753841 at COL11A1, rs1015213 located between PCMTD1 and ST18 son chromosome 8q, rs3816415 at EPDR1, rs1258267 at CHAT, rs736893 at GLIS3, rs7494379 at FERMT2, and rs3739821 mapping in between DPM2 and FAM102A) were genotyped by Taqman assays. The association between SNP genotypes and PACS status was measured using logistic regression. A P value of 0.006 was set to account for the testing of 8 genetic loci using a Bonferroni correction. A meta-analysis was conducted to calculate the overall P value and accompanying per-allele odds ratios for each SNP analyzed. MAIN OUTCOME MEASURES Association of PACG loci with PACS status. RESULTS The PACS patients were significantly older in both cohorts (Chinese, P < 0.001; Indian, P = 0.002), and there were also more women (P < 0.001, both Chinese and Indian cohorts). In the Chinese cohort, significant evidence of association was noted at 3 SNPs: rs1015213 [A] in PCMTD1-ST18 (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.36-4.11; P = 0.002), rs3816415 [A] in EPDR1 (OR, 1.49; 95% CI, 1.19-1.85; P < 0.001), and rs3739821 [G] in DPM2-FAM102A (OR, 1.40; 95% CI, 1.18-1.65; P < 0.001). Only PCMTD1-ST-18 was replicated modestly in the Indian population (P = 0.056). Meta-analysis showed significant evidence of association for PCMTD1-ST-18 (OR, 1.55; 95% CI, 1.18-2.04; P = 0.002) and DPM2-FAM102A (OR, 1.27; 95% CI, 1.12-1.45; P = 0.0002). CONCLUSIONS In this study, 2 of 8 PACG-associated loci were associated significantly with PACS status, the earliest stage in the angle-closure glaucoma disease course. The association of these PACG loci with PACS status suggests that these loci may confer susceptibility to a narrow angle configuration.
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Affiliation(s)
- Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Roopam Duvesh
- Department of Genetics, Aravind Medical Research Foundation, Madurai, India
| | - Saravanan Vijayan
- Department of Genetics, Aravind Medical Research Foundation, Madurai, India
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Singapore, Republic of Singapore
| | - Chiea-Chuen Khor
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Human Genetics, Genome Institute of Singapore, Singapore, Republic of Singapore
| | - John Allen
- Duke-National University of Singapore Medical School, Singapore, Republic of Singapore
| | | | | | - David Goh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Pui Yi Boey
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Desmond Quek
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Ching Lin Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Tina T Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | | | | | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Eranga N Vithana
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Singapore, Republic of Singapore.
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