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Emanuel E, Slater L, Croxford S, Edmundson C, Ibitoye A, Njoroge J, Ijaz S, Hope V, Platt L, Phipps E, Desai M. Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey. Public Health 2023; 225:79-86. [PMID: 37922590 DOI: 10.1016/j.puhe.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. STUDY DESIGN The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. METHODS Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. RESULTS Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043). CONCLUSIONS Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
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Affiliation(s)
- E Emanuel
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - L Slater
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom.
| | - S Croxford
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - A Ibitoye
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - J Njoroge
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Ijaz
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V Hope
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; Liverpool John Moores University, Liverpool, United Kingdom
| | - L Platt
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E Phipps
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Desai
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
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Hibbert MP, Simmons R, Mandal S, Sabin CA, Desai M. A rapid review of antenatal hepatitis C virus testing in the United Kingdom. BMC Pregnancy Childbirth 2023; 23:823. [PMID: 38017404 PMCID: PMC10683241 DOI: 10.1186/s12884-023-06127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The United Kingdom (UK) has committed to the World Health Organization's viral hepatitis elimination targets. New case finding strategies, such as antenatal testing, may be needed to achieve these targets. We conducted a rapid review to understand hepatitis C-specific antibody (anti-HCV) and HCV RNA test positivity in antenatal settings in the United Kingdom to inform guidance. METHODS Articles and conference abstracts published between January 2000 and June 2022 reporting anti-HCV testing in antenatal settings were identified through PubMed and Web of Science searches. Results were synthesised using a narrative approach. RESULTS The search identified 2,011 publications; 10 studies were included in the final synthesis. Seven studies used anonymous testing methods and three studies used universal opt-out testing. Anti-HCV test positivity ranged from 0.1 to 0.99%, with a median value of 0.38%. Five studies reported HCV RNA positivity, which ranged from 0.1 to 0.57% of the testing population, with a median value of 0.22%. One study reported cost effectiveness of HCV and found it to be cost effective at £9,139 per quality adjusted life years. CONCLUSION The relative contribution of universal opt-out antenatal testing for HCV should be reconsidered, as antenatal testing could play an important role in new case-finding and aid achieving elimination targets.
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Affiliation(s)
- M P Hibbert
- Sexually Transmitted Infections and HIV Division, Blood Safety, Health Security Agency (UKHSA), Hepatitis, London, England, UK.
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted, Infections at University College London in partnership with UKHSA, London, England.
| | - R Simmons
- Sexually Transmitted Infections and HIV Division, Blood Safety, Health Security Agency (UKHSA), Hepatitis, London, England, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted, Infections at University College London in partnership with UKHSA, London, England
| | - S Mandal
- Sexually Transmitted Infections and HIV Division, Blood Safety, Health Security Agency (UKHSA), Hepatitis, London, England, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted, Infections at University College London in partnership with UKHSA, London, England
| | - C A Sabin
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted, Infections at University College London in partnership with UKHSA, London, England
- Institute for Global Health, University College London, London, England
| | - M Desai
- Sexually Transmitted Infections and HIV Division, Blood Safety, Health Security Agency (UKHSA), Hepatitis, London, England, UK
- National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted, Infections at University College London in partnership with UKHSA, London, England
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Peterson H, Desai M, Tawfik M, Kerstetter J, Elsensohn A, Furukawa B. Cutaneous lymphangitis carcinomatosa: a unique presentation of a rare disease. Dermatol Online J 2023; 29. [PMID: 37220288 DOI: 10.5070/d329260772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
A 75-year-old man with a three-year history of metastatic lung adenocarcinoma was diagnosed with cutaneous lymphangitic carcinomatosa of unique morphology. He was admitted to our hospital for right neck swelling, erythema, and failure to thrive. Skin examination demonstrated an indurated, thickened, firm, hyperpigmented plaque extending from the right neck and chest to the right ear, cheek, and eyelids. Skin biopsy demonstrated poorly differentiated adenocarcinoma, morphologically consistent with metastasis from the patient's known pulmonary adenocarcinoma and showed dermal invasion, perineural invasion, and involvement of dermal lymphatics. The diagnosis was an atypical presentation of cutaneous lymphangitis carcinomatosa from metastatic lung adenocarcinoma. This case presentation affirms that cutaneous lymphangitis carcinomatosa has a variety of atypical presentations, so physicians must maintain a high index of suspicion when evaluating cutaneous lesions in patients with known or suspected internal malignancy.
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Affiliation(s)
| | - M Desai
- Department of Dermatology, Loma Linda University Medical Center, Loma Linda, California, USA.
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Desai M, Kundu A, Hageman M, Lou H, Boisvert D. Monoclonal antibody and protein therapeutic formulations for subcutaneous delivery: high-concentration, low-volume vs. low-concentration, high-volume. MAbs 2023; 15:2285277. [PMID: 38013454 DOI: 10.1080/19420862.2023.2285277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
Biologic drugs are used to treat a variety of cancers and chronic diseases. While most of these treatments are administered intravenously by trained healthcare professionals, a noticeable trend has emerged favoring subcutaneous (SC) administration. SC administration of biologics poses several challenges. Biologic drugs often require higher doses for optimal efficacy, surpassing the low volume capacity of traditional SC delivery methods like autoinjectors. Consequently, high concentrations of active ingredients are needed, creating time-consuming formulation obstacles. Alternatives to traditional SC delivery systems are therefore needed to support higher-volume biologic formulations and to reduce development time and other risks associated with high-concentration biologic formulations. Here, we outline key considerations for SC biologic drug formulations and delivery and explore a paradigm shift: the flexibility afforded by low-to-moderate-concentration drugs in high-volume formulations as an alternative to the traditionally difficult approach of high-concentration, low-volume SC formulation delivery.
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Affiliation(s)
- M Desai
- Medical Affairs, Enable Injections, Inc, Cincinnati, OH, USA
| | - A Kundu
- Manufacturing Sciences, Takeda Pharmaceuticals, Brooklyn Park, MN, USA
| | - M Hageman
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | - H Lou
- Biopharmaceutical Innovation & Optimization Center, The University of Kansas, Lawrence, KS, USA
| | - D Boisvert
- Independent Chemistry Manufacturing & Controls (CMC) Consultant, El Cerrito, CA, USA
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5
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Orsini S, Milillo A, Lichtenegger H, Varsani A, Barabash S, Livi S, De Angelis E, Alberti T, Laky G, Nilsson H, Phillips M, Aronica A, Kallio E, Wurz P, Olivieri A, Plainaki C, Slavin JA, Dandouras I, Raines JM, Benkhoff J, Zender J, Berthelier JJ, Dosa M, Ho GC, Killen RM, McKenna-Lawlor S, Torkar K, Vaisberg O, Allegrini F, Daglis IA, Dong C, Escoubet CP, Fatemi S, Fränz M, Ivanovski S, Krupp N, Lammer H, Leblanc F, Mangano V, Mura A, Rispoli R, Sarantos M, Smith HT, Wieser M, Camozzi F, Di Lellis AM, Fremuth G, Giner F, Gurnee R, Hayes J, Jeszenszky H, Trantham B, Balaz J, Baumjohann W, Cantatore M, Delcourt D, Delva M, Desai M, Fischer H, Galli A, Grande M, Holmström M, Horvath I, Hsieh KC, Jarvinen R, Johnson RE, Kazakov A, Kecskemety K, Krüger H, Kürbisch C, Leblanc F, Leichtfried M, Mangraviti E, Massetti S, Moissenko D, Moroni M, Noschese R, Nuccilli F, Paschalidis N, Ryno J, Seki K, Shestakov A, Shuvalov S, Sordini R, Stenbeck F, Svensson J, Szalai S, Szego K, Toublanc D, Vertolli N, Wallner R, Vorburger A. Inner southern magnetosphere observation of Mercury via SERENA ion sensors in BepiColombo mission. Nat Commun 2022; 13:7390. [PMID: 36450728 PMCID: PMC9712576 DOI: 10.1038/s41467-022-34988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Mercury's southern inner magnetosphere is an unexplored region as it was not observed by earlier space missions. In October 2021, BepiColombo mission has passed through this region during its first Mercury flyby. Here, we describe the observations of SERENA ion sensors nearby and inside Mercury's magnetosphere. An intermittent high-energy signal, possibly due to an interplanetary magnetic flux rope, has been observed downstream Mercury, together with low energy solar wind. Low energy ions, possibly due to satellite outgassing, were detected outside the magnetosphere. The dayside magnetopause and bow-shock crossing were much closer to the planet than expected, signature of a highly eroded magnetosphere. Different ion populations have been observed inside the magnetosphere, like low latitude boundary layer at magnetopause inbound and partial ring current at dawn close to the planet. These observations are important for understanding the weak magnetosphere behavior so close to the Sun, revealing details never reached before.
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Affiliation(s)
- S Orsini
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy.
| | - A Milillo
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - H Lichtenegger
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - A Varsani
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - S Barabash
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - S Livi
- Southwest Research Institute, San Antonio, TX, USA
- University of Michigan, Department of Climate and Space Sciences and Engineering, Ann Arbor, MI, USA
| | - E De Angelis
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - T Alberti
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - G Laky
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - H Nilsson
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - M Phillips
- Southwest Research Institute, San Antonio, TX, USA
| | - A Aronica
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - E Kallio
- Aalto University, Department of Electronics and Nanoengineering, School of Electrical Engineering, Helsinki, Finland
| | - P Wurz
- University of Bern, Institute of Physics, Bern, Switzerland
| | | | | | - J A Slavin
- University of Michigan, Department of Climate and Space Sciences and Engineering, Ann Arbor, MI, USA
| | - I Dandouras
- Institut de Recherche en Astrophysique et Planétologie, CNRS, CNES, Université de Toulouse, Toulouse, France
| | - J M Raines
- University of Michigan, Department of Climate and Space Sciences and Engineering, Ann Arbor, MI, USA
| | | | - J Zender
- ESA-ESTEC, Noordwijk, The Netherlands
| | | | - M Dosa
- Wigner Research Centre for Physics, Budapest, Hungary
| | - G C Ho
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, 20723, USA
| | - R M Killen
- NASA/Goddard Space Flight Center, Greenbelt, MD, 20771, USA
| | | | - K Torkar
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - O Vaisberg
- IKI Space Research Institute, Moscow, Russia
| | - F Allegrini
- Southwest Research Institute, San Antonio, TX, USA
- University of Texas at San Antonio, Department of Physics and Astronomy, San Antonio, TX, USA
| | - I A Daglis
- National and Kapodistrian University of Athens, Department of Physics, Athens, Greece
- Hellenic Space Center, Athens, Greece
| | - C Dong
- Princeton Plasma Physics Laboratory and Department of Astrophysical Sciences, Princeton University, Princeton, NJ, USA
| | | | - S Fatemi
- Department of Physics, Umeå University, Umeå, Sweden
| | - M Fränz
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077, Göttingen, Germany
| | - S Ivanovski
- Astronomincal Observatory, INAF, Trieste, Italy
| | - N Krupp
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077, Göttingen, Germany
| | - H Lammer
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - V Mangano
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - A Mura
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - R Rispoli
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - M Sarantos
- NASA/Goddard Space Flight Center, Greenbelt, MD, 20771, USA
| | - H T Smith
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, 20723, USA
| | - M Wieser
- Swedish Institute of Space Physics, Kiruna, Sweden
| | | | | | - G Fremuth
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - F Giner
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - R Gurnee
- Laboratory for Atmospheric and Space Physics, Boulder, CO, USA
| | - J Hayes
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, 20723, USA
| | - H Jeszenszky
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - B Trantham
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - J Balaz
- Institute of Experimental Physics SAS, Slovak Academy of Sciences, 040 01, Košice, Slovakia
| | - W Baumjohann
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | | | - M Delva
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - M Desai
- Southwest Research Institute, San Antonio, TX, USA
| | - H Fischer
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077, Göttingen, Germany
| | - A Galli
- University of Bern, Institute of Physics, Bern, Switzerland
| | - M Grande
- Aberystwyth University, Aberystwyth, Ceredigion, UK
| | - M Holmström
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - I Horvath
- Wigner Research Centre for Physics, Budapest, Hungary
| | - K C Hsieh
- University of Arizona, Tucson, AZ, USA
| | - R Jarvinen
- Aalto University, Department of Electronics and Nanoengineering, School of Electrical Engineering, Helsinki, Finland
- Finnish Meteorological Institute FMI, Helsinki, Finland
| | - R E Johnson
- University of Virginia, Charlottesville, VA, 22904, USA
| | - A Kazakov
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - K Kecskemety
- Wigner Research Centre for Physics, Budapest, Hungary
| | - H Krüger
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077, Göttingen, Germany
| | - C Kürbisch
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - M Leichtfried
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - S Massetti
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - D Moissenko
- IKI Space Research Institute, Moscow, Russia
| | - M Moroni
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - R Noschese
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - F Nuccilli
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - N Paschalidis
- NASA/Goddard Space Flight Center, Greenbelt, MD, 20771, USA
| | - J Ryno
- Finnish Meteorological Institute FMI, Helsinki, Finland
| | - K Seki
- University of Tokyo, Department of Earth and Planetary Science, Graduate School of Science, Tokyo, Japan
| | - A Shestakov
- IKI Space Research Institute, Moscow, Russia
| | - S Shuvalov
- IKI Space Research Institute, Moscow, Russia
| | - R Sordini
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - F Stenbeck
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - J Svensson
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - S Szalai
- Wigner Research Centre for Physics, Budapest, Hungary
| | - K Szego
- Wigner Research Centre for Physics, Budapest, Hungary
| | - D Toublanc
- Institut de Recherche en Astrophysique et Planétologie, CNRS, CNES, Université de Toulouse, Toulouse, France
| | - N Vertolli
- Institute of Space Astrophysics and Planetology, INAF, Roma, Italy
| | - R Wallner
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - A Vorburger
- University of Bern, Institute of Physics, Bern, Switzerland
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Smolka S, Fava A, Moshage M, Marwan M, Desai M, Achenbach S. 435 Imaging Parameters And Their Impact On Analysis Time In Ct-ffr. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hufton M, Hussaini Y, Desai M, Saleem N, Srikantaiah R, Fairbank J, Cooper S, Paskin L. WS20.05 Cystic fibrosis, lockdown and CFTR modulators - a perfect storm. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Driscoll S, Patterson K, Goddard P, Desai M, Gilchrist F. WS11.06 A 14-year review of cystic fibrosis newborn screening outcomes from a UK regional laboratory. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Phan TD, Verniero JL, Larson D, Lavraud B, Drake JF, Øieroset M, Eastwood JP, Bale SD, Livi R, Halekas JS, Whittlesey PL, Rahmati A, Stansby D, Pulupa M, MacDowall RJ, Szabo PA, Koval A, Desai M, Fuselier SA, Velli M, Hesse M, Pyakurel PS, Maheshwari K, Kasper JC, Stevens JM, Case AW, Raouafi NE. Parker Solar Probe Observations of Solar Wind Energetic Proton Beams Produced by Magnetic Reconnection in the Near-Sun Heliospheric Current Sheet. Geophys Res Lett 2022; 49:e2021GL096986. [PMID: 35864893 PMCID: PMC9286436 DOI: 10.1029/2021gl096986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 06/09/2023]
Abstract
We report observations of reconnection exhausts in the Heliospheric Current Sheet (HCS) during Parker Solar Probe Encounters 08 and 07, at 16 R s and 20 R s , respectively. Heliospheric current sheet (HCS) reconnection accelerated protons to almost twice the solar wind speed and increased the proton core energy by a factor of ∼3, due to the Alfvén speed being comparable to the solar wind flow speed at these near-Sun distances. Furthermore, protons were energized to super-thermal energies. During E08, energized protons were found to have leaked out of the exhaust along separatrix field lines, appearing as field-aligned energetic proton beams in a broad region outside the HCS. Concurrent dropouts of strahl electrons, indicating disconnection from the Sun, provide further evidence for the HCS being the source of the beams. Around the HCS in E07, there were also proton beams but without electron strahl dropouts, indicating that their origin was not the local HCS reconnection exhaust.
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Affiliation(s)
- T. D. Phan
- SSLUniversity of CaliforniaBerkeleyCAUSA
| | | | - D. Larson
- SSLUniversity of CaliforniaBerkeleyCAUSA
| | - B. Lavraud
- Laboratoire d'Astrophysique de BordeauxUniversity BordeauxPessacFrance
- IRAPCNRSCNESUniversité de ToulouseToulouseFrance
| | | | | | | | - S. D. Bale
- SSLUniversity of CaliforniaBerkeleyCAUSA
- Physics DepartmentUniversity of CaliforniaBerkeleyCAUSA
| | - R. Livi
- SSLUniversity of CaliforniaBerkeleyCAUSA
| | | | | | - A. Rahmati
- SSLUniversity of CaliforniaBerkeleyCAUSA
| | - D. Stansby
- Mullard Space Science LaboratoryUniversity College LondonDorkingUK
| | - M. Pulupa
- SSLUniversity of CaliforniaBerkeleyCAUSA
| | | | - P. A. Szabo
- NASA Goddard Space Flight CenterGreenbeltMDUSA
| | - A. Koval
- NASA Goddard Space Flight CenterGreenbeltMDUSA
- University of MarylandBaltimore CountyBaltimoreMDUSA
| | - M. Desai
- Southwest Research InstituteSan AntonioTXUSA
| | | | - M. Velli
- University of CaliforniaLos AngelesCAUSA
| | - M. Hesse
- NASA Ames Research CenterMoffett FieldCAUSA
| | | | | | - J. C. Kasper
- Climate and Space Sciences and EngineeringUniversity of MichiganAnn ArborMIUSA
| | | | - A. W. Case
- Smithsonian Astrophysical ObservatoryCambridgeMAUSA
| | - N. E. Raouafi
- Johns Hopkins University Applied Physics LaboratoryLaurelMDUSA
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Bhandari M, Hamid A, Tyagi V, Choudhary G, Mallikarjuna C, Desai M, Srivastava A, Ahlawat R, Dubey D, Pratt C, Reddiboina M. The art of data labelling for building supervised computer Vision models for kidney surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sholklapper T, Goldenberg M, Lebastchi A, Abreu A, Desai M, Sotelo R, Gill I, Cacciamani G. Intraoperative adverse event reporting in urology: Global ICARUS survey results. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paludo A, Knijnik P, Silva Neto B, Berger M, Duarte Jr. D, Aron M, Desai M, Kives Berger A. Feasibility of first postoperative day foley catheter removal after robotic assisted radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Misuraca L, Anceschi U, Tuderti G, Mastroianni R, Ferriero M, Brassetti A, Bove A, Guaglianone S, Desai M, Gill I, Gallucci M, Simone G. Eight-yr experience of robotic IVC thrombectomy: surgical technique, perioperative and oncologic outcomes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haque W, Verma V, Teh B, Butler E, Hatch S, Desai M, Arentz S, Jain D, Schwartz M, Chevli N, Farach A. Postmastectomy Radiation Therapy Following Pathologic Complete Nodal Response to Neoadjuvant Chemotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.707] [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: 11/15/2022]
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Watson M, Chambers P, Shiu KK, Bridgewater J, Desai M, Roylance R, Tailor A, Masento S, Forster M, Al Moubayed N. 1859P Using deep learning with demographic and laboratory values from baseline to cycle 2 to predict subsequent renal and hepatic function. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Carvajal R, Weber J, Dudek A, Grewal J, Mehmi I, Hamid O, Du Y, Desai M, Wang Y, Sun L, Rege J, Middleton M. 1034TiP ARTISTRY-6: Nemvaleukin alfa monotherapy in patients with advanced mucosal and cutaneous melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Oppezzo M, Tremmel J, Kapphahn K, Desai M, Baiocchi M, Sanders M, Prochaska J. Feasibility, preliminary efficacy, and accessibility of a twitter-based social support group vs Fitbit only to decrease sedentary behavior in women. Internet Interv 2021; 25:100426. [PMID: 34401385 PMCID: PMC8350596 DOI: 10.1016/j.invent.2021.100426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content. AIMS We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone. METHODS In a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change "tweets" informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up). RESULTS The study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention. CONCLUSION A Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.
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Affiliation(s)
- M.A. Oppezzo
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States of America,Corresponding author at: Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, United States of America.
| | - J.A. Tremmel
- Interventional Cardiology, Women's Heart Health at Stanford, Stanford, CA, United States of America
| | - K. Kapphahn
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Desai
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Baiocchi
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Sanders
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - J.J. Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States of America
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Smolka S, Fava A, Marwan M, Achenbach S, Desai M. Interobserver Agreement Of On-site Ct Derived Ffr In Patients Undergoing Ct Angiography For Suspected Cad By Experience Level. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Bhandari M, Ali H, Desai M, Mallikarjuna C, Srivastava A, Dubey D, Tyagi V, Ahlawat R, Pratt C, Choudhary G, Trevor T, Reddiboina M. Complexities in annotating surgical videos for building supervised deep learning models for critical steps of laparoscopic live donor nephrectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Dell’Oglio P, Andras I, Ortega D, Galfano A, Artibani W, Autorino R, Mazzone E, Crisan N, Bocciardi A, Sanchez-Salas R, Gill I, Wiklund P, Desai M, Mitropoulos D, Mottrie A, Cacciamani G. Impact of the implementation of the EAU Guidelines recommendation on reporting and grading of complications in patients undergoing robot assisted radical cystectomy: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Zorn K, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman R, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Gin G, Goldenberg L, Patterson R, So A, Humphreys M, Kaplan S, Motola J, Desai M, Roehrborn C. Aquablation for benign prostatic hyperplasia in large prostates (80-150cc): 3-year results. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Orsini S, Livi SA, Lichtenegger H, Barabash S, Milillo A, De Angelis E, Phillips M, Laky G, Wieser M, Olivieri A, Plainaki C, Ho G, Killen RM, Slavin JA, Wurz P, Berthelier JJ, Dandouras I, Kallio E, McKenna-Lawlor S, Szalai S, Torkar K, Vaisberg O, Allegrini F, Daglis IA, Dong C, Escoubet CP, Fatemi S, Fränz M, Ivanovski S, Krupp N, Lammer H, Leblanc F, Mangano V, Mura A, Nilsson H, Raines JM, Rispoli R, Sarantos M, Smith HT, Szego K, Aronica A, Camozzi F, Di Lellis AM, Fremuth G, Giner F, Gurnee R, Hayes J, Jeszenszky H, Tominetti F, Trantham B, Balaz J, Baumjohann W, Brienza D, Bührke U, Bush MD, Cantatore M, Cibella S, Colasanti L, Cremonese G, Cremonesi L, D'Alessandro M, Delcourt D, Delva M, Desai M, Fama M, Ferris M, Fischer H, Gaggero A, Gamborino D, Garnier P, Gibson WC, Goldstein R, Grande M, Grishin V, Haggerty D, Holmström M, Horvath I, Hsieh KC, Jacques A, Johnson RE, Kazakov A, Kecskemety K, Krüger H, Kürbisch C, Lazzarotto F, Leblanc F, Leichtfried M, Leoni R, Loose A, Maschietti D, Massetti S, Mattioli F, Miller G, Moissenko D, Morbidini A, Noschese R, Nuccilli F, Nunez C, Paschalidis N, Persyn S, Piazza D, Oja M, Ryno J, Schmidt W, Scheer JA, Shestakov A, Shuvalov S, Seki K, Selci S, Smith K, Sordini R, Svensson J, Szalai L, Toublanc D, Urdiales C, Varsani A, Vertolli N, Wallner R, Wahlstroem P, Wilson P, Zampieri S. SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo. Space Sci Rev 2021; 217:11. [PMID: 33487762 PMCID: PMC7803725 DOI: 10.1007/s11214-020-00787-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.
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Affiliation(s)
- S Orsini
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - S A Livi
- Southwest Research Institute, San Antonio, TX USA
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI USA
| | - H Lichtenegger
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - S Barabash
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - A Milillo
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - E De Angelis
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - M Phillips
- Southwest Research Institute, San Antonio, TX USA
| | - G Laky
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - M Wieser
- Swedish Institute of Space Physics, Kiruna, Sweden
| | | | | | - G Ho
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - R M Killen
- NASA/Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - J A Slavin
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI USA
| | - P Wurz
- Physics Institute, University of Bern, Bern, Switzerland
| | | | - I Dandouras
- Institut de Recherche en Astrophysique et Planétologie, CNRS, CNES, Université de Toulouse, Toulouse, France
| | - E Kallio
- School of Electrical Engineering, Department of Electronics and Nanoengineering, Aalto University, Helsinki, Finland
| | | | - S Szalai
- Wigner Research Centre for Physics, Budapest, Hungary
| | - K Torkar
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - O Vaisberg
- IKI Space Research Institute, Moscow, Russia
| | - F Allegrini
- Southwest Research Institute, San Antonio, TX USA
| | - I A Daglis
- Department of Physics, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Space Center, Athens, Greece
| | - C Dong
- Department of Astrophysical Sciences and Princeton Plasma Physics Laboratory, Princeton University, Princeton, NJ USA
| | | | - S Fatemi
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - M Fränz
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - S Ivanovski
- Astronomical Observatory, INAF, Trieste, Italy
| | - N Krupp
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - H Lammer
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - V Mangano
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - A Mura
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - H Nilsson
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - J M Raines
- Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI USA
| | - R Rispoli
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - M Sarantos
- NASA/Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - H T Smith
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - K Szego
- Wigner Research Centre for Physics, Budapest, Hungary
| | - A Aronica
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | | | | | - G Fremuth
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - F Giner
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - R Gurnee
- Laboratory for Atmospheric and Space Physics, Boulder, CO USA
| | - J Hayes
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - H Jeszenszky
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - B Trantham
- Southwest Research Institute, San Antonio, TX USA
| | - J Balaz
- Institute of Experimental Physics SAS, Slovak Academy of Sciences, 040 01 Košice, Slovakia
| | - W Baumjohann
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - D Brienza
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - U Bührke
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - M D Bush
- Physics Institute, University of Bern, Bern, Switzerland
| | | | - S Cibella
- Istituto di Struttura della Materia (CNR-ISM), 00133 Roma, Italy
| | - L Colasanti
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - G Cremonese
- Astronomical Observatory, INAF, Padova, Italy
| | | | - M D'Alessandro
- Istituto di Struttura della Materia (CNR-ISM), 00133 Roma, Italy
| | | | - M Delva
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - M Desai
- Southwest Research Institute, San Antonio, TX USA
| | - M Fama
- Comisión Nacional de Energía Atómica, cnea, Centro Atómico Bariloche, Bariloche, Argentina
| | - M Ferris
- Southwest Research Institute, San Antonio, TX USA
| | - H Fischer
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - A Gaggero
- Istituto di Struttura della Materia (CNR-ISM), 00133 Roma, Italy
| | - D Gamborino
- Physics Institute, University of Bern, Bern, Switzerland
| | - P Garnier
- Institut de Recherche en Astrophysique et Planétologie, CNRS, CNES, Université de Toulouse, Toulouse, France
| | - W C Gibson
- Southwest Research Institute, San Antonio, TX USA
| | - R Goldstein
- Southwest Research Institute, San Antonio, TX USA
| | - M Grande
- Aberystwyth University, Aberystwyth, Ceredigion SY23 3FL UK
| | - V Grishin
- IKI Space Research Institute, Moscow, Russia
| | - D Haggerty
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - M Holmström
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - I Horvath
- Wigner Research Centre for Physics, Budapest, Hungary
| | - K-C Hsieh
- University of Arizona, Tucson, AZ USA
| | - A Jacques
- NASA/Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - R E Johnson
- University of Virginia, Charlottesville, VA 22904 USA
| | - A Kazakov
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - K Kecskemety
- Wigner Research Centre for Physics, Budapest, Hungary
| | - H Krüger
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - C Kürbisch
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | | | - M Leichtfried
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | | | - A Loose
- Max-Planck-Institut für Sonnensystemforschung, MPS, 37077 Göttingen, Germany
| | - D Maschietti
- Istituto Fotonica e Nanotecnologie, CNR-IFN, Roma, Italy
| | - S Massetti
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | | | - G Miller
- Southwest Research Institute, San Antonio, TX USA
| | - D Moissenko
- IKI Space Research Institute, Moscow, Russia
| | - A Morbidini
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - R Noschese
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - F Nuccilli
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - C Nunez
- Southwest Research Institute, San Antonio, TX USA
| | - N Paschalidis
- NASA/Goddard Space Flight Center, Greenbelt, MD 20771 USA
| | - S Persyn
- Southwest Research Institute, San Antonio, TX USA
| | - D Piazza
- Physics Institute, University of Bern, Bern, Switzerland
| | - M Oja
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - J Ryno
- Finnish Meteorological Institute FMI, Helsinki, Finland
| | - W Schmidt
- Finnish Meteorological Institute FMI, Helsinki, Finland
| | | | - A Shestakov
- IKI Space Research Institute, Moscow, Russia
| | - S Shuvalov
- IKI Space Research Institute, Moscow, Russia
| | - K Seki
- Department of Earth and Planetary Science, Graduate School of Science, University of Tokyo, Tokyo, Japan
| | - S Selci
- Istituto di Struttura della Materia (CNR-ISM), 00133 Roma, Italy
| | - K Smith
- Southwest Research Institute, San Antonio, TX USA
| | - R Sordini
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | | | - L Szalai
- Wigner Research Centre for Physics, Budapest, Hungary
| | - D Toublanc
- Institut de Recherche en Astrophysique et Planétologie, CNRS, CNES, Université de Toulouse, Toulouse, France
| | - C Urdiales
- Southwest Research Institute, San Antonio, TX USA
| | - A Varsani
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - N Vertolli
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
| | - R Wallner
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - P Wahlstroem
- Physics Institute, University of Bern, Bern, Switzerland
| | - P Wilson
- Southwest Research Institute, San Antonio, TX USA
| | - S Zampieri
- Institute of Space Astrophysics and Planetology, INAF, via del Fosso del Cavaliere 100, 00133 Rome, Italy
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Igbinosa I, Lee K, Oakeson A, Riley E, Melchor S, Birdsong J, Tran L, Weng Y, Collins W, Abir G, Bianco Y, He Z, Desai M, Mathew R, Lee G, Ahuja N, Lyell D, Gibbs R, Aziz N. Health disparities among pregnant women with sars-cov-2 infection at a university medical center in northern California. Am J Obstet Gynecol 2020. [PMCID: PMC7683952 DOI: 10.1016/j.ajog.2020.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fava A, Sande Mathias I, Alashi A, Saijo Y, Popovic Z, Thamilarasan M, Lever H, Desai M. Diastolic stress test echocardiography in patients with hypertrophy cardiomyopathy: association with exercise capacity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diastolic dysfunction (DD) is a frequent occurrence in hypertrophic cardiomyopathy (HCM) patients. Symptoms of DD are often unmasked only during exercise, as left ventricular (LV) filling pressure is normal at rest.
Purpose
We sought to establish if abnormal DST parameters are associated with reduced exercise capacity in HCM patients.
Methods
We examined 590 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) with HCM by echocardiography at rest & maximal exercise. Septal and lateral [e'] mitral annular velocity, peak early [E] and late [A] mitral inflow velocity, Mitral E/e' and left atrial volume index (LAVI) was recorded. Exercise functional capacity was stablished as age-gender predicted metabolic equivalents (AGP-METs).
Results
Echocardiography at rest had LVEF of 62±6, wall thickness of 16.7±0.5 mm, LVMI of 111±43 g m–2, LVOT gradient of 26±33 mmHg, LAVI 34.5±17 mm, E/A ratio of 1.2±0.6, and average E/e' ratio 12.7±0.6. Following maximal exercise had a mean LVOT gradient of 61±59 mmHg, E/A ratio of 1.2±1.0 and average E/e' ratio 12.7±1.0. Only 42% had >85% of age-sex predicted METs. Logistic regression analysis testing the association between various predictors and 85% AGP-METs are shown in table 1.
Conclusion
There is a significant association between abnormal diastolic response to exercise and reduced exercise capacity in patients with HCM.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.M Fava
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - I Sande Mathias
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Saijo
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Thamilarasan
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Lever
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Wang T, Griffin B, Cremer P, Gamble G, Unai S, Shrestha N, Gordon S, Pettersson G, Desai M. Meta-analysis of computed tomography and magnetic resonance imaging for diagnosing mycotic aneurysms. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0160] [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: 11/12/2022] Open
Abstract
Abstract
Background
Mycotic aneurysms are a serious complication of infective endocarditis and bloodstream infection with high mortality and morbidity. Computed tomography (CT) and magnetic resonance (MRI) play major roles in detecting mycotic aneurysms, but their accuracy is not well established warranting this meta-analysis.
Purpose
We aimed to assess the diagnostic performance of CT and MRI for mycotic aneurysms in this meta-analysis.
Methods
Pubmed, Cochrane and Embase were searched from 1 January 1980–30 June 2019 for diagnostic studies reporting both sensitivity and specificity of CT and/or MRI for detecting mycotic aneurysms, and pooled using random effects models and Meta-DiSc 1.4 software.
Results
Amongst 1507 articles searched, 15 studies with 622 scans for 249 mycotic aneurysms included. CT was performed in 13 studies and MRI in 5 studies, looking at aortic and cerebral mycotic aneurysm in 12 and 3 studies respectively. The pooled sensitivities and specificities for all mycotic aneurysms with 95% confidence intervals were for CT 0.82 (0.77–0.87) and 0.93 (0.89–0.95) respectively, and for MRI 0.79 (0.61–0.91) and 0.89 (0.81–0.95) (Figure). CT or MRI had pooled sensitivities and specificities of 0.84 (0.78–0.89) and 0.92 (0.89–0.95) for aortic and 0.71 (0.54–0.85) and 0.90 (0.83–0.95) for cerebral mycotic aneurysms. Heterogeneity and publication bias was observed in some pooled analysis.
Conclusion
CT and MRI had moderately high diagnostic accuracy for mycotic aneurysms. Sensitivity was numerically higher for detecting aortic than cerebral mycotic aneurysms, with similar specificity. Study heterogeneity, publication bias and modest sample size from the literature were important limitations, warranting larger and higher quality studies.
Forrest plots for CT and MRI pooled data
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of New Zealand - Overseas Clinical and Research Fellowship
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Affiliation(s)
- T.K.M Wang
- Cleveland Clinic, Cleveland, United States of America
| | - B.P Griffin
- Cleveland Clinic, Cleveland, United States of America
| | - P.C Cremer
- Cleveland Clinic, Cleveland, United States of America
| | - G.D Gamble
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - S Unai
- Cleveland Clinic, Cleveland, United States of America
| | - N Shrestha
- Cleveland Clinic, Cleveland, United States of America
| | - S Gordon
- Cleveland Clinic, Cleveland, United States of America
| | - G Pettersson
- Cleveland Clinic, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic, Cleveland, United States of America
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Fava A, Alashi A, Saijo Y, Sande Mathias I, Popovic Z, Thamilarasan M, Lever H, Desai M. Exercise capacity is associated with rest and peak-exercise left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0081] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) frequently have reduced exercise capacity, which can be associated with subclinical cardiac dysfunction. Left ventricle global myocardial strain (LV-GLS) is a sensitive index to detect subclinical myocardial dysfunction. However, the clinical utility of LV-GLS during exercise test remains uncertain.
Purpose
We assessed the association of functional capacity with LV-GLS at rest and at the peak of stress in HCM patients.
Methods
We examined 566 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) by echo at rest and following maximal exercise. We recorded clinical, echo variables (LV ejection fraction [LVEF], LV thickness, left ventricle mass index [LVMI], left ventricle outflow tract [LVOT] gradient, LV-GLS at rest and at peak stress), and exercise variables (percent of age-gender predicted metabolic equivalents [AGP-METs]).
Results
Echo parameters were as follows: LVEF at rest of 62±6%, wall thickness of 16.9±0.4 mm, LVMI of 117±47 g/m2, LVOT gradient at rest of 27±33 mmHg, LV-GLS at rest of −15.9±3.6%, LV-GLS at peak of stress of −17.4±4.3%, and change in LV strain from rest to stress of −1.9±2.3%. Only 41% of patients achieved >85% of AGP-METs. Logistic regression demonstrating an association between AGP-METs less than 85% and various predictors are shown in Table 1.
Conclusion
Impaired deformation at peak of stress assessed by LV-GLS was associated with reduced exercise capacity measured as AGP-METs less than 85%. These findings suggest that early systolic cardiac deterioration should be considered as a cause of exercise impairment in patients with HCM.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.M Fava
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Saijo
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - I Sande Mathias
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Thamilarasan
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Lever
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Wang T, Akyuz K, Xu B, Gillinov M, Pettersson G, Griffin B, Desai M. Earlier surgery improves long-term survival compared to class I surgical indications and infective endocarditis surgery for isolated severe tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2687] [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: 11/12/2022] Open
Abstract
Abstract
Background
Isolated tricuspid surgery has markedly higher mortality rates (9–10%) in contemporary national registries compared to other single-valve operations. The optimal timing and indications remain controversial, and earlier surgery before developing ESC guidelines class 1 indications may improve the survival for isolated severe tricuspid regurgitation.
Purpose
We aimed to compare the characteristics and outcomes of isolated tricuspid regurgitation (TR) surgery by indication.
Methods
Consecutive patients undergoing isolated tricuspid valve surgery for TR without other concomitant valve surgery at Cleveland Clinic from 2004 to 2019 were studied. Indications were divided into group 1: ESC guidelines class 1 (severe symptomatic TR), group 2: infective endocarditis, and group 3: non-class 1 (asymptomatic severe TR with or without right ventricular dilation and/or dysfunction) and no endocarditis, for comparative analyses of characteristics and outcomes.
Results
The study included 207 patients (group 1: 115, group 2: 48 and group 3: 44) with mean age 54.1±17.8 years, 116 (56.0% females and 151. Tricuspid repair was performed in 72.9% (73.0%, 66.7% and 79.5% for Groups 1–3, P=0.381). Group 3 patients were younger, had higher prevalence of primary TR, lower prevalence of heart failure, atrial fibrillation, chronic lung disease, cirrhosis, renal impairment, right ventricular and left ventricular dysfunction than Group 1. Overall operative mortality rates were 4.9% ( group 1: 7.0%, group 2: 4.2% and group 3: 0.0%), while mortality during follow-up of 3.3±4.0 years was lower for group 3 than for groups 1 or 2 (Figure 1). Independent predictors of long-term mortality were Group 1 compared to Group 3 and reduced estimated glomerular filtration rate.
Conclusion
Patients without class I or endocarditis indications had superior unadjusted and adjusted survival compared to those with these indications. The high mortality rate of isolated TR surgery may be reduced by both earlier surgery and being performed at an experienced cardiac surgery center.
Figure 1. Kaplan-Meier survival curves
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of New Zealand - Overseas Clinical and Research Fellowship
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Affiliation(s)
- T.K.M Wang
- Cleveland Clinic, Cleveland, United States of America
| | - K Akyuz
- Cleveland Clinic, Cleveland, United States of America
| | - B Xu
- Cleveland Clinic, Cleveland, United States of America
| | - M Gillinov
- Cleveland Clinic, Cleveland, United States of America
| | - G Pettersson
- Cleveland Clinic, Cleveland, United States of America
| | - B.P Griffin
- Cleveland Clinic, Cleveland, United States of America
| | - M.Y Desai
- Cleveland Clinic, Cleveland, United States of America
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28
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Kotanidis C, Akawi N, Thomas S, Siddique M, Oikonomou E, Alashi A, Akoumianakis I, Antonopoulos A, Krasopoulos G, Sayeed R, Neubauer S, Channon K, Desai M, Antoniades C. A novel arterial redox-specific machine learning-derived radiomic signature of perivascular adipose tissue predicts cardiac mortality from routine CCTA. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vascular oxidative stress is involved in inflammation and atherogenesis. Vascular inflammation induces spatial changes in perivascular adipose tissue (PVAT) composition, which can be detected by radiomic analysis of coronary computed tomography angiography (CCTA) images.
Purpose
To explore the association of arterial oxidative stress with long-term risk of major adverse cardiovascular events (MACE). To develop a radiomic signature to identify high oxidative stress non-invasively using CCTA. Finally, to assess the ability of this signature to predict future cardiac risk.
Methods
Arm 1 included 272 patients undergoing cardiac surgery. Segments of internal mammary artery (IMA) were used for ex-vivo quantification of NADPH-stimulated and Vas2870 (pan-NOX inhibitor) inhibitable superoxide production by lucigenin-enhanced chemiluminescence. Eighty-two of these patients with CCTA scans available constituted Arm 2. Peri-IMA PVAT was segmented and used to extract 1,616 radiomic features, which, after filtering (40 final features), were utilised to train extreme gradient boosting, a machine learning algorithm, to predict high arterial oxidative stress. Arm 3 included a nested cohort of 308 participants (41 suffering cardiac death and 267 matched controls) from the CRISP-CT (Cardiovascular RISk Prediction using Computed Tomography) study to externally validate the redox-specific signature developed in Arm 2 for cardiac risk prediction.
Results
Over a median follow-up of 40 months, 18 (6.6%) MACE (cardiovascular death, non-fatal myocardial infarction, and stroke) occurred in Arm 1. High arterial NADPH-stimulated superoxide was independently associated with MACE risk (Adj. HR[95% CI]: 1.61 [1.04–2.53] per SD, p=0.03, adjusted for age, sex, diabetes, hypertension, hyperlipidemia, smoking, obesity, and plasma TNFa). Unsupervised hierarchical clustering of radiomic features from peri-IMA PVAT segments in Arm 2 identified two distinct clusters (A) that differed in NADPH stimulated (p=0.01) and Vas2870 inhibitable (p=0.04) IMA superoxide (B), supporting the hypothesis that PVAT mapping can capture changes corresponding to differential levels of underlying vascular redox state. This prompted the development of a radiomic signature specific to PVAT alterations associated with high vascular oxidative stress, which was validated in Arm 3 (AUC:0.61, p=0.026, C). The novel signature was able to stratify cardiac risk in the validation set, independently of the Fat Attenuation Index, epicardial adipose tissue volume, high-risk plaque features, and obstructive CAD (Adj. HR [95% CI]:2.56 [1.35–4.87], p=0.004, D).
Conclusion
Increased arterial oxidative stress predicts cardiac risk in patients with advanced atherosclerosis. We present for the first time a novel, non-invasive CCTA imaging biomarker reflecting changes in vascular redox state by radiomic phenotyping of perivascular space, which stratifies cardiac risk beyond standard and newer risk assessment methods.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation, National Institute of Health Research, Oxford Biomedical Research Centre
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Affiliation(s)
- C.P Kotanidis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - N Akawi
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Thomas
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Siddique
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - E.K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - I Akoumianakis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A.S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - G Krasopoulos
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiothoracic Surgery, Oxford, United Kingdom
| | - R Sayeed
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiothoracic Surgery, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K.M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M.Y Desai
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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Cacciamani G, Simone G, Brassetti A, Iwata A, Iwata T, Shakir A, Tafuri A, Tuderti G, Ferriero M, Miranda G, Anceschi U, Mastroianni R, Berger A, Sotelo R, Abreu A, Aron M, Gallucci M, Gill I, Desai M. Predictors of achieving pentafecta after robotic radical cystectomy with intracorporeal urinary diversions. A multicentric study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34144-6] [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] Open
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Palaniappan S, Ganpule A, Singh A, Sabnis R, Desai M. Is there a role for minimally invasive pyeloplasty in children less than 20 kg? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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31
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Fujihara A, Iwata T, Shakir A, Tafuri A, Cacciamani G, Gill K, Ashrafi A, Ukimura O, Desai M, Duddalwar V, Stern M, Aron M, Palmer S, Gill I, Abreu A. The significance of multiparametric magnetic resonance imaging in monitoring of prostate cancer patients on active surveillance. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Abstract
Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63-year-old ASA physical status 3 woman undergoing a wire-guided wide local excision of a right breast lump. A modified right serratus anterior plane block was performed under ultrasound guidance, injecting 20 ml of bupivacaine 0.25% deep to the serratus anterior muscle. No immediate complications were noted. Intra-operatively the patient developed arterial desaturation associated with high airway pressures. A subsequent chest radiograph in the post-anaesthetic care unit demonstrated a large right-sided pneumothorax which was treated with immediate needle decompression and chest drain insertion. This is the first case of pneumothorax reported from this approach to serratus anterior plane blockade and serves as a reminder of a potential serious complication.
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Affiliation(s)
- M Desai
- Darent Valley Hospital London UK
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33
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Hamade N, Desai M, Thoguluva Chandrasekar V, Chalhoub J, Patel M, Duvvuri A, Gorrepati VS, Jegadeesan R, Choudhary A, Sathyamurthy A, Rai T, Gupta N, Sharma P. Efficacy of cryotherapy as first line therapy in patients with Barrett's neoplasia: a systematic review and pooled analysis. Dis Esophagus 2019; 32:5487971. [PMID: 31076753 DOI: 10.1093/dote/doz040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/28/2019] [Revised: 03/16/2019] [Indexed: 12/11/2022]
Abstract
Cryotherapy has been used as salvage therapy; however, its efficacy as first line treatment in patients with Barrett's esophagus (BE) neoplasia has not been well studied. The aim of this paper was to perform a systematic review to look at the efficacy of cryotherapy as the primary treatment of BE. An electronic database search was performed (PubMed, Embase, Cochrane, and Google Scholar) to search for studies with cryotherapy as the initial primary modality of ablation in patients with BE neoplasia. Studies that included patients with other prior forms of therapy were excluded. The primary outcomes were the pooled rates of complete eradication of intestinal metaplasia (CE-IM) and CE of neoplasia (CE-N). Secondary outcomes were recurrence rates of neoplasia and intestinal metaplasia (IM) and adverse events. The statistical software OpenMetaAnalyst was used for analysis with pooled estimates reported as proportions (%) with 95% confidence intervals (CI) with heterogeneity (I2) among studies. The search revealed 6 eligible studies with a total of 282 patients (91.5% male, average age 65.3 years) with 459 person years of follow-up. 69.35% [95% CI (52.1%-86.5%)] of patients achieved CE-IM and 97.9% (95% CI: 95.5%-100%) had CE-N. 7.3% of patients had persistent dysplasia with 4% progressing to cancer. The recurrence rate of neoplasia was 10.4 and that of IM was 19.1 per 100 patient years of follow-up. The overall rate of stricture formation was 4.9%. There are scarce data on the use of cryotherapy as the primary modality for the treatment of BE dysplasia. The published data demonstrate efficacy rates of 69% and 98% for complete eradication of metaplasia and neoplasia, respectively. These results need to be assessed in prospective, comparative trials with other forms of therapy.
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Affiliation(s)
| | - M Desai
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - V Thoguluva Chandrasekar
- Gastroenterology and Hepatology.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - J Chalhoub
- Division of gastroenterology, baystate medical center
| | - M Patel
- Gastroenterology and Hepatology
| | | | - V S Gorrepati
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | | | - A Choudhary
- Division of gastroenterology, kansas city veteran's affair medical center
| | - A Sathyamurthy
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | - T Rai
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | - N Gupta
- Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - P Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
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Young N, Taetgmeyer M, Zulaika G, Aol G, Desai M, Ter Kuile F, Langley I. Integrating HIV, syphilis, malaria and anaemia point-of-care testing (POCT) for antenatal care at dispensaries in western Kenya: discrete-event simulation modelling of operational impact. BMC Public Health 2019; 19:1629. [PMID: 31795999 PMCID: PMC6892244 DOI: 10.1186/s12889-019-7739-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite WHO advocating for an integrated approach to antenatal care (ANC), testing coverage for conditions other than HIV remains low and women are referred to distant laboratories for testing. Using point-of-care tests (POCTs) at peripheral dispensaries could improve access to testing and timely treatment. However, the effect of providing additional services on nurse workload and client wait times are unknown. We use discrete-event simulation (DES) modelling to understand the effect of providing four point-of-care tests for ANC on nurse utilization and wait times for women seeking maternal and child health (MCH) services. METHODS We collected detailed time-motion data over 20 days from one high volume dispensary in western Kenya during the 8-month implementation period (2014-2015) of the intervention. We constructed a simulation model using empirical arrival distributions, activity durations and client pathways of women seeking MCH services. We removed the intervention from the model to obtain wait times, length-of-stay and nurse utilization rates for the baseline scenario where only HIV testing was offered for ANC. Additionally, we modelled a scenario where nurse consultations were set to have minimum durations for sufficient delivery of all WHO-recommended services. RESULTS A total of 183 women visited the dispensary for MCH services and 14 of these women received point-of-care testing (POCT). The mean difference in total waiting time was 2 min (95%CI: < 1-4 min, p = 0.026) for MCH women when integrated POCT was given, and 9 min (95%CI: 4-14 min, p < 0.001) when integrated POCT with adequate ANC consult times was given compared to the baseline scenario. Mean length-of-stay increased by 2 min (95%CI: < 1-4 min, p = 0.015) with integrated POCT and by 16 min (95%CI: 10-21 min, p < 0.001) with integrated POCT and adequate consult times compared to the baseline scenario. The two nurses' overall daily utilization in the scenario with sufficient minimum consult durations were 72 and 75%. CONCLUSION The intervention had a modest overall impact on wait times and length-of-stay for women seeking MCH services while ensuring pregnant women received essential diagnostic testing. Nurse utilization rates fluctuated among days: nurses experienced spikes in workload on some days but were under-utilized on the majority of days. Overall, our model suggests there was sufficient time to deliver all WHO's required ANC activities and offer integrated testing for ANC first and re-visits with the current number of healthcare staff. Further investigations on improving healthcare worker, availability, performance and quality of care are needed. Delivering four point-of-care tests together for ANC at dispensary level would be a low burden strategy to improve ANC.
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Affiliation(s)
- N Young
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - M Taetgmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Aol
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - M Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - F Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - I Langley
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Patterson KD, Kyriacou T, Desai M, Carroll WD, Gilchrist FJ. Factors affecting the growth of infants diagnosed with cystic fibrosis by newborn screening. BMC Pediatr 2019; 19:356. [PMID: 31615474 PMCID: PMC6794849 DOI: 10.1186/s12887-019-1727-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/16/2019] [Indexed: 01/03/2023] Open
Abstract
Background Newborn screening (NBS) for cystic fibrosis (CF) improves nutritional outcomes. Despite early dietetic intervention some children fail to grow optimally. We report growth from birth to 2 years in a cohort of children diagnosed with CF by NBS and identify the variables that influence future growth. Methods One hundred forty-four children were diagnosed with CF by the West Midlands Regional NBS laboratory between November 2007 and October 2014. All anthropometric measurements and microbiology results from the first 2 years were collated as was demographic and CF screening data. Classification modelling was used to identify the key variables in determining future growth. Results Complete data were available on 129 children. 113 (88%) were pancreatic insufficient (PI) and 16 (12%) pancreatic sufficient (PS). Mean birth weight (z score) was 3.17 kg (− 0.32). There was no significant difference in birth weight (z score) between PI and PS babies: 3.15 kg (− 0.36) vs 3.28 kg (− 0.05); p = 0.33. By the first clinic visit the difference was significant: 3.42 kg (− 1.39) vs 4.60 kg (− 0.48); p < 0.0001. Weight and height remained lower in PI infants in the first year of life. In the first 2 years of life, 18 (14%) infants failed to regain their birth weight z score. The median time to achieve a weight z score of − 2, − 1 and 0 was 18, 33 and 65 weeks respectively. The median times to reach the same z scores for height were 30, 51 and 90 weeks. Birth weight z score, change in weight z score from birth to first clinic, faecal elastase, isolation of Pseudomonas aeruginosa, isolation of Staphylococcus aureus and sweat chloride were the variables identified by the classification models to predict weight and height in the first and second year of life. Conclusions Babies with CF have a lower birth weight than the healthy population. For those diagnosed with CF by NBS, the weight difference between PI and PS babies was not significantly different at birth but became so by the first clinic visit. The presence of certain factors, most already identifiable at the first clinic visit can be used to identify infant at increased risk of poor growth.
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Affiliation(s)
- K D Patterson
- Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - T Kyriacou
- School of Computing and Mathematics, Keele University, Keele, ST5 5BG, UK
| | - M Desai
- Department of Paediatric Respiratory Medicine, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - W D Carroll
- Paediatric Respiratory Services, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke on Trent, ST4 6QG, UK.,Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - F J Gilchrist
- Paediatric Respiratory Services, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke on Trent, ST4 6QG, UK. .,Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, ST4 7QB, UK.
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36
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Cancrini F, Simone G, Tuderti G, Brassetti A, Anceschi U, Daneshmand S, Miranda G, Desai M, Enei HA, Nacchia A, Lombardo R, Tubaro A, De Nunzio C. Validation of the cobra nomogram for the prediction of cancer specific survival in patients with bladder cancer treated with radical cystectomy. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)33614-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Surya N, Desai M. An interesting case of VZV encephalitis with intraparenchymal hemorrhage. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Stead K, Patchell C, Desai M, Kershaw M. P290 Is the 5-point OGTTa better screening tool for CFRD than the standard 2 point OGTT? Results from a paediatric population at Birmingham Children's Hospital. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30583-1] [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: 10/26/2022]
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39
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Simpson J, Millman B, Nagakumar P, Desai M, Butler L, Colley J, Fairbank J, Haw S. P351 Baby PEP or percussion. Is there a clear winner? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30643-5] [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: 10/26/2022]
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40
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Nash E, Osmond J, Nyaboko J, Whitehouse J, Rashid R, Nagakumar P, Arrowsmith C, Gilday N, Tabberner M, Desai M. P438 An interactive group educational event for people with cystic fibrosis, their family and carers - a novel approach. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Paskin L, Aujla H, Nagakumar P, Rao S, Desai M. P171 Audit of itraconazole therapy in the treatment of Aspergillus infection and Allergic Bronchopulmonary Aspergillosis (ABPA) in paediatric cystic fibrosis patients. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30465-5] [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: 11/16/2022]
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42
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Patterson K, Desai M, Tetlow L, Gilchrist F, Burrows E, Hird B, Edgar J, Coakley P, Goddard P, Preece M, Southern K. WS16-5 The challenge of screening newborns for cystic fibrosis from populations with a low incidence of F508del. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stead K, Patchell C, Paskin L, Nagakumar P, Desai M. P326 Are combined vitamin preparations useful in a paediatric cystic fibrosis population? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30618-6] [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: 11/16/2022]
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44
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McArdle C, Robinson F, Heyeer B, Nagakumar P, Desai M. P190 Is annual exercise testing useful in children with cystic fibrosis? J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Modin L, Lloyd C, van Mourik I, Desai M, Kelly D. P312 Long-term follow-up of liver disease in children and young people with cystic fibrosis in the UK. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Neubauer S, Weintraub W, Appelbaum E, Desai M, Desvigne-Nickens P, Dimarco J, Dolman S, Ho C, Jerosch-Herold M, Kolm P, Kwong R, Maron M, Schulz-Menger J, Watkins H, Kramer C. P3165Baseline characteristics of the hypertrophic cardiomyopathy registry (n=2773). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - W Weintraub
- Medstar Research Institute, Washington, United States of America
| | - E Appelbaum
- Harvard Medical School, Boston, United States of America
| | - M Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Desvigne-Nickens
- National Institutes of Health, NHLBI, Bethesda, United States of America
| | - J Dimarco
- University of Virginia, Charlottesville, United States of America
| | - S Dolman
- Medstar Research Institute, Washington, United States of America
| | - C Ho
- Harvard Medical School, Boston, United States of America
| | | | - P Kolm
- Medstar Research Institute, Washington, United States of America
| | - R Kwong
- Harvard Medical School, Boston, United States of America
| | - M Maron
- Harvard Medical School, Boston, United States of America
| | | | - H Watkins
- University of Oxford, Division of Cardiovascular Medicine, Oxford, United Kingdom
| | - C Kramer
- University of Virginia, Charlottesville, United States of America
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47
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Sato K, Sankaramangalam K, Krishnaswamy A, Mick S, Rodriguez L, Grimm R, Menon V, Kapadia S, Desai M, Svensson L, Griffin B, Popovic Z. 1139Prognostic impact of aortic valve replacement in contemporary low-gradient aortic stenosis patients with lack of contractile reserve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Sato
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - K Sankaramangalam
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - A Krishnaswamy
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - S Mick
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - L Rodriguez
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - R Grimm
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - V Menon
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - M Desai
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - L Svensson
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - B Griffin
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
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48
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Stead K, Desai M, Patchell C. P179 A retrospective audit of sodium chloride supplementation in infants with cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30474-0] [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: 11/16/2022]
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49
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Sathishkumar D, Gach JE, Ogboli M, Desai M, Cole T, Högler W, Motwani J, Norton A, Morland B, Colmenero I. Cartilage hair hypoplasia with cutaneous lymphomatoid granulomatosis. Clin Exp Dermatol 2018; 43:713-717. [PMID: 29744913 DOI: 10.1111/ced.13543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
Cartilage-hair hypoplasia (CHH) is an autosomal recessive chondrodysplasia characterized by short-stature, sparse hair and impaired cellular immunity. We describe a young girl who was diagnosed with CHH based on the findings of recurrent infections, short stature with metaphyseal chondrodysplasia, and a confirmed bi-allelic RMRP gene mutation. At 13 years, the patient developed an Epstein-Barr virus (EBV)-driven lymphoproliferative disorder involving the lung, which responded partially to chemotherapy. Simultaneously, she developed multiple indurated plaques involving her face, which had histological findings of granulomatous inflammation and EBV-associated low-grade lymphomatoid granulomatosis. The patient received a matched unrelated peripheral blood stem cell transplant at 15 years of age, and her immunological parameters and skin lesions improved. Lymphomatoid forms of granulomatosis and cutaneous EBV-associated malignancies have not been described previously in CHH. This case highlights the possibility of EBV-associated cutaneous malignancy in CHH.
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Affiliation(s)
- D Sathishkumar
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J E Gach
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M Ogboli
- Department of Dermatology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M Desai
- Department of Respiratory Medicine, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - W Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J Motwani
- Department of Haematology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - A Norton
- Department of Haematology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - B Morland
- Department of Oncology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - I Colmenero
- Department of Pathology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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AbdelRazek M, Khalaf M, Shah R, Jackson K, Desai M, Sundaram V, Kothary N. Abstract No. 509 Same-day discharge after chemoembolization: a predictive model to assist physicians in minimizing overnight admissions. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.554] [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: 11/17/2022] Open
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