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Carney M, Pelaia TM, Chew T, Teoh S, Phu A, Kim K, Wang Y, Iredell J, Zerbib Y, McLean A, Schughart K, Tang B, Shojaei M, Short KR. Host transcriptomics and machine learning for secondary bacterial infections in patients with COVID-19: a prospective, observational cohort study. Lancet Microbe 2024; 5:e272-e281. [PMID: 38310908 DOI: 10.1016/s2666-5247(23)00363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Viral respiratory tract infections are frequently complicated by secondary bacterial infections. This study aimed to use machine learning to predict the risk of bacterial superinfection in SARS-CoV-2-positive individuals. METHODS In this prospective, multicentre, observational cohort study done in nine centres in six countries (Australia, Indonesia, Singapore, Italy, Czechia, and France) blood samples and RNA sequencing were used to develop a robust model of predicting secondary bacterial infections in the respiratory tract of patients with COVID-19. Eligible participants were older than 18 years, had known or suspected COVID-19, and symptoms of a recent respiratory infection. A control cohort of participants without COVID-19 who were older than 18 years and with no infection symptoms was also recruited from one Australian centre. In the pre-analysis phase, data were filtered to include only individuals with complete blood transcriptomics and patient data (ie, age, sex, location, and WHO severity score at the time of sample collection). The dataset was then divided randomly (4:1) into a training set (80%) and a test set (20%). Gene expression data in the training set and control cohort were used for differential expression analysis. Differentially expressed genes, along with WHO severity score, location, age, and sex, were used for feature selection with least absolute shrinkage and selection operator (LASSO) in the training set. For LASSO analysis, samples were excluded if gene expression data were not obtained at study admission, no longitudinal clinical information was available, a bacterial infection at the time of study admission was present, or a fungal infection in the absence of a bacterial infection was detected. LASSO regression was performed using three subsets of predictor variables: patient data alone, gene expression data alone, or a combination of patient data and gene expression data. The accuracy of the resultant models was tested on data from the test set. FINDINGS Between March, 2020, and October, 2021, we recruited 536 SARS-CoV-2-positive individuals and between June, 2013, and January, 2020, we recruited 74 participants into the control cohort. After prefiltering analysis and other exclusions, samples from 158 individuals were analysed in the training set and 47 in the test set. The expression of seven host genes (DAPP1, CST3, FGL2, GCH1, CIITA, UPP1, and RN7SL1) in the blood at the time of study admission was identified by LASSO as predictive of the risk of developing a secondary bacterial infection of the respiratory tract more than 24 h after study admission. Specifically, the expression of these genes in combination with a patient's WHO severity score at the time of study enrolment resulted in an area under the curve of 0·98 (95% CI 0·89-1·00), a true positive rate (sensitivity) of 1·00 (95% CI 1·00-1·00), and a true negative rate (specificity) of 0·94 (95% CI 0·89-1·00) in the test cohort. The combination of patient data and host transcriptomics at hospital admission identified all seven individuals in the training and test sets who developed a bacterial infection of the respiratory tract 5-9 days after hospital admission. INTERPRETATION These data raise the possibility that host transcriptomics at the time of clinical presentation, together with machine learning, can forward predict the risk of secondary bacterial infections and allow for the more targeted use of antibiotics in viral infection. FUNDING Snow Medical Research Foundation, the National Health and Medical Research Council, the Jack Ma Foundation, the Helmholtz-Association, the A2 Milk Company, National Institute of Allergy and Infectious Disease, and the Fondazione AIRC Associazione Italiana per la Ricerca contro il Cancro.
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Affiliation(s)
- Meagan Carney
- School of Mathematics and Physics, University of Queensland, Brisbane, QLD, Australia
| | - Tiana Maria Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, University of Sydney, Sydney, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Sydney Medical School Westmead, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Jonathan Iredell
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia; Sydney Institute for Infectious Disease, University of Sydney, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Yoann Zerbib
- Intensive Care Department, Amiens University Hospital, Amiens, France
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Klaus Schughart
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA; Institute of Virology Münster, University of Münster, Münster, Germany
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia.
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Wang Y, Schughart K, Pelaia TM, Chew T, Kim K, Karvunidis T, Knippenberg B, Teoh S, Phu AL, Short KR, Iredell J, Thevarajan I, Audsley J, Macdonald S, Burcham J, Tang B, McLean A, Shojaei M. Pathway and Network Analyses Identify Growth Factor Signaling and MMP9 as Potential Mediators of Mitochondrial Dysfunction in Severe COVID-19. Int J Mol Sci 2023; 24:ijms24032524. [PMID: 36768847 PMCID: PMC9917147 DOI: 10.3390/ijms24032524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
Patients with preexisting metabolic disorders such as diabetes are at a higher risk of developing severe coronavirus disease 2019 (COVID-19). Mitochondrion, the very organelle that controls cellular metabolism, holds the key to understanding disease progression at the cellular level. Our current study aimed to understand how cellular metabolism contributes to COVID-19 outcomes. Metacore pathway enrichment analyses on differentially expressed genes (encoded by both mitochondrial and nuclear deoxyribonucleic acid (DNA)) involved in cellular metabolism, regulation of mitochondrial respiration and organization, and apoptosis, was performed on RNA sequencing (RNASeq) data from blood samples collected from healthy controls and patients with mild/moderate or severe COVID-19. Genes from the enriched pathways were analyzed by network analysis to uncover interactions among them and up- or downstream genes within each pathway. Compared to the mild/moderate COVID-19, the upregulation of a myriad of growth factor and cell cycle signaling pathways, with concomitant downregulation of interferon signaling pathways, were observed in the severe group. Matrix metallopeptidase 9 (MMP9) was found in five of the top 10 upregulated pathways, indicating its potential as therapeutic target against COVID-19. In summary, our data demonstrates aberrant activation of endocrine signaling in severe COVID-19, and its implication in immune and metabolic dysfunction.
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Affiliation(s)
- Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Kingswood, NSW 2747, Australia
| | - Klaus Schughart
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Institute of Virology Münster, University of Münster, 48149 Münster, Germany
| | - Tiana Maria Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney NSW 2006, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Thomas Karvunidis
- Medical ICU, 1st Department of Internal Medicine, Charles University and Teaching Hospital Pilsen, 323 00 Plzeň, Czech Republic
| | - Ben Knippenberg
- Department of Microbiology, St. George Hospital, Sydney, NSW 2217, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
| | - Amy L. Phu
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, CNR Darcy and Hawkesbury Roads, Sydney, NSW 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School Westmead, Westmead Hospital, The University of Sydney, Sydney, NSW 2145, Australia
| | - Kirsty R. Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jonathan Iredell
- Centre for Infectious Diseases and Microbiology, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW 2145, Australia
- Westmead Hospital, Western Sydney Local Health District, Sydney, NSW 2145, Australia
- Sydney Institute for Infectious Disease, The University of Sydney, Sydney, NSW 2145, Australia
| | - Irani Thevarajan
- Victorian Infectious Disease Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3050, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Jennifer Audsley
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Stephen Macdonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, Perth, WA 6000, Australia
- Medical School, University of Western Australia, Perth, WA 6009, Australia
- Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Jonathon Burcham
- Centre for Clinical Research in Emergency Medicine, Royal Perth Bentley Group, Perth, WA 6000, Australia
| | | | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
- Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Kingswood, NSW 2747, Australia
- Correspondence: (A.M.); (M.S.)
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
- Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Kingswood, NSW 2747, Australia
- Correspondence: (A.M.); (M.S.)
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Shojaei M, Chen UI, Midic U, Thair S, Teoh S, McLean A, Sweeney TE, Thompson M, Liesenfeld O, Khatri P, Tang B. Multisite validation of a host response signature for predicting likelihood of bacterial and viral infections in patients with suspected influenza. Eur J Clin Invest 2023; 53:e13957. [PMID: 36692131 DOI: 10.1111/eci.13957] [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: 10/12/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Indiscriminate use of antimicrobials and antimicrobial resistance is a public health threat. IMX-BVN-1, a 29-host mRNA classifier, provides two separate scores that predict likelihoods of bacterial and viral infections in patients with suspected acute infections. We validated the performance of IMX-BVN-1 in adults attending acute health care settings with suspected influenza. METHOD We amplified 29-host response genes in RNA extracted from blood by NanoString nCounter. IMX-BVN-1 calculated two scores to predict probabilities of bacterial and viral infections. Results were compared against the infection status (no infection; highly probable/possible infection; confirmed infection) determined by clinical adjudication. RESULTS Amongst 602 adult patients (74.9% ED, 16.9% ICU, 8.1% outpatients), 7.6% showed in-hospital mortality and 15.5% immunosuppression. Median IMX-BVN-1 bacterial and viral scores were higher in patients with confirmed bacterial (0.27) and viral (0.62) infections than in those without bacterial (0.08) or viral (0.21) infection, respectively. The AUROC distinguishing bacterial from nonbacterial illness was 0.81 and 0.87 when distinguishing viral from nonviral illness. The bacterial top quartile's positive likelihood ratio (LR) was 4.38 with a rule-in specificity of 88%; the bacterial bottom quartile's negative LR was 0.13 with a rule-out sensitivity of 96%. Similarly, the viral top quartile showed an infinite LR with rule-in specificity of 100%; the viral bottom quartile had a LR of 0.22 and a rule-out sensitivity of 85%. CONCLUSION IMX-BVN-1 showed high accuracy for differentiating bacterial and viral infections from noninfectious illness in patients with suspected influenza. Clinical utility of IMX-BVN will be validated following integration into a point of care system.
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Affiliation(s)
- Maryam Shojaei
- Department of Medicine, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia.,Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia.,Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Uan-I Chen
- Inflammatix, Inc., Sunnyvale, California, USA
| | - Uros Midic
- Inflammatix, Inc., Sunnyvale, California, USA
| | | | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | | | | | | | | | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia.,Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Wang Y, Schughart K, Pelaia TM, Chew T, Kim K, Karvunidis T, Knippenberg B, Teoh S, Phu AL, Short KR, Iredell J, Thevarajan I, Audsley J, Macdonald S, Burcham J, McLean A, Tang B, Shojaei M. Blood transcriptome responses in patients correlate with severity of COVID-19 disease. Front Immunol 2023; 13:1043219. [PMID: 36741372 PMCID: PMC9896980 DOI: 10.3389/fimmu.2022.1043219] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infected individuals display a wide spectrum of disease severity, as defined by the World Health Organization (WHO). One of the main factors underlying this heterogeneity is the host immune response, with severe COVID-19 often associated with a hyperinflammatory state. Aim Our current study aimed to pinpoint the specific genes and pathways underlying differences in the disease spectrum and outcomes observed, through in-depth analyses of whole blood transcriptomics in a large cohort of COVID-19 participants. Results All WHO severity levels were well represented and mild and severe disease displaying distinct gene expression profiles. WHO severity levels 1-4 were grouped as mild disease, and signatures from these participants were different from those with WHO severity levels 6-9 classified as severe disease. Severity level 5 (moderate cases) presented a unique transitional gene signature between severity levels 2-4 (mild/moderate) and 6-9 (severe) and hence might represent the turning point for better or worse disease outcome. Gene expression changes are very distinct when comparing mild/moderate or severe cases to healthy controls. In particular, we demonstrated the hallmark down-regulation of adaptive immune response pathways and activation of neutrophil pathways in severe compared to mild/moderate cases, as well as activation of blood coagulation pathways. Conclusions Our data revealed discrete gene signatures associated with mild, moderate, and severe COVID-19 identifying valuable candidates for future biomarker discovery.
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Affiliation(s)
- Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia,Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, Australia,*Correspondence: Ya Wang,
| | - Klaus Schughart
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, United States,Institute of Molecular Virology, University of Münster, Münster, Germany
| | - Tiana Maria Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, NSW, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Thomas Karvunidis
- Medical ICU, 1 Department of Internal Medicine, Charles University and Teaching Hospital, Pilsen, Czechia
| | - Ben Knippenberg
- Department of Microbiology. St George Hospital, Kogarah, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Amy L. Phu
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, NSW, Westmead, Australia,Faculty of Medicine and Health, Sydney Medical School Westmead, Westmead Hospital, University of Sydney, NSW, Westmead, Australia
| | - Kirsty R. Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan Iredell
- Centre for Infectious Diseases and Microbiology, The Westmead Institute for Medical Research, Westmead, NSW, Australia,Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia,Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia,Sydney Institute for Infectious Disease, The University of Sydney, Sydney, NSW, Australia
| | - Irani Thevarajan
- Victorian Infectious Disease Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jennifer Audsley
- Victorian Infectious Disease Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Stephen Macdonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, Perth, WA, Australia,Medical School, University of Western Australia, Perth, WA, Australia,Emergency Department, Royal Perth Hospital, Perth, WA, Australia
| | - Jonathon Burcham
- Centre for Clinical Research in Emergency Medicine, Royal Perth Bentley Group, Perth, WA, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
| | | | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia,Faculty of Medicine and Health, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, Australia
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Jamal J, Idris H, Faour A, Yang W, McLean A, Burgess S, Shugman I, Oloughlin A, Leung D, Mussap CJ, Juergens CP, Lo S, French JK. Reperfusion strategy and late clinical outcomes of patients with ST-elevation myocardial infarction (STEMI) in the absence of standard modifiable risk factors (SMuRFs). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2034] [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
Introduction
There is growing evidence that patients presenting with STEMI in the absence of standard modifiable cardiovascular risk factors (SMuRFs; smoking, hypertension, hypercholesterolemia, diabetes) have poorer outcomes compared to those with atleast one SMuRF. It has been hypothesised that this may be in part due to decreased administration of pharmacotherapies in the post-infarct period due to perceived low risk. Long term outcomes of patients without SMuRFs based on reperfusion strategy received during the index admission have not been investigated.
Purpose
We sought to analyse late clinical outcomes of STEMI patients with and without SMuRFs based on reperfusion strategy received during the index admission.
Methods
All patients who underwent PCI between 2003 and 2014 were identified from a PCI centre STEMI database. Late clinical outcomes of patients with and without SMuRFs were analysed overall and based on reperfusion strategy [primary PCI (pPCI) vs pharmaco-invasive PCI (PI-PCI)]. Propensity matching was used to account for differences in baseline characteristics between the groups.
Results
Amongst 2,091 STEMI patients, 531 (25%) had no SMuRFs (51% pPCI, 49% PI-PCI) and 1560 (75%) had ≥1 SMuRF (52% pPCI, 48% PI-PCI). Unadjusted late mortality in SMuRF-less patients was 13.4% (18.8% pPCI, 7.7% PI-PCI) and for those with ≥1 SMuRF was 9.7% (11.0% pPCI, 8.4% PI-PCI). After propensity-matching clinical and angiographic characteristics, 5 year mortality rates were significantly higher for patients without SMuRFs compared to those with SMuRFs [HR 1.36, CI: 1.03–1.81, p=0.031]. This difference was attenuated for patients who underwent pPCI [HR 1.72, CI: 1.22–2.43, p=0.002]. Interestingly, this discrepancy was not observed amongst individuals who underwent pharmaco-invasive PCI [HR 1.13, CI: 0.53–1.48, p=0.638], as SMuRF-less patients had similar mortality rates to their counterparts. Long term rates of reinfarction, stent thrombosis and target vessel revascularisation were similar between the groups. Additionally, there was no significant difference in rates of stroke and major bleeding amongst all 4 subgroups.
Conclusion
Patients presenting with STEMI in the absence of SMuRFs have increased overall late mortality compared to those with at least one SMuRF. However, this difference was not observed in patients who underwent a pharmaco-invasive strategy, whereby patients without SMuRFs had similar outcomes to those with SMuRFs after adjusting for confounders. Our findings suggest the use of a pharmaco-invasive strategy in appropriate SMuRF-less patients presenting with STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Jamal
- Liverpool Hospital , Sydney , Australia
| | - H Idris
- Liverpool Hospital , Sydney , Australia
| | - A Faour
- Liverpool Hospital , Sydney , Australia
| | - W Yang
- Liverpool Hospital , Sydney , Australia
| | - A McLean
- Liverpool Hospital , Sydney , Australia
| | - S Burgess
- Liverpool Hospital , Sydney , Australia
| | - I Shugman
- Liverpool Hospital , Sydney , Australia
| | | | - D Leung
- Liverpool Hospital , Sydney , Australia
| | | | | | - S Lo
- Liverpool Hospital , Sydney , Australia
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Affiliation(s)
- Konstantin Yastrebov
- Prince of Wales Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Anthony McLean
- Nepean Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Andrew Hilton
- Austin Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - John Evans
- Townsville Hospital, Townsville, QLD, Australia
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McLean A, Rapaport B. 1307 Linking Pre-ST Trainees into The Surgical Profession - An Example from OMFS Of A Structured Introduction to The Speciality. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.632] [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]
Abstract
Abstract
Introduction
Inspiration and support are two of the key principles that enthuse junior trainees to pursue a career in surgery. Exposure to Oral and Maxillofacial Surgery (OMFS) is minimal at undergraduate level and can present a challenge for those postgraduate individuals who wish to gain more experience before applying to further training. This has prompted the formation of a support programme comprised of two stages: Taste of OMFS and Mentoring and Support Programme (MSP).
Method
Feedback was captured from OMFS junior trainees and educational supervisors on the existing junior trainee programme. It was concluded that a new programme was required to create a more structured system to help support trainees achieve their goals within OMFS. Taste in OMFS aims to provoke intrigue in the specialty. Individuals who are inspired to experience more can advance on to the MSP which consists of checklists, carefully designed to help the trainee obtain adequate exposure and achieve the recommended requirements for second-degree and specialty training applications.
Results
The new programme was trialed by existing junior trainee programme members over a six-month period. The results were encouraging with positive feedback on the structure of both sections. This, in combination with ideas generated from a focus group has helped create the final version, now published and accessible on the British Association of Oral and Maxillofacial Surgeons website.
Conclusions
We hope to raise awareness of this dynamic programme which can be tailored to each individual, in the hope that more junior trainees pursue a career within OMFS.
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Affiliation(s)
- A McLean
- University of Liverpool, Liverpool, United Kingdom
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - B Rapaport
- University of Liverpool, Liverpool, United Kingdom
- Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Wang Y, Gloss B, Tang B, Dervish S, Santner-Nanan B, Whitehead C, Masters K, Skarratt K, Teoh S, Schibeci S, Fewings N, Brignone C, Triebel F, Booth D, McLean A, Nalos M. Immunophenotyping of Peripheral Blood Mononuclear Cells in Septic Shock Patients With High-Dimensional Flow Cytometry Analysis Reveals Two Subgroups With Differential Responses to Immunostimulant Drugs. Front Immunol 2021; 12:634127. [PMID: 33828550 PMCID: PMC8019919 DOI: 10.3389/fimmu.2021.634127] [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: 11/27/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is associated with a dysregulated inflammatory response to infection. Despite the activation of inflammation, an immune suppression is often observed, predisposing patients to secondary infections. Therapies directed at restoration of immunity may be considered but should be guided by the immune status of the patients. In this paper, we described the use of a high-dimensional flow cytometry (HDCyto) panel to assess the immunophenotype of patients with sepsis. We then isolated peripheral blood mononuclear cells (PBMCs) from patients with septic shock and mimicked a secondary infection by stimulating PBMCs for 4 h in vitro with lipopolysaccharide (LPS) with or without prior exposure to either IFN-γ, or LAG-3Ig. We evaluated the response by means of flow cytometry and high-resolution clustering cum differential analysis and compared the results to PBMCs from healthy donors. We observed a heterogeneous immune response in septic patients and identified two major subgroups: one characterized by hypo-responsiveness (Hypo) and another one by hyper-responsiveness (Hyper). Hypo and Hyper groups showed significant differences in the production of cytokines/chemokine and surface human leukocyte antigen-DR (HLA-DR) expression in response to LPS stimulation, which were observed across all cell types. When pre-treated with either interferon gamma (IFN-γ) or lymphocyte-activation gene 3 (LAG)-3 recombinant fusion protein (LAG-3Ig) prior to LPS stimulation, cells from the Hypo group were shown to be more responsive to both immunostimulants than cells from the Hyper group. Our results demonstrate the importance of patient stratification based on their immune status prior to any immune therapies. Once sufficiently scaled, this approach may be useful for prescribing the right immune therapy for the right patient at the right time, the key to the success of any therapy.
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Affiliation(s)
- Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Brian Gloss
- Westmead Research Hub, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Suat Dervish
- Westmead Cytometry, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Brigitte Santner-Nanan
- Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, Kingswood, NSW, Australia
| | - Christina Whitehead
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Kristy Masters
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Kristen Skarratt
- Department of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Kingswood, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Stephen Schibeci
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Nicole Fewings
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | | | - David Booth
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,1st Department of Medicine, Medical Faculty in Plzen, Charles University, Prague, Czechia
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9
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Magennis P, Begley A, McLean A, Rapaport B, Dhariwal DK, Brennan PA, Hutchison I. The UK Mentoring and Support Programme (MSP) for those considering a career in Oral and Maxillofacial Surgery (OMFS). A review of a 'Register Interest in OMFS' website and the MSP as two key resources created by the British Association of Oral and Maxillofacial Surgeons to promote recruitment and retention (2008-2020). Br J Oral Maxillofac Surg 2020; 59:935-940. [PMID: 34400024 DOI: 10.1016/j.bjoms.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes. Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new 'Taste of OMFS 2020' programme was created. The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk. Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.
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Affiliation(s)
- P Magennis
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A Begley
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - A McLean
- University of Liverpool, United Kingdom.
| | - B Rapaport
- University of Liverpool, United Kingdom.
| | - D K Dhariwal
- John Radcliffe Hospital, Oxford, United Kingdom.
| | | | - I Hutchison
- Institute of Dentistry, Barts and The London, United Kingdom.
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10
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Sanfilippo F, Huang S, Herpain A, Balik M, Chew MS, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies. Intensive Care Med 2020; 47:1-13. [PMID: 33275163 DOI: 10.1007/s00134-020-06262-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 07/17/2020] [Accepted: 09/25/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies. METHODS The PRICE panel identified lists of clinical and echocardiographic parameters (the "items") deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts' opinion into account. RESULTS A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed. CONCLUSION The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Stephen Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Antoine Herpain
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fernando Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - Daniel De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Nick Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - Guillaume Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Armand Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Anthony McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Andrea Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Sam Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Tatjana Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Inserm CIC 1435, Limoges University Hospital, Limoges, France
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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11
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McLean A, Lowe D, Rogers SN. Administration of intravenous iron and tranexamic acid in the management of postoperative iron deficiency anaemia following free flap reconstruction: re-audit. Br J Oral Maxillofac Surg 2020; 59:97-101. [PMID: 33168366 DOI: 10.1016/j.bjoms.2020.08.064] [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] [Received: 04/20/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022]
Abstract
Following free tissue transfer, intravenous iron (IVI) has a role in reducing the rates of blood transfusion and more rapidly restoring haemoglobin (Hb) levels. Anaemia has a detrimental effect on survival, postoperative complications, fatigue, and health-related quality of life, therefore early correction is recommended. The aim of this re-audit is to assess the use of IVI, of tranexamic acid intraoperatively, and of perioperative blood transfusions. A total of 148 consecutive patients who underwent ablative surgery and free flap reconstruction between May 2018 and September 2019 were audited. The median (IQR) age was 66 (59,72) years and 36% were female. For two-thirds, surgery was for cancer located in the oral cavity and two-thirds of the free flaps were soft tissue. Tranexamic acid (TXA) was used intraoperatively for 30%, red blood cells (RBC) were transfused for 20% and 55 patients (37%) received IV iron. This compares with 4%, 26%, and 0, respectively, in the initial audit. Those having IVI were more likely (56%) to have had a composite flap, a lower postoperative haemoglobin and lower discharge Hb. The Hb between four and twelve weeks' follow up, known for 40, was a median (IQR) of 122 (104,138). There were no adverse reactions to IV iron. Although it is straightforward to administer IVI postoperatively, this re-audit demonstrates that it can be a challenge to embed change in protocols. Through raised awareness of the benefits of IVI, lack of adverse events and clarification of selection criteria, it is hoped that rates of IVI use will increase.
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Affiliation(s)
- A McLean
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool L9 7AL, UK.
| | - D Lowe
- Astraglobe Ltd., Congleton, Cheshire.
| | - S N Rogers
- Regional Maxillofacial Unit, Aintree University Hospital, Liverpool L9 7AL, UK.
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12
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Toulza F, Dominy K, Cook T, Galliford J, Beadle J, McLean A, Roufosse C. Technical considerations when designing a gene expression panel for renal transplant diagnosis. Sci Rep 2020; 10:17909. [PMID: 33087822 PMCID: PMC7578804 DOI: 10.1038/s41598-020-74794-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Gene expression analysis is emerging as a new diagnostic tool in transplant pathology, in particular for the diagnosis of antibody-mediated rejection. Diagnostic gene expression panels are defined on the basis of their pathophysiological relevance, but also need to be tested for their robustness across different preservatives and analysis platforms. The aim of this study is the investigate the effect of tissue sampling and preservation on candidate genes included in a renal transplant diagnostic panel. Using the NanoString platform, we compared the expression of 219 genes in 51 samples, split for formalin-fixation and paraffin-embedding (FFPE) and RNAlater preservation (RNAlater). We found that overall, gene expression significantly correlated between FFPE and RNAlater samples. However, at the individual gene level, 46 of the 219 genes did not correlate across the 51 matched FFPE and RNAlater samples. Comparing gene expression results using NanoString and qRT-PCR for 18 genes in the same pool of RNA (RNAlater), we found a significant correlation in 17/18 genes. Our study indicates that, in samples from the same routine diagnostic renal transplant biopsy procedure split for FFPE and RNAlater, 21% of 219 genes of potential biological significance do not correlate in expression. Whether this is due to fixatives or tissue sampling, selection of gene panels for routine diagnosis should take this information into consideration.
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Affiliation(s)
- F Toulza
- Department of Immunology and Inflammation, Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College, London, UK
| | - K Dominy
- Molecular Pathology Laboratory, North West London Pathology, London, UK
| | - T Cook
- Department of Immunology and Inflammation, Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College, London, UK
| | - J Galliford
- Imperial Kidney and Transplant Centre, London, UK
| | - J Beadle
- Department of Immunology and Inflammation, Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College, London, UK
| | - A McLean
- Imperial Kidney and Transplant Centre, London, UK
| | - C Roufosse
- Department of Immunology and Inflammation, Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College, London, UK.
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13
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Wong A, Galarza L, Forni L, De Backer D, Slama M, Cholley B, Mayo P, McLean A, Vieillard-Baron A, Lichtenstein D, Volpicelli G, Arntfield R, Martin-Loeches I, Istrate GM, Duška F. Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM). Crit Care 2020; 24:393. [PMID: 32620166 PMCID: PMC7333303 DOI: 10.1186/s13054-020-03099-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 12/22/2022]
Abstract
Abstract Critical care ultrasound (CCUS) is an essential component of intensive care practice. Although existing international guidelines have focused on training principles and determining competency in CCUS, few countries have managed to operationalize this guidance into an accessible, well-structured programme for clinicians training in multidisciplinary intensive care. We seek to update and reaffirm appropriate CCUS scope so that it may be integrated into the international Competency-based Training in Intensive Care Medicine. The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described. Importantly, we discuss the rationale for inclusion but also exclusion of competencies listed. Background/aim Critical care ultrasound (CCUS) is an essential component of intensive care practice. The purpose of this consensus document is to determine those CCUS competencies that should be a mandatory part of training in multidisciplinary intensive care. Methods A three-round Delphi method followed by face-to-face meeting among 32 CCUS experts nominated by the European Society of Intensive Care Medicine. Agreement of at least 90% of experts was needed in order to enlist a competency as mandatory. Results The final list of competencies includes 15 echocardiographic, 5 thoracic, 4 abdominal, deep vein thrombosis diagnosis and central venous access aid. Conclusion The resulting recommendations offer the most contemporary and evolved set of core CCUS competencies for an intensive care clinician yet described.
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Affiliation(s)
- Adrian Wong
- European Society of Intensive Care Medicine, Brussels, Belgium. .,Department of Critical Care, King's College Hospital, London, UK.
| | - Laura Galarza
- European Society of Intensive Care Medicine, Brussels, Belgium.,Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Lui Forni
- European Society of Intensive Care Medicine, Brussels, Belgium.,Department of Intensive Care, Royal Surrey County Hospital, Guildford, UK
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Slama
- Medical Intensive Care, DRIME department in University Hospital of Amiens, Amiens, France
| | - Bernard Cholley
- Service d'Anesthésie-Réanimation, Hôspital Européen Georges Pompidou, AP-HP, Paris, France
| | - Paul Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northshore/Long Island Jewish Medical Centers, Northwell Health, New Hyde Park, NY, USA
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, Australia
| | - Antoine Vieillard-Baron
- Unit of Medical-Surgical Intensive Care, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Daniel Lichtenstein
- Medical Intensive Care Unit, Hospital Ambroise-Paré (AP-HP), Boulogne (Paris-Ouest university), Boulogne-Billancourt, France
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy
| | - Robert Arntfield
- Division of Critical Care, Department of Medicine, Western University London, Ontario, Canada
| | - Ignacio Martin-Loeches
- European Society of Intensive Care Medicine, Brussels, Belgium.,St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | | | - František Duška
- European Society of Intensive Care Medicine, Brussels, Belgium.,Department of Anaesthesia and Intensive Care, Charles University, Third Faculty of Medicine and FNKV University Hospital in Prague, Prague, Czech Republic
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14
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Huang S, Sanfilippo F, Herpain A, Balik M, Chew M, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel. Ann Intensive Care 2020; 10:49. [PMID: 32335780 PMCID: PMC7183522 DOI: 10.1186/s13613-020-00662-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. Methods We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other “topic-specific” items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. Results From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. Conclusion This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.
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Affiliation(s)
- S Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - F Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - A Herpain
- Department of Intensive Care, Erasme University Hospital, Univeristé Libre de Bruxelles, Brussels, Belgium
| | - M Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Chew
- Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - D De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - N Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - G Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - A Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - A McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - A Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - S Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - T Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - M Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - I C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - P Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Inserm CIC 1435, Limoges, France
| | - P Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - A Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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15
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Rajamani A, Huang S, Subramaniam A, Thomson M, Luo J, Simpson A, McLean A, Aneman A, Madapusi TV, Lakshmanan R, Flynn G, Poojara L, Gatward J, Pusapati R, Howard A, Odlum D. Evaluating the influence of data collector training for predictive risk of death models: an observational study. BMJ Qual Saf 2020; 30:202-207. [PMID: 32229628 DOI: 10.1136/bmjqs-2020-010965] [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: 01/30/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Severity-of-illness scoring systems are widely used for quality assurance and research. Although validated by trained data collectors, there is little data on the accuracy of real-world data collection practices. OBJECTIVE To evaluate the influence of formal data collection training on the accuracy of scoring system data in intensive care units (ICUs). STUDY DESIGN AND METHODS Quality assurance audit conducted using survey methodology principles. Between June and December 2018, an electronic document with details of three fictitious ICU patients was emailed to staff from 19 Australian ICUs who voluntarily submitted data on a web-based data entry form. Their entries were used to generate severity-of-illness scores and risks of death (RoDs) for four scoring systems. The primary outcome was the variation of severity-of-illness scores and RoDs from a reference standard. RESULTS 50/83 staff (60.3%) submitted data. Using Bayesian multilevel analysis, severity-of-illness scores and RoDs were found to be significantly higher for untrained staff. The mean (95% high-density interval) overestimation in RoD due to training effect for patients 1, 2 and 3, respectively, were 0.24 (0.16, 0.31), 0.19 (0.09, 0.29) and 0.24 (0.1, 0.38) respectively (Bayesian factor >300, decisive evidence). Both groups (trained and untrained) had wide coefficients of variation up to 38.1%, indicating wide variability. Untrained staff made more errors in interpreting scoring system definitions. INTERPRETATION In a fictitious patient dataset, data collection staff without formal training significantly overestimated the severity-of-illness scores and RoDs compared with trained staff. Both groups exhibited wide variability. Strategies to improve practice may include providing adequate training for all data collection staff, refresher training for previously trained staff and auditing the raw data submitted by individual ICUs. The results of this simulated study need revalidation on real patients.
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Affiliation(s)
- Arvind Rajamani
- Department of Intensive Care Medicine, The University of Sydney Nepean Clinical School, Kingswood, New South Wales, Australia
| | - Stephen Huang
- Department of Intensive Care Medicine, The University of Sydney Nepean Clinical School, Kingswood, New South Wales, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | | | - Jinghang Luo
- Nepean Hospital, Penrith, New South Wales, Australia
| | | | - Anthony McLean
- Department of Intensive Care Medicine, The University of Sydney Nepean Clinical School, Kingswood, New South Wales, Australia
| | - Anders Aneman
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | | | - Gordon Flynn
- Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Latesh Poojara
- Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Jonathan Gatward
- The University of Sydney Northern Clinical School, Saint Leonards, New South Wales, Australia
| | - Raju Pusapati
- Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Adam Howard
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Debbie Odlum
- Nepean Hospital, Penrith, New South Wales, Australia
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16
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Zerbib Y, Jenkins EK, Shojaei M, Meyers AFA, Ho J, Ball TB, Keynan Y, Pisipati A, Kumar A, Kumar A, Nalos M, Tang BM, Schughart K, McLean A. Pathway mapping of leukocyte transcriptome in influenza patients reveals distinct pathogenic mechanisms associated with progression to severe infection. BMC Med Genomics 2020; 13:28. [PMID: 32066441 PMCID: PMC7027223 DOI: 10.1186/s12920-020-0672-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Background Influenza infections produce a spectrum of disease severity, ranging from a mild respiratory illness to respiratory failure and death. The host-response pathways associated with the progression to severe influenza disease are not well understood. Methods To gain insight into the disease mechanisms associated with progression to severe infection, we analyzed the leukocyte transcriptome in severe and moderate influenza patients and healthy control subjects. Pathway analysis on differentially expressed genes was performed using a topology-based pathway analysis tool that takes into account the interaction between multiple cellular pathways. The pathway profiles between moderate and severe influenza were then compared to delineate the biological mechanisms underpinning the progression from moderate to severe influenza. Results 107 patients (44 severe and 63 moderate influenza patients) and 52 healthy control subjects were included in the study. Severe influenza was associated with upregulation in several neutrophil-related pathways, including pathways involved in neutrophil differentiation, migration, degranulation and neutrophil extracellular trap (NET) formation. The degree of upregulation in neutrophil-related pathways were significantly higher in severely infected patients compared to moderately infected patients. Severe influenza was also associated with downregulation in immune response pathways, including pathways involved in antigen presentation such as CD4+ T-cell co-stimulation, CD8+ T cell and Natural Killer (NK) cells effector functions. Apoptosis pathways were also downregulated in severe influenza patients compare to moderate and healthy controls. Conclusions These findings showed that there are changes in gene expression profile that may highlight distinct pathogenic mechanisms associated with progression from moderate to severe influenza infection.
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Affiliation(s)
- Yoann Zerbib
- Department of medical Intensive Care, Amiens University Hospital, Amiens, France. .,Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia. .,Centre for immunology and allergy research, the Westmead Institute for Medical Research, Sydney, Australia.
| | - Emily K Jenkins
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia.,Centre for immunology and allergy research, the Westmead Institute for Medical Research, Sydney, Australia
| | - Adrienne F A Meyers
- National HIV and Retrovirology Laboratories, JC Wilt infectious disease research centre, Public health agency of Canada, Winnipeg, Canada.,Department of medical microbiology and infectious diseases, University of Manitoba, Winnipeg, Canada
| | - John Ho
- National HIV and Retrovirology Laboratories, JC Wilt infectious disease research centre, Public health agency of Canada, Winnipeg, Canada.,Department of medical microbiology and infectious diseases, University of Manitoba, Winnipeg, Canada
| | - T Blake Ball
- National HIV and Retrovirology Laboratories, JC Wilt infectious disease research centre, Public health agency of Canada, Winnipeg, Canada.,Department of medical microbiology and infectious diseases, University of Manitoba, Winnipeg, Canada
| | - Yoav Keynan
- Department of internal medicine, medical microbiology and community health sciences, University of Manitoba, Winnipeg, Canada
| | - Amarnath Pisipati
- Department of medical microbiology and infectious diseases, University of Manitoba, Winnipeg, Canada.,Department of chemistry and chemical biology, Harvard University, Cambridge, USA
| | - Aseem Kumar
- Department of chemistry and biochemistry, Laurentian University, Sudbury, Canada
| | - Anand Kumar
- Section of critical care medicine and section of infectious diseases, department of medicine, medical microbiology and pharmacology, University of Manitoba, Winnipeg, Canada
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Benjamin M Tang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia.,Centre for immunology and allergy research, the Westmead Institute for Medical Research, Sydney, Australia
| | - Klaus Schughart
- Department of Infection Genetics, Helmholtz Centre for Infection Research, Braunschweig, Germany.,University of Veterinary Medicine Hannover, Hannover, Germany.,Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, Germany
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
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17
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Paterson C, Thomson M, Caldwell B, Young R, McLean A, Porteous S, Clark S, Messow C, Kean S, Grose D, Lamb C, Rizwannullah M, James A, Schipani S, Wilson C, Rulach R, Jones R. Radiotherapy-induced xerostomia: a randomised, double-blind, controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2019; 57:1119-1125. [DOI: 10.1016/j.bjoms.2019.10.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
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18
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Thayaparan AS, Said JM, Lowe SA, McLean A, Yang Y. Pre-eclampsia and long-term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post-partum period. Australas J Ultrasound Med 2019; 22:234-244. [PMID: 34760564 PMCID: PMC8411796 DOI: 10.1002/ajum.12173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/24/2018] [Revised: 04/08/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pre-eclampsia is a disease of pregnancy characterised by the manifestations of multi-organ dysfunction. The recent use of transthoracic echocardiography in the assessment of women with pre-eclampsia has allowed the detection of cardiac systolic and diastolic dysfunction in the acute phase. Women with a history of pre-eclampsia also have increased lifelong risks of cardiovascular disease and mortality that persists well beyond the post-partum period. These developments raise the possibility that pre-eclampsia may be an early marker of cardiovascular disease and the potential role for echocardiography in guiding the detection and management of this. This review aims to summarise the existing evidence of echocardiographic cardiac assessment of women with a history of pre-eclampsia performed more than 12 weeks post-partum. METHODS A systematic search of PubMed and OVID EMBASE databases was performed to identify studies featuring assessment of cardiac function performed after 12 weeks post-partum in women with a history of pre-eclampsia. Studies without post-partum cardiac assessment or with other documented causes for cardiomyopathy were excluded. RESULTS Thirteen studies were identified that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia. Common findings across the studies were of increased diastolic dysfunction, increased left ventricular mass index (LVMI) and concentric hypertrophy in women with a history of pre-eclampsia, as compared to women with uncomplicated pregnancy histories. This was predominantly seen in those with a history of early or preterm pre-eclampsia. CONCLUSIONS Women with a history of early or preterm pre-eclampsia have an increased prevalence of diastolic dysfunction. This review demonstrates that the cardiac dysfunction associated with previous pre-eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality. The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women.
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Affiliation(s)
| | - Joanne M Said
- Joan Kirner Women's and Childrens HospitalSt AlbansVictoriaAustralia
| | - Sandra A Lowe
- Royal Hospital for WomenRandwickNew South WalesAustralia
| | | | - Yang Yang
- Western Health, Eastern HealthEpworth HospitalVictoriaAustralia
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19
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Abstract
Abstract
Background
Worldwide, and in Australia, a large proportion of patients with ST-segment elevation myocardial infarction (STEMI) are unable to undergo timely primary percutaneous coronary intervention (PCI), and so are transferred for PCI after receiving fibrinolytic therapy (so-called pharmaco-invasive PCI).
Methods
Our Hospital, the primary PCI centre for Southwest Sydney, Australia receives patients for both primary PCI and transferred post- fibrinolytic therapy for rescue or prognostic PCI. Associations were determined between late outcomes (bleeding according to Bleeding Academic Research Consortium (BARC) criteria and mortality) and reperfusion strategy, either primary PCI, or pharmaco-invasive PCI, in patients undergoing PCI for STEMI during hospitalization.
Results
Among 2083 consecutive patients (80% male) with STEMI who underwent PCI (1076 [52%] primary PCI and 1007 [48%] pharmaco-invasive PCI), mortality at 3 years was 8.7%,11.1% after primary PCI and 6.2% after pharmaco-invasive PCI (9.4% after rescue PCI and 4.6% after prognostic PCI); p<0.001 (Figure). Rates of type 2–5 BARC bleeding post-PCI were 35% after primary PCI and 24% after pharmaco-invasive PCI (42% after rescue PCI and 15% after prognostic PCI); p<0.001. while the rate of major bleeding type 3b-5 were 5% after primary PCI and 3% after pharmaco-invasive PCI (8% after rescue PCI and 1% after prognostic PCI); p=0.112.The independent predictors of 3 year mortality were, pre-PCI cardiogenic shock HR=0.25 [95% CI: 0.16–0.39], p<0.001), age (HR=1.05 [95% CI: 1.03–1.06], p<0.001), TIMI 3 flow post-PCI (HR=5.25 [95% CI: 2.51–11.00], p≤0.001), eGFR<60mL/min/1.73m2 (HR=2.90 [95% CI: 1.93–4.34], p≤0.001), post PCI bleeding (HR=2.17 [95% CI: 1.53–3.08], p≤0.001), anterior infarction (HR=1.76 [95% CI: 1.23–2.51], p=0.002), and female gender (HR=1.56 [95% CI: 1.07–2.27], p=0.022); and primary PCI (HR=1.6 [95% CI: 1.18–2.19; p=0.003]. On multi-variable analysis, age, cardiogenic shock presentation, rescue PCI, intra-aortic balloon pump, Pre-procedural anaemia, (all p<0.001) and eGFR<60mL/min/1.73m2 (p=0.006) were associated with bleeding.
Figure 1. Late survival after primary & PI PCI
Conclusion
Among patients with STEMI who underwent pharmaco-invasive PCI had lower mortality rates than to those who had primary PCI, though procedural selection criteria may have been different; bleeding rates were similar. Among suitable patients pharmaco-invasive PCI should be evaluated in large clinical trials.
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Affiliation(s)
- H Idris
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - W Yang
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - S Burgess
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - A Faour
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - A McLean
- Liverpool Hospital, Liverpool, Australia
| | - S Sidney Lo
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - C J Mussap
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - C P Juergens
- Liverpool Hospital, Cardiology, Sydney, Australia
| | - J K French
- Liverpool Hospital, Cardiology, Sydney, Australia
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20
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Main AB, Braham R, Campbell D, Inglis AJ, McLean A, Orde S. Subcostal TAPSE: a retrospective analysis of a novel right ventricle function assessment method from the subcostal position in patients with sepsis. Ultrasound J 2019; 11:19. [PMID: 31456096 PMCID: PMC6712122 DOI: 10.1186/s13089-019-0134-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is frequently used as an objective measure of right-ventricular dysfunction. Abnormal TAPSE values are associated with poor prognosis in a number of disease states; however, the measure is not always easy to obtain in the critically ill. The purpose of this study is to assess the feasibility and accuracy of using a subcostal view and TAPSE measurement as a measure of right-ventricular dysfunction. A secondary aim was to perform a pilot study to assess whether right-ventricular dysfunction was associated with adverse outcomes including mortality. Results Subcostal TAPSE corresponds well with TAPSE obtained from the apical window at low and moderate TAPSE values (mean difference 1.2 mm (CI 0.04–2.36; 100% data pairs < 3-mm difference for TAPSE < 19 mm; 92% had < 3 mm difference at TAPDE < 24 mm). Subcostal TAPSE is able to accurately discriminate between abnormal and normal TAPSE results (sensitivity 97.8%, specificity 87.5%). There was no association between right-ventricular (RV) dysfunction and 90-day mortality. Conclusions Subcostal TAPSE is a feasible and accurate alternative to conventional TAPSE from the apical view in critically ill patients. Further research is required to elucidate the relationship between RV dysfunction and outcomes in sepsis.
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Affiliation(s)
- Alison B Main
- Alice Springs Hospital, Gap Road, The Gap, NT, 0870, Australia
| | - Rachel Braham
- Gold Coast University Hospital, Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Daniel Campbell
- Royal Darwin Hospital, Rocklands Dr, Tiwi, NT, 0810, Australia
| | | | - Anthony McLean
- Nepean Hospital, Derby St, Penrith, NSW, 2747, Australia
| | - Sam Orde
- Nepean Hospital, Derby St, Penrith, NSW, 2747, Australia.
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21
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Tang BM, Shojaei M, Teoh S, Meyers A, Ho J, Ball TB, Keynan Y, Pisipati A, Kumar A, Eisen DP, Lai K, Gillett M, Santram R, Geffers R, Schreiber J, Mozhui K, Huang S, Parnell GP, Nalos M, Holubova M, Chew T, Booth D, Kumar A, McLean A, Schughart K. Neutrophils-related host factors associated with severe disease and fatality in patients with influenza infection. Nat Commun 2019; 10:3422. [PMID: 31366921 PMCID: PMC6668409 DOI: 10.1038/s41467-019-11249-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/28/2019] [Indexed: 11/09/2022] Open
Abstract
Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817-0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy.
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Affiliation(s)
- Benjamin M Tang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia. .,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, Australia. .,Respiratory Tract Infection Research Node, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia.
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Adrienne Meyers
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada
| | - John Ho
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada
| | - T Blake Ball
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Department of Medical Microbiology and Infectious Disease, University of Manitoba, Winnipeg, Canada
| | - Yoav Keynan
- Department of Internal Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amarnath Pisipati
- Department of Chemistry and Biological Chemistry, Harvard University, Cambridge, MA, USA
| | - Aseem Kumar
- Department of Chemistry and Biochemistry, Laurentian University, Laurentian, Canada
| | - Damon P Eisen
- Townsville Hospital, Townsville, Queensland, Australia
| | - Kevin Lai
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Mark Gillett
- Department of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Rahul Santram
- Department of Emergency Medicine, St. Vincent Hospital, Sydney, Australia
| | - Robert Geffers
- Genome Analytics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jens Schreiber
- Otto-von-Guerike University of Magdeburg, Clinic of Pneumology, Magdeburg, Germany
| | - Khyobeni Mozhui
- Department of Preventive Medicine, University of Tennessee Health Science Centre, Memphis, TN, USA
| | - Stephen Huang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Grant P Parnell
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, Australia
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia.,Department of Internal Medicine, Medical Faculty Plzen, Charles University Prague, Staré Město, Czech Republic
| | - Monika Holubova
- Biomedical Centre, Medical Faculty Plzen, Charles University Prague, Staré Město, Czech Republic
| | - Tracy Chew
- Sydney Informatic Hub, The University of Sydney, Sydney, Australia
| | - David Booth
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, Australia
| | - Anand Kumar
- Section of Critical Care Medicine and Section of Infectious Diseases, Departments of Medicine, Medical Microbiology and Pharmacology, University of Manitoba, Winnipeg, Canada
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Klaus Schughart
- Department of Infection Genetics, Helmholtz Centre for Infection Research, Braunschweig, Germany.,University of Veterinary Medicine, Hannover, Germany.,Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Centre, Memphis, TN, USA
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22
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Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. Correction to: A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45:911. [PMID: 30989263 DOI: 10.1007/s00134-019-05616-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article unfortunately contained a mistake.
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Affiliation(s)
- Antoine Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
| | - S J Millington
- Department of Critical Care Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - F Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - M Chew
- Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - J Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - A McLean
- Intensive Care Nepean Hospital, University of Sydney, Sydney, Australia
| | - M R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Pulido
- Cardiothoracic Anesthesiology and Critical Care Medicine, Cardiovascular Intensive Care Unit, Swedish Heart and Vascular Institute, Swedish Medical Center, US Anesthesia Partners, Seattle, WA, USA
| | - P Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, USA
| | - N Fletcher
- Consultant in Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK.,Cleveland Clinic London, London, UK
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23
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Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45:770-788. [DOI: 10.1007/s00134-019-05604-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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24
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Yang W, Idris H, Burgess S, McLean A, Nguyen T, Kaddapu K, Makris A, Mussap C, Juergens C, French J. PO152 Chronic Kidney Disease and Late Outcomes In Patients With Stemi Undergoing PCI. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Sadick V, Lane S, Fischer E, Seppelt I, Shetty A, McLean A. Post-partum catastrophic antiphospholipid syndrome presenting with shock and digital ischaemia - A diagnostic and management challenge. J Intensive Care Soc 2018; 19:357-364. [PMID: 30515245 PMCID: PMC6259081 DOI: 10.1177/1751143718762343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Catastrophic antiphospholipid syndrome is a rare multisystem autoimmune condition characterised by rapid development of widespread thrombotic disease and subsequent multi-organ failure. It is the most severe complication of antiphospholipid syndrome, carrying significant morbidity and mortality. We report a patient with post-partum catastrophic antiphospholipid syndrome with cardiac, hepatic, renal and cutaneous manifestations. The diagnostic challenges in establishing a definitive diagnosis in catastrophic antiphospholipid syndrome is discussed, along with the difficulties in managing these patients in the intensive care unit.
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Affiliation(s)
- Victoria Sadick
- Intensive Care Unit,
Nepean
Hospital, Kingswood, NSW, Australia
| | - Stuart Lane
- Intensive Care Medicine,
Nepean
Hospital, Kingswood, NSW, Australia
- Sydney Medical School, Kingswood, NSW,
Australia
| | - Eddy Fischer
- Department of Renal Medicine,
Nepean
Hospital, Kingswood, NSW, Australia
| | - Ian Seppelt
- Intensive Care Medicine,
Nepean
Hospital, Kingswood, NSW, Australia
| | - Anita Shetty
- Department of Haematology,
Nepean
Hospital, Kingswood, NSW, Australia
| | - Anthony McLean
- Intensive Care Medicine,
Nepean
Hospital, Kingswood, NSW, Australia
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26
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Ren J, Donovan D, Watkins J, Wang HQ, Rudakov D, Murphy C, McLean A, Lasnier C, Unterberg E, Thomas D, Boivin R. The surface eroding thermocouple for fast heat flux measurement in DIII-D. Rev Sci Instrum 2018; 89:10J122. [PMID: 30399945 DOI: 10.1063/1.5038677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
A novel type of surface eroding thermocouple (SETC) has been tested and demonstrated in the small angle slot (SAS) divertor of DIII-D for fast local heat flux measurements. The thermojunction of the SETC is formed between two thin (10 μm) ribbons, which are filed over to create microfiber junctions. These thermocouples are able to be exposed directly to the plasma at surface temperatures exceeding 2000 °C and are capable of sub-10 ms time resolution. Before installation in SAS, the SETCs were exposed in the lower DIII-D divertor during L-mode and H-mode discharges, from which results are presented. In preliminary tests, SETCs proved to be a qualified diagnostic to accurately measure both the intra-edge localized mode (ELM) and inter-ELM heat flux during H-mode shots with high frequency ELMs (hundreds of Hz) and to resolve heat flux profiles during strike point sweeps. The heat fluxes measured by using SETCs are consistent with the heat fluxes measured by using IR cameras and Langmuir probes. These new diagnostic capabilities will complement the existing IR camera measurements and will be of particularly significant value to measure surface heat flux in the SAS divertor or other regions where the IR camera lacks line of sight.
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Affiliation(s)
- J Ren
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - D Donovan
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - J Watkins
- Sandia National Laboratories, Livermore, California 94551, USA
| | - H Q Wang
- Oak Ridge Associated Universities, Oak Ridge, Tennessee 37830, USA
| | - D Rudakov
- University of California San Diego, San Diego, California 92093, USA
| | - C Murphy
- General Atomics, San Diego, California 92186-5608, USA
| | - A McLean
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Lasnier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Unterberg
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - D Thomas
- General Atomics, San Diego, California 92186-5608, USA
| | - R Boivin
- General Atomics, San Diego, California 92186-5608, USA
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27
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Route De Lennik 808, 1070, Brussels, Belgium.
| | - Kenneth B Christopher
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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28
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Tang BM, Shojaei M, Branley J, McLean A. Biomarkers for high-risk influenza patients: what are the next steps? Expert Rev Mol Diagn 2017; 18:205-206. [PMID: 29264948 DOI: 10.1080/14737159.2018.1420475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin M Tang
- a Department of intensive care medicine , Nepean Hospital , Sydney , Australia.,b Centre for immunology and allergy research , the Westmead institute for medical research , Sydney , Australia.,c Respiratory virus infection research , Marie Bashir institute for infectious diseases and biosecurity , Sydney , Australia
| | - Maryam Shojaei
- a Department of intensive care medicine , Nepean Hospital , Sydney , Australia.,b Centre for immunology and allergy research , the Westmead institute for medical research , Sydney , Australia
| | - James Branley
- d Department of microbiology , Nepean Hospital , Sydney , Australia
| | - Anthony McLean
- a Department of intensive care medicine , Nepean Hospital , Sydney , Australia
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Abstract
Critical care echocardiography is developing rapidly with an increasing number of specialists now performing comprehensive studies using Doppler and other advanced techniques. However, this imaging can be challenging, interpretation is far from simple in the complex critically ill patient and mistakes can be easy to make. We aim to address clinically relevant areas where potential errors may occur and suggest methods to hopefully improve accuracy of imaging and interpretation.
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Affiliation(s)
- Sam Orde
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW Australia
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Andrew Hilton
- Intensive Care Unit, Austin Hospital, Heidelberg, Melbourne, VIC Australia
| | | | - Anthony McLean
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW Australia
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Smiley M, O’Neill R, Vasquez J, Lasnier C, McLean A, Feder R, Smith M, Jariwala A, Stratton B, Johnson D, Verlaan A, Heijmans J. Design update of the ITER upper wide angle viewing system. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.03.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McLean A. Defining infrastructure integration: Abstract aspirations and institutional variations. PPP 2017. [DOI: 10.3351/ppp.2017.5848622524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tang BM, Shojaei M, Parnell GP, Huang S, Nalos M, Teoh S, O'Connor K, Schibeci S, Phu AL, Kumar A, Ho J, Meyers AFA, Keynan Y, Ball T, Pisipati A, Kumar A, Moore E, Eisen D, Lai K, Gillett M, Geffers R, Luo H, Gul F, Schreiber J, Riedel S, Booth D, McLean A, Schughart K. A novel immune biomarker IFI27 discriminates between influenza and bacteria in patients with suspected respiratory infection. Eur Respir J 2017; 49:49/6/1602098. [PMID: 28619954 DOI: 10.1183/13993003.02098-2016] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 03/15/2017] [Indexed: 11/05/2022]
Abstract
Host response biomarkers can accurately distinguish between influenza and bacterial infection. However, published biomarkers require the measurement of many genes, thereby making it difficult to implement them in clinical practice. This study aims to identify a single-gene biomarker with a high diagnostic accuracy equivalent to multi-gene biomarkers.In this study, we combined an integrated genomic analysis of 1071 individuals with in vitro experiments using well-established infection models.We identified a single-gene biomarker, IFI27, which had a high prediction accuracy (91%) equivalent to that obtained by multi-gene biomarkers. In vitro studies showed that IFI27 was upregulated by TLR7 in plasmacytoid dendritic cells, antigen-presenting cells that responded to influenza virus rather than bacteria. In vivo studies confirmed that IFI27 was expressed in influenza patients but not in bacterial infection, as demonstrated in multiple patient cohorts (n=521). In a large prospective study (n=439) of patients presented with undifferentiated respiratory illness (aetiologies included viral, bacterial and non-infectious conditions), IFI27 displayed 88% diagnostic accuracy (AUC) and 90% specificity in discriminating between influenza and bacterial infections.IFI27 represents a significant step forward in overcoming a translational barrier in applying genomic assay in clinical setting; its implementation may improve the diagnosis and management of respiratory infection.
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Affiliation(s)
- Benjamin M Tang
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia .,Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia.,Respiratory Virus Infection Research, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia.,These authors contributed equally to the study
| | - Maryam Shojaei
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia.,Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia.,These authors contributed equally to the study
| | - Grant P Parnell
- Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia
| | - Stephen Huang
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Marek Nalos
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Sally Teoh
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Kate O'Connor
- Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia
| | - Stephen Schibeci
- Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia
| | - Amy L Phu
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Anand Kumar
- Section of Critical Care Medicine and Section of Infectious Diseases, Dept of Medicine, Medical Microbiology and Pharmacology, University of Manitoba, Winnipeg, Canada
| | - John Ho
- National Laboratory for HIV Immunology, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Adrienne F A Meyers
- National Laboratory for HIV Immunology, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Yoav Keynan
- Dept of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Dept of Medical Microbiology, University of Manitoba, Winnipeg, Canada.,Dept of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Dept of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Terry Ball
- National Laboratory for HIV Immunology, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Canada.,Dept of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Amarnath Pisipati
- Dept of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Aseem Kumar
- Dept of Chemistry and Biochemistry, Laurentian University, Sudbury, Canada
| | - Elizabeth Moore
- Transfusion Research Unit, Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Damon Eisen
- Dept of Infectious Diseases, Townsville Hospital, Townsville, Australia
| | - Kevin Lai
- Dept of Emergency Medicine, Westmead Hospital, Sydney, Australia
| | - Mark Gillett
- Dept of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Robert Geffers
- Genome Analytics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Hao Luo
- Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Fahad Gul
- Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jens Schreiber
- Clinic of Pneumology, Otto-von-Guerike University of Magdeburg, Magdeburg, Germany
| | - Sandra Riedel
- Clinic of Pneumology, Otto-von-Guerike University of Magdeburg, Magdeburg, Germany
| | - David Booth
- Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Sydney, Australia
| | - Anthony McLean
- Dept of Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Klaus Schughart
- Dept of Infection Genetics, Helmholtz Centre for Infection Research, Braunschweig, Germany.,University of Veterinary Medicine, Hannover, Germany.,University of Tennessee Health Science Center, Memphis, TN, USA
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Arruda AG, Poljak Z, Knowles D, McLean A. Development of a stochastic agent-based model to evaluate surveillance strategies for detection of emergent porcine reproductive and respiratory syndrome strains. BMC Vet Res 2017; 13:171. [PMID: 28606148 PMCID: PMC5468968 DOI: 10.1186/s12917-017-1091-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/03/2015] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background The objective of the current study was to develop a stochastic agent-based model using empirical data from Ontario (Canada) swine sites in order to evaluate different surveillance strategies for detection of emerging porcine reproductive and respiratory syndrome virus (PRRSV) strains at the regional level. Four strategies were evaluated, including (i) random sampling of fixed numbers of swine sites monthly; (ii) risk-based sampling of fixed numbers, specifically of breeding sites (high-consequence sites); (iii) risk-based sampling of fixed numbers of low biosecurity sites (high-risk); and (iv) risk-based sampling of breeding sites that are characterized as low biosecurity sites (high-risk/high-consequence). The model simulated transmission of a hypothetical emerging PRRSV strain between swine sites through three important industry networks (production system, truck and feed networks) while considering sites’ underlying immunity due to past or recent exposure to heterologous PRRSV strains, as well as demographic, geographic and biosecurity-related PRRS risk factors. Outcomes of interest included surveillance system sensitivity and time to detection of the three first cases over a period of approximately three years. Results Surveillance system sensitivities were low and time to detection of three first cases was long across all examined scenarios. Conclusion Traditional modes of implementing high-risk and high-consequence risk-based surveillance based on site’s static characteristics do not appear to substantially improve surveillance system sensitivity. Novel strategies need to be developed and considered for rapid detection of this and other emerging swine infectious diseases. None of the four strategies compared herein appeared optimal for early detection of an emerging PPRSV strain at the regional level considering model assumptions, the underlying population of interest, and absence of other forms of surveillance.
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Affiliation(s)
- A G Arruda
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Rd East, Guelph, ON, N1G 2W1, Canada.
| | - Z Poljak
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Rd East, Guelph, ON, N1G 2W1, Canada
| | - D Knowles
- Department of Computer Science, Computational Epidemiology and Public Health Informatics Lab, University of Saskatchewan, 176 Thorvaldson Bldg, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
| | - A McLean
- Department of Computer Science, Computational Epidemiology and Public Health Informatics Lab, University of Saskatchewan, 176 Thorvaldson Bldg, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
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Lasnier CJ, Allen SL, Boedo JA, Groth M, Brooks NH, McLean A, LaBombard B, Skinner CH, Rudakov DL, West WP, Wong CPC. Chapter 10: First Wall and Operational Diagnostics. Fusion Science and Technology 2017. [DOI: 10.13182/fst08-a1682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. J. Lasnier
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - S. L. Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - J. A. Boedo
- University of California, San Diego, California 92093
| | - M. Groth
- Lawrence Livermore National Laboratory, Livermore, California 94550
| | - N. H. Brooks
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - A. McLean
- University of Toronto, Toronto, Ontario M3H 5T6, Canada
| | - B. LaBombard
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - C. H. Skinner
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - D. L. Rudakov
- University of California, San Diego, California 92093
| | - W. P. West
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - C. P. C. Wong
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
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Mayo P, Arntfield R, Balik M, Kory P, Mathis G, Schmidt G, Slama M, Volpicelli G, Xirouchaki N, McLean A, Vieillard-Baron A. The ICM research agenda on critical care ultrasonography. Intensive Care Med 2017; 43:1257-1269. [DOI: 10.1007/s00134-017-4734-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/21/2017] [Indexed: 11/29/2022]
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Abstract
The Michigan Alcoholism Screening Test (MAST) was administered to 129 male and 102 female prison inmates. Use of the usual classification rule for the MAST resulted in 71% and 65% of the samples classified as “alcoholic”, far higher than the incidence of alcoholism in studies which used overseas prisoners. Item analyses conducted with these data, and reconsideration of data from previous New Zealand studies using the MAST, indicate that it is a sound detection instrument. The high incidence of alcoholism here therefore probably reflects the high sensitivity of the MAST by comparison with assessment procedures based on traditional alcoholism criteria, although New Zealand offender groups seem to score higher than comparable overseas offenders and the classification rule may be slightly too liberal. Accordingly, the use of a higher cut-off score seems appropriate when using MAST score in classifying individuals. A higher cut-off score still resulted in around 50–60% of inmates being classified as alcoholics. The likely benefits of rehabilitative efforts within the criminal justice system focusing on alcohol abuse are discussed.
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Philippsen T, Orini M, Martin C, Volkova E, Ormerod J, Sohaib S, Elamin N, Blake S, Sawhney V, Ahmad S, Waring O, Bowers R, Raiman L, Hazelwood T, Mills R, Corrado C, Honarbakhsh S, Von Maydell A, Norrish G, Chubb H, Chubb H, Chubb H, Toledano M, Ruiz A, van Zalen J, Foley P, Pearman C, Rehal O, Foley P, Wong L, Foley P, Pearman C, Brahmbhatt D, Khan H, Wardley J, Akbar S, Christensen L, Hansen M, Brandes A, Tinker A, Munroe P, Lambiase P, Honarbakhsh S, McLean A, Lambiase P, Schilling R, Lane J, Chow A, Earley M, Hunter R, Khan F, Lambiase P, Schilling R, Sporton S, Dhinoja M, Camm C, Xavier R, de Sousa M, Betts T, Shun-Shin M, Wright I, Lim E, Lim P, Koawing M, Lefroy D, Linton N, Davies D, Peters N, Kanagaratnam P, Francis D, Whinnett Z, Khan M, Bowes R, Sahu J, Sheridan P, Rogers D, Kyriacou A, Kelland N, Lewis N, Lee J, Segall E, Diab I, Breitenstein A, Ullah W, Sporton S, Earley M, Finlay M, Dhinoja M, Schilling R, Hunter R, Ahmed M, Petkar S, Davidson N, Stout M, Pearce KP, Leo M, Ginks M, Rajappan K, Bashir Y, Balasubramaniam R, Sopher S, Betts T, Paisey J, Cheong J, Roy D, Adhya S, Williams S, O'Neill M, Niederer S, Providencia R, Srinivasan N, Ahsan S, Lowe M, Segal O, Hunter R, Finlay M, Earley M, Schilling R, Lambiase P, Stella S, Cantwell C, Chowdhury R, Kim S, Linton N, Whinnett Z, Koa-Wing M, Lefroy D, Davies DW, Kanagaratnam P, Lim PB, Qureshi N, Peters N, Cantarutti N, Limongelli G, Elliott P, Kaski J, Williams S, Lal K, Harrison J, Whitaker J, Kiedrowicz R, Wright M, O'Neill M, Harrison J, Whitaker J, Williams S, Wright M, Schaeffter T, Razavi R, O'Neill M, Karim R, Williams S, Harrison J, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Montanes M, Ella Field E, Walsh H, Callaghan N, Till J, Mangat J, Lowe M, Kaski J, Ruiz Duthil A, Li A, Saba M, Patel N, Beale L, Brickley G, Lloyd G, French A, Khavandi A, McCrea W, Barnes E, Chandrasekaran B, Parry J, Garth L, Chapman J, Todd D, Hobbs J, Modi S, Waktare J, Hall M, Gupta D, Snowdon R, Papageorgiou N, Providência R, Falconer D, Sewart E, Ahsan S, Segal O, Ezzat V, Rowland E, Lowe M, Lambiase P, Chow A, Swift M, Charlton P, James J, Colling A, Barnes E, Starling L, Kontogeorgis A, Roses-Noguer F, Wong T, Jarman J, Clague J, Till J, Colling A, James J, Hawkins M, Burnell S, Chandrasekaran B, Coulson J, Smith L, Choudhury M, Oguguo E, Boyett M, Morris G, Flinn W, Chari A, Belham M, Pugh P, Somarakis K, Parasa R, Allata A, Hashim H, Mathew T, Kayasundar S, Venables P, Quinn J, Ivanova J, Brown S, Oliver R, Lyons M, Chuen M, Walsh J, Robinson T, Staniforth A, Ahsan A, Jamil-Copley S. POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY
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(F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION? Europace 2016. [DOI: 10.1093/europace/euw274] [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: 11/14/2022] Open
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North S, Hemingway A, McLean A, Laurie H, Ellis-Hill C. Evaluating a natural horsemanship program in relation to the ISES first principles of horse training. J Vet Behav 2016. [DOI: 10.1016/j.jveb.2016.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Study design: Retrospective review Objectives: To present and discuss the outcome of halo jacket immobilisation of cervical spine injuries. Setting: National Spinal Injuries Unit in a Scottish University teaching Hospital. Methods: Retrospective review of case-notes and radiographs of all patients treated with halo jacket both as primary means of immobilisation or as adjunct to surgical stabilisation between 1992–1999 and followed up at a weekly halo clinic. Results: Out of a total one hundred and four patients with cervical spine injury, eighty-six were treated with Halo jacket as primary means of cervical immobilisation. Halo was used as adjunct to surgical stabilisation for the rest. There were nine cases of true failure. This is a failure rate of 10% for primary halo immobilisation. Of the nine patients who had failure of bony healing, four had fibrous healing, three had surgery to stabilise spine, two were subsequently lost to follow-up. The highest incidence of recurrence of subluxation occurred in patients with fracture/subluxation with a healing rate of 85%. Patients with ankylosing spondylitis did well. Odontoid fractures had 18% failure rate. The commonest complication was loss of reduction, followed by pin-site infection. Conclusion: Halo is an effective non-surgical treatment for the injured cervical spine at both upper and lower levels.
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Affiliation(s)
- M Hosssain
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, 1345 Govan Road, Glasgow.
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Abstract
INTRODUCTION Rings are required to be removed from a finger in many clinical situations. Rings that are difficult to remove is a problem encountered frequently. Many techniques have been reported for this problem. This study looks at the effectiveness of a single technique for removing difficult rings from fingers. METHODS A two rubber band technique was used in this study of 69 difficult to remove rings. Success of the technique and time to removal were recorded. RESULTS Difficult rings were removed in 92.5% of cases, in a mean time of 10.7 seconds. No fingers or rings suffered damage during the study. CONCLUSIONS This two rubber band technique is a rapid, safe and effective method for removing rings that cannot be removed easily.
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Affiliation(s)
- D Kingston
- Gold Coast University Hospital , Southport, QLD , Australia
- University of Queensland , Brisbane, QLD , Australia
| | - D Bopf
- University of Queensland , Brisbane, QLD , Australia
| | - U Dhanjee
- University of Queensland , Brisbane, QLD , Australia
| | - A McLean
- Gold Coast University Hospital , Southport, QLD , Australia
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Sam Orde
- Nepean Hospital, Intensive Care Unit, 2747, Sydney, NSW, Australia.
| | - Anthony McLean
- Nepean Hospital, Intensive Care Unit, 2747, Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, Australia
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McLean A. The application of ultrasound in the critical care setting Part I. Critical Care Echocardiography. Australas J Ultrasound Med 2015; 15:3-4. [PMID: 28191130 PMCID: PMC5025126 DOI: 10.1002/j.2205-0140.2012.tb00133.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anthony McLean
- Department of Intensive Care Medicine Sydney Medical School Nepean
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McLean A. Part II - Critical Care Ultrasound. Australas J Ultrasound Med 2015; 15:39-42. [PMID: 28191141 PMCID: PMC5025118 DOI: 10.1002/j.2205-0140.2012.tb00225.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Anthony McLean
- Department of Intensive Care Medicine Sydney Medical School Nepean
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Payne E, Boot M, Starling M, Henshall C, McLean A, Bennett P, McGreevy P. Evidence of horsemanship and dogmanship and their application in veterinary contexts. Vet J 2015; 204:247-54. [PMID: 25959129 DOI: 10.1016/j.tvjl.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/22/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
This review collates peer-reviewed evidence for desirable attributes for those who work with dogs and horses. It is written with a particular focus on the veterinary profession. Although veterinarians and veterinary nurses (VNs) occupy variable roles when interacting with their patients, several behavioural attributes emerge as helpful across the range of such roles. In light of recent research on the value of considering animals' arousal and affective state as predictors of behaviour and welfare, best practice in human-horse and human-dog-interactions is outlined. The attributes of affiliation, safety and positive reinforcement seem to contribute greatly to the development and maintenance of moderate arousal and positive affect in animals. The information in this review article is offered in an attempt to show why veterinary professionals with good horsemanship are likely to remain safe, and to introduce the concept of dogmanship. In the light of the peer-reviewed evidence assembled here, it is arguable that veterinary teams, comprising both veterinarians and VNs, can become scholars in these areas. The benefits of this approach for practitioner safety, animal welfare and client satisfaction are likely to be significant.
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Affiliation(s)
- E Payne
- Faculty of Veterinary Science (B19), University of Sydney, NSW 2006, Australia.
| | - M Boot
- Faculty of Veterinary Science (B19), University of Sydney, NSW 2006, Australia
| | - M Starling
- Faculty of Veterinary Science (B19), University of Sydney, NSW 2006, Australia
| | - C Henshall
- Faculty of Veterinary Science (B19), University of Sydney, NSW 2006, Australia
| | - A McLean
- Australian Equine Behaviour Centre, Broadford, Vic. 3658, Australia
| | - P Bennett
- School of Psychological Science, La Trobe University, Bendigo, Vic. 3552, Australia
| | - P McGreevy
- Faculty of Veterinary Science (B19), University of Sydney, NSW 2006, Australia
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Paterson C, Thomson M, Caldwell B, Porteous S, McLean A, Park G, Messow C. PO-134: Dose related efficacy of LMS-611 in Radiotherapy Induced Xerostomia ñ an ex vivo study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ullah W, McLean A, Tayebjee M, Gupta D, Ginks M, Haywood G, O'Neil M, Lambiase P, Schilling R. 72 * Contact force timing reduces pulmonary vein reconnection, early results from the smart AF trial. Europace 2014. [DOI: 10.1093/europace/euu243.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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McLean A, Lamperti M, Poelaert J. Echography is mandatory for the initial management of critically ill patients: yes. Intensive Care Med 2014; 40:1763-5. [PMID: 25288207 DOI: 10.1007/s00134-014-3465-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Anthony McLean
- Department of Intensive Care Medicine, Sydney Medical School-Nepean, Sydney, Australia,
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Hunter RJ, Lee G, Ullah W, Finlay M, Lovell M, Baker V, McLean A, Dhinoja M, Earley MJ, Sporton S, Schilling RJ. 30 * Use of a contact force sensing catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation. Europace 2014. [DOI: 10.1093/europace/euu238.12] [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: 11/14/2022] Open
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McLean A, Chan K, Roufosse C, Cook T, Brookes P, Goodall D, Willicombe M, Galliford J, Taube D. 5-Year Outcomes of a Randomized Prospective Trial of Tacrolimus Maintenance Monotherapy After Alemtuzumab Induction and Early Steroid Withdrawal in Kidney Transplantation: Rejection, HLA Antibody Formation, and Recurrent Disease. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Willicombe M, Brookes P, Blow M, Eva S, McLean A, Taube D. Immunogenicity of DQ7 HLA Antigens in Renal Transplantation. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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