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ALLIANCE A022104/NRG-GI010: The Janus Rectal Cancer Trial: a randomized phase II/III trial testing the efficacy of triplet versus doublet chemotherapy regarding clinical complete response and disease-free survival in patients with locally advanced rectal cancer. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.25.24306396. [PMID: 38712176 PMCID: PMC11071544 DOI: 10.1101/2024.04.25.24306396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Recent data have demonstrated that in locally advanced rectal cancer (LARC), a total neoadjuvant therapy (TNT) approach improves compliance with chemotherapy and increases rates of tumor response compared to neoadjuvant chemoradiation (CRT) alone. They further indicate that the optimal sequencing of TNT involves consolidation (rather than induction) chemotherapy to optimize complete response rates. Data, largely from retrospective studies, have also shown that patients with clinical complete response (cCR) after neoadjuvant therapy may be managed safely with the watch and wait approach (WW) instead of preemptive total mesorectal resection (TME). However, the optimal consolidation chemotherapy regimen to achieve cCR has not been established, and a randomized clinical trial has not robustly evaluated cCR as a primary endpoint. Collaborating with a multidisciplinary oncology team and patient groups, we designed this NCI-sponsored study of chemotherapy intensification to address these issues and to drive up cCR rates, to provide opportunity for organ preservation, improve quality of life for patients and improve survival outcomes. Methods In this NCI-sponsored multi-group randomized, seamless phase II/III trial (1:1), up to 760 patients with LARC, T4N0, any T with node positive disease (any T, N+) or T3N0 requiring abdominoperineal resection or coloanal anastomosis and distal margin within 12 cm of anal verge will be enrolled. Stratification factors include tumor stage (T4 vs T1-3), nodal stage (N+ vs N0) and distance from anal verge (0-4; 4-8; 8-12 cm). Patients will be randomized to receive neoadjuvant long course chemoradiation (LCRT) followed by consolidation doublet (mFOLFOX6 or CAPOX) or triplet chemotherapy (mFOLFIRINOX) for 3-4 months. LCRT in both arms involves 4500 cGy in 25 fractions over 5 weeks + 900 cGy boost in 5 fractions with a fluoropyrimidine (capecitabine preferred). Patients will undergo assessment 8-12 (+/- 4) weeks post-TNT completion. The primary endpoint for the phase II portion will compare cCR between treatment arms. A total number of 296 evaluable patients (148 per arm) will provide statistical power of 90.5% to detect an 17% increase in cCR rate, at a one-sided alpha=0.048. The primary endpoint for the phase III portion will compare disease-free survival (DFS) between treatment arms. A total of 285 DFS events will provide 85% power to detect an effect size of hazard ratio 0.70 at a one-sided alpha of 0.025, requiring enrollment of 760 patients (380 per arm). Secondary objectives include time-to event outcomes (overall survival, organ preservation time and time to distant metastasis) and adverse effects. Biospecimens including archival tumor tissue, plasma and buffy coat in EDTA tubes, and serial rectal MRIs will be collected for exploratory correlative research. This study, activated in late 2022, is open across the NCTN and has a current accrual of 312. Support: U10CA180821, U10CA180882, U24 CA196171; https://acknowledgments.alliancefound.org . Discussion Building off of data from modern day rectal cancer trials and patient input from national advocacy groups, we have designed the current trial studying chemotherapy intensification via a consolidation chemotherapy approach with the intent to enhance cCR and DFS rates, increase organ preservation rates, and improve quality of life for patients with rectal cancer. Trial Registration Clinicaltrials.gov ID: NCT05610163 ; Support includes U10CA180868 (NRG) and U10CA180888 (SWOG).
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Combined petrosal approach: a systematic review and meta-analysis of surgical complications. Neurosurg Rev 2023; 46:172. [PMID: 37439884 PMCID: PMC10344984 DOI: 10.1007/s10143-023-02072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023]
Abstract
Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or temporal lobe injury. We aimed to evaluate the morbidity of the standard combined petrosal approach (CPA), defined as a combination of the posterior (retrolabyrinthine) and the anterior petrosal approach. We performed a systematic review and meta-analysis of articles reporting on clinical series of patients operated on for petroclival meningiomas through CPA. Studies that used the terminology "combined petrosal approach" without matching the aforementioned definition were excluded as well as clinical series that included less than 5 patients. A total of 8 studies were included involving 160 patients. The pooled complication rates were 3% (95% CI, 0.5-5.6) for CSF leak, 8.6% (95% CI, 4.1-13.2%) for facial palsy, 8.2% (95% CI, 3.9-12.6%) for hearing impairment, 2.8% (95% CI, 0.9-6.5%) for venous complications, and finally 4.8% (95%, 1.2-8.4%) for temporal lobe injury. Contrary to the general belief, CPA is associated with an acceptable rate of complications, especially when compared to alternative approaches to the petroclival area. In view of the major advantages like shorter trajectory, multiple angles of surgical attack, and early tumor devascularization, CPA remains an important tool in the armamentarium of the skull base surgeon.
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The Impact of Living with INOCA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is limited literature available on the impact of myocardial ischemia but no obstructive coronary arteries (INOCA) on patients' lives.
Purpose
We sought to determine how INOCA impacts the physical, social, and mental health of persons with this diagnosis.
Methods
A survey was made available to all members of the patient support group from INOCA International over a 3-month time period. Fitness was estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior to the onset of INOCA symptoms, and after the diagnosis of INOCA. The formula to estimate fitness in metabolic equivalents (METs) = 0.43 × DASI + 9.6 / 3.5
Results
A total of 297 patients with INOCA responded to the survey; 91.2% were women. The most common diagnosis was coronary microvascular dysfunction (64.3%) and coronary artery spasm (50.5%) (Table 1). 34.4% reported living with symptoms for ≥3 years before their diagnosis of INOCA was made. 77.8% who had been told their symptoms were not cardiac. The symptoms the respondents experienced were numerous, but 92.9% reported symptoms of chest pain, pressure, or discomfort. Fitness levels prior to the onset of INOCA symptoms were significantly higher compared to after diagnosed with INOCA (8.6±1.8 METs vs 5.6±1.8 METs; P<0.0001). Most respondents reported an adverse impact on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%). Work life was also affected once living with INOCA: approximately three-quarters had reduced their work hours or stopping work completely, 47.5% retired early, and 38.4% applied for disability. While living with INOCA, for each 1-MET decrease in fitness, there was a loss of 3.0±0.6 days/months of physical health, 1.8±0.6 days/month of mental health, and 2.9±0.7 days/months of inability to perform recreational activities (p<0.0001) (Figure 1).
Conclusions
Living with INOCA has significant impact on physical, mental and social health. Significant physical fitness declines are seen in those living with INOCA and are lower in those experiencing any adverse impact of living with INOCA. Additionally, the impact of INOCA on the ability to work has important economic consequences to both the patient and society. Increased recognition of the impact of INOCA on these aspects of health need to be recognized and further work is needed to better diagnosis and treat the symptoms of INOCA to improve the quality of life, cardiovascular outcomes, and overall health of this frequently encountered cardiovascular disorder.
Funding Acknowledgement
Type of funding sources: None.
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Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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POS0656 FRAILTY AND RISK OF ADVERSE OUTCOMES IN BIOLOGIC OR TARGETED-SYNTHETIC DMARD TREATED PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRecently, it has been recognized that frailty and pre-frailty are common in patients with rheumatoid arthritis (RA) [1]. Whether frailty status portends an increased risk of adverse outcomes in patients with RA on biologic or targeted synthetic disease modifying anti-rheumatic drugs (b- or tsDMARDs) remains unknown.ObjectivesTo evaluate the association between frailty and adverse outcomes in patients with RA exposed to b- or tsDMARDs.MethodsUsing the IBM/Watson MarketScan Commercial Claims and Encounters Databases, we identified all patients with RA who filled new prescriptions (or received infusions) for TNFα antagonists (TNFi), non-TNFi biologics (rituximab, abatacept, tocilizumab) or Janus Kinase inhibitors (JAKi) between 2008-2019. We used a 1-year lookback period without the use of these drugs to identify new users. The date of the first prescription within these three drug categories was the index date. Patients’ frailty risk score was calculated using the Claims-Based Frailty Index (CFI) [2], which estimates a deficit-accumulation frailty index using International Classification of Diseases codes, Current Procedural Terminology codes, and Healthcare Common Procedure Coding System codes in administrative claims data in the 1-year baseline period. The index ranges from 0 (not at all frail) to 1 (severely frail). The primary outcome was time to serious infections (those requiring hospitalization); secondary outcomes: any infection (outpatient or inpatient encounters) and all-cause hospitalizations.Patients were followed until 1) outcome occurrence; 2) disenrollment; 3) >90 days elapsed (or >180 days for rituximab) without further fills of the first drug categories; 4) they filled/received infusions of b-/tsDMARDs from a different drug category; or 5) 2 years after index. Cox proportional hazards adjusting for demographics, calendar year, serious and/or opportunistic infections in the 12-months prior to index were used to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for each outcome. In separate model, we additionally adjusted for comorbidity burden, and health care utilization (HCU).ResultsA total of 62,246 patients with RA met our inclusion criteria of whom 50,910 (82%) started TNFi as their first biologic, 9525 (15%) non-TNFi biologics, and 1811 (3%) JAKi. Among these, 3928 (6%) were considered frail. In multivariable analyses, frail patients had higher risk of serious infections compared to non-frail patients (aHR 2.37, 95% CI 2.05-2.74) which decreased to aHR 1.34, 95% CI 1.13-1.58 (Table 1) after adjusting for comorbidity burden and the HCU. Similarly, frailty was associated with increased risk of any infection (aHR 1.18, 95% CI 1.11-1.25), and all-cause hospitalizations (aHR 1.34, 95% CI 1.21-1.49) relative to non-frail individuals.Table 1.Multivariable models evaluating the association between frailty status and inpatient infections as the outcomeVariable#Hazard Ratio (95% Confidence Interval)@Hazard Ratio (95% Confidence Interval)Frail2.37 (2.05, 2.74)1.34 (1.13, 1.58)#Model adjusts for age, sex, major infection requiring inpatient admission in 12 months prior, concomitant baseline drugs such as csDMARDs, glucocorticoids, NSAIDs and opioids@Model additionally adjusts for Chalrson comorbidy score and healthcare utilizationConclusionFrailty is an important predictor for the risk of adverse outcomes among patients with RA treated with b- or tsDMARDs. Our findings underscore the need for considering this parameter in patient evaluations (even among younger patients) in the clinic.References[1]Salaffi F et al: Prevalence of frailty and its associated factors in patients with rheumatoid arthritis: a cross-sectional analysis. Clin Rheumatol 2019[2]Kim DH et al. Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2019AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsNone declared
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POS1564-PARE EDUCATION TOPICS AND SMARTPHONE APP FUNCTIONS PRIORITIZED BY PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGenerating information that people living with a rheumatic and musculoskeletal disease (RMD) find useful while making decisions about their treatment requires identifying and understanding educational needs and interests directly expressed from people living with RMD.ObjectivesTo identify what types of information US adults with RMD perceive as important to know about their disease and how they express and prioritize such information.MethodsUsing nominal group technique, focus groups of participants (pts) with RMD generated sets of rank-order educational items which were then aggregated across groups into themes. Based on nominal group results, a survey with the final 28 items was administered online, along with a question about desired functions of a smartphone app for RMD, to members of the ArthritisPower registry in January 2022.ResultsSix nominal groups (n=47) yielded 28 unique items for the online survey of educational priorities. To date, a total of 570 pts completed the survey, of whom 85.4% were female, 89.5% white, mean age of 59.6 (SD 11.2) years. Rheumatoid arthritis (52.5%), osteoarthritis (16.0%), psoriatic arthritis (12.5%), and axial spondyloarthritis (7.5%) were the most common RMDs. Knowing how to tell when a medication is not working, how RMD affects other medical conditions, understanding the results of tests used to monitor their RMD, available treatment options and possible side effects, and how life will change as an RMD progresses were each items that > 75% of pts considered extremely important (Table 1). Top functions pts listed as useful for a smartphone app included being able to participate in research, view lab results, record symptoms or flares, share how they are doing with their provider, and get educational information about their disease (Table 2).Table 1.Top Education Topics Adults with Rheumatic and Musculoskeletal Disease Consider Extremely Important (N=570).Itemn (%)Knowing when the medication is not working505 (88.6)Knowing how a rheumatologic condition can affect your other health conditions or medical issues481 (84.4)Understanding the results of tests used to monitor your condition471 (82.6)Knowing the side effects of available drugs, and how the drugs interact with each other461 (80.9)Finding the right rheumatologist453 (79.5)Having realistic expectations of the effectiveness of the medications445 (78.1)Knowing how the disease will progress, even if the news is bad439 (77.0)Knowing the available medications and treatments for your rheumatologic condition437 (76.7)Knowing how long it takes drugs to work436 (76.5)Understanding how your life will change as your disease progresses434 (76.1)Table 2.Desired Smartphone App Functions Rated By Adults with Rheumatic and Musculoskeletal Disease (N=570).App Functionn (%)Participate in patient-centered research299 (52.5)View my lab results283 (49.7)Record my symptoms (e.g. pain, fatigue) or disease flares to track my health over time278 (48.8)Record my symptoms and share how I am doing with my rheumatology provider to know if I am meeting my treatment goals230 (40.4)Get educational information about my disease225 (39.5)Keep track of the medications prescribed by doctor200 (35.1)Schedule and keep track of my medical appointments, rheumatology and other199 (34.9)Track the vaccines I get (i.e. vaccination record)188 (33.0)Help me improve some of my health habits (e.g. sleep, diet, exercise)187 (32.8)Keep track of my use of over-the-counter, complementary or alternative therapies (herbs, tinctures, acupuncture, massage, stretching, etc.)174 (30.5)Get support for my disease from trained patients with my same health condition (i.e. ‘peer coaching’)144 (25.3)ConclusionPeople with RMD prioritized information about medications and prognosis in educational materials, providing guidance for the development of educational tools. A sizeable minority felt educational materials were an important component of a smartphone app, but also identified other important features such as participation in research.Disclosure of InterestsW. Benjamin Nowell Grant/research support from: Research support from AbbVie, Amgen, Eli Lilly and Scipher, Kelly Gavigan: None declared, Kimberly Garza: None declared, Alexis Ogdie: None declared, Michael George: None declared, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer, Maria Danila: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jeffrey Curtis Consultant of: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Gilead, Janssen, Myriad, Novartis, Pfizer, Regeneron, Roche, and UCB, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB
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Impaired fasting glucose levels among perinatally HIV-infected adolescents and youths in Dar es Salaam, Tanzania. Front Endocrinol (Lausanne) 2022; 13:1045628. [PMID: 36561566 PMCID: PMC9763284 DOI: 10.3389/fendo.2022.1045628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study assessed impaired fasting glucose and associated factors among perinatally HIV-infected adolescents and youths in Dar es salaam Tanzania. BACKGROUND Impaired fasting glucose is a marker of heightened risk for developing type 2 diabetes among perinatally HIV-infected individuals. Therefore, identifying individuals at this stage is crucial to enable early intervention. Therefore, we assessed impaired fasting glucose (IFG) and associated factors among perinatally HIV-infected population in Dar es salaam Tanzania. METHODS A cross-sectional study was conducted among 152 adolescents and youth attending HIV clinic at Muhimbili National Hospital and Infectious Disease Centre from July to August 2020. Fasting blood glucose (>8 hours) was measured using one-touch selects LifeScan, CA, USA. We also examined C-Reactive Protein and interleukin-6 inflammatory biomarkers in relation to impaired fasting glucose (IFG). Associations between categorical variables were explored using Chi-square, and poison regression with robust variance was used to calculate the prevalence ratios. RESULTS Of the 152 participants, the majority were male (n=83[54.6%]), and the median age was 15(14-18) years. Overweight or obesity was prevalent in 16.4%, while more than one in ten (13.2%) had high blood pressure (≥149/90mmHg). All participants were on antiretroviral therapy (ART); 46% had used medication for over ten years, and about one in three had poor medication adherence. Among the recruited participants, 29% had impaired fasting glucose. The odds of IFG were two times higher in males compared to females (PR, 2.07, 95% CI 1.19 -3.59 p=0.001). Moreover, we found with every increase of Interleukin 6 biomarker there was a 1.01 probability increase of impaired fasting glucose (PR, 1.01, 95% CI 1.00 - 1.02 p=0.003). CONCLUSION About one in three perinatally HIV-infected youths had impaired fasting glucose in Dar es Salaam, Tanzania, with males bearing the biggest brunt. Moreover, with every increase of 1.101 of the probability of having IFG increased. This calls for urgent measures to interrupt the progression to diabetes disease and prevent the dual burden of disease for this uniquely challenged population.
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224: Moving up: Health care transition experiences of adolescents and young adults with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ulcerating nodules on the face due to Mycobacterium chimaera in a patient with diabetes. Clin Exp Dermatol 2021; 47:587-589. [PMID: 34674389 DOI: 10.1111/ced.14993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/19/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
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P11.03 Sleep analysis of accelerometer data from High Grade Glioma patients in the BrainWear study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Sleep disturbance is a common symptom in patients with high grade glioma (HGG). Existing self-reported and uni-dimensional data from questionnaires are of limited value. The observational phase 2 trial, BrainWear (ISRCTN 34351424) provides the first objective analysis of sleep in HGG patients.
MATERIAL AND METHODS
Patients with HGG were asked to wear an AX3 Axivity tri-axial accelerometer throughout treatment. The study employed a wear-as-long-as-possible approach to accelerometry data collection, and we used age-sex matched controls from the UK Biobank as comparators. Baseline was established as a 7 day period of wear prior to surgery or at least 7 days post-surgery. The dataset for this analysis consists of 21 patients with data at baseline and 15 patients during chemo-radiation. Only 16 of the 21 HGG patients at baseline were included for initial comparisons with healthy controls due to age limitations of the UK Biobank cohort for matching. Raw accelerometer data was processed using the GGIR package, with non-imputation of missing data, exclusion of days with <16 hours of wear time and removal of algorithm-identified problematic data. Mann-Whitney U-tests and unpaired T-tests were used to compare 7 sleep-related features between HGG patients and healthy controls at baseline, with choice of statistical test based on shapiro-wilk derived normality. Secondly, to assess changes in sleep in HGG patients across treatment period, K-means clustering of 5 sleep parameters, available longitudinally, was conducted to explore sleep behaviours at baseline (n = 21) and during chemo-radiation.
RESULTS
HGG patients (n = 16) exhibited greater daytime inactivity than healthy controls (n = 32) (p < 0.0001, 2.2 vs 0.5 hrs) and more variation in their 24 hour activity rhythm from day to day (p < 0.0001, 0.12 vs 0.18). We identified 5 sleep features which allowed us to cluster patients’ sleep behaviour, and most (62.5%) of HGG patients have a poor sleep profile. This sleep profile was characterised by an average of 5.4 hours of night-time sleep, 2.1 hours of daytime inactivity and disturbed sleep quality. However, evaluation of HGG patient sleep cluster designation at baseline and during chemoradiation, showed HGG patients with data at both timepoints (n = 9) demonstrate stability or improvement in sleep profile.
CONCLUSION
Patients with HGG have objective evidence of poor sleep compared to healthy matched controls. Further work will explore changes in sleep over time.
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Selected Poster Abstracts from MauiDerm 2021 for Dermatologists. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:S8-S30. [PMID: 34055192 PMCID: PMC8152815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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355P Impact of comorbidities and rurality on treatment commencement, completion and outcomes, and health related quality of life, for geriatric oncology patients: Preliminary findings from a regional Australian study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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P223 EVALUATING PERFORMANCE OF THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ™) AT 3-MONTH INTERVALS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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P213 UNMET MEDICAL NEED ACROSS THE ASTHMA DISEASE SPECTRUM: A US FOCUS GROUP STUDY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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FRI0572 LEPTIN-ADJUSTMENT OF THE MULTI-BIOMARKER DISEASE ACTIVITY (MBDA) SCORE REDUCES THE INFLUENCE OF ADIPOSITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Obesity and excess adiposity influence inflammatory markers and bias disease activity assessment, especially among women. A multi-biomarker disease activity (aMBDA) score has been developed to account for the effects of age, sex and adiposity (leptin) and improves prediction of radiographic damage progression.1Objectives:1) Determine if the adjusted measure demonstrates a reduced association with adiposity.2) Assess the impact of the leptin-adjustment on the score over the range of adiposity.3) Assess relationships between MBDA scores and clinical disease activity.Methods:Patients with rheumatoid arthritis (RA), ages 18-75 years, completed whole-body dual-energy x-ray absorptiometry to quantify fat mass indices (FMI, kg/m2). Age-, sex-, and race-specific Z-Scores were calculated based on the distributions in a healthy reference population. Disease activity was assessed with the CDAI and swollen joint count (SJC). Baseline van der Heijde-Sharpe (vdHS) scores were determined by a radiologist. MBDA assays were performed on stored serum samples. Descriptive statistics described relationships between the FMI Z-Score and the MBDA and the aMBDA. Clinical disease activity, SJC, and radiographic damage were also compared across MBDA score categories.Results:Of 104 participants (50% female), the mean (SD) age was 56.1 (12.5) and mean BMI was 28.8 (6.9) (Table 1). The unadjusted MBDA score was strongly associated with BMI among women (Women: Rho=0.46 [p< 0.001]; Men: Rho=-0.12), while the aMBDA was not associated with BMI in women and was inversely correlated in men (Women: Rho=0.17; Men: Rho=-0.32 [p=0.02]). The unadjusted MBDA score was also strongly associated with FMI Z-Score among women (Figure; Women: Rho=0.42 [p=0.002]; Men: Rho=-0.10; p=0.01). The aMBDA was not significantly associated with FMI Z-Score (Female: Rho= 0.17; Male: Rho=-0.26). Leptin-adjustment reduced the MBDA score in the highest quartile of FMI in women but not men, and increased the MBDA score in the lowest FMI quartiles in both women and men; these patients in the lowest FMI quartile had the highest median SJC (p=0.05 for men, p=0.78 for women; Figure). The aMBDA reclassified 4 women (8%) and 9 men (17%) into higher disease activity categories and 2 women (4%) and 2 men (4%) into lower categories. CDAI, SJC, and radiographic scores were similar across activity categories for the unadjusted MBDA score and aMBDA (Table 2).Table 1.Baseline Characteristics.MenWomenN5252Age (yrs)59.1 (11.5)53.0 (12.8)Black, N (%)13 (25%)19 (36%)BMI27.3 (5.4)30.3 (8.0)FMI Z-Score-0.28 (1.3)0.05 (1.1)DAS28(CRP)3.09 (1.13)3.21 (1.24)Disease Duration11.4 (10.9)11.6 (11.9)CRP, mg/dL0.8 (0.5, 1.2)0.8 (0.5, 1.4)CCP Positive, N (%)45 (87%)40 (78%)vdHS (N=93)13 (4, 73)10.5 (2, 47)HAQ0.71 (0.59)0.83, (0.67)MBDA40.0 (13.8)42.1 (16.6)aMBDA43.6 (13.4)42.1 (15.3)Leptin, ng/mL15.1 (21.5)48.9 (41.5)Table 2.Clinical assessments across MBDA score categories.CDAISJCvdHSMBDAaMBDAMBDAaMBDAMBDAaMBDAMBDA CategoryLow14.6 (10.9)13.9 (9.9)2 (1, 5)2 (1, 5)9 (1, 33.5)9 (3, 32)Moderate13.2 (10.0)14.4 (11.4)2 (0, 5)3 (0, 6)10 (4, 49)10 (2, 53)High18.4 (12.3)17.7 (11.8)4 (1, 8)5 (2, 7)20.5 (5, 70.5)18 (4, 73)Conclusion:Leptin-adjustment of the MBDA score reduced bias related to excess adiposity in women with RA. Adjustment results in lower MBDA scores in women with greater adiposity, and higher MBDA scores in women and men with lesser adiposity. The aMBDA may reduce misclassification due to excess adiposity and improve identification of active disease among patients with lower adiposity. High aMBDA scores among men with low adiposity may reflect severe disease or excess comorbidity in this group.References:[1] Curtis et al.Rheumatology (Oxford) 2018. PMID: 30590790Figure.Impact of Adjustment on MBDA Score by FMI Z-Score Quartile.Disclosure of Interests:Joshua Baker Grant/research support from: Myriad RBM, Consultant of: Bristol-Myers Squib, Burns-White LLC, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, David Chernoff Employee of: Myriad, Michael George Grant/research support from: Bristol Myers Squibb, Consultant of: AbbVie
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OP0150 WHAT IS THE ROLE OF TEMPORAL ARTERY BIOPSY IN GIANT CELL ARTERITIS FAST-TRACK PATHWAYS WHEN TEMPORAL ARTERY ULTRASOUND IS NEGATIVE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:A number of centres are now running fast track pathways for diagnosis and management of Giant cell arteritis with ultrasound as the first port of call for diagnosis1. Temporal artery biopsies (TABs) have become the second line of investigation, and it is unclear how useful TAB is in this setting.Objectives:This study looked at accuracy of Temporal artery biopsy (TAB) in patients with suspected Giant Cell arteritis (GCA) with negative/inconclusive ultrasound (U/S) and how duration of treatment on steroids prior to these investigations and arterial specimen size affected it.Methods:Prospective study of all patients with suspected GCA referred for TAB when U/S was negative or inconclusive, as part of the local fast-track pathway (Coventry). Database included clinical findings, serological work up, U/S and TAB results and treatment. Sensitivity and specificity of U/S and TAB was calculated and compared based on duration of treatment with steroids.Results:One hundred and nine patients were referred for TAB via Coventry fast-track-pathway. The sensitivity of U/S in this cohort of patients was 9.08% and specificity was 93.33%. After 3 days of steroid this was 0% and 100% respectively. For TAB when done within 10 days of starting steroids, this was 65% and 87.5% respectively. After 20 days of steroids this was 0 % and 100%. The sensitivity and specificity was 20% and 85% when arterial specimen size was 11-15mm and 47% and 100% when specimen size was 16 mm or more. Sensitivity and specificity of U/S of 644 suspected GCA patients was 48% and 98%.Conclusion:Our study demonstrates that TAB plays a relevant role in GCA fast-track-pathways, when U/S is negative/inconclusive. TAB was more sensitive than U/S in this cohort of patients, but overall sensitivity of U/S was higher when calculated for all patients suspected with GCA. Both remain useful tests if performed early. TAB specimen size should ideally be 16mm or more and done within 10 days of starting steroids.References:[1]Jonathan Pinnell, Carl Tiivas, Kaushik Chaudhuri, Purnima Mehta, Shirish Dubey, O38 The diagnostic performance of ultrasound Doppler in a fast-track pathway for giant cell arteritis,Rheumatology, Volume 58, Issue Supplement_3, April 2019, kez105.036,https://doi.org/10.1093/rheumatology/kez105.036Disclosure of Interests:None declared
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Stress transmission in cemented bidisperse granular materials. Phys Rev E 2020; 101:052901. [PMID: 32575325 DOI: 10.1103/physreve.101.052901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/08/2020] [Indexed: 11/07/2022]
Abstract
We analyze stress distributions in a two-dimensional bidisperse cemented granular packing for a broad range of the values of particle-size ratio, the volumes of large and small particles, and the amount of cementing matrix. In such textured porous materials, the stress concentration, which controls the fracture and fragmentation of the material under tensile loading or in grinding processes, reflects not only the porosity but also the contact network of the particle phase and the resulting stress chains. By means of peridynamic simulations under tensile loading, we show how both the texture and stress distribution depend on size ratio, volume ratio, and the amount of the cementing matrix. In particular, the volume fraction of the class of small particles plays a key role in homogenizing stresses across the system by reducing porosity. Interestingly, the texture controls not only the porosity but also the distribution of pores inside the system with its statistical variability, found to be strongly correlated with the homogeneity of stresses inside the large particles. The most homogeneous stress distribution occurs for the largest size ratio and largest volume fraction of small particles, corresponding to the lowest pore size dispersion and the cushioning effect of small particles and its similar role to the binding matrix for stress redistribution across the packing. At higher porosity, the tensile stresses above the mean stress fall off exponentially in all phases with an exponent that strongly depends on the texture. The exponential part broadens with decreasing matrix volume fraction and particle-size ratio. These correlations reveal the strong interplay between size polydispersity and the cohesive action of the binding matrix for stress distribution, which is significant for the behavior of textured materials in grinding operations.
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A retrospective analysis of 66 colorectal cancer cases from Guy’s and St Thomas’ (GSTT) Molecular Tumour Board. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Outcomes of emergency laparotomy in patients on extracorporeal membrane oxygenation for severe respiratory failure: A retrospective, observational cohort study. J Crit Care 2019; 53:253-257. [PMID: 31301640 DOI: 10.1016/j.jcrc.2019.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/21/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS A single centre, retrospective, observational cohort study of 355 patients admitted to a university teaching hospital Severe Respiratory Failure service between December 2011 and January 2017. RESULTS The prevalence of emergency laparotomy in patients on ECMO was 3.7%. These patients had significantly higher SOFA and APACHE II scores compared to similar patients not requiring laparotomy. There was no difference in the duration of ECMO or intensive care unit (ICU) stay post decannulation between the two groups. 31% of laparotomy patients survived to hospital discharge. Major haemorrhage was uncommon, however emergency change of ECMO oxygenator was commonly required. CONCLUSION Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision.
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Protonation of Curcumin Triggers Sequential Double Cyclization in the Gas-Phase: An Electrospray Mass Spectrometry and DFT Study. INTERNATIONAL JOURNAL OF MASS SPECTROMETRY 2019; 438:107-114. [PMID: 31080356 PMCID: PMC6508607 DOI: 10.1016/j.ijms.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ESI-protonated natural curcumin (1) undergoes gas-phase cyclization and dissociates via competitive expulsions of 2-methoxy phenol and C4H4O2 (diketene or an isomer). Evidence from mechanistic mass spectrometry and from Density Functional Theory (DFT) reveals that a two-step sequential cyclization occurs for the protonated molecule prior to the unusual loss of the elements of 2-methoxy phenol. Furthermore, the presence of the methoxy group at postion-3 is essential for the second cyclization. The transformation of curcumin upon protonation in the gas phase may be predictive of its solution chemistry and explain how curcumin plays a protective role in biology.
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A case series exploring the effect of twenty sessions of repetitive transcranial magnetic stimulation (rTMS) on cannabis use and craving. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Emotional arousal and neurocircuit integrity: A concurrent TMS-fMRI investigation of state dependence. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Methods for paired-pulse cerebellar-M1 TMS with neuronavigation. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Preliminary work toward creating a desktop-portable device for quickly measuring brain level of consciousness. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Efficacy, safety and tolerability of repetitive transcranial magnetic stimulation for smoking cessation in lung cancer: a preliminary report. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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A two-site, open-label, non-randomized update, suggests focal electrically administered seizure therapy (FEAST) may have a reduced time to re-orientation compared to right unilateral ultra-brief pulse electroconvulsive therapy (UBP-RUL ECT). Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Attenuating pain with theta burst stimulation (TBS): a sham-controlled neuroimaging study evaluating the relative efficacy of medial versus dorsolateral stimulation. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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NMDA receptor-dependent synaptic plasticity of rTMS. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Imaging brain plasticity in stroke patients with simultaneous paired associative stimulation PAS /fMRI. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Combined TMS-EEG-fMRI. The level of TMS-evoked activation in anterior cingulate cortex depends on timing of TMS delivery relative to frontal alpha phase. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Two-week repetitive transcranial magnetic stimulation of the dorsal lateral prefrontal cortex does not affect cortical excitability in chronic smokers. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A novel pilot study of tavns paired with oral feeding in neonates with brain injury. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Individualizing tES dose and montage from non-invasive EEG monitoring. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Open path incoherent broadband cavity-enhanced measurements of NO 3 radical and aerosol extinction in the North China Plain. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 208:24-31. [PMID: 30286400 DOI: 10.1016/j.saa.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/31/2018] [Accepted: 09/11/2018] [Indexed: 06/08/2023]
Abstract
We describe the observation of the NO3 radical using an incoherent broadband cavity-enhanced absorption spectrometer in an open-path configuration (OP-IBBCEAS) in a polluted summer environment in continental China. The instrument was installed 17 m above the ground at the top of a residential complex near the CAREBeijing-NCP 2014 site in Wangdu, Hebei province, about 200 km southwest of Beijing over the period 28 to 30 June 2014. The separation between the transmitter and receiver components of the instrument was 335 cm and the effective pathlength in clean reference air was ~3.4 km. NO3 was detected above the detection limit on all three nights when the instrument was operational. The maximum mixing ratio measured was ~175 pptv with a detection sensitivity of ~36 pptv for measurements with an average acquisition time of 10 min. While most extractive instruments try to avoid interferences arising from aerosol extinction, the open path configuration has advantages owing to its ability to detect trace gases even in the presence of aerosol loading. Moreover, concurrent retrieval of aerosol optical extinction is possible from analysis of the absorption magnitude of the oxygen B-band at 687 nm. The experimental setup, its calibration, data acquisition, and analysis procedure are discussed, and the results presented here demonstrate the sensitivity and specificity that can be achieved at high spatial and temporal resolution using the novel configuration of IBBCEAS in the open path.
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A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Latitude, urbanization, age, and sex as risk factors for vitamin D deficiency disease in the Roman Empire. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 167:484-496. [DOI: 10.1002/ajpa.23646] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022]
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On the effect of local sample slope during modulus measurements by contact-resonance atomic force microscopy. Ultramicroscopy 2018; 194:78-88. [PMID: 30092392 DOI: 10.1016/j.ultramic.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/03/2018] [Accepted: 07/22/2018] [Indexed: 11/28/2022]
Abstract
Contact-resonance atomic force microscopy (CR-AFM) is of great interest and very valuable for a deeper understanding of the mechanics of biological materials with moduli of at least a few GPa. However, sample surfaces can present a high topography range with significant slopes, where the local angle can be as large as ± 50°. The non-trivial correlation between surface slope and CR-frequency hinders a straight-forward interpretation of CR-AFM indentation modulus measurements on such samples. We aim to demonstrate the significant influence of the surface slope on the CR-frequency that is caused by the local angle between sample surface and the AFM cantilever and present a practical method to correct the measurements. Based on existing analytical models of the effect of the AFM set-up's intrinsic cantilever tilt on CR-frequencies, we compute the non-linear variation of the first two (eigen)modes CR-frequency for a large range of surface angles. The computations are confirmed by CR-AFM experiments performed on a curved surface. Finally, the model is applied to directly correct contact modulus measurements on a durum wheat starch granule as an exemplary sample.
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Evidence of niche partitioning among bacteria living on plastics, organic particles and surrounding seawaters. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 236:807-816. [PMID: 29459335 DOI: 10.1016/j.envpol.2017.12.027] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 05/20/2023]
Abstract
Plastic pollution is widespread in ocean ecosystems worldwide, but it is unknown if plastic offers a unique habitat for bacteria compared to communities in the water column and attached to naturally-occurring organic particles. The large set of samples taken during the Tara-Mediterranean expedition revealed for the first time a clear niche partitioning between free-living (FL), organic particle-attached (PA) and the recently introduced plastic marine debris (PMD). Bacterial counts in PMD presented higher cell enrichment factors than generally observed for PA fraction, when compared to FL bacteria in the surrounding waters. Taxonomic diversity was also higher in the PMD communities, where higher evenness indicated a favorable environment for a very large number of species. Cyanobacteria were particularly overrepresented in PMD, together with essential functions for biofilm formation and maturation. The community distinction between the three habitats was consistent across the large-scale sampling in the Western Mediterranean basin. 'Plastic specific bacteria' recovered only on the PMD represented half of the OTUs, thus forming a distinct habitat that should be further considered for understanding microbial biodiversity in changing marine ecosystems.
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Abstract
This paper reports on an observation made in the course of the authors’ investigations into the connection between life events and mania. Briefcase summaries are given where repeated relapses in the same patient appeared to focus around a theme or meaning which is specific for each patient, yet quite different across patients. The therapeutic implications of such individualized vulnerabilities are discussed.
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Recent studies in concentrated photovoltaic system (CPV): a review. 5TH IET INTERNATIONAL CONFERENCE ON CLEAN ENERGY AND TECHNOLOGY (CEAT2018) 2018. [DOI: 10.1049/cp.2018.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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P4940Infarct size in a rat model of STEMI is reduced by interleukin-6 trans-signalling blockade using sgp130fc but not an anti-IL6R monoclonal antibody. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Topological cell clustering in the ATLAS calorimeters and its performance in LHC Run 1. THE EUROPEAN PHYSICAL JOURNAL. C, PARTICLES AND FIELDS 2017; 77:490. [PMID: 28943797 PMCID: PMC5586976 DOI: 10.1140/epjc/s10052-017-5004-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/21/2017] [Indexed: 05/07/2023]
Abstract
The reconstruction of the signal from hadrons and jets emerging from the proton-proton collisions at the Large Hadron Collider (LHC) and entering the ATLAS calorimeters is based on a three-dimensional topological clustering of individual calorimeter cell signals. The cluster formation follows cell signal-significance patterns generated by electromagnetic and hadronic showers. In this, the clustering algorithm implicitly performs a topological noise suppression by removing cells with insignificant signals which are not in close proximity to cells with significant signals. The resulting topological cell clusters have shape and location information, which is exploited to apply a local energy calibration and corrections depending on the nature of the cluster. Topological cell clustering is established as a well-performing calorimeter signal definition for jet and missing transverse momentum reconstruction in ATLAS.
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Identifying Daily Stress, Family Conflict and Health Care Resource Gaps
at the Sri Lankan Tamil Refugee Camps in India: Implications for Developing
an Evidence-based Family Intervention for Refugees. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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P211 Development, safety, and parameter optimization of a novel form of noninvasive vagus nerve stimulation: Transcutaneous auricular vagus nerve stimulation (taVNS). Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Résection chirurgicale subtotale planifiée et radiochirurgie pour les schwannomes vestibulaires de grand volume. Résultats fonctionnels pour le nerf facial et de l’audition. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Bridging to deep brain stimulation implantation using electroconvulsive therapy in Parkinson’s disease. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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47
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The reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) among dermatologists, rheumatologists and neurologists. Br J Dermatol 2016; 176:423-430. [PMID: 28004387 DOI: 10.1111/bjd.15140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have shown that skin disease in dermatomyositis (DM) is best assessed using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). Although the CDASI has been validated for use by dermatologists, it has not been validated for use by other physicians such as rheumatologists and neurologists, who also manage patients with DM and assess skin activity in clinical trials. OBJECTIVES To assess the reliability of the CDASI among dermatologists, rheumatologists and neurologists. METHODS Fifteen patients with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists and five neurologists. RESULTS The mean CDASI activity scores for dermatologists, rheumatologists and neurologists were 21·0, 21·8 and 20·8, respectively. These mean scores were not different among the specialists. The CDASI damage score means for dermatologists, rheumatologists and neurologists were 5·3, 7·0 and 4·8, respectively. The mean scores between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for interrater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intrarater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower interrater and intrarater reliability relative to the CDASI. CONCLUSIONS Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data for its use by neurologists were not as robust.
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Nonhealing surgical wound due to cutaneous malakoplakia. Clin Exp Dermatol 2016; 42:123-125. [PMID: 27935636 DOI: 10.1111/ced.12972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/30/2022]
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Short period incidence sTudy of severe acute respiratory infection (SPRINT-SARI) initial data from a global observational study to better describe SARI epidemiology in critically ill patients. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Performance of pile-up mitigation techniques for jets in [Formula: see text] collisions at [Formula: see text] TeV using the ATLAS detector. THE EUROPEAN PHYSICAL JOURNAL. C, PARTICLES AND FIELDS 2016; 76:581. [PMID: 28316490 PMCID: PMC5335592 DOI: 10.1140/epjc/s10052-016-4395-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 09/26/2016] [Indexed: 05/07/2023]
Abstract
The large rate of multiple simultaneous proton-proton interactions, or pile-up, generated by the Large Hadron Collider in Run 1 required the development of many new techniques to mitigate the adverse effects of these conditions. This paper describes the methods employed in the ATLAS experiment to correct for the impact of pile-up on jet energy and jet shapes, and for the presence of spurious additional jets, with a primary focus on the large 20.3 [Formula: see text] data sample collected at a centre-of-mass energy of [Formula: see text]. The energy correction techniques that incorporate sophisticated estimates of the average pile-up energy density and tracking information are presented. Jet-to-vertex association techniques are discussed and projections of performance for the future are considered. Lastly, the extension of these techniques to mitigate the effect of pile-up on jet shapes using subtraction and grooming procedures is presented.
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