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Basan F, Fischer JG, Putland R, Brinkkemper J, de Jong CAF, Binnerts B, Norro A, Kühnel D, Ødegaard LA, Andersson M, Lalander E, Tougaard J, Griffiths ET, Kosecka M, Edwards E, Merchant ND, de Jong K, Robinson S, Wang L, Kinneging N. The underwater soundscape of the North Sea. Mar Pollut Bull 2024; 198:115891. [PMID: 38101054 DOI: 10.1016/j.marpolbul.2023.115891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
As awareness on the impact of anthropogenic underwater noise on marine life grows, underwater noise measurement programs are needed to determine the current status of marine areas and monitor long-term trends. The Joint Monitoring Programme for Ambient Noise in the North Sea (JOMOPANS) collaborative project was funded by the EU Interreg to collect a unique dataset of underwater noise levels at 19 sites across the North Sea, spanning many different countries and covering the period from 2019 to 2020. The ambient noise from this dataset has been characterised and compared - setting a benchmark for future measurements in the North Sea area. By identifying clusters with similar sound characteristics in three broadband frequency bands (25-160 Hz, 0.2-1.6 kHz, and 2-10 kHz), geographical areas that are similarly affected by sound have been identified. The measured underwater sound levels show a persistent and spatially uniform correlation with wind speed at high frequencies (above 1 kHz) and a correlation with the distance from ships at mid and high frequencies (between 40 Hz and 4 kHz). Correlation with ocean current velocity at low frequencies (up to 200 Hz), which are susceptible to nonacoustic contamination by flow noise, was also evaluated. These correlations were evaluated and simplified linear scaling laws for wind and current speeds were derived. The presented dataset provides a baseline for underwater noise measurements in the North Sea and shows that spatial variability of the dominant sound sources must be considered to predict the impact of noise reduction measures.
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Affiliation(s)
- F Basan
- Federal Maritime and Hydrographic Agency (BSH), Germany.
| | - J-G Fischer
- Federal Maritime and Hydrographic Agency (BSH), Germany
| | - R Putland
- Centre for Environment, Fisheries & Aquaculture Science (CEFAS), United Kingdom
| | - J Brinkkemper
- WaterProof Marine Consultancy & Services B.V., Netherlands
| | - C A F de Jong
- Netherlands Organization for Applied Scientific Research (TNO), Netherlands
| | - B Binnerts
- Netherlands Organization for Applied Scientific Research (TNO), Netherlands
| | - A Norro
- Royal Belgian Institute of Natural Sciences (RBINS), Belgium
| | - D Kühnel
- Federal Maritime and Hydrographic Agency (BSH), Germany
| | - L-A Ødegaard
- Norwegian Defence Research Establishment (FFI), Norway
| | - M Andersson
- Swedish Defence Research Agency (FOI), Sweden
| | - E Lalander
- Swedish Defence Research Agency (FOI), Sweden
| | - J Tougaard
- Aarhus University (AU), Department of Ecoscience, Denmark
| | - E T Griffiths
- Aarhus University (AU), Department of Ecoscience, Denmark
| | - M Kosecka
- Marine Scotland (MS), United Kingdom
| | - E Edwards
- Marine Scotland (MS), United Kingdom
| | - N D Merchant
- Centre for Environment, Fisheries & Aquaculture Science (CEFAS), United Kingdom
| | - K de Jong
- Institute of Marine Research (IMR), Norway
| | - S Robinson
- National Physical Laboratory (NPL), United Kingdom
| | - L Wang
- National Physical Laboratory (NPL), United Kingdom
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Mair BA, Zelt JGE, Nekesa K, Saint-Georges Z, Dinelle K, Adi M, Robinson S, Mielniczuk LM, Shlik J, Beanlands RS, deKemp RA, Rotstein BH. Pharmacological and metabolic parameters of [ 18F]flubrobenguane in clinical imaging populations. J Nucl Cardiol 2023; 30:2089-2095. [PMID: 37495763 DOI: 10.1007/s12350-023-03338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Cardiac sympathetic nervous system molecular imaging has demonstrated prognostic value. Compared with meta-[11C]hydroxyephedrine, [18F]flubrobenguane (FBBG) facilitates reliable estimation of SNS innervation using similar analytical methods and possesses a more convenient physical half-life. The aim of this study was to evaluate pharmacokinetic and metabolic properties of FBBG in target clinical cohorts. METHODS Blood sampling was performed on 20 participants concurrent to FBBG PET imaging (healthy = NORM, non-ischemic cardiomyopathy = NICM, ischemic cardiomyopathy = ICM, post-traumatic stress disorder = PTSD). Image-derived blood time-activity curves were transformed to plasma input functions using cohort-specific corrections for plasma protein binding, plasma-to-whole blood distribution, and metabolism. RESULTS The plasma-to-whole blood ratio was 0.78 ± 0.06 for NORM, 0.64 ± 0.06 for PTSD and 0.60 ± 0.14 for (N)ICM after 20 minutes. 22 ± 4% of FBBG was bound to plasma proteins. Metabolism of FBBG in (N)ICM was delayed, with a parent fraction of 0.71 ± 0.05 at 10 minutes post-injection compared to 0.53 ± 0.03 for PTSD/NORM. While there were variations in metabolic rate, metabolite-corrected plasma input functions were similar across all cohorts. CONCLUSIONS Rapid plasma clearance of FBBG limits the impact of disease-specific corrections of the blood input function for tracer kinetic modeling.
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Affiliation(s)
- Braeden A Mair
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Jason G E Zelt
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Kirabo Nekesa
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Zacharie Saint-Georges
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- The University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Canada
| | - Katie Dinelle
- The University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Canada
| | - Myriam Adi
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | | | - Lisa M Mielniczuk
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Jakov Shlik
- The University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Rob S Beanlands
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Benjamin H Rotstein
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Canada.
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada.
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Nepozitek J, Varga Z, Dostalova S, Perinova P, Keller J, Robinson S, Ibarburu V, Prihodova I, Bezdicek O, Ruzicka E, Sonka K, Dusek P. Magnetic susceptibility changes in the brainstem reflect REM sleep without atonia severity in isolated REM sleep behavior disorder. NPJ Parkinsons Dis 2023; 9:112. [PMID: 37452075 PMCID: PMC10349141 DOI: 10.1038/s41531-023-00557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
REM sleep without atonia (RWA) is the hallmark of isolated REM sleep behavior disorder (iRBD) and is caused by neurodegeneration of brainstem structures. Previously, quantitative susceptibility mapping (QSM) was shown to detect microstructural tissue changes in neurodegenerative diseases. The goal of the study was to compare brainstem magnetic susceptibility (MS) in iRBD and controls using the voxel-based QSM approach and to examine the association between brainstem MS and severity of RWA in iRBD. Sixty iRBD patients and 41 healthy controls were included in the study. Phasic, tonic, mixed RWA and SINBAR score was quantified. QSM maps were reconstructed with QSMbox software from a multi-gradient-echo sequence acquired at 3T MRI system and normalized using a custom T1 template. Voxel-based analysis with age and gender as covariates was performed using a two-sample t-test model for between-group comparison and using a linear regression model for association with the RWA parameters. Statistical maps were generated using threshold free cluster enhancement with p-value p < 0.05, corrected for family wise error. Compared to controls, the iRBD group had higher MS in bilateral substantia nigra (SN), red nucleus and the ventral tegmental area. MS positively correlated with iRBD duration in the right pedunculotegmental nucleus and white matter of caudal mesencephalic and pontine tegmentum and with phasic RWA in bilateral SN. QSM was able to detect MS abnormalities in several brainstem structures in iRBD. Association of MS levels in the brainstem with the intensity of RWA suggests that increased iron content in SN is related to RWA severity.
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Affiliation(s)
- Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Zsoka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Simona Dostalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavla Perinova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Keller
- Radiodiagnostic Department, Na Homolce Hospital, Prague, Czech Republic
| | - Simon Robinson
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Veronika Ibarburu
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iva Prihodova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Bilgic B, Costagli M, Chan KS, Duyn J, Langkammer C, Lee J, Li X, Liu C, Marques JP, Milovic C, Robinson S, Schweser F, Shmueli K, Spincemaille P, Straub S, van Zijl P, Wang Y. Recommended Implementation of Quantitative Susceptibility Mapping for Clinical Research in The Brain: A Consensus of the ISMRM Electro-Magnetic Tissue Properties Study Group. ArXiv 2023:arXiv:2307.02306v1. [PMID: 37461418 PMCID: PMC10350101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This article provides recommendations for implementing quantitative susceptibility mapping (QSM) for clinical brain research. It is a consensus of the ISMRM Electro-Magnetic Tissue Properties Study Group. While QSM technical development continues to advance rapidly, the current QSM methods have been demonstrated to be repeatable and reproducible for generating quantitative tissue magnetic susceptibility maps in the brain. However, the many QSM approaches available give rise to the need in the neuroimaging community for guidelines on implementation. This article describes relevant considerations and provides specific implementation recommendations for all steps in QSM data acquisition, processing, analysis, and presentation in scientific publications. We recommend that data be acquired using a monopolar 3D multi-echo GRE sequence, that phase images be saved and exported in DICOM format and unwrapped using an exact unwrapping approach. Multi-echo images should be combined before background removal, and a brain mask created using a brain extraction tool with the incorporation of phase-quality-based masking. Background fields should be removed within the brain mask using a technique based on SHARP or PDF, and the optimization approach to dipole inversion should be employed with a sparsity-based regularization. Susceptibility values should be measured relative to a specified reference, including the common reference region of whole brain as a region of interest in the analysis, and QSM results should be reported with - as a minimum - the acquisition and processing specifications listed in the last section of the article. These recommendations should facilitate clinical QSM research and lead to increased harmonization in data acquisition, analysis, and reporting.
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Affiliation(s)
- Berkin Bilgic
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Kwok-Shing Chan
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Jeff Duyn
- Advanced MRI Section, NINDS, National Institutes of Health, Bethesda, MD, United States
| | | | - Jongho Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Xu Li
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Carlos Milovic
- School of Electrical Engineering (EIE), Pontificia Universidad Catolica de Valparaiso, Valparaiso, Chile
| | - Simon Robinson
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
- Center for Biomedical Imaging, Clinical and Translational Science Institute at the University at Buffalo, Buffalo, NY, United States
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Pascal Spincemaille
- MRI Research Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Sina Straub
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Peter van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Yi Wang
- MRI Research Institute, Departments of Radiology and Biomedical Engineering, Cornell University, New York, NY, United States
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5
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Kavsak PA, Clark L, Arnoldo S, Lou A, Shea JL, Eintracht S, Lyon AW, Bhayana V, Thorlacius L, Raizman JE, Tsui AKY, Djiana R, Chen M, Huang Y, Booth RA, McCudden C, Lavoie J, Beriault DR, Blank DW, Fung AWS, Hoffman B, Taher J, St-Cyr J, Yip PM, Belley-Cote EP, Abramson BL, Borgundvaag B, Friedman SM, Mak S, McLaren J, Steinhart B, Udell JA, Wijeysundera HC, Atkinson P, Campbell SG, Chandra K, Cox JL, Mulvagh S, Quraishi AUR, Chen-Tournoux A, Clark G, Segal E, Suskin N, Johri AM, Sivilotti MLA, Garuba H, Thiruganasambandamoorthy V, Robinson S, Scheuermeyer F, Humphries KH, Than M, Pickering JW, Worster A, Mills NL, Devereaux PJ, Jaffe AS. Analytic Result Variation for High-Sensitivity Cardiac Troponin: Interpretation and Consequences. Can J Cardiol 2023; 39:947-951. [PMID: 37094710 DOI: 10.1016/j.cjca.2023.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Affiliation(s)
| | - Lorna Clark
- McMaster University, Hamilton, Ontario, Canada
| | | | - Amy Lou
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | | | - Andrew W Lyon
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Joshua E Raizman
- Department of Laboratory Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Albert K Y Tsui
- Department of Laboratory Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael Chen
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Yun Huang
- Queen's University, Kingston, Ontario, Canada
| | | | | | - Joël Lavoie
- Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | | | | | - Angela W S Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Paul M Yip
- University of Toronto, Toronto, Ontario, Canada
| | - Emilie P Belley-Cote
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | | | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Eli Segal
- McGill University, Montréal, Québec, Canada
| | | | | | | | | | | | - Simon Robinson
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - John W Pickering
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - P J Devereaux
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Allan S Jaffe
- Mayo Clinic and Medical Center, Rochester, Minnesota, United States
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Thomas LT, Lee CMY, McClelland K, Nunis G, Robinson S, Norman R. Health workforce perceptions on telehealth augmentation opportunities. BMC Health Serv Res 2023; 23:182. [PMID: 36810089 PMCID: PMC9943033 DOI: 10.1186/s12913-023-09174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The availability and use of telehealth to support health care access from a distance has expanded in response to the COVID-19 pandemic. Telehealth services have supported regional and remote health care access for many years and could be augmented to improve health care accessibility, acceptability and overall experiences for both consumers and clinicians. This study aimed to explore health workforce representatives' needs and expectations to move beyond existing telehealth models and plan for the future of virtual care. METHODS To inform recommendations for augmentation, semi-structured focus group discussions were held (November-December 2021). Health workforce representatives with experience in health care delivery via telehealth across country Western Australia were approached and invited to join a discussion. RESULTS Focus group participants included 53 health workforce representatives, with between two and eight participants per discussion. In total, 12 focus groups were conducted: seven were specific to regions, three with staff in centralised roles, and two with a mixture of participants from regional and central roles. Findings identified four key areas for telehealth augmentation: improvements required to existing service practice and processes; equity and access considerations; health workforce-focussed opportunities; and consumer-focussed opportunities. CONCLUSIONS Following the onset of the COVID-19 pandemic and the rapid increase in health services delivered via telehealth modalities, it is timely to explore opportunities to augment pre-existing models of care. Workforce representatives consulted in this study suggested modifications to existing process and practice that would improve the current models of care, and recommendations on ways to improve clinician and consumer experiences with telehealth. Improving experiences with virtual delivery of health care is likely to support continued use and acceptance of this modality in health care delivery.
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Affiliation(s)
- L. T. Thomas
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
| | - C. M. Y. Lee
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
| | - K. McClelland
- grid.413880.60000 0004 0453 2856Government of Western Australia Department of Health, Perth, WA Australia
| | - G. Nunis
- WA Primary Health Alliance, Perth, WA Australia
| | - S. Robinson
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia ,grid.1021.20000 0001 0526 7079Deakin University, Melbourne, VIC Australia
| | - R. Norman
- grid.1032.00000 0004 0375 4078 School of Population Health, Curtin University, Perth, WA Australia
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Cognolato F, O'Brien K, Jin J, Robinson S, Laun FB, Barth M, Bollmann S. NeXtQSM-A complete deep learning pipeline for data-consistent Quantitative Susceptibility Mapping trained with hybrid data. Med Image Anal 2023; 84:102700. [PMID: 36529002 DOI: 10.1016/j.media.2022.102700] [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: 07/16/2021] [Revised: 09/16/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Deep learning based Quantitative Susceptibility Mapping (QSM) has shown great potential in recent years, obtaining similar results to established non-learning approaches. Many current deep learning approaches are not data consistent, require in vivo training data or solve the QSM problem in consecutive steps resulting in the propagation of errors. Here we aim to overcome these limitations and developed a framework to solve the QSM processing steps jointly. We developed a new hybrid training data generation method that enables the end-to-end training for solving background field correction and dipole inversion in a data-consistent fashion using a variational network that combines the QSM model term and a learned regularizer. We demonstrate that NeXtQSM overcomes the limitations of previous deep learning methods. NeXtQSM offers a new deep learning based pipeline for computing quantitative susceptibility maps that integrates each processing step into the training and provides results that are robust and fast.
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Affiliation(s)
- Francesco Cognolato
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia
| | - Kieran O'Brien
- ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia; Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Jin Jin
- ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia; Siemens Healthcare Pty Ltd, Brisbane, Queensland, Australia
| | - Simon Robinson
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; High Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Neurology, Medical University of Graz, Graz, Austria; Karl Landsteiner Institute for Clinical Molecular MR in Musculoskeletal Imaging, Vienna, Austria
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Barth
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Steffen Bollmann
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia; ARC Training Centre for Innovation in Biomedical Imaging Technology, The University of Queensland, Brisbane, Australia; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
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8
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Wu JH, Robinson S, Tsemg JS, Hsu YP, Hsieh MC, Chen YC. Digital and physical factors influencing an individual's preventive behavior during the COVID-19 pandemic in Taiwan: A perspective based on the S-O-R model. Comput Human Behav 2023; 139:107525. [PMID: 36268219 PMCID: PMC9557089 DOI: 10.1016/j.chb.2022.107525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
COVID-19 has caused considerable stress to individuals and communities. Daily press briefings on public health during the COVID-19 pandemic have increased individuals' feelings of social pressure. Abrupt changes to a person's immediate environment, such as the changes caused by COVID-19, can substantially affect their mental health and cognitive adjustment. On the basis of the stimulus-organism-response (S-O-R) framework, we examined the effects of digital and physical stimuli related to COVID-19 in Taiwan on individuals' psychological states and preventive behavior, including social distancing and personal hygiene. The data obtained from 498 valid survey questionnaires indicated that digital and physical factors including informativeness, social pressure, and severity exerted direct effects on cognitive assimilation and anxiety, which in turn affected individuals' preventive behavior. Moreover, cognitive assimilation and anxiety had significant mediating effects on the relationships of informativeness, social pressure, and severity with individuals' preventive behavior. The results of this study indicate how digital and physical stimulus factors affect cognitive assimilation and anxiety, which influence preventive behavior during a pandemic.
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Affiliation(s)
- Jen-Her Wu
- Department of Information Management, Southern Taiwan Interdisciplinary Center for Innovative Technologies, Advisory Board Member, E-Da Healthcare Group, National Sun Yat-Sen University, 70 Lien-Hai Rd, Kaohsiung, 804, Taiwan
| | - Simon Robinson
- Department of English, Wenzao Ursuline University of Languages, 900 Minzu 1st Road, Kaohsiung, Taiwan
| | - Jing-Shiang Tsemg
- Department of Information Management, National Sun Yat-Sen University, 70 Lien-Hai Rd, Kaohsiung, 804, Taiwan
| | - Yu-Ping Hsu
- Department of Information Management, National Sun Yat-Sen University, 70 Lien-Hai Rd, Kaohsiung, 804, Taiwan
| | - Ming-Che Hsieh
- Department of Information Science and Management Systems, National Taitung University, 369, Section 2, University Road, Taitung, 950, Taiwan
| | - Yi-Cheng Chen
- Department of Information Science and Management Systems, National Taitung University, 369, Section 2, University Road, Taitung, 950, Taiwan
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9
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Lim YT, Robinson S, Tang MM. Liver Disease Among Patients with Psoriasis: The Malaysian Psoriasis Registry. Clin Exp Dermatol 2023; 48:476-483. [PMID: 36632801 DOI: 10.1093/ced/llad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Therapeutic options for psoriasis may be limited for patients with concomitant liver disease. OBJECTIVE We aim to report the frequency of liver disease among psoriasis patients, describe the clinical features, treatment modalities and quality of life. METHODS This was a multi-center cross-sectional study of psoriasis patients notified to the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. RESULTS Of 21,735 psoriasis patients, 174 (0.8%) had liver disease. The three most common liver diseases were viral hepatitis (62.1%), fatty liver (14.4%) and liver cirrhosis (10.9%). The male-to-female ratio was 3.8:1. Mean age of onset of psoriasis was higher in those with liver disease compared to those without (37.25 ± 13.47 years vs 33.26 ± 16.96 years, p < 0.001). Psoriasis patients with liver disease had a higher rate of dyslipidemia (27.5%vs16.4%, p < 0.001), hypertension (33.9%vs23.7%, p = 0.002), diabetes mellitus (22.4%vs15.9%, p = 0.021) and HIV infection (5.3%vs0.4%, p < 0.001) compared to those without liver disease.They were also more likely to have severe disease (BSA > 10% and/or DLQI > 10) (59.3%vs49.9%, p = 0.027), psoriatic arthropathy (21.1%vs13.0%, p = 0.002), and nail involvement (78.2%vs56.1%, p < 0.001) compared to those without liver disease. The use of phototherapy (8.4%vs2.6%, p < 0.001), acitretin (7.3%vs2.8%, p < 0.001) and cyclosporin (3.0%vs0.7%, p < 0.001) were significantly higher in the group with liver disease. The mean Dermatology Life Quality Index were similar in both groups (9.69 ± 7.20vs9.62 ± 6.75, p = 0.88). CONCLUSIONS The frequency of psoriasis patients with liver disease in MPR was 0.8%. Psoriasis patients with liver disease were more likely to be male, had a higher rate of co-morbidities, severe disease, nail and joint involvement than those without liver disease.
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Affiliation(s)
- Y T Lim
- Department of Dermatology, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - S Robinson
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - M M Tang
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Hawkes D, Brookes-Fazakerley S, Robinson S, Bhalaik V. Intraoperative and early postoperative complications of reverse shoulder arthroplasty: A current concepts review. J Orthop 2023; 35:120-125. [PMID: 36471697 PMCID: PMC9718996 DOI: 10.1016/j.jor.2022.11.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/19/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background Reverse shoulder arthroplasty is a common procedure performed for a variety of shoulder pathologies. Aims and objectives This current concept review evaluates the intraoperative and early postoperative complications, with a specific focus given to neurological and vascular injury, fracture, dislocation and venous thromboembolism. Conclusion A detailed knowledge of potential complications will allow surgeons to mitigate risk and maximise outcomes.
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Affiliation(s)
- David Hawkes
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Steven Brookes-Fazakerley
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Simon Robinson
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
| | - Vijay Bhalaik
- Upper Limb Unit, Wirral University Teaching Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, CH49 5PE, UK
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11
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Hagberg GE, Eckstein K, Tuzzi E, Zhou J, Robinson S, Scheffler K. Phase-based masking for quantitative susceptibility mapping of the human brain at 9.4T. Magn Reson Med 2022; 88:2267-2276. [PMID: 35754142 PMCID: PMC7613679 DOI: 10.1002/mrm.29368] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/05/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop improved tissue masks for QSM. METHODS Masks including voxels at the brain surface were automatically generated from the magnitude alone (MM) or combined with test functions from the first (PG) or second (PB) derivative of the sign of the wrapped phase. Phase images at 3T and 9.4T were simulated at different TEs and used to generate a mask, PItoh , with between-voxel phase differences less than π. MM, PG, and PB were compared with PItoh . QSM were generated from 3D multi-echo gradient-echo data acquired at 9.4T (21 subjects aged: 20-56y), and from the QSM2016 challenge 3T data using different masks, unwrapping, background removal, and dipole inversion algorithms. QSM contrast was quantified using age-based iron concentrations. RESULTS Close to air cavities, phase wraps became denser with increasing field and echo time, yielding increased values of the test functions. Compared with PItoh , PB had the highest Dice coefficient, while PG had the lowest and MM the highest percentage of voxels outside PItoh. Artifacts observed in QSM at 9.4T with MM were mitigated by stronger background filters but yielded a reduced QSM contrast. With PB, QSM contrast was greater and artifacts diminished. Similar results were obtained with challenge data, evidencing larger effects of mask close to air cavities. CONCLUSION Automatic, phase-based masking founded on the second derivative of the sign of the wrapped phase, including cortical voxels at the brain surface, was able to mitigate artifacts and restore QSM contrast across cortical and subcortical brain regions.
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Affiliation(s)
- Gisela E. Hagberg
- Department for Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
- High Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Korbinian Eckstein
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- High Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Elisa Tuzzi
- Department for Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
- High Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Jiazheng Zhou
- Department for Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
- High Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Simon Robinson
- Department of Neurology, Medical University of Graz, Graz, Austria
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
- High Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Murphy R, Doyle E, O'Connor A, Coen M, Connolly A, Breen C, Carty J, Waters R, Canavan M, Robinson S. 332 THE PATIENT EXPERIENCE OF THE OLDER PERSONS REHAB AT HOME (OPRAH) SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.290] [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
Background
The Older Persons Rehab at Home (OPRAH) team is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. This provides rehabilitation in the patients’ own home and accelerates discharge from the acute care sector. In this study patient and carer experiences of the service were explored.
Methods
Patients were sent a postal questionnaire after discharge from the service to collect information on the patient experience of the OPRAH service. The following measures were collected: satisfaction with the service, experience of interacting with therapy staff, involvement in shared goal setting and achievement of rehabilitation goals. Data from participants who responded to feedback questionnaires from the first 12 months of the service were analysed using descriptive statistics.
Results
Ninety-five participants were sent feedback questionnaires with 31 responses received (33%). 96% of participants reported that they were satisfied with the service, with the same proportion expressing that they both felt they were treated with respect and dignity and that they had confidence and trust in the staff. All respondents felt that they could understand the answers to any questions they had while receiving rehabilitation and 92% of participants understood their rehabilitation goals, with 88% of participants feeling they achieved their rehabilitation goals. 88% of participants felt they were adequately involved in their care planning with 83% of participants feeling their family members had ample opportunity to ask questions during their rehabilitation experience. Results did not different by age group of patient or by time with the service.
Conclusion
In this structured evaluation of the OPRAH team participants highly rated the service. Our results highlight that this integrated approach to care allowed patients to be involved in shared goal setting with the majority of patients satisfied that they achieved their goals.
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Affiliation(s)
- R Murphy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - E Doyle
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - A O'Connor
- Galway University Hospital Department of Medical Social Work, , Galway, Ireland
| | - M Coen
- Department of Physiotherapy , Galway, Ireland
| | - A Connolly
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - C Breen
- Galway University Hospital Department of Occupational Therapy, , Galway, Ireland
| | - J Carty
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - R Waters
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - M Canavan
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - S Robinson
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
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Griffith V, Murphy R, Sheil O, Roche E, Devaney T, Geoghegan J, Robinson S, Waters R, O'Donnell M, Canavan M. 311 FROM ONE FRONT DOOR TO ANOTHER: OUTCOMES OF PATIENTS DIRECTLY DISCHARGED FROM THE FRAILTY AT THE FRONT DOOR SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.273] [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
Background
The Frailty at the Front Door service is a novel service that provides comprehensive geriatric assessment in the emergency department for older adults who have an unplanned emergency presentation to hospital. It is important to monitor outcomes of patients discharged by the service to ensure appropriate patient selection.
Methods
Patients over the age of 75 with a Manchester Triage Score of between three and five and a possible frailty syndrome are eligible for review by the service. After initial review patients are either discharged directly or recommended for admission. We reviewed the outcomes of patients who were discharged directly after Emergency Department (ED) assessment by the service.
Results
Discharge disposition was available for review in 413 (95%) of patients since initiation of the service in October 2021. 30% (n= 122) of patients were discharged directly after initial ED review. Elevated 4AT score (p = 0.002) but not frailty (p = 0.80) was associated with decreased chances of direct discharge. Of patients discharged directly from ED 13% were reviewed post discharge by the community integrated care team (GICOP), with 43% of these reviews taking place within 30 days. Overall, 16% of patients discharged directly represented to ED within 30 days. There was a trend towards lower rates of representation to ED among patients who were seen by GICOP after discharge from ED (p = 0.12).
Conclusion
There was a high rate of direct discharge after review by the service, with low rates of representation to hospital. While limited by low numbers there was a trend towards lower representation rates in patients reviewed post-discharge by the integrated care team. Future quality improvement initiatives will aim to improve the integration between the services and highlighting patients who would benefit from more timely reviews.
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Affiliation(s)
- V Griffith
- Galway University Hospital , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
| | - O Sheil
- Galway University Hospital , Galway, Ireland
| | - E Roche
- Galway University Hospital , Galway, Ireland
| | - T Devaney
- Galway University Hospital , Galway, Ireland
| | - J Geoghegan
- Galway University Hospital , Galway, Ireland
| | - S Robinson
- Galway University Hospital , Galway, Ireland
| | - R Waters
- Galway University Hospital , Galway, Ireland
| | - M O'Donnell
- Galway University Hospital , Galway, Ireland
| | - M Canavan
- Galway University Hospital , Galway, Ireland
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Coen M, Murphy R, Connolly A, O'Connor A, Doyle E, Byrne S, Carty J, Breen C, Canavan M, Waters R, Robinson S. 225 OLDER PERSONS REHAB AT HOME (OPRAH) INDICATES AN EFFECTIVE ALTERNATIVE PATHWAY TO INPATIENT REHABILITATION. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.195] [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
Background
Older adults have longer hospital stays, higher incidence of nosocomial complications and higher readmissions rates. Older persons rehabilitation at home (OPRaH) is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. OPRaH offers a comprehensive geriatric and interdisciplinary approach. The model enables a safe and accelerated discharge from acute care to home.
Methods
Patients are identified and screened by a team coordinator. On Discharge to OPRaH the following measures were collected; basic demographics, referral source, clinical frailty score and Functional Independence Measures (FIM). Outcomes evaluated are the FIM change, readmission rates, length of inpatient stay savings and time on the service. Data from the first year of operation was analysed using descriptive statistics.
Results
109 patients have undergone rehabilitation with the service with a median age of 82 years (63-103 range). Over two thirds (68%) were classified as frail, with 44% living alone. An injurious fall was the most common reason for index hospitalisation (50%). Referral source was inpatient acute medical team in 50% of cases, with 21% from acute geriatrics , 13 % ortho geriatrics, 13% surgical. Average functional independence measure scores improved from 89 to 102 (p = 0.007). There was no difference in the magnitude of improvement by frailty status (13 vs 14, p = 0.85). The average length of stay saving was 7 days per case, with a total of 757 days saved in one year. Readmission rate within 30 days was 9.3 %. Participants highly rated the service through structured evaluation.
Conclusion
This novel service provides a valuable intervention to a wide case-mix of older adults with evidence of improvements in formal markers of functional impairment after intervention. Referral was based on definable rehabilitation goals and not just on frailty status, age, or gender.
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Affiliation(s)
- M Coen
- Galway University Hospital , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - A Connolly
- Galway University Hospital , Galway, Ireland
| | - A O'Connor
- Galway University Hospital , Galway, Ireland
| | - E Doyle
- Galway University Hospital , Galway, Ireland
| | - S Byrne
- Galway University Hospital , Galway, Ireland
| | - J Carty
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - C Breen
- Galway University Hospital , Galway, Ireland
| | - M Canavan
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - R Waters
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
| | - S Robinson
- Galway University Hospital , Galway, Ireland
- National University of Ireland , Galway, Ireland
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15
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Mannion E, Murphy R, Robinson S, Waters R, Donnell MO, Walsh T, Geoghegan J, Conry M, Canavan M. 342 THE DISCRIMINATORY VALUE OF ANP-LED CGA ON PATIENT REPORTED SYMPTOMS AND IMPACT ON CARERS: A CROSS-SECTIONAL STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.299] [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
Background
Comprehensive Geriatric Assessment (CGA) is a cornerstone in geriatric care. Objective findings from CGA may differ to patient and carer reported symptoms. This study compared patient reported symptoms with objective metrics collected during CGA and explored the relationship with carer burnout.
Methods
Cross-sectional study of patients attending an Advanced Nurse Practitioner (ANP)-led integrated care clinic. Patient-reported geriatric syndromes included low mood, memory concerns, incontinence, falls or dizziness. CGA metrics collected included Barthel Index, Lawton IADLs, MOCA scores, Geriatric depression scale scores, Rockwood Clinical Frailty Scale (CFS) scores and presence or absence of carer burnout. Descriptive statistics were used to compare the relationship between these variables and logistic regression explored the magnitude of association with carer burnout.
Results
We reviewed 99 CGAs over three months. Median age was 81 (IQR 75–86) with 62% female. Cognitive impairment was present in 96% of patients. Self-reported memory trouble was associated with lower MOCA scores (9 vs 23, p < 0.001) and the presence of dizziness was associated with an increased prevalence of falls (89% vs 24%, < 0.001). The presence of incontinence and functional dependency on IADL were both associated with carer strain and a larger magnitude of association with carer strain was seen with increasing frailty (OR 13.7, 95% CI 3.8-58.8 for moderate to severe frailty) than moderate to severe cognitive impairment (OR 8, 95% CI 3.0–24.1)
Conclusion
Older people reported a wide range of symptoms often subtle, some of which are unmasked during CGA. The resultant frailty syndromes often represent increasing degrees of functional impairment impacting on patient and carer quality of life. Striking the balance between patient reported symptoms and objective measurement is important to allow individualised care pathways to be developed as well as highlighting patients at risk of functional and cognitive decline.
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Affiliation(s)
- E Mannion
- Galway University Hospital , Galway, Ireland
- Galway Integrated Care Older Person , Galway, Ireland
| | - R Murphy
- Galway University Hospital , Galway, Ireland
- National University of Ireland Galway , Galway, Ireland
| | - S Robinson
- Galway Integrated Care Older Person , Galway, Ireland
| | - R Waters
- Galway Integrated Care Older Person , Galway, Ireland
| | - MO Donnell
- National University of Ireland Galway , Galway, Ireland
| | - T Walsh
- Galway University Hospital , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care Older Person , Galway, Ireland
| | - M Conry
- Galway Integrated Care Older Person , Galway, Ireland
| | - M Canavan
- Galway Integrated Care Older Person , Galway, Ireland
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16
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Whelan A, Murphy R, Shiel E, Griffith V, Mannion K, Neachtain MN, Mannion E, Conry M, Geoghegan J, Waters R, O'Donnell M, Robinson S, Canavan M. 355 PREDICTORS OF HOME SUPPORT SERVICES AND THE CONSEQUENCES OF MISMATCH BETWEEN ALLOCATED AND RECEIVED SERVICES IN COGNITIVELY-IMPAIRED OLDER ADULTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.312] [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
Background
Home support services aim to support older people to remain at home. Despite substantial investment in home support hours (€600 million), this has not translated into increased carers on the ground for older people. We aimed to report patterns of home support service utilisation in older patients with memory problems, and identify any mis-matches between allocated and received hours, and the impact on patients and caregivers.
Methods
Retrospective analysis of consecutive patients referred to community geriatric clinic from January 2021 to May 2022. 95/104 patients who were identified were suitable for inclusion.
Results
Participants had a median age of 82 (IQR 78-86) of whom 57% were female (n=54). 80% (n=76) were frail (CFS ≥4), with 82% dependent for IADLs (Lawton-Brody IADL Scale ≤6). Median MOCA score was 18, with 44% having moderate to severe cognitive impairment (MOCA ≤17). 40% of patients lived with alone (n=38). 52% (n=49) received formal home supports while 80% (n=76) had an informal carer. 37% (n=18) had a mismatch between hours allocated and hours received. There was a significant difference between median hours of care allocated (7) and median hours of care received (5), p <0.001. Increasing age and frailty, worsening cognitive and functional impairment and living status (living alone) predicted allocation of home supports. Patients who lived with family members were 3 times more likely not to receive allocated hours (OR 3.84 (95% CI 1.2–13.7))
Conclusion
In this vulnerable population with cognitive and functional decline, just over half received formal home support hours. A large proportion experienced significant mismatch between allocated and received hours. Family and informal caregivers often have to fill gaps, adding to existing carer strain. Future models of home support should prioritise early intervention for people with IADL loss to remain independent at home and broaden of the scope of practice of carers to facilitate this.
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Affiliation(s)
- A Whelan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - R Murphy
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- School of Medicine, National University of Ireland, Galway , Galway, Ireland
| | - E Shiel
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - V Griffith
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
| | - K Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Ní Neachtain
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - E Mannion
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- University Hospital Galway Department of Nursing, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Conry
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
- University Hospital Galway Department of Social Work, , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - S Robinson
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
| | - M Canavan
- University Hospital Galway Department of Geriatric and Stroke Medicine, , Galway, Ireland
- Galway Integrated Care Team, Community Healthcare West , Galway, Ireland
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Gelder CL, Robinson S, Leitch F, McMahon AJ. Drowning in antibiotics. Ann R Coll Surg Engl 2022; 104:605-610. [PMID: 35639453 PMCID: PMC9433187 DOI: 10.1308/rcsann.2022.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid prescription is commonly delegated to junior doctors despite being a notoriously challenging topic. When antibiotics are given as an infusion they are diluted in 100ml of fluid, which is often unaccounted for when thinking about a patient's fluid requirements. This closed-loop audit aimed to assess first, intravenous (IV) fluid therapy and second, electrolyte prescribing compliance with National Institute for Health and Care Excellence (NICE) guidelines, with and without the additional fluid given with antibiotic administration. METHODS Two retrospective audits were performed. Total fluid and electrolyte volume received with and without antibiotic fluids was correlated with recommendations in the NICE guidelines. Between cycles 1 and 2, potassium chloride with sodium chloride and glucose (PSG) was introduced as an alternative to IV maintenance fluid, and bolusing of antibiotics was mandatory. RESULTS When analysing total fluid volume input per day, 10.4% and 7.45% of patients met their fluid requirement accurately in the first and second cycles, respectively. Within cycle 1, the mean total additional fluid that was given over 3 days with antibiotics was 1,572.73ml. In cycle 2, this decreased to 469.44ml when antibiotics were given as a bolus. CONCLUSIONS In this closed-loop audit we noted that patients receiving IV fluids and IV antibiotics received too much additional fluid when the antibiotic dilution fluid was taken into account. Additional fluid was reduced alongside the proportion of electrolyte complications when bolusing of antibiotics was introduced. We recommend that that all nurses are trained to give antibiotics as a bolus because it can help to reduce fluid-related complications.
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Affiliation(s)
| | | | - F Leitch
- NHS Greater Glasgow and Clyde, UK
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Iqbal MB, Robinson S, Nadra I, Das D, Sikkel M, Della Siega A. TCT-189 The Efficacy and Safety of an Adjunctive Transcoronary Pacing Strategy During Rotational Atherectomy: The Results of the Strategy to Rotablate and PACE (ROTA-PACE) Study. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Cockle J, Bjerke L, Mackay A, Grabovska Y, Burford A, Molinari V, Pereira R, Boult J, Robinson S, Carvalho DM, Clarke M, Titley I, Yara E, Straathof K, Wennerberg E, Becher O, Castro M, Melcher A, Jones C. IMMU-12. Exploring and modulating the tumour immune microenvironment to facilitate the selection of immunotherapies for paediatric-type diffuse high-grade glioma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.305] [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
Immune cells have the potential to selectively eradicate high-risk brain tumours such as paediatric-type diffuse high-grade glioma (PDHGG). We aim to characterize the tumour immune microenvironment (TIME) of intra-cranial syngeneic mouse models of diffuse hemispheric glioma, H3G34 (DHG-H3G34) and diffuse midline glioma, H3K27 (DMG-H3K27). We also demonstrate how an oncolytic reovirus (Reolysin) can “heat-up” the TIME of our syngeneic models. Orthotopic immunocompetent mouse models of DHG-H3G34 (C57BL/6, NRASG12V + shp53 + shATRX +/- H3.3G34R) and DMG-H3K27 (Nestin-Tv-a/p53fl/fl, RCAS-ACVR1R206H + RCAS-H3.1K27M) were profiled using single-cell RNA-sequencing (scRNA-seq) (10x genomics), a 22-colour custom flow cytometry immune panel and spatial transcriptomics. Differential marker expression was validated with immunohistochemistry and immunofluorescence in tissue sections. Syngeneic mouse tumours treated systemically with Reolysin were also profiled to evaluate the effects of the oncolytic virus on the TIME. Cell type predictions in scRNA-seq using singleR, ssGSEA and expression of individual marker genes suggested that the predominant immune cell types within hemispheric tumours were monocytes (11-21%) and macrophages (10-19%) with much smaller proportions of CD4+ and CD8+ T-cells (4-10%). By contrast, much smaller proportions of monocytes (2%) and macrophages (3%) were observed in the H3.1K27M pontine model. Flow cytometry, immunohistochemistry and immunofluorescence validated scRNA-seq immune profiles and characterised signalling of the PD-1/PD-L1 checkpoint pathway. Spatial transcriptomics allowed immune cell populations to be positioned within tumour sections and showed significant co-localization of CD4+ and CD8+ lymphocytes at tumour margins. Treatment of syngeneic mouse tumours with Reolysin resulted in reduced tumour volumes and altered the TIME, in particular increasing cytotoxic T-cell tumour infiltration. Our results highlight immunological heterogeneity within molecular subgroups of PDHGG and demonstrate ability of a systemically delivered oncolytic virus, Reolysin, to “heat-up” the TIME, contributing to a more immune actionable profile. Future work will help to identify optimal combinations for the next generation of immunotherapies in PDHGG.
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Affiliation(s)
- Julia Cockle
- Institute of Cancer Research , London , United Kingdom
- The Royal Marsden NHS Foundation Trust , Surrey , United Kingdom
| | - Lynn Bjerke
- Institute of Cancer Research , London , United Kingdom
| | - Alan Mackay
- Institute of Cancer Research , London , United Kingdom
| | | | - Anna Burford
- Institute of Cancer Research , London , United Kingdom
| | | | - Rita Pereira
- Institute of Cancer Research , London , United Kingdom
| | - Jessica Boult
- Institute of Cancer Research , London , United Kingdom
| | | | | | | | - Ian Titley
- Institute of Cancer Research , London , United Kingdom
| | - Erika Yara
- Institute of Cancer Research , London , United Kingdom
| | - Karin Straathof
- University College London, Great Ormond Street Institute of Child Health , London , United Kingdom
| | | | - Oren Becher
- Mount Sinai Kravis Children’s Hospital , New York , USA
| | - Maria Castro
- University of Michigan Medical School , Michigan , USA
| | - Alan Melcher
- Institute of Cancer Research , London , United Kingdom
| | - Chris Jones
- Institute of Cancer Research , London , United Kingdom
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20
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Mackay A, Temelso S, Carvalho D, Kessler K, Boult J, Izquierdo E, Pereira R, Potente EF, Burford A, Molinari V, Bjerke L, Grabovska Y, Rogers R, Crampsie S, Das M, Robinson S, Clarke M, Jones C. HGG-42. Evolutionary selection of key oncogenic alterations in patient-derived models of paediatric diffuse high grade glioma (PDHGG) subtypes in vitro and in vivo. Neuro Oncol 2022. [PMCID: PMC9164821 DOI: 10.1093/neuonc/noac079.257] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PDHGG are a diverse group of childhood brain tumours comprising multiple subgroups carrying distinct molecular drivers. Patient-derived models accurately recapitulating this underlying biology are critical for mechanistic/preclinical studies aimed at improving patient outcome, however their behaviour over time in the environments in which they are propagated, and how this relates to the human disease, is largely unknown. To explore this, we collected 94 models of PDHGG established as 2D/3D stem cell cultures in vitro, and generated patient-derived xenografts (PDX) in 33/62 specimens implanted orthotopically in vivo. We carried out exome/targeted sequencing, methylation profiling and RNAseq to profile cells through their first 25 passages in culture, and sequential implantation from p0-p2 in mice. In 15/83 cultures, we observed enrichment of gene expression signatures of non-malignant cells over the first 5 passages, with concurrent depletion of somatic mutations/CNAs, excluding them from further study. Validated models retained tumour-matched genotypes, CNAs and driver alterations including H3.3G34R, H3.3/H3.1K27M, BRAF and ACVR1 over time, however subclonal alterations underwent selection in culture which profoundly altered their response to targeted drug treatment. In 6/7 PDGFRA-mutant models, activating mutations were selected against between p5-20 in 2D and/or 3D, whilst MAPK pathway mutations in NF1/PIK3R1 similarly diverged over 15 passages under different growth conditions, resulting in isogenic models with differential signalling, in vivo tumorigenicity, and in vitro sensitivity to multiple MEK inhibitors. In PDXs, serial xenografting reduced the time to tumour formation by up to half, with a concomitant shift in clonal architecture. Multi-region sequencing of diffusely-infiltrating tumours showed selection for alterations such as PIK3CA/NF1 at distant sites, with evidence for convergent evolution of subclonal mutations, as in human tumours. Understanding the evolutionary dynamics of targetable/predictive alterations in PDHGG model systems is key to developing new and effective therapeutic interventions in this highly heterogenous disease.
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Affiliation(s)
- Alan Mackay
- Institiute of Cancer Research , London , United Kingdom
| | - Sara Temelso
- Institiute of Cancer Research , London , United Kingdom
| | | | - Ketty Kessler
- Institiute of Cancer Research , London , United Kingdom
| | - Jessica Boult
- Institiute of Cancer Research , London , United Kingdom
| | | | - Rita Pereira
- Institiute of Cancer Research , London , United Kingdom
| | | | - Anna Burford
- Institiute of Cancer Research , London , United Kingdom
| | | | - Lynn Bjerke
- Institiute of Cancer Research , London , United Kingdom
| | | | | | | | - Molina Das
- Institiute of Cancer Research , London , United Kingdom
| | | | | | - Chris Jones
- Institiute of Cancer Research , London , United Kingdom
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21
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Boult J, Carvalho D, Kessler K, Vinci M, Fernandez E, Bjerke L, Fofana M, Molinari V, Carcaboso A, Jones C, Robinson S. IMG-09. Characterisation of a panel of in vivo models of paediatric-type diffuse high-grade glioma (PDHGG) using magnetic resonance imaging. Neuro Oncol 2022. [PMCID: PMC9165046 DOI: 10.1093/neuonc/noac079.285] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Novel therapies for paediatric-type diffuse high-grade glioma (PDHGG) are urgently required. Orthotopic models using patient-derived material are invaluable tools in preclinical drug development as they retain key genetic/epigenetic features, eg. histone H3G34 or H3K27 alterations. Their evaluation in situ is vital and requires sensitive imaging techniques such as MRI. 12 diffuse hemispheric glioma (DHG; 2 DHG-G34) and 21 diffuse midline glioma (DMG; 17 DMG-K27M) tumours have been characterised using MRI following site-specific orthotopic implantation of patient-derived cells directly from tumour material or after minimal expansion as stem cell cultures. Of the 62 models implanted; 3 DHG and 10 DMG samples were not tumourigenic and 13 DHG/3 DMG models are currently under MRI surveillance. Tumours identified on T2-weighted (T2w)-images varied from a diffuse hyperintense signal to well-defined high contrast masses. Tumour growth in 5 DMG models was too diffuse for longitudinal monitoring with T2w-MRI. Once established, diffusion-weighted, T1/T2 mapping and contrast-enhanced MRI were used to further assess tumour phenotype. Quantitative data from 15 DMG models demonstrated higher water diffusivity and T2 than 10 DHG tumours, which suggests less tightly packed tumour cells but may also reflect the closer proximity of tumours growing in the thalamus/pons/cerebellum to the ventricular system. Lack of contrast-agent enhancement in 11 DMG and 6/10 DHG models indicated an intact blood-brain barrier (BBB), with heterogeneous disruption observed in 4 DHGs; H3-G34 had no bearing on BBB integrity. Upon serial re-implantation survival was shortened in 3/4 DHG and 2/6 DMG models, while quantitative MRI parameters remained similar. Likewise, when 2 DHG and 2 DMG models grown in 2D/3D in vitro were implanted in parallel, poorer survival/improved penetrance was associated with 3D-cultured cells with no difference in imaging phenotype. The study highlights the potential of non-invasive MRI to accurately evaluate the efficacy of novel therapeutics in these PDHGG models.
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Affiliation(s)
- Jessica Boult
- The Institute of Cancer Research , London , United Kingdom
| | - Diana Carvalho
- The Institute of Cancer Research , London , United Kingdom
| | - Ketty Kessler
- The Institute of Cancer Research , London , United Kingdom
| | - Maria Vinci
- Bambino Gesù Children’s Hospital - IRCSS , Rome , Italy
| | | | - Lynn Bjerke
- The Institute of Cancer Research , London , United Kingdom
| | - Mariama Fofana
- The Institute of Cancer Research , London , United Kingdom
| | | | | | - Chris Jones
- The Institute of Cancer Research , London , United Kingdom
| | - Simon Robinson
- The Institute of Cancer Research , London , United Kingdom
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22
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Teng N, Dalby M, Kiu R, Robinson T, Gion Cortes M, Bermejo De Las Heras B, Perez Garcia J, Calvo-Martinez L, Prat A, Marquez Vazquez R, Ruiz Borrego M, de la Cruz S, Llombart Cussac A, Curigliano G, Schmid P, Mancino M, Hall L, Robinson S, Cortés J, Malfettone A. 14P Gut and oral microbiota profiling in patients (pts) with hormone receptor-positive (HR+) metastatic breast cancer (MBC) receiving pembrolizumab (P) plus eribulin (E): CALADRIO. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Lugo Gavidia LM, Burger D, Robinson S, Nolde J, Carnagarin R, Matthews VB, Schlaich MP. Circulating extracellular vesicles correlate with nocturnal blood pressure and vascular organ damage and may serve as an integrative biomarker of vascular health. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Council on Science and Technology, Mexico (CONACYT).
Background
Elevated blood pressure (BP) has been associated with increased levels of circulating extracellular vesicles (EVs) which could potentially serve as a novel integrative biomarker for vascular health.
Purpose
The present study therefore aimed to assess the relationship between increased EV release, blood pressure and macrovascular organ damage.
Methods
A total of 83 patients with BP ranging from normal to high were included in the present analysis. Extracellular vesicles were evaluated by flow cytometry (CD41+/Annexin v+). BP evaluation included unobserved automated office BP (AOBP) and ambulatory BP monitoring (24hr-BP, day-BP and night-BP). Carotid-femoral pulse wave velocity (PWV) was measured by the SphygmoCor XCEL as a marker of macrovascular organ damage.
Results
Hypertensive patients (n = 73, BP 132.9 ± 17.4/79.4 ± 14.0) compared to normotensive patients (n = 10, BP 113.4 ± 10.4/71.3 ± 9.6) had higher levels of EVs (10.6 ± 8.2 vs 6.5 ± 4.5 EV/µL; p = 0.02). Circulating EVs were positively correlated with nocturnal systolic BP (r= 0.3; p = 0.01) and night-time dipping (r= -0.26; p = 0.02) in univariable analysis. In contrast, systolic AOBP, 24hr-BP and day-BP did not show significant associations. No significant correlations were found with diastolic BP. EVs were significantly correlated with PWV (r = 0.26 p = 0.02).While all BP measures were associated with PWV, average systolic night-time BP demonstrated the strongest correlation with PWV (r = 0.55; p < 0.001) compared to systolic AOBP (r = 0.51; p < 0.001), 24hr-BP (r = 0.46; p < 0.001), and average day-BP (r = 0.48; p < 0.001). Multivariable regression models confirmed robustness of the models.
Conclusion
We demonstrate a close positive relationship between a variety of BP measures and levels of circulating EVs as well as macrovascular damage assessed by PWV. The strongest correlation with EVs was found for average systolic nocturnal BP. Given that average nocturnal BP is the strongest predictor of CV events, EVs may serve as a useful integrative marker of vascular health and useful biomarker for CV risk assessment, a proposition that will need to be tested in prospective clinical trials. Abstract Figure.
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Affiliation(s)
- L M Lugo Gavidia
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - D Burger
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Robinson
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - J Nolde
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - R Carnagarin
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - V B Matthews
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
| | - M P Schlaich
- Royal Perth Hospital Unit-Medical Research Foundation; The University of Western Australia, Dobney Hypertension Center, Perth, Australia
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24
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Markey K, Moloney M, Doody O, Robinson S. Time to re-envisage integrity among nurse leaders. J Nurs Manag 2022; 30:2236-2240. [PMID: 35118739 PMCID: PMC10078655 DOI: 10.1111/jonm.13557] [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: 11/25/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
AIM This paper highlights integrity as a central tenet in the journey of ethical leadership among nurse leaders, and dialogue as a way of working within integrity. BACKGROUND Nurse leaders play a critical role in ensuring ethically sound, safe patient care by supporting staff and fostering positive working environments. Although there is an abundance of literature on leadership, no universally accepted leadership theory exists. Hence, it can be difficult to apply leadership theory and principals to real-life clinical practice. EVALUATION From the literature, it is evident that integrity is a crucial aspect of leadership. This paper proposes suggestions for nurturing integrity and fostering open and honest dialogue. KEY ISSUES Globally, public health care is complex and evolving and effective nursing leadership is paramount to meet public health needs and support healthcare systems. CONCLUSION This paper explores integrity with leadership, re-envisaging personal and professional integrity as a portal to authentic leadership, which has human relationships and dialogue at its core. IMPLICATIONS FOR NURSING MANAGEMENT Nurse leaders need support in guiding the nursing profession and promoting ethically sound patient care. The true nature of leadership is dialogue and nurturing a culture of listening and openness at different levels within an organisation is crucial.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland
| | - Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland
| | - Simon Robinson
- Emeritus Professor of Applied and Professional Ethics, Leeds Beckett University, Hon Research Fellow, Philosophy, Religion and History of Science, University of Leeds
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25
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Tamayao PJ, Ominski KH, Robinson S, Wittenberg KM, Crow G, McGeough EJ. Ruminal dry matter disappearance, total gas and methane production, and fermentation parameters as affected by fat and protein concentration in by-product supplemented grass hay-based diets. Anim Prod Sci 2022. [DOI: 10.1071/an22073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Dai L, Gootjes J, Dorje T, Maiorana A, Shah A, Dembo L, Rankin J, Robinson S, Chih H, Atherton J, Reid C, Hillis G. An Audit of Adherence to Guideline-Recommended Treatment at Discharge of Heart Failure Hospitalisation in Cardiology and Non-Cardiology Wards in a Tertiary Hospital in Western Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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27
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Geoghegan J, Conry M, Mannion E, Shiel E, Flanagan L, McCleane F, Nolan M, Corry M, Chawke M, Coffey K, Costello M, McCarty CE, O'Donnell M, Robinson S, Waters R, Canavan M. 90 IMPACT OF AN INTEGRATED CARE MODEL FOR OLDER PERSONS: EVALUATING A PILOT PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.90] [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: 02/25/2023] Open
Abstract
Abstract
Background
In September 2019 Sláintecare helped establish an Integrated Care team for Older People. The aim of this service was to provide a Comprehensive Geriatric Assessment (CGA) to older people within a community network. Service user experience/feedback are critically important for development of a team and a service. To give service users a platform to evaluate the service a patient experience survey was conducted.
Methods
The survey was designed by the multidisciplinary team, consisting of 13 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. A question on impact of COVID-19 was also included.
150 of the 950 service users who received a CGA from June 2020 to June 2021 were selected randomly and invited to participate in the postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys.
Results
47% response rate (71/150). 77% were aged ≥75. 52% completed the survey themselves, 48% required assistance. 61% attended more than twice and most would prefer to attend a local spoke clinic. 96% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 93% agreed that they were involved in care decisions. 82% reported their carers had the opportunity to discuss concerns. Themes emerging included importance of care close to home, avoiding acute hospital, difficulty parking at tertiary centres. 42% highlighted isolation and loneliness due to COVID-19 as a major issue.
Conclusion
Service users had an overwhelmingly positive experience especially when care was delivered in clinics close to their homes. Development of the hub and spoke model is acceptable and feasible to older people and their carers’ in this region and will be the focus for expansion of this service.
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Affiliation(s)
- J Geoghegan
- Galway University Hospitals , Galway, Ireland
| | - M Conry
- Galway University Hospitals , Galway, Ireland
| | - E Mannion
- Galway University Hospitals , Galway, Ireland
| | - E Shiel
- St Brendan's Community Nursing Unit , Loughrea, Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - F McCleane
- Community Healthcare West , Galway, Ireland
| | - M Nolan
- Galway University Hospitals , Galway, Ireland
| | - M Corry
- Galway University Hospitals , Galway, Ireland
| | - M Chawke
- Galway University Hospitals , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - M Costello
- Galway University Hospitals , Galway, Ireland
| | - C E McCarty
- Galway University Hospitals , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M O'Donnell
- Galway University Hospitals , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway University Hospitals , Galway, Ireland
| | - R Waters
- Galway University Hospitals , Galway, Ireland
| | - M Canavan
- Galway University Hospitals , Galway, Ireland
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28
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Costello M, McCarthy C, Bosch J, Robinson S, Canavan M, O'Donnell M. 33 ARE CLINICAL TRIALS RANDOMISING HOUSEHOLDS TO LIFESTYLE INTERVENTIONS FOR THE PREVENTION OF COGNITIVE DECLINE FEASIBLE? Age Ageing 2021. [DOI: 10.1093/ageing/afab219.33] [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: 02/25/2023] Open
Abstract
Abstract
Background
Dementia is increasing in prevalence worldwide. Several lifestyle factors have been identified as targets for dementia prevention, which may be more effective if targeted at households instead of an individual. To date there have been no clinical trials randomising households to lifestyle interventions of sleep, diet and/or physical activity to prevent cognitive decline. To inform future studies, qualitative approaches can give valuable in-depth insights into the values and beliefs of all household members towards behavioural change.
Methods
Semi structured interviews were carried out among eight households affected by cognitive impairment. Interview content was analysed, and important themes identified.
Results
Eighteen participants were interviewed within household pods. Among those, eight had cognitive impairment and the remainder were spouses or first-degree relatives living in the same home. Several themes of interest emerged including household members without dementia were more likely to report poor sleep habits; sleep was perceived the hardest behaviour to change; although most participants had healthy diets, most were interested in making a change and felt there was a strong link with nutrition and cognition; physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired and motivation to pursue physical activity in households centred on relaxation and social interaction.
Conclusion
This study identified beliefs and preferences of households towards lifestyle intervention trials. Barriers to study participation including risk of harm, complexity of intervention and deviation from routine emerged during discussions. Findings from this study should be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.
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Affiliation(s)
- M Costello
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - C McCarthy
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - J Bosch
- Population Health Research Institute , Hamilton, Canada
| | - S Robinson
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - M Canavan
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
| | - M O'Donnell
- Galway University Hosptial , Galway, Ireland
- HRB-Clinical Research Facility, National University of Ireland Galway , Galway, Ireland
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29
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Shiel E, Costello M, McCarthy C, Murphy R, McDermott C, Geoghegan J, Mannion E, Conry M, Flanagan L, Moroney E, Bhaoill CU, Walsh C, Coffey K, Waters R, Robinson S, O'Donnell M, Canavan M. 112 INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE (ICPOP) IN A RURAL SETTING—ROLE OF ADVANCED NURSE PRACTITIONER (ANP). Age Ageing 2021. [DOI: 10.1093/ageing/afab219.112] [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: 02/25/2023] Open
Abstract
Abstract
Background
Sláintecare advocates for right care, in the right place at the right time. ANPs for Older Persons in the community are uniquely placed to deliver care as close as possible to the older person’s home and to lead a holistic, flexible model of care minimising admission to acute care and maximising existing local resources. A pilot programme aimed at providing ANP led comprehensive geriatric assessment (CGA) (with Geriatrician support) to older people in a defined area commenced in June 2019. This pilot was part of a larger Hub and Spoke model funded by Sláintecare which gave additional MDT support.
Methods
A referral template was designed. Criteria for referral included; age > 75 years, Rockwood Frailty Scale 4–6 (focusing on Falls, Cognitive Impairment and Complex Frailty). Older people on the cusp of requiring long term care (LTC) were also prioritised. A prospective database of patients was maintained by the ANP to evaluate the service.
Results
From June 2019 to August 2021, 156 patients received an ANP led CGA, mostly conducted in the home. 247 reviews were conducted at the local spoke clinic and 46 joint ANP/Geriatrician home visits. Majority of referrals were from GP (n = 69), hospital (n = 30), LTC reviews (n = 22) and Community Nursing Units (CNUs) (n = 19). 449 outpatient appointments have been removed from the tertiary referral centre. Independent case load management from the ANP includes further appointments, telephone follow up/advice and she is a point of contact where crises arise before referral to acute services. 99% of patients surveyed reported satisfaction with the service especially the ease of local access and home visits.
Conclusion
Older Persons’ ANP can provide longitudinal care pathways for older adults in the community in conjunction with ICPOP and local CNUs, intervening before crises emerge and providing continuity of care and an alternative to acute care.
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Affiliation(s)
- E Shiel
- University Hospital Galway\St. Brendan's CNU , Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
| | - C McCarthy
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
| | - C McDermott
- University Hospital Galway , Galway, Ireland
| | - J Geoghegan
- University Hospital Galway , Galway, Ireland
| | - E Mannion
- University Hospital Galway , Galway, Ireland
| | - M Conry
- University Hospital Galway , Galway, Ireland
| | - L Flanagan
- Community Healthcare West , Galway, Ireland
| | - E Moroney
- Community Healthcare West , Galway, Ireland
| | | | - C Walsh
- Community Healthcare West , Galway, Ireland
| | - K Coffey
- Community Healthcare West , Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - S Robinson
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
| | - M Canavan
- University Hospital Galway , Galway, Ireland
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30
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Mc Carthy CE, O'Malley K, Mannion E, Geoghegan J, Costello M, Conry M, Flanagan L, Corry M, Reddin C, Murphy R, Waters R, O'Donnell M, Robinson S, Canavan M. 102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.102] [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: 02/25/2023] Open
Abstract
Abstract
Background
Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP).
Methods
From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed.
Results
30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient.
Conclusion
There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
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Affiliation(s)
- C E Mc Carthy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - K O'Malley
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - E Mannion
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Costello
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M Conry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - L Flanagan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Corry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - C Reddin
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Canavan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
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31
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Gutiérrez-García G, Martínez C, Boumendil A, Finel H, Malladi R, Afanasyev B, Tsoulkani A, Wilson KMO, Bloor A, Nikoloudis M, Richardson D, López-Corral L, Castagna L, Cornelissen J, Giltat A, Collin M, Fanin R, Bonifazi F, Robinson S, Montoto S, Peggs KS, Sureda A. Long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation as first transplant for high-risk Hodgkin lymphoma: a retrospective analysis from the Lymphoma Working Party-EBMT. Br J Haematol 2021; 196:1018-1030. [PMID: 34750806 DOI: 10.1111/bjh.17939] [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: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
We analysed long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation (allo-HSCT) as a first transplant for high-risk Hodgkin lymphoma (HL). One hundred and ninety patients were included in this study, 63% of them had previously received brentuximab vedotin and/or checkpoint inhibitors. Seventy patients (37%) received an unrelated donor allo-HSCT, 99 (51%) had myeloablative conditioning (MAC) and 60% had in vivo T-cell/depleted grafts (TCD). The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% and the 3-year CI of chronic GVHD was 38%. The 3-year CI of non-relapse mortality (NRM) and relapse rate were 21% and 38% respectively. After a median follow-up of 58 months, 3-year overall survival (OS) and progression-free survival (PFS) were 58% and 41% respectively. Multivariate analysis showed that, in comparison to reduced-intensity conditioning regimens with or without TCD, MAC using TCD had similar NRM and a lower risk of relapse leading to significantly better OS and PFS. MAC without TCD was associated with higher NRM and worse survival outcomes. These results suggest that in patients with high-risk HL and candidates of allo-HSCT, a MAC strategy with TCD might be the best option.
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Affiliation(s)
- G Gutiérrez-García
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - C Martínez
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | | | - H Finel
- Lymphoma Working Party, EBMT, Paris, France
| | - R Malladi
- School of Cancer Sciences, University of Birmingham, Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - B Afanasyev
- State Medical Pavlov University, St. Petersburg, Russia
| | | | | | - A Bloor
- Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - M Nikoloudis
- Haematology Department Heart of England NHS Trust, Birmingham, UK
| | - D Richardson
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | | | - L Castagna
- Department of Haematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Cornelissen
- Erasmus MC Cancer Institute University Medical Centre Rotterdam Department of Haematology, Rotterdam, Netherlands
| | - A Giltat
- Department of Haematology, Medical University Hospital, Angers, France
| | | | - R Fanin
- Department of Haematology and Cellular Therapy 'Carlo Melzi', S. Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - F Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - S Robinson
- Department of Haematology and Oncology, Bristol University Hospital, Bristol, UK
| | - S Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - K S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
| | - A Sureda
- Clinical Department of Haematology, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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32
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Nolde J, Lugo-Gavidia LM, Kannenkeril D, Chan J, Robinson S, Jose A, Joyson A, Schlaich L, Carnagarin R, Azzam O, Kiuchi M, Schlaich M. Simultaneously measured interarm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events, previous studies have demonstrated associations with other risk parameters.
Purpose
We aimed to reproduce these associations in a cohort of 199 treated, at-risk, hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage.
Methods
Simultaneously measured Inter-arm blood pressure differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients of a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multivariate regression models.
Results
Out of 199 participants, 90 showed an Inter-arm blood pressure difference of more than 5 mmHg. The Inter-arm difference was not associated with PWV. Furthermore, neither observed single blood pressure measurements nor 24 hour ambulatory blood pressure was associated with Inter-arm blood pressure differences.
Conclusion
In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design or the sample characteristics of this treated, hypertensive cohort may explain the negative results. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nolde
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L M Lugo-Gavidia
- The University of Western Australia, School of Medicine, Perth, Australia
| | - D Kannenkeril
- University of Erlangen-Nuremberg, Department for Nephrology, Erlangen, Germany
| | - J Chan
- The University of Western Australia, School of Medicine, Perth, Australia
| | - S Robinson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Jose
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Joyson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
| | - R Carnagarin
- The University of Western Australia, School of Medicine, Perth, Australia
| | - O Azzam
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Kiuchi
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
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33
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Mahendran V, Ricart P, Wadley M, Perry A, Robinson S. 1338 Bariatric Surgery as a Viable Treatment for Idiopathic Intracranial Hypertension: A Case Series. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Idiopathic Intracranial Hypertension (IIH) is a significant cause of preventable blindness. Patients also suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia, and radicular pain. If IIH continues to rise as predicted, treatment cost will increase to 462.7 million GBP annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of IIH. Bariatric surgery is an attractive treatment option due to superlative weight loss and reversal of related comorbidities. The case series aims to raise awareness of bariatric surgery as a safe and effective treatment modality for IIH.
Method
The case series consists of a retrospective analysis of four patients with a pre-operative diagnosis of IIH. They were referred to our department for bariatric surgery between January to December 2018. They were followed up for a total of two years.
Results
In our case series, all four patients were females with a mean age of 34 years. Mean BMI reduced from 47.3 kg/m2 before surgery to 30 kg/m2 with an EWL of 76.4% at the end of two years after surgery. They all showed significant improvement or resolution in their symptoms related to IIH, and none of them required further CSF pressure reducing procedures afterwards.
Conclusions
Bariatric surgery is a safe and effective method of treating IIH. It is superior compared to medical management and CSF pressure reducing procedures which have high rates of recurrence.
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Affiliation(s)
- V Mahendran
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - P Ricart
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - M Wadley
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - A Perry
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - S Robinson
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
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34
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Mahendran V, Ricart P, Robinson S, Perry A, Wadley M. 1329 Can One Size Fit All: Is Laparoscopic Roux-En-Y Gastric Bypass the Best Bariatric Procedure for Treating Type 2 Diabetes Mellitus (T2DM)? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Bariatric surgery produces superior weight loss and reversal of comorbidities in morbidly obese individuals compared to medical therapy alone. Laparoscopic Roux-en-Y gastric bypass (LRYGB) was traditionally considered to prolonged remission of T2DM compared to other procedures such as Laparoscopic Sleeve-Gastrectomy (LSG). But recently published studies seek to disprove this by emphasising on duration and severity of T2DM before surgery rather than the type of procedure. We aim to verify if the severity of T2DM and type of operation (LRYGB Vs LSG) influence remission rates.
Method
In this retrospective cohort study, 204 patients were diagnosed with T2DM pre-operatively and had undergone either LRYGB or LSG. We used the Individualised Metabolic Surgery Score (IMSS) tool to divide patients into mild, moderate, and severe categories.
Results
Results showed that of the 204 patients 15% (n = 31) had mild disease, 62%( n = 127) had moderate disease and 23% (n = 46) had severe disease. Remission rates in each category were as follows:
Conclusions
We agree that patients with longstanding and severe T2DM have low remission rates after bariatric surgery, probably due to diminished beta-cell reserve. It is in contrary to recent publications which recommend LSG over LRYGB in patients with severe disease. This evidence necessitates further prospective studies before deciding which is the best procedure for patients with severe and longstanding T2DM.
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Affiliation(s)
- V Mahendran
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - P Ricart
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - S Robinson
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - A Perry
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - M Wadley
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
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35
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Mitchell T, Astley J, Robinson S, Bryant H, Danson S, Tahir B, Hatton M. FP08.02 Artificial Neural Network-Based Tumour Recurrence Prediction in Non-Small Cell Lung Cancer Patients Following Radical Radiotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Goodman S, Bagai A, Tan M, Andrade J, Spindler C, Malek-Marzban P, Har B, Yip A, Paniagua M, Elbarouni B, Bainey K, Paradis J, Maranda R, Cantor W, Doucet M, Khan R, Eisenberg M, Dery J, Schwalm J, Madan M, Lam A, Hameed A, Noronha L, Cieza T, Matteau A, Roth S, So D, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh R, Kim H, Robinson S, Daneault B, Chong A, Le May M, Ahooja V, Gregoire J, Nadeau P, Laksman Z, Heilbron B, Bonakdar H, Yung D, Yan A. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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37
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Bilen M, Xi A, Wong A, Schroeder A, Kim R, Liu F, Peng J, Robinson S, Bhanegaonkar A. 701P Real-world (RW) treatment (Tx) patterns and clinical outcomes in patients (pts) with metastatic urothelial carcinoma (mUC) receiving first-line (1L) Tx: Results from IMPACT UC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.097] [Citation(s) in RCA: 1] [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: 11/16/2022] Open
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38
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Tan WF, Voo SYM, Sulaiman N, Robinson S. Psychosocial burden of patients with atopic dermatitis at two tertiary referral centres in Malaysia. Med J Malaysia 2021; 76:643-652. [PMID: 34508369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic pruritic skin disorder that affects up to 20% of children and 10% of adults. The disease course is unpredictable with periods of exacerbation and remission, thus having a significant impact on the mental health and quality of life (QOL). We evaluated the prevalence of anxiety and depression and their association with disease severity, QOL and their associated factors in adolescents (≥ 13 years old) and adults with AD. METHODS A cross-sectional study was conducted involving patients aged ≥ 13 years with AD who fulfilled the Hanifin and Rajka diagnostic criteria. These patients were recruited from Hospital Queen Elizabeth, Kota Kinabalu and Hospital Kuala Lumpur between January 2020 to March 2021. Assessment instruments used were Scoring for Atopic Dermatitis (SCORAD), Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS). RESULTS Of the 217 participants, 75 (34.6%) had mild eczema, 116 (53.5%) moderate eczema and 26 (12.0%) severe eczema with a mean SCORAD score of 30.4 (standard deviation [SD] = 4.70). Twenty-six (12.0%) and 17 (7.8%) had anxiety and depression, respectively. Patients with moderate to severe disease reported higher HADS-A (HADS-anxiety component), HADS-D (HADS-depression component), POEM, DLQI, itch, sleep loss and skin pain scores (p < 0.001 for all). Severe sleep loss (adjusted odd ratio [AOR] 12.41, p < 0.001) and hospitalisation in the past year (AOR 6.44, p = 0.004) were significant predictors for anxiety whereas those aged 41 to 60 (AOR 10.83, p = 0.020), having severe skin pain (AOR 6.12, p = 0.028), DLQI ≥ 10 (AOR 5.27, p = 0.002) and history of hospitalisation in the past year (AOR 12.73, p = 0.002) had increased risk for depression. CONCLUSION The prevalence of anxiety was 12.0% while depression was 7.8% in our cohort. AD renders a significant burden on mental health and QOL with a higher impact on those with more severe disease. The use of screening tools such as HADS and DLQI for assessment of mental health and QOL should be considered to address the multidimensional burden of AD.
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Affiliation(s)
- W F Tan
- Hospital Queen Elizabeth, Department of Dermatology, Sabah, Malaysia.
| | - S Y M Voo
- Hospital Queen Elizabeth, Department of Dermatology, Sabah, Malaysia
| | - N Sulaiman
- Hospital Queen Elizabeth, Clinical Research Centre, Sabah, Malaysia
| | - S Robinson
- Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia
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39
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Robinson S, Towler J, Kitson R, Saleh D, Younan H, Mukhopadhyay S, Weir J, Gujral D. PO-1024 Survival outcomes for p16+ oropharyngeal squamous cell carcinoma based on HPV status. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Zhou R, Prasad G, Robinson S, Shahane S, Sinha A. The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study. Shoulder Elbow 2021; 13:303-310. [PMID: 34659471 PMCID: PMC8512999 DOI: 10.1177/1758573220913285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The highlight of the British Elbow and Shoulder Society pathway for the management of traumatic anterior shoulder instability is early imaging in patients aged over 40 years to assess rotator cuff integrity and early repair, if indicated to optimise function. The senior author set up a protocol in our institute to streamline the diagnostic process for this cohort of patients. This was a retrospective analysis from a prospectively collected database to highlight the importance of early specialist imaging. METHODS Our protocol is to perform urgent ultrasound scans for all suitable patients above 40 years after first-time traumatic shoulder dislocation. Demographics, associated injuries, ultrasound scan results, operations and functional outcomes were collated. RESULTS One year following the introduction of our protocol, 40 patients with a mean age of 67 (range, 42-89; SD = 13.1) had ultrasound. The incidence of full-thickness rotator cuff tears was 57.5% (n = 23). Eleven patients with confirmed full-thickness rotator cuff tears underwent surgery. The mean age of surgical patients was significantly younger than the non-surgical group (p = 0.004). DISCUSSION The use of early diagnostic imaging demonstrated a high incidence of full-thickness rotator cuff tears in this cohort of patients. This allowed early surgical repair to optimise function.
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Affiliation(s)
- R Zhou
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - G Prasad
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Robinson
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Shahane
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - A Sinha
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
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41
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Wu RY, Li B, Horne R, Ghamel A, Robinson S, Cadette M, Miyake H, Johnson-Henry K, Pierro A, Sherman PM. A47 SYNTHETIC HUMAN MILK OLIGOSACCHARIDES PREVENT EXPERIMENTAL NECROTIZING ENTEROCOLITIS VIA DIVERGENT TRANSCRIPTOMIC RESPONSES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Breastmilk reduces the risk of necrotizing enterocolitis (NEC) in preterm infants, but the bioactive components mediating this effect are not well understood. Human milk oligosaccharides (HMOs) reduce NEC both in humans and in relevant animal models. However, it is unclear if there are functional differences between individual oligosaccharides.
Aims
The objective of this study was to compare the intestinal transcriptome responses of individual HMOs using complementary in vitro and in vivo models of NEC.
Methods
RNA sequencing was performed on Caco-2Bbe1 gut epithelial cells after exposure to commercially-purified 2’-fucosyllactose (2’FL), 3-fucosyllactose, 6’-siallyllactose, lacto-N-tetraose (LNT) or lacto-N-neotetraose for 24hr at 37°C for 24 h (n=3). Signaling pathways were analyzed in murine- and human-derived NEC enteroids by qPCR. To validate these findings, five-day-old mouse pups were orally gavaged formula with or without individual HMOs, followed by NEC induction with hypoxia (5% O2, 95% N2) and lipopolysaccharide (4 mg/kg/day). Coded ileal sections (n=6–7/group) were analyzed for mucosal injury by histology, immune fluorescence, immunohistochemistry, and gene expression via qPCR.
Results
The HMO transcriptome clustered into divergent functional categories including metabolic process, protein processing and responses to external stimuli. Each synthetic HMO induced a unique transcriptome and exhibited varying effects on the intestinal epithelial functions and biological pathways. This was confirmed in the murine model of NEC, as both LNT and 2FL mitigated NEC injury with comparable recovery of intestinal cell proliferation (Ki67) and expression of stem cells (Lgr5+). Both qPCR and immunofluorescence staining showed differences between 2FL- and LNT-fed pups in host inflammatory and immune responses.
Conclusions
This study demonstrates that synthetic HMOs ameliorate intestinal injury in experimental NEC. However, the mechanisms by which individual oligosaccharides act on the intestine differ, suggesting that single synthetic HMOs may not fully recapitulate the benefits of pooled HMOs. Future studies will further delineate structure-function relationships of synthetic HMOs on host intestinal innate and adaptive immune responses.
Funding Agencies
CIHRFerring Canada Medical Student Research grant
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Affiliation(s)
- R Y Wu
- SickKids Research Institute, Toronto, ON, Canada
| | - B Li
- SickKids Research Institute, Toronto, ON, Canada
| | - R Horne
- SickKids Research Institute, Toronto, ON, Canada
| | - A Ghamel
- SickKids Research Institute, Toronto, ON, Canada
| | - S Robinson
- SickKids Research Institute, Toronto, ON, Canada
| | - M Cadette
- SickKids Research Institute, Toronto, ON, Canada
| | - H Miyake
- SickKids Research Institute, Toronto, ON, Canada
| | | | - A Pierro
- SickKids Research Institute, Toronto, ON, Canada
| | - P M Sherman
- SickKids Research Institute, Toronto, ON, Canada
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42
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Voelker MN, Kraff O, Goerke S, Laun FB, Hanspach J, Pine KJ, Ehses P, Zaiss M, Liebert A, Straub S, Eckstein K, Robinson S, Nagel AN, Stefanescu MR, Wollrab A, Klix S, Felder J, Hock M, Bosch D, Weiskopf N, Speck O, Ladd ME, Quick HH. The traveling heads 2.0: Multicenter reproducibility of quantitative imaging methods at 7 Tesla. Neuroimage 2021; 232:117910. [PMID: 33647497 DOI: 10.1016/j.neuroimage.2021.117910] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/25/2021] [Accepted: 02/20/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECT This study evaluates inter-site and intra-site reproducibility at ten different 7 T sites for quantitative brain imaging. MATERIAL AND METHODS Two subjects - termed the "traveling heads" - were imaged at ten different 7 T sites with a harmonized quantitative brain MR imaging protocol. In conjunction with the system calibration, MP2RAGE, QSM, CEST and multi-parametric mapping/relaxometry were examined. RESULTS Quantitative measurements with MP2RAGE showed very high reproducibility across sites and subjects, and errors were in concordance with previous results and other field strengths. QSM had high inter-site reproducibility for relevant subcortical volumes. CEST imaging revealed systematic differences between the sites, but reproducibility was comparable to results in the literature. Relaxometry had also very high agreement between sites, but due to the high sensitivity, differences caused by different applications of the B1 calibration of the two RF coil types used were observed. CONCLUSION Our results show that quantitative brain imaging can be performed with high reproducibility at 7 T and with similar reliability as found at 3 T for multicenter studies of the supratentorial brain.
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Affiliation(s)
- Maximilian N Voelker
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany; High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kerrin J Pine
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Philipp Ehses
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Moritz Zaiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Andrzej Liebert
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sina Straub
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Korbinian Eckstein
- High Field MR Center, Department for Biomedical Imaging and Image guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Simon Robinson
- High Field MR Center, Department for Biomedical Imaging and Image guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Armin N Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maria R Stefanescu
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Astrid Wollrab
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Sabrina Klix
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck-Center for Molecular Medicine, Berlin-Buch, Germany
| | - Jörg Felder
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Hock
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Dario Bosch
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
| | - Oliver Speck
- Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Mark E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany; High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Fletcher AJ, Robinson S, Rana BS. Echocardiographic RV-E/e' for predicting right atrial pressure: a review. Echo Res Pract 2020; 7:R11-R20. [PMID: 33293465 PMCID: PMC7923036 DOI: 10.1530/erp-19-0057] [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: 09/23/2020] [Accepted: 11/27/2020] [Indexed: 01/10/2023] Open
Abstract
Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e′ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e′ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operating characteristic analyses showed reasonable diagnostic ability of RV-E/e′ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e′ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland–Altman analyses showed good accuracy but poor precision of RV-E/e′ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e′ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e′, nor about the independent prognostic ability of RV-E/e′ . Recommended areas for future research concerning RV-E/e′ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.
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Affiliation(s)
- A J Fletcher
- Department of Cardiac Physiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - S Robinson
- Department of Cardiac Investigations, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - B S Rana
- Department of Cardiology, Imperial College London NHS Foundation Trust, London, UK
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Carvalho D, Mackay A, Temelso S, Izquierdo E, Fernandez EP, Rogers R, Boult J, Salom JF, Simon N, Clarke M, Molinari V, Kessler K, Burford A, Bjerke L, Fofana M, Hubank M, Pears J, Moore A, Carcaboso AM, Marshall L, Carceller F, Robinson S, Hargrave D, Vinci M, Jones C. MODL-20. A BIOBANK OF ~100 PATIENT-DERIVED MODELS REPRESENTING BIOLOGICAL HETEROGENEITY AND DISTINCT THERAPEUTIC DEPENDENCIES IN PAEDIATRIC HIGH GRADE GLIOMA AND DIPG. Neuro Oncol 2020. [PMCID: PMC7715119 DOI: 10.1093/neuonc/noaa222.593] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Paediatric high-grade glioma comprise multiple biological and clinical subgroups, the majority of which urgently require novel therapies. Patient-derived models represent useful tools for mechanistic and preclinical investigations based upon their retention of key genetic/epigenetic features and their amenability to high-throughput approaches. We have collected ~100 in vitro models representing multiple subtypes (H3.3/H3.2/H3.1K27M, H3.3G34R/V, BRAF, MYCN_amp, NTRK_fusion, hypermutator, others) established under 2D (laminin) and/or 3D (neurosphere) conditions, credentialed by phenotypic (growth, invasion/migration) and molecular (methylation array, DNA sequencing, RNAseq) comparison to the original tumour sample. These were derived from patients at our local hospitals (n=29), as part of national co-clinical trials (n=19), from international collaborating centres (n=11), or shared directly by research groups worldwide (n=45). These have variously been subjected to pharmacological (approved/experimental drug libraries) and/or genetic screening (whole-genome CRISPR) to identify specific biological dependencies. Many have been established as orthotopic xenografts in vivo (PDX), with detailed pathological and radiological correlations with the clinical disease, and with tumorigenic latencies ranging from 48–435 days. This resource has allowed us to identify genotype-specific synthetic lethalities and responses to targeted inhibitors, including olaparib (PARP) with ATRX, nutlin-3 (MDM2) with PPM1D, AZD1775 (WEE1) with TP53, and CYC065 (CDK9) with MYCN-amplification. Combinatorial screening highlighted synergies in ACVR1-mutant DIPG between novel ALK2 inhibitors and ONC201 (DRD2). Rapid screening allows for feedback of drug sensitivities to treating clinicians at relapse, whilst mechanistic underpinning of these interactions and use of the models to identify specific mediators of resistance will allow for rational future trial design.
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Affiliation(s)
| | - Alan Mackay
- Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jessica Boult
- Institute of Cancer Research, London, United Kingdom
| | | | - Natalie Simon
- Institute of Cancer Research, London, United Kingdom
| | | | | | - Ketty Kessler
- Institute of Cancer Research, London, United Kingdom
| | - Anna Burford
- Institute of Cancer Research, London, United Kingdom
| | - Lynn Bjerke
- Institute of Cancer Research, London, United Kingdom
| | | | - Michael Hubank
- Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Jane Pears
- Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Andrew Moore
- The University of Queensland, Brisbane, Australia
| | | | | | | | | | | | - Maria Vinci
- Bambino Gesù Children’s Hospital, Rome, Italy
| | - Chris Jones
- Institute of Cancer Research, London, United Kingdom
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Boult J, Bjerke L, Fofana M, Vinci M, Molinari V, Mackay A, Temelso S, Box G, Eccles S, Carcaboso A, Castro M, Waanders A, Cole K, Jones C, Robinson S. IMG-12. CHARACTERISATION OF MODELS OF H3F3A_G34R/V MUTANT PAEDIATRIC GLIOBLASTOMA IN VIVO USING MAGNETIC RESONANCE IMAGING. Neuro Oncol 2020. [PMCID: PMC7715122 DOI: 10.1093/neuonc/noaa222.347] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Approximately 15% of paediatric/young adult cerebral hemispheric glioblastomas (pGBM) harbour G34R/V mutations in H3F3A, encoding the histone H3.3 variant. Development of novel therapeutic interventions demands models that accurately recapitulate this subset of disease and sensitive imaging methods with which to study tumours in situ. Three H3F3A_G34R primary-patient-derived cultures, alongside established cell-line KNS42 (H3F3A_G34V), were implanted orthotopically in immunocompromised mice. KNS42 (TP53_R342*) tumours were clearly detectable using T2-weighted (T2w)-MRI, enhanced following contrast agent administration, indicating impaired blood-brain barrier (BBB) integrity, and demonstrated minimal invasion. OPBG_GBM_001 cells (TP53_89-90X,ATRX_II2133-2144X) formed infiltrative tumours that were hyperintense on T2w-MRI and demonstrated contrast-enhancement suggestive of heterogeneous BBB integrity. HSJD_GBM_002 cells (TP53_P278T,ATRX_R666*) spread diffusely throughout the brain with their full extent typically not discernible by T2w-MRI, the BBB also remaining intact. No evidence of CHOP_GBM_001 tumour was detected by MRI 11months post-implantation. Immunocompetent syngeneic models using tumour cells induced by mutations modelling hemispheric pGBM (NRAS/shP53/shATRX±H3.3G34R) are being explored. Fast growing heterogeneous lesions with variable contrast-enhancement were identified; the H3.3G34R mutation conferred longer median survival (2 clones:25/28days, control:14days). These models have the advantage of an intact immune system and short latency for initial efficacy studies. Primary pGBM cells yield tumours that are more representative of the spectrum of clinical disease; variable hyperintensity on T2w-MRI corresponding to cellular density, with diffusely infiltrative disease less clearly definable, a paucity of oedema and a range of contrast-enhancement. Pathological features including giant multinucleated cells, and mitotic figures were also evident.
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Affiliation(s)
- Jessica Boult
- The Institute of Cancer Research, London, United Kingdom
| | - Lynn Bjerke
- The Institute of Cancer Research, London, United Kingdom
| | - Mariama Fofana
- The Institute of Cancer Research, London, United Kingdom
| | - Maria Vinci
- Bambino Gesù Ospedale Pediatrico - IRCSS, Rome, Italy
| | | | - Alan Mackay
- The Institute of Cancer Research, London, United Kingdom
| | - Sara Temelso
- The Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- The Institute of Cancer Research, London, United Kingdom
| | - Suzanne Eccles
- The Institute of Cancer Research, London, United Kingdom
| | | | - Maria Castro
- University of Michigan Medical School, Ann Arbor, USA
| | | | - Kristina Cole
- The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
| | - Simon Robinson
- The Institute of Cancer Research, London, United Kingdom
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Abstract
Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation.
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Hsia TL, Wu JH, Xu X, Li Q, Peng L, Robinson S. Omnichannel retailing: The role of situational involvement in facilitating consumer experiences. Information & Management 2020. [DOI: 10.1016/j.im.2020.103390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Banerji V, Aw A, Robinson S, Doucette S, Christofides A, Sehn LH. Bruton tyrosine kinase inhibitors for the frontline treatment of chronic lymphocytic leukemia. Curr Oncol 2020; 27:e645-e655. [PMID: 33380880 PMCID: PMC7755444 DOI: 10.3747/co.27.6795] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic lymphocytic leukemia (cll) is the most commonly diagnosed adult leukemia in Canada. Biologic heterogeneity of cll between patients results in variable disease trajectories and responses to therapy. Notably, compared with patients lacking high-risk features, those with such features-such as deletions in chromosome 17p, aberrations in the TP53 gene, or unmutated immunoglobulin heavy chain variable region genes-experience inferior outcomes and responses to standard chemoimmunotherapy. Novel agents that target the B cell receptor signalling pathway, such as Bruton tyrosine kinase (btk) inhibitors, have demonstrated clinical efficacy and safety in patients with treatment-naïve cll, particularly those with high-risk features. However, given the current lack of head-to-head trials comparing btk inhibitors, selection of the optimal btk inhibitor for patients with cll is unclear and requires consideration of multiple factors. In the present review, we focus on the efficacy, safety, and pharmacologic features of the btk inhibitors that are approved or under clinical development, and we discuss the practical considerations for the use of those agents in the Canadian treatment landscape.
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Affiliation(s)
- V Banerji
- Departments of Internal Medicine and Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Science, University of Manitoba and Research Institute of Oncology and Hematology at CancerCare Manitoba, Winnipeg, MB
| | - A Aw
- Ottawa Blood Disease Centre, University of Ottawa, Ottawa, ON
| | - S Robinson
- Division of Hematology, Dalhousie University, Halifax, NS
| | | | | | - L H Sehn
- BC Cancer-Centre for Lymphoid Cancer, and University of British Columbia, Vancouver, BC
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Brangsch J, Reimann C, Kaufmann JO, Adams LC, Onthank D, Thöne-Reineke C, Robinson S, Wilke M, Weller M, Buchholz R, Karst U, Botnar R, Hamm B, Makowski MR. Molecular MR-Imaging for Noninvasive Quantification of the Anti-Inflammatory Effect of Targeting Interleukin-1β in a Mouse Model of Aortic Aneurysm. Mol Imaging 2020; 19:1536012120961875. [PMID: 33216687 PMCID: PMC7682246 DOI: 10.1177/1536012120961875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Molecular-MRI is a promising imaging modality for the assessment of abdominal aortic aneurysms (AAAs). Interleukin-1β (IL-1β) represents a new therapeutic tool for AAA-treatment, since pro-inflammatory cytokines are key-mediators of inflammation. This study investigates the potential of molecular-MRI to evaluate therapeutic effects of an anti-IL-1β-therapy on AAA-formation in a mouse-model. Methods: Osmotic-minipumps were implanted in apolipoprotein-deficient-mice (N = 27). One group (Ang-II+01BSUR group, n = 9) was infused with angiotensin-II (Ang-II) for 4 weeks and received an anti-murine IL-1β-antibody (01BSUR) 3 times. One group (Ang-II-group, n = 9) was infused with Ang-II for 4 weeks but received no treatment. Control-group (n = 9) was infused with saline and received no treatment. MR-imaging was performed using an elastin-specific gadolinium-based-probe (0.2 mmol/kg). Results: Mice of the Ang-II+01BSUR-group showed a lower aortic-diameter compared to mice of the Ang-II-group and control mice (p < 0.05). Using the elastin-specific-probe, a significant decrease in elastin-destruction was observed in mice of the Ang-II+01BSUR-group. In vivo MR-measurements correlated well with histopathology (y = 0.34x-13.81, R2 = 0.84, p < 0.05), ICP-MS (y = 0.02x+2.39; R2 = 0.81, p < 0.05) and LA-ICP-MS. Immunofluorescence and western-blotting confirmed a reduced IL-1β-expression. Conclusions: Molecular-MRI enables the early visualization and quantification of the anti-inflammatory-effects of an IL-1β-inhibitor in a mouse-model of AAAs. Responders and non-responders could be identified early after the initiation of the therapy using molecular-MRI.
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Affiliation(s)
- Julia Brangsch
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Berlin, Germany
| | - Carolin Reimann
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Berlin, Germany
| | - Jan Ole Kaufmann
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Division 1.5 Protein Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany.,Department of Chemistry, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Christine Adams
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - David Onthank
- 128865Lantheus Medical Imaging, North Billerica, MA, USA
| | - Christa Thöne-Reineke
- Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Berlin, Germany
| | - Simon Robinson
- 128865Lantheus Medical Imaging, North Billerica, MA, USA
| | - Marco Wilke
- Division 1.5 Protein Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
| | - Michael Weller
- Division 1.5 Protein Analysis, Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
| | - Rebecca Buchholz
- Institute of Inorganic and Analytical Chemistry, 9185Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, 9185Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, 4616King's College London, St Thomas' Hospital, London, United Kingdom.,Wellcome Trust/EPSRC Centre for Medical Engineering, 4616King's College London, United Kingdom.,BHF Centre of Excellence, 4616King's College London, Denmark Hill Campus, London, United Kingdom.,Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernd Hamm
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Marcus Richard Makowski
- Department of Radiology, 14903Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,School of Biomedical Engineering and Imaging Sciences, 4616King's College London, St Thomas' Hospital, London, United Kingdom.,BHF Centre of Excellence, 4616King's College London, Denmark Hill Campus, London, United Kingdom.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Zhao Y, Izadnegahdar M, Lee MK, Kavsak PA, Singer J, Scheuermeyer F, Udell JA, Robinson S, Norris CM, Lyon AW, Pilote L, Cox J, Hassan A, Rychtera A, Johnson D, Mills NL, Christenson J, Humphries KH. High-Sensitivity Cardiac Troponin-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE-MI): Rationale and design for a multicenter, stepped-wedge, cluster-randomized trial. Am Heart J 2020; 229:18-28. [PMID: 32916606 DOI: 10.1016/j.ahj.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
Despite evidence that high-sensitivity cardiac troponin (hs-cTn) levels in women are lower than in men, a single threshold based on the 99th percentile upper reference limit of the overall reference population is commonly used to diagnose myocardial infarction in clinical practice. This trial aims to determine whether the use of a lower female-specific hs-cTn threshold would improve the diagnosis, treatment, and outcomes of women presenting to the emergency department with symptoms suggestive of myocardial ischemia. METHODS/DESIGN: CODE-MI (hs-cTn-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women) is a multicenter, stepped-wedge, cluster-randomized trial of 30 secondary and tertiary care hospitals across 8 Canadian provinces, with the unit of randomization being the hospital. All adults (≥20 years of age) presenting to the emergency department with symptoms suggestive of myocardial ischemia and at least 1 hs-cTn test are eligible for inclusion. Over five, 5-month intervals, hospitals will be randomized to implement lower female hs-cTn thresholds according to the assay being used at each site. Men will continue to be assessed using the overall thresholds throughout. Women with a peak hs-cTn value between the female-specific and the overall thresholds will form our primary cohort. The primary outcome, a 1-year composite of all-cause mortality or readmission for nonfatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization, will be compared before and after the implementation of female thresholds using mixed-effects logistic regression models. The cohort and outcomes will be obtained from routinely collected administrative data. The trial is designed to detect a 20% relative risk difference in the primary outcome, or a 2.2% absolute difference, with 82% power. CONCLUSIONS: This pragmatic trial will assess whether adopting lower female hs-cTn thresholds leads to appropriate assessment of women with symptoms suggestive of myocardial infarction, thereby improving treatment and outcomes.
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