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Patel SR. Enduring Value of the (UK-) COMPASS. Eur J Vasc Endovasc Surg 2024; 67:856-857. [PMID: 38588777 DOI: 10.1016/j.ejvs.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
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Vallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, Holder SM, Jenkins MP, Ormesher DC, Rosala-Hallas A, Jackson RJ. Editor's Choice - Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) - Peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024; 67:540-553. [PMID: 38428672 DOI: 10.1016/j.ejvs.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Treatment of juxtarenal and complex neck abdominal aortic aneurysms (AAAs) is now commonly by endovascular rather than open surgical repair (OSR). Published comparisons show poor validity and scientific precision. UK-COMPASS is a comparative cohort study of endovascular treatments vs. OSR for patients with an AAA unsuitable for standard on label endovascular aneurysm repair (EVAR). METHODS All procedures for AAA in England (November 2017 to October 2019) were identified, AAA anatomy assessed in a Corelab, peri-operative risk scores determined, and propensity scoring used to identify patients suitable for either endovascular treatment or OSR. Patients were stratified by aneurysm neck length (0 - 4 mm, 5 - 9 mm, or ≥ 10 mm) and operative risk; the highest quartile was considered high risk and the remainder standard risk. Death was the primary outcome measure. Endovascular treatments included fenestrated EVAR (FEVAR) and off label standard EVAR (± adjuncts). RESULTS Among 8 994 patients, 2 757 had AAAs that were juxtarenal, short neck, or complex neck in morphology. Propensity score stratification and adjustment method comparisons included 1 916 patients. Widespread off label use of standard EVAR devices was noted (35.6% of patients). The adjusted peri-operative mortality rate was 2.9%, lower for EVAR (1.2%; p = .001) and FEVAR (2.2%; p = .001) than OSR (4.5%). In standard risk patients with a 0 - 4 mm neck, the mortality rate was 7.4% following OSR and 2.3% following FEVAR. Differences were smaller for patients with a neck length ≥ 5 mm: 2.1% OSR vs. 1.0% FEVAR. At 3.5 years of follow up, the overall mortality rate was 20.7% in the whole study population, higher following FEVAR (27.6%) and EVAR (25.2%) than after OSR (14.2%). However, in the 0 - 4 mm neck subgroup, overall survival remained equivalent. The aneurysm related mortality rate was equivalent between treatments, but re-intervention was more common after EVAR and FEVAR than OSR. CONCLUSION FEVAR proves notably safer than OSR in the peri-operative period for juxtarenal aneurysms (0 - 4 mm neck length), with comparable midterm survival. For patients with short neck (5 - 9 mm) and complex neck (≥ 10 mm) AAAs, overall survival was worse in endovascularly treated patients compared with OSR despite relative peri-operative safety. This warrants further research and a re-appraisal of the current clinical application of endovascular strategies, particularly in patients with poor general survival outlook owing to comorbidity and age.
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Affiliation(s)
- Srinivasa R Vallabhaneni
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
| | - Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Bruce Campbell
- Royal Devon University Healthcare Trust, Exeter, UK; University of Exeter Medical School, Exeter, UK
| | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust, Cambridge, UK; Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | | | - Alastair Crosher
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Sophie M Holder
- Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Michael P Jenkins
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - David C Ormesher
- East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Anna Rosala-Hallas
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard J Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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3
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Patel SR, Lip GYH, Vallabhaneni SR. Response to 'Re. Comparison of open, standard, and complex endovascular aortic repair treatments for juxtarenal/short neck aneurysms: a systematic review and network meta-analysis'. Eur J Vasc Endovasc Surg 2023; 65:455-456. [PMID: 36574566 DOI: 10.1016/j.ejvs.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Srinivasa R Vallabhaneni
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Miller P, Patel SR, Skinner R, Dignan F, Richter A, Jeffery K, Khan A, Heath PT, Clark A, Orchard K, Snowden JA, de Silva TI. Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients: Prepared on behalf of the British society of blood and marrow transplantation and cellular therapy (BSBMTCT), the Children's cancer and Leukaemia Group (CCLG), and British Infection Association (BIA). J Infect 2023; 86:1-8. [PMID: 36400155 DOI: 10.1016/j.jinf.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Haematopoietic stem cell transplant (HSCT) recipients have deficiencies in their adaptive immunity against vaccine preventable diseases. National and International guidance recommends that HSCT recipients are considered 'never vaccinated' and offered a comprehensive course of revaccination. This position statement aims to draw upon the current evidence base and existing guidelines, and align this with national vaccine availability and licensing considerations in order to recommend a pragmatic and standardised re-vaccination schedule for adult and paediatric HSCT recipients in the UK.
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Affiliation(s)
- Pde Miller
- British Society of Blood and Marrow Transplantation and Cellular Therapy, UK
| | - S R Patel
- Paediatric Department, Croydon Health Services NHS Trust, Croydon, UK
| | - R Skinner
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - F Dignan
- Department of Clinical Haematology, University of Manchester, Manchester, UK
| | - A Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - K Jeffery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Khan
- St. James' Hospital, Leeds, UK
| | - P T Heath
- Vaccine Institute, Institute of Infection and Immunity, St. George's, University of London, London, UK
| | - A Clark
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - K Orchard
- Wessex Blood and Marrow Transplant and Cellular Therapy Program, Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Oncology and Metabolism, Medical School, The University of Sheffield, Sheffield, UK
| | - T I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, The University of Sheffield, Sheffield, UK.
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Patel SR, Ormesher DC, Griffin R, Jackson RJ, Lip GYH, Vallabhaneni SR. Editor's Choice - Comparison of Open, Standard, and Complex Endovascular Aortic Repair Treatments for Juxtarenal/Short Neck Aneurysms: A Systematic Review and Network Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 63:696-706. [PMID: 35221243 DOI: 10.1016/j.ejvs.2021.12.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysms (AAAs) with adverse morphology of the aneurysm neck are "complex". Techniques employed to repair complex aneurysms include open surgical repair (OSR) and a number of on label endovascular techniques such as fenestrated endovascular aneurysm repair (FEVAR) and endovascular aneurysm repair (EVAR) with adjuncts (including chimneys and endo-anchors), as well as off label use of standard EVAR. The aim was to conduct a network meta-analysis (NMA) of published comparative outcomes. DATA SOURCES An electronic search was performed in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). These databases were interrogated using the PubMed interface and the Healthcare Databases Advanced Search (HDAS) interface developed by the National Institute of Health and Care Excellence. REVIEW METHODS Online databases were interrogated up to April 2020. Studies were included if they compared outcomes between at least two methods of repair for complex aneurysms (those with at least one adverse neck feature: absent/short neck, conicality, angulation, calcification, large diameter, and thrombus). The primary outcome measure was peri-operative death. Pre-registration was done in PROSPERO (CRD42020177482). RESULTS The search identified 24 observational studies and 7854 patients who underwent OSR, FEVAR, off label EVAR, or chimney EVAR. No comparative studies included EVAR with endo-anchors. NMA was performed on 23 studies that reported outcomes of aneurysms with short/absent infrarenal neck. Compared with OSR, off label EVAR (relative risk [RR] 0.10, 95% confidence interval [CI] 0.01 - 0.41) and FEVAR (RR 0.62, 95% CI 0.32-0.94) were associated with lower peri-operative mortality. This difference was not seen at the midterm follow up (30 months). Compared with OSR, FEVAR was associated with a lower peri-operative myocardial infarction (MI) rate (RR 0.37, 95% CI 0.16 - 0.62) but a higher midterm re-intervention rate (hazard ratio 1.65, 95% CI 1.04 - 2.66). All studies had a "moderate" or "high" risk of bias. Confidence in the network findings (GRADE) was generally "low". CONCLUSION This NMA demonstrated a peri-operative survival benefit for off label EVAR and FEVAR compared with OSR, potentially due to reduced risk of MI. FEVAR carries a greater midterm re-intervention risk than OSR, with potential implications for cost effectiveness. There is paucity of comparative data for cases with adverse neck features other than short length.
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Affiliation(s)
- Shaneel R Patel
- Liverpool University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, UK; Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK.
| | - David C Ormesher
- Liverpool University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, UK
| | - Rebecca Griffin
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard J Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Srinivasa R Vallabhaneni
- Liverpool University Hospitals NHS Foundation Trust, Prescot Road, Liverpool, UK; Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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6
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Patel SR, Ormesher DC, Smith SR, Wong KHF, Bevis P, Bicknell CD, Boyle JR, Brennan JA, Campbell B, Cook A, Crosher AP, Duarte RV, Flett MM, Gamble C, Jackson RJ, Juszczak MT, Loftus IM, Nordon IM, Patel JV, Platt K, Psarelli EE, Rowlands PC, Smyth JV, Spachos T, Taggart L, Taylor C, Vallabhaneni SR. A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms-the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol. BMJ Open 2021; 11:e054493. [PMID: 34848524 PMCID: PMC8634354 DOI: 10.1136/bmjopen-2021-054493] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In one-third of all abdominal aortic aneurysms (AAAs), the aneurysm neck is short (juxtarenal) or shows other adverse anatomical features rendering operations more complex, hazardous and expensive. Surgical options include open surgical repair and endovascular aneurysm repair (EVAR) techniques including fenestrated EVAR, EVAR with adjuncts (chimneys/endoanchors) and off-label standard EVAR. The aim of the UK COMPlex AneurySm Study (UK-COMPASS) is to answer the research question identified by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme: 'What is the clinical and cost-effectiveness of strategies for the management of juxtarenal AAA, including fenestrated endovascular repair?' METHODS AND ANALYSIS UK-COMPASS is a cohort study comparing clinical and cost-effectiveness of different strategies used to manage complex AAAs with stratification of physiological fitness and anatomical complexity, with statistical correction for baseline risk and indication biases. There are two data streams. First, a stream of routinely collected data from Hospital Episode Statistics and National Vascular Registry (NVR). Preoperative CT scans of all patients who underwent elective AAA repair in England between 1 November 2017 and 31 October 2019 are subjected to Corelab analysis to accurately identify and include every complex aneurysm treated. Second, a site-reported data stream regarding quality of life and treatment costs from prospectively recruited patients across England. Site recruitment also includes patients with complex aneurysms larger than 55 mm diameter in whom an operation is deferred (medical management). The primary outcome measure is perioperative all-cause mortality. Follow-up will be to a median of 5 years. ETHICS AND DISSEMINATION The study has received full regulatory approvals from a Research Ethics Committee, the Confidentiality Advisory Group and the Health Research Authority. Data sharing agreements are in place with National Health Service Digital and the NVR. Dissemination will be via NIHR HTA reporting, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ISRCTN85731188.
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Affiliation(s)
- Shaneel R Patel
- Vascular Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - David C Ormesher
- Vascular Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Samuel R Smith
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Paul Bevis
- Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Colin D Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan R Boyle
- Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John A Brennan
- Vascular Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Bruce Campbell
- Vascular Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
| | - Alastair P Crosher
- Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Richard J Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Maciej T Juszczak
- Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian M Loftus
- Vascular Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ian M Nordon
- Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jai V Patel
- Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kellie Platt
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | | | - Peter C Rowlands
- Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - John V Smyth
- Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Theodoros Spachos
- Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Leigh Taggart
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Claire Taylor
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Srinivasa Rao Vallabhaneni
- Vascular Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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7
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Patel SR, Roy IN, McWilliams RG, Brennan JA, Vallabhaneni SR, Neequaye SK, Smout JD, Fisher RK. Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR). JRSM Cardiovasc Dis 2021; 10:20480040211012503. [PMID: 34211706 PMCID: PMC8217896 DOI: 10.1177/20480040211012503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/20/2021] [Accepted: 04/01/2021] [Indexed: 12/05/2022] Open
Abstract
Background In FEVAR, visceral stents provide continuity and maintain perfusion between
the main body of the stent and the respective visceral artery. The aim of
this study was to characterise the incidence and mode of visceral stent
failure (type Ic endoleak, type IIIa endoleak, stenosis/kink, fracture,
crush and occlusion) after FEVAR in a large cohort of patients at a
high-volume centre. Methods A retrospective review of visceral stents placed during FEVAR over 15 years
(February 2003-December 2018) was performed. Kaplan-Meier analyses of
freedom from visceral stent-related complications were performed. The
outcomes between graft configurations of varying complexity were compared,
as were the outcomes of different stent types and different visceral
vessels. Results Visceral stent complications occurred in 47/236 patients (19.9%) and 54/653
stents (8.3%). Median follow up was 3.7 years (IQR 1.7–5.3 years). There was
no difference in visceral stent complication rate between renal, SMA and
coeliac arteries. Visceral stent complications were more frequent in more
complex grafts compared to less complex grafts. Visceral stent complications
were more frequent in uncovered stents compared to covered stents. Visceral
stent-related endoleaks (type Ic and type IIIa) occurred exclusively around
renal artery stents. The most common modes of failure with SMA stents were
kinking and fracture, whereas with coeliac artery stents it was external
crush. Conclusion Visceral stent complications after FEVAR are common and merit continued and
close long-term surveillance. The mode of visceral stent failure varies
across the vessels in which the stents are located.
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Affiliation(s)
- Shaneel R Patel
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Iain N Roy
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Richard G McWilliams
- Department of Interventional Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | - John A Brennan
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Simon K Neequaye
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Jonathan D Smout
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert K Fisher
- Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
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Alcantara C, Wallace M, Sotres-Alvarez D, Vetter C, Phillips AJ, Shafazand S, Johnson DA, Wallace D, Gallo LC, Ramos AR, Penedo F, Wohlgemuth WK, Zee PC, Redline S, Patel SR. 1097 Sleep Disturbances, Sleep Burden, And Depressive Symptoms In US Hispanics/Latinos: Results From The HCHS/SOL Sueño Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1092] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
While sleep disturbances and depression often co-occur, these associations are understudied among Hispanics/Latinos. We examined the associations of sleep disturbances and sleep burden with depressive symptoms among Hispanic/Latino adults in the United States.
Methods
We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sueño Ancillary study (2010-2013). The study enrolled 2072 adults (ages 18-64; 51.5% females) who completed one-week wrist-actigraphy and sleep questionnaires. Sleep burden was operationalized as the total count of sleep disturbances across six domains (duration, efficiency, midpoint, variability, insomnia, sleepiness). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale (CESD-10). We used weighted survey linear regressions to evaluate the association of sleep disturbances and sleep burden with elevated depressive symptoms (CESD≥10) in individual models adjusted for age, gender, site, heritage, nativity, education, income, and employment. Sensitivity analyses further adjusted for behavioral health risk factors and apnea-hypopnea index.
Results
An estimated 28.3% had elevated depressive symptoms, 8.0% had short sleep duration (<6 hours of sleep), 10.9% had long sleep duration (>9 hours), 45.2% exhibited a later sleep midpoint (≥4:00AM), 38.4% had high sleep timing variability (upper third tertile for between day sleep midpoint), 15.3% had insomnia (ISI≥10), 17.3% had excessive daytime sleepiness (ESS ≥10), 21.5% had poor sleep efficiency (<85%), and 77.4% had a total sleep burden count of ≥0. Insomnia (ß=0.49,95%CI:.43,.56), later sleep timing (ß=0.10,95%CI:.04,.16), excessive daytime sleepiness (ß=0.19,95%CI:.11,.27), poor sleep efficiency (ß=0.09,95%CI:.02,.17), high variability (ß=0.07, 95%CI:.01,.12), and sleep burden (ß=0.11,95%CI:.09,.13), were each positively associated with elevated depressive symptoms in individual adjusted models and sensitivity analyses. Extreme sleep durations were not associated with elevated depressive symptoms.
Conclusion
Multiple inter-related sleep disturbances, particularly those pertaining to sleep quality and timing, are associated with depression and may be targets for future interventions aimed at improving mood among Hispanics/Latinos.
Support
HL127307, HL098927, HL125748
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Affiliation(s)
| | - M Wallace
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - C Vetter
- University of Colorado--Boulder, Boulder, CO
| | | | | | | | | | - L C Gallo
- San Diego State University, San Diego, CA
| | | | | | | | - P C Zee
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - S R Patel
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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Carmona ET, Nouraie SM, Bakker JP, Stitt CJ, Aloia MS, Patel SR. 0357 CPAP Adherence is Lower in Minority Neighborhoods. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The effectiveness of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) is limited by adherence. Small, single-center studies have reported CPAP adherence is lower in racial minorities suggesting disparities in OSA care. We used nationally representative data to assess racial differences in CPAP adherence at a neighborhood level.
Methods
Telemonitoring data were obtained from a therapy database maintained by a CPAP manufacturer. Usage over the first 90 days in patients initiated on CPAP between 11/01/2015 and 10/31/2018 who had at least one usage session, age 18-90 years, and valid U.S. zip code were mapped to a zip code tabulation area (ZCTA). Age- and sex-adjusted CPAP usage was calculated for each ZCTA with greater than 10 CPAP users. Ecologic analyses were performed to model the association of the proportion of blacks and Hispanics in each ZCTA (obtained from the 2013-2017 American Community Survey) on CPAP usage controlling for proportion of adults with bachelor’s degree and proportion of adults with household income below the poverty line.
Results
Our analysis included 13,118 ZCTAs averaging data over 737,274 patients. In adjusted analyses, each 10% increase in the proportion of blacks and Hispanics was associated with a 0.12 (95% CI 0.11-0.12) hour and 0.14 (95% CI 0.14-0.15) hour decrease in nightly CPAP use, respectively. Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% blacks were 4.96, 4.81, 4.67, 4.56, and 4.14 hours respectively (p<0.001). Mean usage in ZCTAs with <1%, 1-2.5%, 2.5-10%, 10-25%, and 25-100% Hispanics were 4.87, 4.86, 4.75, 4.50, and 4.10 hours respectively (p<0.001).
Conclusion
CPAP adherence is lower in neighborhoods with higher proportions of black and Hispanic residents independent of differences in education or poverty. These differences lead to lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.
Support
Philips Respironics, NIH R25HL130600 and K24HL127307.
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Affiliation(s)
- E T Carmona
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA
| | - S M Nouraie
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA
| | | | - C J Stitt
- Philips Respironics, Murrysville, PA
| | - M S Aloia
- Philips Respironics, Murrysville, PA
| | - S R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA
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Kline CE, Egeler ME, Kubala AG, Patel SR, Lehrer HM, Duggan KA, Hall MH. 0402 Impact of Various Actigraphic Editing Approaches on Sleep/Wake Outputs in Adults with Insomnia and Healthy Sleepers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Actigraphy data can be edited using a variety of approaches. However, whether time-intensive manual editing provides different sleep/wake estimates compared to other approaches is unknown. The purpose of this study was to compare sleep/wake data obtained from a standardized editing approach that incorporates multiple inputs versus three other common approaches.
Methods
72 adults (33.8±11.1 y, 74% female, 71% white) provided 1022 nights of data for analysis; 45 were healthy sleepers (678 nights) and 27 met DSM-5 criteria for insomnia. Participants wore an Actiwatch Spectrum on their nondominant wrist and completed a sleep diary for 3-24 nights. Each night’s rest interval was set using four different approaches: (1) a standardized process based upon published guidelines (Patel et al., Sleep 2015) that incorporates a hierarchical order of multiple inputs (event marker, light, diary, activity; STANDARD); (2) software-provided automated algorithm (AUTO); (3) automated algorithm with incorporation of event markers (AUTOE); and (4) sleep diary (DIARY). We used linear mixed-effects models to evaluate whether sleep/wake parameters differed between the STANDARD and other editing approaches, accounting for patient status (healthy sleeper, insomnia) and the possibility that differences among editing approaches may be dependent on patient status.
Results
All results are expressed relative to the STANDARD approach. Bedtime was 36.1±5.1 min earlier (P<.0001) and morning out-of-bed time was 13.6±5.7 min later (P=.02) using the AUTO (P<.0001) approach. Time in bed was 42.3±4.7 min longer with AUTO (P<.0001). Sleep onset latency was 11.7±1.4 min and 2.8±1.4 min longer for AUTO (P<.0001) and DIARY (P=.05), respectively. Sleep duration was 22.5±4.4 min longer with AUTO (P<.0001). Wake after sleep onset was 6.8±1.2 min greater with AUTO (P<.0001). Similar patterns were observed for all sleep/wake measures among healthy sleepers and adults with insomnia.
Conclusion
A standardized approach to editing actigraphy data leads to different sleep/wake estimates compared to other common approaches, though the differences were often small in magnitude and not dependent upon sleep status. Most notably, reliance upon the automated algorithm yielded longer time in bed, sleep duration, sleep onset latency, and wake after sleep onset compared to the standardized approach.
Support
NIH K23HL118318
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Affiliation(s)
- C E Kline
- University of Pittsburgh, Pittsburgh, PA
| | - M E Egeler
- University of Pittsburgh, Pittsburgh, PA
| | - A G Kubala
- University of Pittsburgh, Pittsburgh, PA
| | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
| | - H M Lehrer
- University of Pittsburgh, Pittsburgh, PA
| | - K A Duggan
- North Dakota State University, Fargo, ND
| | - M H Hall
- University of Pittsburgh, Pittsburgh, PA
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11
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Borker PV, Wyland C, Patel SR. 0677 Patient Preferences On Initiating Treatment With Continuous Positive Airway Pressure. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.673] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Clinical guidelines recommend continuous positive airway pressure (CPAP) therapy be initiated in patients with obstructive sleep apnea (OSA) either at home using an auto-titrating device or following manual titration in the sleep laboratory. Patient preference between these two options is unknown.
Methods
Patients newly prescribed CPAP therapy for the treatment of OSA at an academic sleep medicine clinic were surveyed by telephone within one month of initiating treatment. Data on demographics, disease severity and CPAP adherence were obtained from the medical record.
Results
A total of 75 participants (56% male, mean age 52±15 yrs, 48% moderate to severe OSA) were surveyed. Physicians prescribed home initiation of CPAP in 51%, lab initiation in 23%, and allowed the patient to choose in 27% of cases. Overall, 67% of participants (95% CI [56%-77%]) reported preference for home initiation. Preference for home initiation did not vary by age, sex, AHI, degree of sleepiness, or type of diagnostic study (home vs. lab sleep study) performed (p>0.10 for all). Convenience (44%) and starting treatment faster (44%) were the most common reasons provided for those favoring home initiation, while sleep technician availability (40%), optimization of pressure settings (32%), and ability to try multiple masks (28%) were cited by those favoring lab initiation. The prevalence of CPAP adherence at 90 days tended to be higher in those whose treatment was initiated aligned to preference (79% in those whose treatment initiation was concordant with preference vs. 64% in those whose treatment initiation was discordant, p=0.16).
Conclusion
Overall, two-thirds of patients with OSA prefer initiation of CPAP be done at home. This preference does not vary by demographics, OSA severity or diagnostic modality. Initiating treatment concordant with patient preference may lead to greater adherence.
Support
American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship, K24 HL127307
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Affiliation(s)
- P V Borker
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - C Wyland
- Lake Erie College of Osteopathic Medicine, Greensburg, PA
| | - S R Patel
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, PA
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12
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Agudelo C, Tarraf W, Wu B, Wallace DM, Patel SR, Redline S, Daviglus ML, Zee PC, Simonelli G, Levin BE, Mossavar-Rahmani Y, Sotres-Alvarez D, Zeng D, González HM, Ramos AR. 1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1138] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline.
Methods
We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use).
Results
At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p<0.01), verbal learning (β=-0.0028, p<0.001) and verbal memory (β=-0.036, p<0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p<0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change.
Conclusion
Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline.
Support
This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).
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Affiliation(s)
- C Agudelo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - W Tarraf
- Department of Healthcare Sciences and Institute of Gerontology, Wayne State University, Detroit, MI
| | - B Wu
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA
| | - D M Wallace
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - S R Patel
- Department of Medicine and Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - S Redline
- Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - M L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - P C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - G Simonelli
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Springs, MD
| | - B E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - Y Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - D Sotres-Alvarez
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - D Zeng
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - H M González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA
| | - A R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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13
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Wu B, Tarraf W, Wallace DM, Stickel A, Schneiderman N, Redline S, Patel SR, Gallo LC, Mossavar-Rahmani Y, Daviglus M, Zee PC, Talavera GA, Sotres-Alvarez D, Gonzalez HM, Ramos AR. 0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Sleep 2020. [DOI: 10.1093/sleep/zsaa056.606] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias).
Methods
Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality.
Results
Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 <90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2<90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2<90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2<90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2<90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds.
Conclusion
We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities.
Support
5R01AG048642-05; R21AG056952; R21HL140437.
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Affiliation(s)
- B Wu
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA, University of California San Diego, CA
| | - W Tarraf
- Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Detroit, Michigan, Wayne State University, MI
| | - D M Wallace
- University of Miami, Miller School of Medicine, University of Miami, FL
| | - A Stickel
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA, University of California San Diego, CA
| | - N Schneiderman
- University of Miami, Department of Psychology, University of Miami, FL
| | - S Redline
- Harvard Medical School, Harvard University, MA
| | - S R Patel
- University of Pittsburgh, School of Medicine, University of Pittsburgh, PA
| | - L C Gallo
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, San Diego, CA
| | - Y Mossavar-Rahmani
- Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY
| | - M Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, Chicago, IL
| | - P C Zee
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - G A Talavera
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, San Diego, CA
| | - D Sotres-Alvarez
- University of North Carolina, Department of Biostatistics, Chapel Hill, NC
| | - H M Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA, University of California San Diego, CA
| | - A R Ramos
- University of Miami, Miller School of Medicine, Miami, FL
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14
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Gonzalez KT, Tarraf W, Wallace DM, Stickel A, Schneiderman N, Redline S, Patel SR, Gallo LC, Mossavar-Rahmani Y, Daviglus M, Zee PC, Talavera GA, Sotres-Alvarez D, Gonzalez HM, Ramos AR. 0607 Clinical Phenotypes of OSA in Diverse Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent work on US non-Latino Whites and Europeans from clinical samples used obstructive sleep apnea (OSA) symptoms to generate OSA phenotypes for individuals with moderate-severe OSA and proposed between 3-5 clusters. Validating these clusters in a diverse Hispanic/Latino community-based population with different biopsychosocial characteristics is crucial for early OSA identification and more personalized treatment.
Methods
This work is based on baseline data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is a prospective cohort study designed using a multisite (Bronx, NY, Chicago, IL, Miami, FL, San Diego, CA) multistage probability sample. The subpopulation of interest included adults 18-74 years (unweighted n=1,623) meeting criteria for moderate-severe OSA symptoms (≥15 Apnea-Hypopnea index (AHI) events per hour). We performed latent class analysis (LCA) using 15 common OSA symptoms to identify phenotype clusters.
Results
Average age was 52.4 ± 13.9 years and 34.1% were female. Mean AHI was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided best fit to the data. The symptom profiles were consistent with (1) a Minimally Symptomatic group (46.8%), (2) a Disturbed Sleep group (38.1%), and (3) a Daytime Sleepiness group (15.1%). Validation analyses using alternative hierarchical and partitioning algorithms also suggested support for a three-class solution.
Conclusion
Sleep apnea phenotypes among diverse Hispanics/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium. However, we found notable differences in the prevalence of these clusters relative to Whites. This suggests that other biopsychosocial factors may be contributing to OSA phenotypes among Hispanics/Latinos. Identification of OSA phenotypes in Hispanics/Latinos could inform better sleep interventions and therapeutics and help better align public health resources.
Support
5R01AG048642-05; R21AG056952; R21HL140437.
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Affiliation(s)
- K T Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| | - W Tarraf
- Wayne State University, Detroit, MI
| | | | - A Stickel
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| | | | - S Redline
- Harvard Medical School, Harvard University, MA
| | - S R Patel
- University of Pittsburgh, School of Medicine, University of Pittsburgh, PA
| | - L C Gallo
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Y Mossavar-Rahmani
- Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, NY
| | - M Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - P C Zee
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - G A Talavera
- Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | | | - H M Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| | - A R Ramos
- University of Miami, Miller School of Medicine, Miami, FL
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15
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Streeter KA, Sunshine MD, Patel SR, Gonzalez-Rothi EJ, Reier PJ, Baekey DM, Fuller DD. Mid-cervical interneuron networks following high cervical spinal cord injury. Respir Physiol Neurobiol 2019; 271:103305. [PMID: 31553921 DOI: 10.1016/j.resp.2019.103305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/12/2019] [Revised: 08/22/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022]
Abstract
Spinal interneuron (IN) networks can facilitate respiratory motor recovery after spinal cord injury (SCI). We hypothesized that excitatory synaptic connectivity between INs located immediately caudal to unilateral cervical SCI would be most prevalent in a contra- to ipsilateral direction. Adult rats were studied following chronic C2 spinal cord hemisection (C2Hx) injury. Rats were anesthetized and ventilated and a multi-electrode array was used to simultaneously record INs on both sides of the C4-5 spinal cord. The temporal firing relationship between IN pairs was evaluated using cross-correlation with directionality of synaptic connections inferred based on electrode location. During baseline recordings, the majority of detectable excitatory IN connections occurred in a contra- to- ipsilateral direction. However, acute respiratory stimulation with hypoxia abolished this directionality, while simultaneously increasing the detectable inhibitory connections within the ipsilateral cord. We conclude that propriospinal networks caudal to SCI can display a contralateral-to-ipsilateral directionality of synaptic connections and that these connections are modulated by acute exposure to hypoxia.
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Affiliation(s)
- K A Streeter
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, United States; McKnight Brain Institute, University of Florida, Gainesville, FL 32601, United States; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, United States
| | - M D Sunshine
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, United States; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, United States
| | - S R Patel
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, United States
| | - E J Gonzalez-Rothi
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, United States; McKnight Brain Institute, University of Florida, Gainesville, FL 32601, United States; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, United States
| | - P J Reier
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, United States; McKnight Brain Institute, University of Florida, Gainesville, FL 32601, United States
| | - D M Baekey
- Department of Physiological Sciences, University of Florida, Gainesville, FL 32610, United States; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, United States
| | - D D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, United States; McKnight Brain Institute, University of Florida, Gainesville, FL 32601, United States; Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, United States.
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16
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Saand AR, Genuardi MV, DeSensi RS, Ogilvie RP, Patel SR. 0330 Development And Validation Of An Algorithm To Quantify Obstructive Sleep Apnea Severity From The Electronic Medical Record. Sleep 2018. [DOI: 10.1093/sleep/zsy061.329] [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: 11/12/2022] Open
Affiliation(s)
- A R Saand
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - M V Genuardi
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R S DeSensi
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R P Ogilvie
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - S R Patel
- University of Pittsburgh Medical Center, Pittsburgh, PA
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17
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Genuardi MV, Ogilvie RP, Saand A, Magnani JW, Patel SR. 0869 Short Sleep Time Is Associated With Increased Risk Of Incident Atrial Fibrillation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.868] [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: 11/14/2022] Open
Affiliation(s)
- M V Genuardi
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - R P Ogilvie
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - A Saand
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - J W Magnani
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - S R Patel
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
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18
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Genuardi MV, Althouse AD, Sharbaugh MS, Ogilvie RP, Patel SR. 0743 Race, Ethnicity, and Risk Factors Associated With Falling Asleep While Driving. Sleep 2018. [DOI: 10.1093/sleep/zsy061.742] [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: 11/12/2022] Open
Affiliation(s)
- M V Genuardi
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - A D Althouse
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - M S Sharbaugh
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | | | - S R Patel
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
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19
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Cade BE, Lee J, Sofer T, Wang H, Chen H, Gharib SA, Mei H, Ochs-Balcom HM, Patel SR, Saxena R, Shah NA, Zhu X, Gottlieb DJ, Lin X, Redline S. 0018 Whole Genomic Associations of Transcription Factor Networks With Sleep Disordered Breathing Traits in Trans-Omics for Precision Medicine (TOPMed). Sleep 2018. [DOI: 10.1093/sleep/zsy061.017] [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: 11/14/2022] Open
Affiliation(s)
- B E Cade
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - J Lee
- Brigham and Women’s Hospital, Boston, MA
| | - T Sofer
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - H Wang
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - H Chen
- University of Texas Health Science Center, Houston, TX
| | | | - H Mei
- University of Mississippi Medical Center, Jackson, MS
| | | | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
| | - R Saxena
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - N A Shah
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - X Zhu
- Case Western Reserve University, Cleveland, OH
| | - D J Gottlieb
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - X Lin
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - S Redline
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
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20
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Ogilvie RP, Simonelli G, Sotres-Alvarez D, St-Onge M, Mossavar-Rahmani Y, Perreira K, Petrov M, Kim Y, Balkin T, Wallace D, Reid KJ, Daviglus M, Zee PC, Patel SR. 0152 Caffeine Use And Sleep In U.S. Hispanic/Latinos: Findings From HCHS/SOL Sueño Ancillary Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.151] [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)
| | - G Simonelli
- Walter Reed Army Institute of Research, Silver Spring, MD
| | | | | | | | - K Perreira
- University of North Carolina, Chapel Hill, NC
| | - M Petrov
- Arizona State University, Phoenix, AZ
| | - Y Kim
- University of Miami, Miami, FL
| | - T Balkin
- Walter Reed Army Institute of Research, Silver Spring, MD
| | - D Wallace
- University of Miami Miller School of Medicine, Miami, FL
| | - K J Reid
- Northwestern University, Chicago, IL
| | - M Daviglus
- University of Illinois at Chicago, Chicago, IL
| | - P C Zee
- Northwestern University, Chicago, IL
| | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
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21
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George J, Wang L, Nawabit R, Kaffashi F, Walia HK, Punjabi NM, Patel SR, Gottlieb DJ, Quan SF, Loparo K, Redline S, Mehra R. 0444 Impact of CPAP versus Supplemental Oxygen on Cardiac Electophysiological Indices in Obstructive Sleep Apnea: The HeartBEAT study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.443] [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: 11/14/2022] Open
Affiliation(s)
- J George
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - L Wang
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - R Nawabit
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - F Kaffashi
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH
| | - H K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - N M Punjabi
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - S R Patel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D J Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - S F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - K Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH
| | - S Redline
- Department of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - R Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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Kubala AG, Santos EC, Barone Gibbs B, Buysse DJ, Patel SR, Hall MH, Kline CE. 0322 Field-Based Sleep Measurement: Concordance Between Commercial Activity Monitors and an Actigraph. Sleep 2018. [DOI: 10.1093/sleep/zsy061.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A G Kubala
- University of Pittsburgh, Pittsburgh, PA
| | - E C Santos
- University of Pittsburgh, Pittsburgh, PA
| | | | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
| | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
| | - M H Hall
- University of Pittsburgh, Pittsburgh, PA
| | - C E Kline
- University of Pittsburgh, Pittsburgh, PA
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23
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Patel SR, Allen C, Grima MJ, Brownrigg JRW, Patterson BO, Holt PJE, Thompson MM, Karthikesalingam A. A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance. Vasc Endovascular Surg 2017; 51:417-428. [PMID: 28656809 DOI: 10.1177/1538574417712648] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current surveillance protocols after endovascular aneurysm repair (EVAR) are ineffective and costly. Stratifying surveillance by individual risk of reintervention requires an understanding of the factors involved in developing post-EVAR complications. This systematic review assessed risk factors for reintervention after EVAR and proposals for stratified surveillance. METHODS A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting on risk factors predicting reintervention after EVAR and proposals for stratified surveillance. RESULTS Twenty-nine studies reporting on 39 898 patients met the primary inclusion criteria for reporting predictors of reintervention or aortic complications with or without suggestions for stratified surveillance. Five secondary studies described external validation of risk scores for reintervention or aortic complications. There was great heterogeneity in reporting risk factors identified at the pre-EVAR, intraoperative, and post-EVAR stages of treatment, although large preoperative abdominal aortic aneurysm diameter was the most commonly observed risk factor for reintervention after EVAR. CONCLUSION Existing data on predictors of post-EVAR complications are generally of poor quality and largely derived from retrospective studies. Few studies describing suggestions for stratified surveillance have been subjected to external validation. There is a need to refine risk prediction for EVAR failure and to conduct prospective comparative studies of personalized surveillance with standard practice.
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Affiliation(s)
- Shaneel R Patel
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Chris Allen
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Matthew J Grima
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Jack R W Brownrigg
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Benjamin O Patterson
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Peter J E Holt
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Matt M Thompson
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Alan Karthikesalingam
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
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Dudley KA, Johnson DA, Weng J, Wallace DM, Alcantara C, Wallace M, Ramos AR, Mossavar-Rahmani Y, Perreira K, Zee PC, Salazar ZU, Redline S, Reid KJ, Sotres-Alvarez D, Patel SR. 0838 ACCULTURATION AND SLEEP PATTERNS IN U.S. HISPANIC/LATINOS: THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) SUEÑO ANCILLARY STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Streeter KA, Sunshine MD, Patel SR, Liddell SS, Denholtz LE, Reier PJ, Fuller DD, Baekey DM. Coupling multielectrode array recordings with silver labeling of recording sites to study cervical spinal network connectivity. J Neurophysiol 2016; 117:1014-1029. [PMID: 27974450 DOI: 10.1152/jn.00638.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/12/2016] [Indexed: 01/24/2023] Open
Abstract
Midcervical spinal interneurons form a complex and diffuse network and may be involved in modulating phrenic motor output. The intent of the current work was to enable a better understanding of midcervical "network-level" connectivity by pairing the neurophysiological multielectrode array (MEA) data with histological verification of the recording locations. We first developed a method to deliver 100-nA currents to electroplate silver onto and subsequently deposit silver from electrode tips after obtaining midcervical (C3-C5) recordings using an MEA in anesthetized and ventilated adult rats. Spinal tissue was then fixed, harvested, and histologically processed to "develop" the deposited silver. Histological studies verified that the silver deposition method discretely labeled (50-μm resolution) spinal recording locations between laminae IV and X in cervical segments C3-C5. Using correlative techniques, we next tested the hypothesis that midcervical neuronal discharge patterns are temporally linked. Cross-correlation histograms produced few positive peaks (5.3%) in the range of 0-0.4 ms, but 21.4% of neuronal pairs had correlogram peaks with a lag of ≥0.6 ms. These results are consistent with synchronous discharge involving mono- and polysynaptic connections among midcervical neurons. We conclude that there is a high degree of synaptic connectivity in the midcervical spinal cord and that the silver-labeling method can reliably mark metal electrode recording sites and "map" interneuron populations, thereby providing a low-cost and effective tool for use in MEA experiments. We suggest that this method will be useful for further exploration of midcervical network connectivity.NEW & NOTEWORTHY We describe a method that reliably identifies the locations of multielectrode array (MEA) recording sites while preserving the surrounding tissue for immunohistochemistry. To our knowledge, this is the first cost-effective method to identify the anatomic locations of neuronal ensembles recorded with a MEA during acute preparations without the requirement of specialized array electrodes. In addition, evaluation of activity recorded from silver-labeled sites revealed a previously unappreciated degree of connectivity between midcervical interneurons.
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Affiliation(s)
- K A Streeter
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - M D Sunshine
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - S R Patel
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - S S Liddell
- Department of Neuroscience, University of Florida, Gainesville, Florida; and
| | - L E Denholtz
- Department of Neuroscience, University of Florida, Gainesville, Florida; and
| | - P J Reier
- Department of Neuroscience, University of Florida, Gainesville, Florida; and
| | - D D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - D M Baekey
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
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Karthikesalingam A, de Bruin JL, Patel SR, Azhar B, Rossi L, Morgan RA, Holt PJE, Loftus IM, Thompson MM. Appearance of the Nellix endovascular aneurysm sealing system on computed tomography: implications for postoperative imaging surveillance. J Endovasc Ther 2016; 22:297-302. [PMID: 25991765 DOI: 10.1177/1526602815583455] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the imaging characteristics of the Nellix Endovascular Aneurysm Sealing (EVAS) System on serial computed tomography (CT) surveillance. METHODS Sixty-eight patients undergoing EVAS were enrolled in a surveillance protocol that included CT scans prior to hospital discharge and at 3, 6, and 9 months postoperatively. Images were analyzed for the presence of gas within the endobag, endoleak, and for maximum radiodensity measured in Hounsfield units (HU) within the uppermost, middle, and lowermost regions of each endobag. RESULTS Gas was seen within the endobags of all 68 EVAS repairs at the first postoperative CT compared with 2 (5.6%) of 36 undergoing the 3-month scan. The endobags appeared radiodense during initial imaging, and the median (interquartile range) radiodensity of the Nellix polymer decreased from 158.3 HU (149.5; 169.5) at the postoperative CT to 81.0 HU (74.0; 88.0) at 3 months, excluding 3 cases in which contrast pre-fill was utilized. Type I endoleak was seen at the periphery of the aneurysm sac or in the cleft between the endobags, with a substantially different appearance to endoleak after endovascular aneurysm repair. CONCLUSION The evolution of CT appearances after EVAS was characteristic and predictable. The device endobags were initially radiodense, which may impact the detection of endoleak within 3 months of EVAS. Endoleaks after EVAS were seen in a different anatomical area to endoleaks after conventional stent-graft repair.
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Affiliation(s)
- Alan Karthikesalingam
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jorg L de Bruin
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Shaneel R Patel
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bilal Azhar
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Luca Rossi
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Milan, Italy
| | - Robert A Morgan
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter J E Holt
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ian M Loftus
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Matthew M Thompson
- Department of Outcomes Research, St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
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28
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Azhar B, Patel SR, Holt PJE, Hinchliffe RJ, Thompson MM, Karthikesalingam A. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. J Endovasc Ther 2015; 21:568-75. [PMID: 25101588 DOI: 10.1583/13-4626mr.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses. METHODS A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990. RESULTS Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively. CONCLUSION The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
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Affiliation(s)
- Bilal Azhar
- Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK
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29
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Patel SR, Hughes CO, Jones KG, Holt PJE, Thompson MM, Hinchliffe RJ, Karthikesalingam A. A Systematic Review and Meta-analysis of Endovascular Popliteal Aneurysm Repair Using the Hemobahn/Viabahn Stent-Graft. J Endovasc Ther 2015; 22:330-7. [DOI: 10.1177/1526602815579252] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To perform an evidence synthesis study to assess outcomes of endovascular repair of popliteal artery aneurysms (PAAs) using the Hemobahn or Viabahn stent-graft. Methods: A systematic literature review was conducted conforming to established standards to identify articles published between 1996 (the date of introduction of the Hemobahn stent-graft) and 2013 reporting stent-graft repair of PAAs in at least 10 patients. The data were pooled for Kaplan-Meier analysis of primary and secondary patency rates [presented with 95% confidence intervals (CIs)] as the primary outcomes. Random effects meta-analysis was performed for secondary outcomes that included rates of reintervention, endoleak, stent-graft fracture, and limb salvage. Results: Fourteen studies reported outcomes for 514 PAAs. There was considerable heterogeneity in reporting standards among studies. Pooled primary and secondary patency rates were 69.4% (95% CI 63.3% to 76.2%) and 77.4% (95% CI 70.1% to 85.3%), respectively, at 5 years. Five studies (including only one randomized controlled trial) compared surgical to endovascular repair; no difference was found in primary patency on evidence synthesis (hazard ratio 1.30, 95% CI 0.79 to 12.14, p=0.189). Conclusion: Stent-graft repair provides a feasible treatment option for anatomically suitable PAAs. Further studies are required to optimize both patient selection and follow-up protocols.
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Affiliation(s)
- Shaneel R. Patel
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Cían O. Hughes
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Keith G. Jones
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Peter J. E. Holt
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
| | - Matt M. Thompson
- Department of Outcomes Research, St George’s Vascular Institute, London, UK
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Affiliation(s)
| | - Ashok Handa
- Nuffield Department of Surgery, University of Oxford, UK
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Karthikesalingam A, Bahia SS, Patel SR, Azhar B, Jackson D, Cresswell L, Hinchliffe RJ, Holt PJ, Thompson MM. A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair. Kidney Int 2015; 87:442-51. [PMID: 25140912 PMCID: PMC5590709 DOI: 10.1038/ki.2014.272] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 06/08/2014] [Accepted: 06/13/2014] [Indexed: 01/20/2023]
Abstract
Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVRs). The etiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarize incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. Here a systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random-effects meta-analyses were performed to estimate pooled postoperative changes in serum creatinine and creatinine clearance at four time points after EVR. Clinically relevant deterioration in renal function was also estimated at 1 year or more after EVR. Pooled probability of clinically relevant deterioration in renal function at 1 year or more was 18% (95% confidence interval of 14-23%, I2 of 82.5%). Serum creatinine increased after EVR by 0.05 mg/dl at 30 days/1 month, 0.09 mg/dl at 1 month to 1 year, and 0.11 mg/dl at 1 year or more (all significant). Creatinine clearance decreased after EVR by 5.65 ml/min at 1 month-1 year and by 6.58 ml/min at 1 year or more (both significant). Thus, renal dysfunction after EVR is common and merits attention.
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Affiliation(s)
- Alan Karthikesalingam
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Sandeep S. Bahia
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Shaneel R. Patel
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Bilal Azhar
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Dan Jackson
- MRC Biostatistics Unit, University of Cambridge, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR
| | - Lynne Cresswell
- MRC Biostatistics Unit, University of Cambridge, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR
| | - Robert J. Hinchliffe
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Peter J.E. Holt
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Matt M. Thompson
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
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Abstract
BACKGROUND/AIMS To investigate the effect of increased CO2 levels on flicker defined stimuli. METHODS The sensitivity of two flicker defined tasks was measured in nine healthy, trained observers using the Flicker Defined Form (FDF) stimulus of the Heidelberg Edge Perimeter (HEP; Heidelberg Engineering) and Frequency Doubling Technology (FDT) stimulus of the Matrix perimeter (Carl Zeiss Meditec) during normoxia and 15% hypercapnia (end-tidal CO2 increased by 15% relative to baseline). HEP-FDF and Matrix-FDT sensitivities were analysed for the global field, superior and inferior hemifields and at specific matched eccentricities, using repeated measures analysis of variance. The main effect of hypercapnia on flicker sensitivity was analysed using regression models. RESULTS Higher flicker sensitivity outcomes with increasing CO2 values were found for HEP-FDF and Matrix-FDT with a statistically significant main effect for HEP-FDF global, superior and inferior hemifields (p<0.01 for all) as well as 6°, 18°, 12° and 24° eccentricities (p=0.03, 0.04, 0.01, 0.05, respectively). When comparing mean sensitivity values between normocapnia and hypercapnia conditions, no statistically significantly different results were found for HEP-FDF and Matrix-FDT (p>0.05). CONCLUSIONS As CO2 levels were increased in healthy young individuals, there was an associated increase in visual sensitivity that was only significant for HEP-FDF stimuli, highlighting the different mechanisms involved in processing each of HEP-FDF and Matrix-FDT stimuli. Mean visual sensitivity outcomes were found to be similar for normocapnia and hypercapnia suggesting that a capability to compensate for a mild and stable increase in systemic CO2 levels may exist.
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Affiliation(s)
- A M Shahidi
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | - C Hudson
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - S R Patel
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J G Flanagan
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Patel SR, Smith K, Letley DP, Cook KW, Memon AA, Ingram RJM, Staples E, Backert S, Zaitoun AM, Atherton JC, Robinson K. Helicobacter pylori downregulates expression of human β-defensin 1 in the gastric mucosa in a type IV secretion-dependent fashion. Cell Microbiol 2013; 15:2080-92. [PMID: 23870035 PMCID: PMC4028989 DOI: 10.1111/cmi.12174] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 05/23/2013] [Accepted: 07/15/2013] [Indexed: 02/06/2023]
Abstract
Helicobacter pylori establishes a chronic lifelong infection in the human gastric mucosa, which may lead to peptic ulcer disease or gastric adenocarcinoma. The human beta-defensins (hβDs) are antimicrobial peptides, hβD1 being constitutively expressed in the human stomach. We hypothesized that H. pylori may persist, in part, by downregulating gastric hβD1 expression. We measured hβD1 and hβD2 expression in vivo in relation to the presence, density and severity of H. pylori infection, investigated differential effects of H. pylori virulence factors, and studied underlying signalling mechanisms in vitro. Significantly lower hβD1 and higher hβD2 mRNA and protein concentrations were present in gastric biopsies from infected patients. Those patients with higher-level bacterial colonization and inflammation had significantly lower hβD1 expression, but there were no differences in hβD2. H. pylori infection of human gastric epithelial cell lines also downregulated hβD1. Using wild-type strains and isogenic mutants, we showed that a functionalcag pathogenicity island-encoded type IV secretion system induced this downregulation. Treatment with chemical inhibitors or siRNA revealed that H. pylori usurped NF-κB signalling to modulate hβD1 expression. These data indicate that H. pylori downregulates hβD1 expression via NF-κB signalling, and suggest that this may promote bacterial survival and persistence in the gastric niche.
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Affiliation(s)
- S R Patel
- Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, NG7 2RD, UK; Centre for Biomolecular Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
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Patel SR, Mason J, Hakim N. The Duodenal-Jejunal Bypass Sleeve (EndoBarrier Gastrointestinal Liner) for Weight Loss and Treatment of Type II Diabetes. Indian J Surg 2013; 74:275-7. [PMID: 23904712 DOI: 10.1007/s12262-012-0721-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shaneel R Patel
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
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Jajda HM, Patel KG, Patel SR, Solanki VH, Patel KN, Singh S. Comparative efficacy of two standard methods for determination of iron and zinc in fruits, pulses and cereals. J Food Sci Technol 2013; 52:1096-102. [PMID: 25694724 DOI: 10.1007/s13197-013-1088-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
Abstract
Micronutrients are essential elements needed in small amounts for adequate human nutrition and include the elements iron and zinc. Both of these minerals are essential to human well-being and an adequate supply of iron and zinc help to prevent iron deficiency anaemia and zinc deficiency, two prevalent health concerns of the developing world. The levels of zinc and, iron were measured in the Banana, Papaya, Rice, Finger millet, Soybean and Urdbean. Standard Atomic absorption spectroscopy (AAS) method was also applied to all the samples for zinc and iron analysis and compared with inductively coupled plasma mass spectroscopy (ICP-MS). It was observed that there was no matrix interference affecting the determination of both elements interested in all the samples analyzed. Average concentration relative standard deviation and standard deviation were used for the statistical evaluation of the results for both elements. Correlation coefficient was used as statistical model to compare both the techniques.
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Affiliation(s)
- H M Jajda
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
| | - K G Patel
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
| | - S R Patel
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
| | - V H Solanki
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
| | - K N Patel
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
| | - Susheel Singh
- Food Quality Testing Laboratory, Navsari Agricultural University, Navsari, 396450 India
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Abstract
Pancreatic transplant effectively cures type 1 diabetes mellitus and maintains consistent long-term euglycemia. However, technical failure, and in particular graft thrombosis, accounts for the vast majority of transplants lost in the early postoperative period. The pancreas' inherently low microvascular flow state makes it vulnerable to vascular complications, as does the hypercoagulable blood of diabetic patients. Ultimately, the phenomenon is most definitely multifactorial. Prevention, as opposed to treatment, is key and should focus on reducing these multiple risk factors. This will involve tactical donor selection, optimal surgical technique and some form of anticoagulation. Close monitoring and early intervention will be crucial when treating thrombosis once preventative methods have failed. This may be achieved by further anticoagulation, graft salvage, or pancreatectomy with retransplant. This article will explore the multiple factors contributing to graft thrombus formation and the ways in which they may be addressed to firstly prevent, or more likely, reduce thrombosis. Secondly, we will consider the management strategies which can be implemented once thrombosis has occurred.
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Affiliation(s)
- Shaneel R Patel
- The West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom
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Patel SR, Gohel MS, Hamady M, Albayati MA, Riga CV, Cheshire NJW, Bicknell CD. Reducing errors in combined open/endovascular arterial procedures: influence of a structured mental rehearsal before the endovascular phase. J Endovasc Ther 2012; 19:383-9. [PMID: 22788891 DOI: 10.1583/11-3785r.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the incidence of errors before and after implementation of a structured mental rehearsal prior to the endovascular phase of combined open/endovascular arterial procedures. METHODS Over 6 weeks, 15 combined open/endovascular procedures (7 abdominal aorta and 8 thoracic aorta) lasting 58 hours were evaluated by a trained observer. In a blinded fashion, 2 individuals scrutinized event logs for errors, which were categorized by type, by potential to cause patient harm (danger), and by potential to disrupt the procedure (delay). After 9 procedures, a focus group-devised structured mental rehearsal was implemented prior to the endovascular phase for 6 combined procedures. Error patterns were compared before and after implementation. Data are expressed as median (range). RESULTS The error rate during the endovascular phase of the combined procedures was higher than the non-endovascular phase [7.64/hour (1.71-9.6) vs. 3.75/hour (1.71-5.54), respectively; p = 0.05]. Error rates during the endovascular phase were lower after the intervention compared to before [2.5/hour (1.4-6.0) vs. 7.6/hour (1.7-9.6), respectively; p = 0.05]. During the endovascular phase, danger and delay scores were also lower after the intervention [1.2/error (1.0-2.0) and 1.3/error (1.0-2.3), respectively] compared to before [1.75/error (1.4-2.5) and 2.0/error (1.3-2.5), respectively] (p = 0.036 and p = 0.036 for danger and delay, respectively). CONCLUSION A structured mental rehearsal before critical stages of procedures may reduce the rate and severity of intraoperative error.
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Affiliation(s)
- Shaneel R Patel
- Department of Surgery and Cancer, Imperial College London, UK
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Patel SR, Heitmar R. Response to Chittari et al. Impact of acute hyperglycaemia on endothelial function and retinal vascular reactivity in patients with Type 2 diabetes. Diabet Med 2012; 29:156-7. [PMID: 21992529 DOI: 10.1111/j.1464-5491.2011.03486.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Purpose. Patients with soft tissue sarcoma (STS) who have previously received standard chemotherapy including adriamycin (doxorubicin), ifosfamide, cyclophosphamide and DTIC (dacarbazine) have very limited therapeutic options. It is important to identify new drugs with some activity in this disease and we therefore undertook this trial to determine the antitumor activity of paclitaxel (Taxol).Methods. We conducted a phase II study of paclitaxel in patients with STS who had received prior standard chemotherapy. Paclitaxel was administered at a starting dose of 200 mg m(-2) as a 24-h infusion with STS premedication, every 21 days or upon hematologic recovery (absolute granulocyte count (AGC) >/= 1500/mul, platelets >/= 100 000/mul). Neupogen was not used routinely. The study was conducted based on a two-stage design proposed by Simon. Responses were assessed radiographically using standard criteria.Results. Nineteen eligible patients were treated in the first stage of the study. The median age was 50 years (range 20-68 years), and there were nine females and 10 males with Zubrod performance status of 1 or 2. One patient achieved a minor response. Median AGC nadir was 0.1/mul on day 12 with absolute neutropenia lasting 5 days. Median platelet nadir was 171 000/mul on day 9. There were no grade 3/4 non-hematologic toxicities and no deaths related to treatment.Discussion. Paclitaxel, at this dose and schedule, is well tolerated but inactive in this patient population.
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Affiliation(s)
- S R Patel
- Department of Melanoma/Sarcoma Medical Oncology MD Anderson Cancer Center University of Texas PO Box 77, 1515 Holcombe Blvd Houston TX 77030 USA
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Albayati MA, Gohel MS, Patel SR, Riga CV, Cheshire NJW, Bicknell CD. Identification of patient safety improvement targets in successful vascular and endovascular procedures: analysis of 251 hours of complex arterial surgery. Eur J Vasc Endovasc Surg 2011; 41:795-802. [PMID: 21320788 DOI: 10.1016/j.ejvs.2011.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 01/25/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate failures in patient safety for patients undergoing vascular and endovascular procedures to guide future quality and safety interventions. DESIGN Single centre prospective observational study. METHODS 66 procedures (17 thoracoabdominal and 23 abdominal aortic aneurysms, 4 carotid and 22 limb procedures) were observed prospectively over a 9-month period (251 h operating time) by two trained observers. Event logs were recorded for each procedure. Two blinded experts identified and independently categorised failures into 22 types (using a validated category tool) and severity (5-point scale). Data are expressed as median (range). Statistical analysis was performed using Mann-Whitney U, Kruskal-Wallis and Spearman's Rank tests. RESULTS 1145 failures were identified with good inter-assessor reliability (Cronbach's alpha 0.844). The commonest failure types related to equipment (including unavailability, configuration and other failures) (269/1145 [23.5%]) and communication (240/1145 [21.0%]). A comparatively lower number of technical and psychomotor failures were identified (103 [9.0%]). The number of failures correlated with procedure duration (rho = 0.695, p < 0.001) but not anatomical site of the procedure or pathology of the disease process. Failure rate was higher in patients undergoing combined surgical/endovascular procedures compared to open surgery (median 5.7/h [IQR 4.2-8.1] vs 3.0/h [2.5-3.5]; p < 0.001). The severity of failures was similar (1.5/5 [1-2] vs 1/5 [1-2] respectively; p = 0.095). For combined procedures, failure rates were significantly higher during the endovascular phase (9.6/h [7.5-13.7]) compared to the non-endovascular phase (3.0/h [1.0-5.0]; p < 0.001). CONCLUSIONS Failures in patient safety are common during complex arterial procedures. Few failures were severe, although minor failures during critical stages and accumulation of multiple minor failures may potentially be important. Failures occurred especially during the endovascular phase and were often related to equipment or communication aspects. Interventions to improve procedural safety and quality of care should primarily target these specific areas.
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Affiliation(s)
- M A Albayati
- Department of Surgery and Cancer, Imperial College London, United Kingdom
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Singh A, Mavalankar DV, Bhat R, Desai A, Patel SR, Singh PV, Singh N. Providing skilled birth attendants and emergency obstetric care to the poor through partnership with private sector obstetricians in Gujarat, India. Bull World Health Organ 2010; 87:960-4. [PMID: 20454488 DOI: 10.2471/blt.08.060228] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 04/06/2009] [Accepted: 04/07/2009] [Indexed: 11/27/2022] Open
Abstract
PROBLEM India has the world's largest number of maternal deaths estimated at 117,000 per year. Past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level. APPROACH We have documented an innovative public-private partnership scheme between the Government of Gujarat, in India, and private obstetricians practising in rural areas to provide delivery care to poor women. LOCAL SETTING In April 2007, the majority of poor women delivered their babies at home without skilled care. RELEVANT CHANGES More than 800 obstetricians joined the scheme and more than 176,000 poor women delivered in private facilities. We estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between April and October 2007. The programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor. LESSONS LEARNED At least in some areas of India, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. Poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.
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Voora D, Koboldt DC, King CR, Lenzini PA, Eby CS, Porche-Sorbet R, Deych E, Crankshaw M, Milligan PE, McLeod HL, Patel SR, Cavallari LH, Ridker PM, Grice GR, Miller RD, Gage BF. A polymorphism in the VKORC1 regulator calumenin predicts higher warfarin dose requirements in African Americans. Clin Pharmacol Ther 2010; 87:445-51. [PMID: 20200517 DOI: 10.1038/clpt.2009.291] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Warfarin demonstrates a wide interindividual variability in response that is mediated partly by variants in cytochrome P450 2C9 (CYP2C9) and vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1). It is not known whether variants in calumenin (CALU) (vitamin K reductase regulator) have an influence on warfarin dose requirements. We resequenced CALU regions in a discovery cohort of dose outliers: patients with high (>90th percentile, n = 55) or low (<10th percentile, n = 53) warfarin dose requirements (after accounting for known genetic and nongenetic variables). One CALU variant, rs339097, was associated with high doses (P = 0.01). We validated this variant as a predictor of higher warfarin doses in two replication cohorts: (i) 496 patients of mixed ethnicity and (ii) 194 African-American patients. The G allele of rs339097 (the allele frequency was 0.14 in African Americans and 0.002 in Caucasians) was associated with the requirement for a 14.5% (SD +/- 7%) higher therapeutic dose (P = 0.03) in the first replication cohort and a higher-than-predicted dose in the second replication cohort (allele frequency 0.14, one-sided P = 0.03). CALU rs339097 A>G is associated with higher warfarin dose requirements, independent of known genetic and nongenetic predictors of warfarin dose in African Americans.
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Affiliation(s)
- D Voora
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Cavallari LH, Langaee TY, Momary KM, Shapiro NL, Nutescu EA, Coty WA, Viana MAG, Patel SR, Johnson JA. Genetic and clinical predictors of warfarin dose requirements in African Americans. Clin Pharmacol Ther 2010; 87:459-64. [PMID: 20072124 DOI: 10.1038/clpt.2009.223] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The objective of this study was to determine whether, in African-American patients, additional vitamin K oxidoreductase complex subunit 1 (VKORC1), cytochrome P450 2C9 (CYP2C9), CYP4F2, or apolipoprotein E (APOE) polymorphisms contribute to variability in the warfarin maintenance dose beyond what is attributable to the CYP2C9*2 and *3 alleles and the VKORC1 -1639G>A genotype. In a cohort of 226 African-American patients, weekly warfarin dose requirements were lower in those with the CYP2C9*8 allele (34 (30-47) mg; P = 0.023) and the CYP2C9 *2, *3, *5, *6, or *11 allele (33(28-40 mg); P < 0.001) as compared with those with the CYP2C9*1/*1 genotype (43 (35-56) mg). The combination of CYP2C9 alleles, VKORC1 -1639G>A genotype, and clinical variables explained 36% of the interpatient variability in warfarin dose requirements. By comparison, a model without the CYP2C9*5, *6, *8, and *11 alleles explained 30% of the variability in dose. No other VKORC1, CYP4F2, or APOE polymorphism contributed to the variance. The inclusion of additional CYP2C9 variants may improve the predictive ability of warfarin dosing algorithms for African Americans.
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Affiliation(s)
- L H Cavallari
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA.
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Abstract
Poor sleep has increasingly gained attention as a potential contributor to the recent obesity epidemic. The increased prevalence of obesity in Western nations over the past half-century has been paralleled by a severe reduction in sleep duration. Physiological studies suggest reduced sleep may impact hormonal regulation of appetite. Prospective studies suggest reduced habitual sleep duration as assessed by self-report is an independent risk factor for an increased rate of weight gain and incident obesity. Cross-sectional studies have demonstrated that the association between reduced sleep and obesity persists when sleep habits are measured objectively, that the association is as a result of elevations in fat and not muscle mass and that this association is not related to sleep apnoea. Thus, reduced sleep appears to represent a novel, independent risk factor for increased weight gain. Further research is needed to determine whether interventions aimed at increasing sleep may be useful in combating obesity.
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Affiliation(s)
- S R Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Larkin EK, Patel SR, Elston RC, Gray-McGuire C, Zhu X, Redline S. Using linkage analysis to identify quantitative trait loci for sleep apnea in relationship to body mass index. Ann Hum Genet 2008; 72:762-73. [PMID: 18754839 DOI: 10.1111/j.1469-1809.2008.00472.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To understand the genetics of sleep apnea, we evaluated the relationship between the apnea hypopnea index (AHI) and body mass index (BMI) through linkage analysis to identify genetic loci that may influence AHI and BMI jointly and AHI independent of BMI. Haseman-Elston sibling regression was conducted on AHI, AHI adjusted for BMI and BMI in African-American and European-American pedigrees. A comparison of the magnitude of linkage peaks was used to assess the relationship between AHI and BMI. In EAs, the strongest evidence for linkage to AHI was on 6q23-25 and 10q24-q25, both decreasing after BMI adjustment, suggesting loci with pleiotropic effects. Also, a promising area of linkage to AHI but not BMI was observed on 6p11-q11 near the orexin-2 receptor, suggesting BMI independent pathways. In AAs the strongest evidence of linkage for AHI after adjusting for BMI was on chromosome 8p21.3 with linkage increasing after BMI adjustment and on 8q24.1 with linkage decreasing after BMI adjustment. Novel linkage peaks were also observed in AAs to both BMI and AHI on chromosome 13 near the serotonin-2a receptor. These analyses suggest genetic loci for sleep apnea that operate both independently of BMI and through BMI-related pathways.
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Affiliation(s)
- E K Larkin
- Center for Clinical Investigation, Case Western Reserve University, School of Medicine, Cleveland, OH 44106-6083, USA.
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Abstract
Acoustic pharyngometry represents a simple, quick noninvasive method of measuring upper airway dimensions, which are predictive of sleep apnoea risk. The aim of the present study was to assess the genetic basis of upper airway size as determined using pharyngometry. Participants in the Cleveland Family Study aged >14 yrs underwent three acoustic pharyngometric measurements. Variance component models adjusted for age and sex were used to estimate the heritability of pharyngometry-derived airway measures. A total of 568 out of 655 (87%) subjects provided pharyngometric curves of sufficient quality. Although African-Americans tended to show narrower airways compared with white subjects, heritability patterns were similar in these two groups. The minimum cross-sectional area exhibited a heritability of 0.34 in white subjects and 0.39 in African-Americans, suggesting that 30-40% of the total variance in this measure is explained by shared familial factors. Estimates were unchanged after adjustment for body mass index or neck circumference. In contrast, oropharyngeal length did not show significant heritability in either ethnic group. The minimum cross-sectional area of the oropharynx is a highly heritable trait, suggesting the presence of an underlying genetic basis. These findings demonstrate the potential utility of acoustic pharyngometry in dissecting the genetic basis of sleep apnoea.
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Affiliation(s)
- S R Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA.
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Affiliation(s)
| | | | - Ramesh Bhat
- Indian Institute of Management, Vastrapur, Ahmedabad, 380015 India
| | | | - S R Patel
- Indian Institute of Management, Vastrapur, Ahmedabad, 380015 India
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Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, Wellman A, Schory K, Dover L, White DP. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax 2006; 61:435-9. [PMID: 16490766 PMCID: PMC2111199 DOI: 10.1136/thx.2005.052084] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have shown that changes in lung volume influence upper airway size and resistance, particularly in patients with obstructive sleep apnoea (OSA), and that continuous positive airway pressure (CPAP) requirements decrease when the lung volume is increased. We sought to determine the effect of a constant lung volume increase on sleep disordered breathing during non-REM sleep. METHODS Twelve subjects with OSA were studied during non-REM sleep in a rigid head-out shell equipped with a positive/negative pressure attachment for manipulation of extrathoracic pressure. The increase in lung volume due to CPAP (at a therapeutic level) was determined with four magnetometer coils placed on the chest wall and abdomen. CPAP was then stopped and the subjects were studied for 1 hour in three conditions (in random order): (1) no treatment (baseline); (2) at "CPAP lung volume", with the increased lung volume being reproduced by negative extrathoracic pressure alone (lung volume 1, LV1); and (3) 500 ml above the CPAP lung volume(lung volume 2, LV2). RESULTS The mean (SE) apnoea/hypopnoea index (AHI) for baseline, LV1, and LV2, respectively, was 62.3 (10.2), 37.2 (5.0), and 31.2 (6.7) events per hour (p = 0.009); the 3% oxygen desaturation index was 43.0 (10.1), 16.1 (5.4), and 12.3 (5.3) events per hour (p = 0.002); and the mean oxygen saturation was 95.4 (0.3)%, 96.0 (0.2)%, 96.3 (0.3)%, respectively (p = 0.001). CONCLUSION An increase in lung volume causes a substantial decrease in sleep disordered breathing in patients with OSA during non-REM sleep.
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Affiliation(s)
- R C Heinzer
- Sleep Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Patel SR, Desai KK. Study of ground water quality for irrigation in some villages of Surat District, Gujarat (India). J Environ Sci Eng 2005; 47:304-9. [PMID: 17051917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
40 ground water samples of 10 villages in Surat district, Gujarat (India) were analyzed for their suitability for irrigation purpose. The mean values of 4 samples taken from each village have been reported in the present study. Ground water of the study area was classified according to sodium adsorption ratio (SAR), percentage sodium (PS), residual sodium carbonate (RSC), Kelley's ratio and electrical conductivity. The value of sodium adsorption ratio indicated that majority of samples (9 out of 10) fall in low sodium hazard category. As per classification made by Wilcox (1948), on the basis of percentage sodium and electrical conductivity, only 1 sample (Vesu) not found suitable for irrigation purpose while only 1 sample (Gaviyar) found in good category. The remaining 8 samples were in good to permissible and permissible to doubtful category. Ground water was also classified according to the classification of United States Salinity Laboratory based on sodium and salinity hazard.
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Affiliation(s)
- S R Patel
- Department of Chemistry, VNSG University, Surat, India
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