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Ray S, Behera KK, Tripathy TP. Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus. J Postgrad Med 2024; 70:113-115. [PMID: 38099610 DOI: 10.4103/jpgm.jpgm_377_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 04/30/2024] Open
Abstract
ABSTRACT We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.
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Affiliation(s)
- S Ray
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - K K Behera
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - T P Tripathy
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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2
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Gemmell AJ, Brown CM, Ray S, Small A. Quantitative uptake in 99m Tc-EDDA/HYNIC-TOC somatostatin receptor imaging - the effect of long-acting release somatostatin analogue therapy. Nucl Med Commun 2023; 44:944-952. [PMID: 37578312 DOI: 10.1097/mnm.0000000000001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE Withdrawal of long-acting release somatostatin analogue (LAR-SSA) treatment before somatostatin receptor imaging is based on empirical reasoning that it may block uptake at receptor sites. This study aims to quantify differences in uptake of 99m Tc-EDDA/HYNIC-TOC between patients receiving LAR-SSA and those who were not. METHODS Quantification of 177 patients (55 on LAR-SSA) imaged with 99m Tc-EDDA/HYNIC-TOC was performed, with analysis of pathological tissue and organs with physiological uptake using thresholded volumes of interest. Standardised uptake values (SUVs) and tumour/background (T/B) ratios were calculated and compared between the two patient groups. RESULTS SUVs were significantly lower for physiological organ uptake for patients on LAR-SSA (e.g. spleen: SUV max 13.3 ± 5.9 versus 33.9 ± 9.0, P < 0.001); there was no significant difference for sites of pathological uptake (e.g. nodal metastases: SUV max 19.2 ± 13.0 versus 17.4 ± 11.5, P = 0.552) apart from bone metastases (SUV max 14.1 ± 13.5 versus 7.7 ± 8.0, P = 0.017) where it was significantly higher. CONCLUSION LAR-SSA has an effect only on physiological organ uptake of 99m Tc-EDDA/HYNIC-TOC, reducing uptake. It has no significant effect on pathological uptake for most sites of primary and metastatic disease. This should be taken into account if making quantitative measurements, calculating T/B ratios or assigning Krenning Scores. There is the potential for improved dosimetric results in Peptide Receptor Radionuclide Therapy by maintaining patients on LAR-SSA.
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Affiliation(s)
- Alastair J Gemmell
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Colin M Brown
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
| | - Surajit Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Alexander Small
- Department of Nuclear Medicine, Gartnavel General Hospital, NHS Greater Glasgow & Clyde
- Department of Clinical Physics & Bioengineering, NHS Greater Glasgow & Clyde
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3
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Cantoni D, Wilkie C, Bentley EM, Mayora-Neto M, Wright E, Scott S, Ray S, Castillo-Olivares J, Heeney JL, Mattiuzzo G, Temperton NJ. Correlation between pseudotyped virus and authentic virus neutralisation assays, a systematic review and meta-analysis of the literature. Front Immunol 2023; 14:1184362. [PMID: 37790941 PMCID: PMC10544934 DOI: 10.3389/fimmu.2023.1184362] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
Background The virus neutralization assay is a principal method to assess the efficacy of antibodies in blocking viral entry. Due to biosafety handling requirements of viruses classified as hazard group 3 or 4, pseudotyped viruses can be used as a safer alternative. However, it is often queried how well the results derived from pseudotyped viruses correlate with authentic virus. This systematic review and meta-analysis was designed to comprehensively evaluate the correlation between the two assays. Methods Using PubMed and Google Scholar, reports that incorporated neutralisation assays with both pseudotyped virus, authentic virus, and the application of a mathematical formula to assess the relationship between the results, were selected for review. Our searches identified 67 reports, of which 22 underwent a three-level meta-analysis. Results The three-level meta-analysis revealed a high level of correlation between pseudotyped viruses and authentic viruses when used in an neutralisation assay. Reports that were not included in the meta-analysis also showed a high degree of correlation, with the exception of lentiviral-based pseudotyped Ebola viruses. Conclusion Pseudotyped viruses identified in this report can be used as a surrogate for authentic virus, though care must be taken in considering which pseudotype core to use when generating new uncharacterised pseudotyped viruses.
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Affiliation(s)
- Diego Cantoni
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Craig Wilkie
- School of Mathematics & Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Emma M. Bentley
- Medicines and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Martin Mayora-Neto
- Viral Pseudotype Unit, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, United Kingdom
| | - Edward Wright
- Viral Pseudotype Unit, School of Life Sciences, University of Sussex, Brighton, United Kingdom
| | - Simon Scott
- Viral Pseudotype Unit, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, United Kingdom
| | - Surajit Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Javier Castillo-Olivares
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Cambridge, United Kingdom
| | - Jonathan Luke Heeney
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge University, Cambridge, United Kingdom
- DIOSynVax, University of Cambridge, Cambridge, United Kingdom
| | - Giada Mattiuzzo
- Medicines and Healthcare Products Regulatory Agency, South Mimms, United Kingdom
| | - Nigel James Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, United Kingdom
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4
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van Hal SJ, Whiley DM, Le T, Ray S, Kundu RL, Kerr E, Lahra MM. Rapid expansion of Neisseria gonorrhoeae ST7827 clone in Australia, with variable ceftriaxone phenotype unexplained by genotype. J Antimicrob Chemother 2023; 78:2203-2208. [PMID: 37452731 DOI: 10.1093/jac/dkad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Neisseria gonorrhoeae is identified as a priority pathogen due to its capacity to rapidly develop antimicrobial resistance (AMR). Following the easing of SARS-CoV-2 pandemic travel restrictions across international borders in the state of New South Wales (NSW), Australia, a surge of gonococcal isolates with raised ceftriaxone MIC values were detected. METHODS All N. gonorrhoeae isolates (n = 150) with increased ceftriaxone MIC values in NSW between 1 January 2021 and July 2022 from males and females from all sites were sequenced. RESULTS A new emergence and rapid expansion of an N. gonorrhoeae ST7827 clone was documented within NSW, Australia and provides further evidence of the ability of N. gonorrhoeae to undergo sufficient genomic changes and re-emerge as a geographically restricted subclone. Mapping AMR determinants to MIC results did not reveal any genomic pattern that correlated with MIC values. CONCLUSIONS The rapid dissemination and establishment of this clone at the population level is a new and concerning demonstration of the agility of this pathogen, and underscores concerns about similar incursions and establishment of MDR clones. Moreover, it is notable that in this context the AMR genotype-phenotype correlates remain unclear, which requires further investigation to enable better understanding of genomic aspects of AMR in N. gonorrhoeae.
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Affiliation(s)
- S J van Hal
- Department of Infectious Diseases and Microbiology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Central Clinical School, University of Sydney, Sydney, NSW 2006, Australia
| | - D M Whiley
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland Central Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - T Le
- Department of Infectious Diseases and Microbiology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - S Ray
- World Health Organization Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - R L Kundu
- World Health Organization Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - E Kerr
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, Australia
| | - M M Lahra
- World Health Organization Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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5
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Zhang W, Ray S. From coarse to fine: a deep 3D probability volume contours framework for tumour segmentation and dose painting in PET images. Front Radiol 2023; 3:1225215. [PMID: 37745205 PMCID: PMC10512384 DOI: 10.3389/fradi.2023.1225215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
With the increasing integration of functional imaging techniques like Positron Emission Tomography (PET) into radiotherapy (RT) practices, a paradigm shift in cancer treatment methodologies is underway. A fundamental step in RT planning is the accurate segmentation of tumours based on clinical diagnosis. Furthermore, novel tumour control methods, such as intensity modulated radiation therapy (IMRT) dose painting, demand the precise delineation of multiple intensity value contours to ensure optimal tumour dose distribution. Recently, convolutional neural networks (CNNs) have made significant strides in 3D image segmentation tasks, most of which present the output map at a voxel-wise level. However, because of information loss in subsequent downsampling layers, they frequently fail to precisely identify precise object boundaries. Moreover, in the context of dose painting strategies, there is an imperative need for reliable and precise image segmentation techniques to delineate high recurrence-risk contours. To address these challenges, we introduce a 3D coarse-to-fine framework, integrating a CNN with a kernel smoothing-based probability volume contour approach (KsPC). This integrated approach generates contour-based segmentation volumes, mimicking expert-level precision and providing accurate probability contours crucial for optimizing dose painting/IMRT strategies. Our final model, named KsPC-Net, leverages a CNN backbone to automatically learn parameters in the kernel smoothing process, thereby obviating the need for user-supplied tuning parameters. The 3D KsPC-Net exploits the strength of KsPC to simultaneously identify object boundaries and generate corresponding probability volume contours, which can be trained within an end-to-end framework. The proposed model has demonstrated promising performance, surpassing state-of-the-art models when tested against the MICCAI 2021 challenge dataset (HECKTOR).
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Affiliation(s)
- Wenhui Zhang
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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6
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Sen IS, Nizam S, Ansari A, Bowes M, Choudhary B, Glendell M, Ray S, Scott M, Miller C, Wilkie C, Sinha R. Geochemical evolution of dissolved trace elements in space and time in the Ramganga River, India. Environ Monit Assess 2023; 195:1150. [PMID: 37668950 PMCID: PMC10480240 DOI: 10.1007/s10661-023-11665-0] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023]
Abstract
Understanding the spatiotemporal dynamics of river water chemistry from its source to sinks is critical for constraining the origin, transformation, and "hotspots" of contaminants in a river basin. To provide new spatiotemporal constraints on river chemistry, dissolved trace element concentrations were measured at 17 targeted locations across the Ramganga River catchment. River water samples were collected across three seasons: pre-monsoon, monsoon, and post-monsoon between 2019 and 2021. To remove the dependency of trace element concentrations on discharge, we used molar ratios, as discharge data on Indian transboundary rivers are not publicly available. The dataset reveals significant spatiotemporal variability in dissolved trace element concentrations of the Ramganga River. Samples collected upstream of Moradabad, a major industrial city in western Uttar Pradesh, are characterized by ~ 1.2-2.5 times higher average concentrations of most of the trace elements except Sc, V, Cr, Rb, and Pb, likely due to intense water-rock interactions in the headwaters. Such kind of enrichment in trace metal concentrations was also observed at sites downstream of large cities and industrial centers. However, such enrichment was not enough to bring a major change in the River Ganga chemistry, as the signals got diluted downstream of the Ramganga-Ganga confluence. The average river water composition of the Ramganga River was comparable to worldwide river water composition, albeit a few sites were characterized by very high concentrations of dissolved trace elements. Finally, we provide an outlook that calls for an assessment of stable non-traditional isotopes that are ideally suited to track the origin and transformation of elements such as Li, Mg, Ca, Ti, V, Cr, Fe, Ni, Cu, Zn, Sr, Ag, Cd, Sn, Pt, and Hg in Indian rivers.
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Affiliation(s)
- Indra Sekhar Sen
- Department of Earth Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Sarwar Nizam
- Department of Earth Sciences, Indian Institute of Technology Kanpur, Kanpur, India
- Physical Research Laboratory, Navrangpura, Ahmedabad, 380009, India
| | - Aqib Ansari
- Department of Earth Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - Michael Bowes
- UK Centre for Ecology and Hydrology, OX10 8BB, Wallingford, UK
| | - Bharat Choudhary
- Department of Earth Sciences, Indian Institute of Technology Kanpur, Kanpur, India
| | | | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G128QQ, UK.
| | - Marian Scott
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G128QQ, UK
| | - Claire Miller
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G128QQ, UK
| | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G128QQ, UK
| | - Rajiv Sinha
- Department of Earth Sciences, Indian Institute of Technology Kanpur, Kanpur, India.
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7
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Pascall DJ, Vink E, Blacow R, Bulteel N, Campbell A, Campbell R, Clifford S, Davis C, da Silva Filipe A, El Sakka N, Fjodorova L, Forrest R, Goldstein E, Gunson R, Haughney J, Holden MTG, Honour P, Hughes J, James E, Lewis T, MacLean O, McHugh M, Mollett G, Nyberg T, Onishi Y, Parcell B, Ray S, Robertson DL, Seaman SR, Shabaan S, Shepherd JG, Smollett K, Templeton K, Wastnedge E, Wilkie C, Williams T, Thomson EC. Directions of change in intrinsic case severity across successive SARS-CoV-2 variant waves have been inconsistent. J Infect 2023; 87:128-135. [PMID: 37270070 PMCID: PMC10234362 DOI: 10.1016/j.jinf.2023.05.019] [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: 09/26/2022] [Revised: 03/27/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine how the intrinsic severity of successively dominant SARS-CoV-2 variants changed over the course of the pandemic. METHODS A retrospective cohort analysis in the NHS Greater Glasgow and Clyde (NHS GGC) Health Board. All sequenced non-nosocomial adult COVID-19 cases in NHS GGC with relevant SARS-CoV-2 lineages (B.1.177/Alpha, Alpha/Delta, AY.4.2 Delta/non-AY.4.2 Delta, non-AY.4.2 Delta/Omicron, and BA.1 Omicron/BA.2 Omicron) during analysis periods were included. Outcome measures were hospital admission, ICU admission, or death within 28 days of positive COVID-19 test. We report the cumulative odds ratio; the ratio of the odds that an individual experiences a severity event of a given level vs all lower severity levels for the resident and the replacement variant after adjustment. RESULTS After adjustment for covariates, the cumulative odds ratio was 1.51 (95% CI: 1.08-2.11) for Alpha versus B.1.177, 2.09 (95% CI: 1.42-3.08) for Delta versus Alpha, 0.99 (95% CI: 0.76-1.27) for AY.4.2 Delta versus non-AY.4.2 Delta, 0.49 (95% CI: 0.22-1.06) for Omicron versus non-AY.4.2 Delta, and 0.86 (95% CI: 0.68-1.09) for BA.2 Omicron versus BA.1 Omicron. CONCLUSIONS The direction of change in intrinsic severity between successively emerging SARS-CoV-2 variants was inconsistent, reminding us that the intrinsic severity of future SARS-CoV-2 variants remains uncertain.
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Affiliation(s)
- David J Pascall
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, United Kingdom; Joint Universities Pandemic and Epidemiological Research (JUNIPER) Consortium, United Kingdom.
| | - Elen Vink
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom; NHS Lothian, Edinburgh EH1 3EG, United Kingdom.
| | - Rachel Blacow
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom; NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom.
| | | | | | | | | | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | - Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | | | | | | | - Emily Goldstein
- NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom.
| | - Rory Gunson
- NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom.
| | - John Haughney
- NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom.
| | - Matthew T G Holden
- Public Health Scotland, Edinburgh EH12 9EB, United Kingdom; School of Medicine, University of St Andrews, St Andrews KY16 9TF, United Kingdom.
| | | | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | | | - Tim Lewis
- NHS Lothian, Edinburgh EH1 3EG, United Kingdom.
| | - Oscar MacLean
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | | | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom; NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom.
| | - Tommy Nyberg
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, United Kingdom.
| | | | - Ben Parcell
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, United Kingdom.
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow G12 8TA, United Kingdom.
| | - David L Robertson
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | - Shaun R Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, United Kingdom.
| | - Sharif Shabaan
- Public Health Scotland, Edinburgh EH12 9EB, United Kingdom.
| | - James G Shepherd
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | - Katherine Smollett
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom.
| | | | | | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow G12 8TA, United Kingdom.
| | - Thomas Williams
- NHS Lothian, Edinburgh EH1 3EG, United Kingdom; Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom.
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research (CVR), Glasgow G61 1QH, United Kingdom; NHS Greater Glasgow and Clyde, Glasgow G12 0XH, United Kingdom; London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
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8
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Ho A, Orton R, Tayler R, Asamaphan P, Herder V, Davis C, Tong L, Smollett K, Manali M, Allan J, Rawlik K, McDonald SE, Vink E, Pollock L, Gannon L, Evans C, McMenamin J, Roy K, Marsh K, Divala T, Holden MTG, Lockhart M, Yirrell D, Currie S, O'Leary M, Henderson D, Shepherd SJ, Jackson C, Gunson R, MacLean A, McInnes N, Bradley-Stewart A, Battle R, Hollenbach JA, Henderson P, Odam M, Chikowore P, Oosthuyzen W, Chand M, Hamilton MS, Estrada-Rivadeneyra D, Levin M, Avramidis N, Pairo-Castineira E, Vitart V, Wilkie C, Palmarini M, Ray S, Robertson DL, da Silva Filipe A, Willett BJ, Breuer J, Semple MG, Turner D, Baillie JK, Thomson EC. Adeno-associated virus 2 infection in children with non-A-E hepatitis. Nature 2023; 617:555-563. [PMID: 36996873 DOI: 10.1038/s41586-023-05948-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
An outbreak of acute hepatitis of unknown aetiology in children was reported in Scotland1 in April 2022 and has now been identified in 35 countries2. Several recent studies have suggested an association with human adenovirus with this outbreak, a virus not commonly associated with hepatitis. Here we report a detailed case-control investigation and find an association between adeno-associated virus 2 (AAV2) infection and host genetics in disease susceptibility. Using next-generation sequencing, PCR with reverse transcription, serology and in situ hybridization, we detected recent infection with AAV2 in plasma and liver samples in 26 out of 32 (81%) cases of hepatitis compared with 5 out of 74 (7%) of samples from unaffected individuals. Furthermore, AAV2 was detected within ballooned hepatocytes alongside a prominent T cell infiltrate in liver biopsy samples. In keeping with a CD4+ T-cell-mediated immune pathology, the human leukocyte antigen (HLA) class II HLA-DRB1*04:01 allele was identified in 25 out of 27 cases (93%) compared with a background frequency of 10 out of 64 (16%; P = 5.49 × 10-12). In summary, we report an outbreak of acute paediatric hepatitis associated with AAV2 infection (most likely acquired as a co-infection with human adenovirus that is usually required as a 'helper virus' to support AAV2 replication) and disease susceptibility related to HLA class II status.
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Affiliation(s)
- Antonia Ho
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Richard Orton
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Rachel Tayler
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | - Patawee Asamaphan
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Vanessa Herder
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Chris Davis
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Lily Tong
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Katherine Smollett
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Maria Manali
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Jay Allan
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Konrad Rawlik
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah E McDonald
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Elen Vink
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Louisa Pollock
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | | | - Clair Evans
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Celia Jackson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | | | - Neil McInnes
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | | | - Richard Battle
- Histocompatibility and Immunogenetics (H&I) Laboratory, Scottish National Blood Transfusion Service, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jill A Hollenbach
- Department of Neurology and Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Paul Henderson
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Miranda Odam
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Primrose Chikowore
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Wilna Oosthuyzen
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | | | - Melissa Shea Hamilton
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Diego Estrada-Rivadeneyra
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Michael Levin
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Nikos Avramidis
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Erola Pairo-Castineira
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Veronique Vitart
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute for Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Massimo Palmarini
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - David L Robertson
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Ana da Silva Filipe
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Brian J Willett
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | | | - David Turner
- Histocompatibility and Immunogenetics (H&I) Laboratory, Scottish National Blood Transfusion Service, Edinburgh Royal Infirmary, Edinburgh, UK
| | - J Kenneth Baillie
- Pandemic Science Hub, Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute for Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Emma C Thomson
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
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9
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Pascall DJ, Vink E, Blacow R, Bulteel N, Campbell A, Campbell R, Clifford S, Davis C, da Silva Filipe A, El Sakka N, Fjodorova L, Forrest R, Goldstein E, Gunson R, Haughney J, Holden MTG, Honour P, Hughes J, James E, Lewis T, Lycett S, MacLean O, McHugh M, Mollett G, Onishi Y, Parcell B, Ray S, Robertson DL, Shabaan S, Shepherd JG, Smollett K, Templeton K, Wastnedge E, Wilkie C, Williams T, Thomson EC. The SARS-CoV-2 Alpha variant was associated with increased clinical severity of COVID-19 in Scotland: A genomics-based retrospective cohort analysis. PLoS One 2023; 18:e0284187. [PMID: 37053201 PMCID: PMC10101505 DOI: 10.1371/journal.pone.0284187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES The SARS-CoV-2 Alpha variant was associated with increased transmission relative to other variants present at the time of its emergence and several studies have shown an association between Alpha variant infection and increased hospitalisation and 28-day mortality. However, none have addressed the impact on maximum severity of illness in the general population classified by the level of respiratory support required, or death. We aimed to do this. METHODS In this retrospective multi-centre clinical cohort sub-study of the COG-UK consortium, 1475 samples from Scottish hospitalised and community cases collected between 1st November 2020 and 30th January 2021 were sequenced. We matched sequence data to clinical outcomes as the Alpha variant became dominant in Scotland and modelled the association between Alpha variant infection and severe disease using a 4-point scale of maximum severity by 28 days: 1. no respiratory support, 2. supplemental oxygen, 3. ventilation and 4. death. RESULTS Our cumulative generalised linear mixed model analyses found evidence (cumulative odds ratio: 1.40, 95% CI: 1.02, 1.93) of a positive association between increased clinical severity and lineage (Alpha variant versus pre-Alpha variants). CONCLUSIONS The Alpha variant was associated with more severe clinical disease in the Scottish population than co-circulating lineages.
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Affiliation(s)
- David J. Pascall
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Joint Universities Pandemic and Epidemiological Research (JUNIPER) Consortium, United Kingdom
| | - Elen Vink
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - Rachel Blacow
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | | | | | | | - Chris Davis
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | - Ana da Silva Filipe
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | | | | | | | | | - Rory Gunson
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John Haughney
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Matthew T. G. Holden
- Public Health Scotland, Edinburgh, United Kingdom
- School of Medicine, University of St Andrews, St Andrews, Fife, United Kingdom
| | | | - Joseph Hughes
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | - Edward James
- NHS Borders, Melrose, Scottish Borders, United Kingdom
| | - Tim Lewis
- NHS Lothian, Edinburgh, United Kingdom
| | - Samantha Lycett
- The Roslin Institute, University of Edinburgh, Midlothian, United Kingdom
| | - Oscar MacLean
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | | | - Guy Mollett
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Ben Parcell
- School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - David L. Robertson
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | | | - James G. Shepherd
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | - Katherine Smollett
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
| | | | | | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Thomas Williams
- NHS Lothian, Edinburgh, United Kingdom
- Royal Hospital for Children and Young People, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma C. Thomson
- MRC–University of Glasgow Centre for Virus Research (CVR), Glasgow, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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10
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Charlesworth M, Williams B, Ray S. Infective endocarditis. BJA Educ 2023; 23:144-152. [PMID: 36960439 PMCID: PMC10028394 DOI: 10.1016/j.bjae.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- M. Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B.G. Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S. Ray
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
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11
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Jones KA, Paterson CA, Ray S, Motherwell DW, Hamilton DJ, Small AD, Martin W, Goodfield NER. Beta-blockers and mechanical dyssynchrony in heart failure assessed by radionuclide ventriculography. J Nucl Cardiol 2023; 30:193-200. [PMID: 36417121 PMCID: PMC9984517 DOI: 10.1007/s12350-022-03142-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radionuclide ventriculography (RNVG) can be used to quantify mechanical dyssynchrony and may be a valuable adjunct in the assessment of heart failure with reduced ejection fraction (HFrEF). The study aims to investigate the effect of beta-blockers on mechanical dyssynchrony using novel RNVG phase parameters. METHODS A retrospective study was carried out in a group of 98 patients with HFrEF. LVEF and dyssynchrony were assessed pre and post beta-blockade. Dyssynchrony was assessed using synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy from planar RNVG phase images. Subgroups split by ischemic etiology were also investigated. RESULTS An improvement in dyssynchrony and LVEF was measured six months post beta-blockade for both ischemic and non-ischemic groups. CONCLUSIONS A significant improvement in dyssynchrony and LVEF was measured post beta-blockade using novel measures of dyssynchrony.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow , UK
| | - D W Motherwell
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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12
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Pall A, Ray S, Thomas S. Invasive Staphylococcus aureus case outcome and epidemiologic class in the COVID era. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00587-6] [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: 01/28/2023]
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13
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Dangerfield CE, David Abrahams I, Budd C, Butchers M, Cates ME, Champneys AR, Currie CS, Enright J, Gog JR, Goriely A, Déirdre Hollingsworth T, Hoyle RB, INI Professional Services, Isham V, Jordan J, Kaouri MH, Kavoussanakis K, Leeks J, Maini PK, Marr C, Merritt C, Mollison D, Ray S, Thompson RN, Wakefield A, Wasley D. Getting the most out of maths: How to coordinate mathematical modelling research to support a pandemic, lessons learnt from three initiatives that were part of the COVID-19 response in the UK. J Theor Biol 2023; 557:111332. [PMID: 36323393 PMCID: PMC9618296 DOI: 10.1016/j.jtbi.2022.111332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
In March 2020 mathematics became a key part of the scientific advice to the UK government on the pandemic response to COVID-19. Mathematical and statistical modelling provided critical information on the spread of the virus and the potential impact of different interventions. The unprecedented scale of the challenge led the epidemiological modelling community in the UK to be pushed to its limits. At the same time, mathematical modellers across the country were keen to use their knowledge and skills to support the COVID-19 modelling effort. However, this sudden great interest in epidemiological modelling needed to be coordinated to provide much-needed support, and to limit the burden on epidemiological modellers already very stretched for time. In this paper we describe three initiatives set up in the UK in spring 2020 to coordinate the mathematical sciences research community in supporting mathematical modelling of COVID-19. Each initiative had different primary aims and worked to maximise synergies between the various projects. We reflect on the lessons learnt, highlighting the key roles of pre-existing research collaborations and focal centres of coordination in contributing to the success of these initiatives. We conclude with recommendations about important ways in which the scientific research community could be better prepared for future pandemics. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".
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Affiliation(s)
- Ciara E. Dangerfield
- Isaac Newton Institute to Mathematical Sciences, University of Cambridge, United Kingdom,Joint UNIversities Pandemic and Epidemiological Research (JUNIPER) Consortium, United Kingdom1,Corresponding author
| | - I. David Abrahams
- Department for Applied Mathematics and Theoretical Physics, University of Cambridge, United Kingdom
| | - Chris Budd
- Department of Mathematics, University of Bath, United Kingdom
| | - Matt Butchers
- Department of Mathematics, University of Bath, United Kingdom
| | - Michael E. Cates
- Department for Applied Mathematics and Theoretical Physics, University of Cambridge, United Kingdom
| | - Alan R. Champneys
- Department of Engineering Mathematics, University of Bristol, United Kingdom
| | | | - Jessica Enright
- School of Computing Science, University of Glasgow, United Kingdom
| | - Julia R. Gog
- Joint UNIversities Pandemic and Epidemiological Research (JUNIPER) Consortium, United Kingdom1,Department for Applied Mathematics and Theoretical Physics, University of Cambridge, United Kingdom
| | - Alain Goriely
- Mathematical Institute, University of Oxford, United Kingdom
| | - T. Déirdre Hollingsworth
- Joint UNIversities Pandemic and Epidemiological Research (JUNIPER) Consortium, United Kingdom1,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, United Kingdom
| | - Rebecca B. Hoyle
- School of Mathematical Sciences, University of Southampton, United Kingdom
| | | | - Valerie Isham
- Department of Statistical Science, University College London, United Kingdom
| | | | - Maha H. Kaouri
- Isaac Newton Institute to Mathematical Sciences, University of Cambridge, United Kingdom
| | | | - Jane Leeks
- Isaac Newton Institute to Mathematical Sciences, University of Cambridge, United Kingdom
| | - Philip K. Maini
- Mathematical Institute, University of Oxford, United Kingdom
| | - Christie Marr
- Isaac Newton Institute to Mathematical Sciences, University of Cambridge, United Kingdom
| | - Clare Merritt
- Isaac Newton Institute to Mathematical Sciences, University of Cambridge, United Kingdom
| | - Denis Mollison
- Department of Actuarial Mathematics and Statistics, Heriot-Watt University, United Kingdom
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, United Kingdom
| | - Robin N. Thompson
- Mathematics Institute, University of Warwick, United Kingdom,Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, United Kingdom
| | | | - Dawn Wasley
- International Centre for Mathematical Sciences, University of Edinburgh & Heriot-Watt University, United Kingdom
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14
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Emani S, Kan A, Storms T, Bonanno S, Law J, Ray S, Joshi N. Periplasmic stress contributes to a tradeoff between protein secretion and cell growth in E. Coli Nissile. bioRxiv 2023:2023.01.09.523330. [PMID: 36711660 PMCID: PMC9882030 DOI: 10.1101/2023.01.09.523330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Maximizing protein secretion is an important target in the design of engineered living systems. In this paper, we characterize a tradeoff between cell growth and per cell protein secretion in the curli biofilm secretion system of E Coli Nissile 1917. Initial characterization using 24-hour continuous growth and protein production monitoring confirms decreased growth rates at high induction leading to a local maximum in total protein production at intermediate induction. Propidium iodide staining at the endpoint indicates that cellular death is a dominant cause of growth reduction. Assaying variants with combinatorial constructs of inner and outer membrane secretion tags, we find that diminished growth at high production is specific to secretory variants associated with accumulation of protein containing the outer membrane transport tag in the periplasmic space. RNA sequencing experiments indicate upregulation of known periplasmic stress response genes in the highly secreting variant, further implicating periplasmic stress in the growth-secretion tradeoff. Overall, these results motivate additional strategies for optimizing total protein production and longevity of secretory engineered living systems.
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15
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Waterhouse D, Ray S, Betts K, Yuan Y, Yin L, Gao S, Sundar M, Stenehjem D. 60MO Real-world overall and progression-free survival for first-line immunotherapy-based regimens in advanced non-small cell lung cancer. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Ray S, Banerjee A, Swift A, Fanstone JW, Mamalakis M, Vorselaars B, Wilkie C, Cole J, Mackenzie LS, Weeks S. A robust COVID-19 mortality prediction calculator based on Lymphocyte count, Urea, C-Reactive Protein, Age and Sex (LUCAS) with chest X-rays. Sci Rep 2022; 12:18220. [PMID: 36309547 PMCID: PMC9617052 DOI: 10.1038/s41598-022-21803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/04/2022] [Indexed: 01/08/2023] Open
Abstract
There have been numerous risk tools developed to enable triaging of SARS-CoV-2 positive patients with diverse levels of complexity. Here we presented a simplified risk-tool based on minimal parameters and chest X-ray (CXR) image data that predicts the survival of adult SARS-CoV-2 positive patients at hospital admission. We analysed the NCCID database of patient blood variables and CXR images from 19 hospitals across the UK using multivariable logistic regression. The initial dataset was non-randomly split between development and internal validation dataset with 1434 and 310 SARS-CoV-2 positive patients, respectively. External validation of the final model was conducted on 741 Accident and Emergency (A&E) admissions with suspected SARS-CoV-2 infection from a separate NHS Trust. The LUCAS mortality score included five strongest predictors (Lymphocyte count, Urea, C-reactive protein, Age, Sex), which are available at any point of care with rapid turnaround of results. Our simple multivariable logistic model showed high discrimination for fatal outcome with the area under the receiving operating characteristics curve (AUC-ROC) in development cohort 0.765 (95% confidence interval (CI): 0.738-0.790), in internal validation cohort 0.744 (CI: 0.673-0.808), and in external validation cohort 0.752 (CI: 0.713-0.787). The discriminatory power of LUCAS increased slightly when including the CXR image data. LUCAS can be used to obtain valid predictions of mortality in patients within 60 days of SARS-CoV-2 RT-PCR results into low, moderate, high, or very high risk of fatality.
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Affiliation(s)
- Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Abhirup Banerjee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, UK
| | - Andrew Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
| | | | - Michail Mamalakis
- School of Computer Science, University of Sheffield, 211 Portobello, Sheffield City Centre, Sheffield, S1 4DP, UK
| | - Bart Vorselaars
- School of Mathematics and Physics, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Craig Wilkie
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Joby Cole
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
| | - Louise S Mackenzie
- School of Applied Sciences, University of Brighton, Brighton, BN2 4AT, UK.
| | - Simonne Weeks
- School of Applied Sciences, University of Brighton, Brighton, BN2 4AT, UK
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17
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Willett BJ, Grove J, MacLean OA, Wilkie C, De Lorenzo G, Furnon W, Cantoni D, Scott S, Logan N, Ashraf S, Manali M, Szemiel A, Cowton V, Vink E, Harvey WT, Davis C, Asamaphan P, Smollett K, Tong L, Orton R, Hughes J, Holland P, Silva V, Pascall DJ, Puxty K, da Silva Filipe A, Yebra G, Shaaban S, Holden MTG, Pinto RM, Gunson R, Templeton K, Murcia PR, Patel AH, Klenerman P, Dunachie S, Haughney J, Robertson DL, Palmarini M, Ray S, Thomson EC. Publisher Correction: SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway. Nat Microbiol 2022; 7:1709. [PMID: 36114232 PMCID: PMC9483304 DOI: 10.1038/s41564-022-01241-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
| | - Joe Grove
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
| | - Oscar A MacLean
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Craig Wilkie
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Giuditta De Lorenzo
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Wilhelm Furnon
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Diego Cantoni
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Sam Scott
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Shirin Ashraf
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Maria Manali
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Agnieszka Szemiel
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Vanessa Cowton
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Elen Vink
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - William T Harvey
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Patawee Asamaphan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Katherine Smollett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Lily Tong
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Richard Orton
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - David J Pascall
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - Matthew T G Holden
- Public Health Scotland, Glasgow, UK
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rute Maria Pinto
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - Pablo R Murcia
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Arvind H Patel
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | | | - David L Robertson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Massimo Palmarini
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Surajit Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
- NHS Greater Glasgow & Clyde, Glasgow, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
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18
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Willett BJ, Grove J, MacLean OA, Wilkie C, De Lorenzo G, Furnon W, Cantoni D, Scott S, Logan N, Ashraf S, Manali M, Szemiel A, Cowton V, Vink E, Harvey WT, Davis C, Asamaphan P, Smollett K, Tong L, Orton R, Hughes J, Holland P, Silva V, Pascall DJ, Puxty K, da Silva Filipe A, Yebra G, Shaaban S, Holden MTG, Pinto RM, Gunson R, Templeton K, Murcia PR, Patel AH, Klenerman P, Dunachie S, Haughney J, Robertson DL, Palmarini M, Ray S, Thomson EC. SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway. Nat Microbiol 2022; 7:1161-1179. [PMID: 35798890 PMCID: PMC9352574 DOI: 10.1038/s41564-022-01143-7] [Citation(s) in RCA: 274] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022]
Abstract
Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant.
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Affiliation(s)
- Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
| | - Joe Grove
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
| | - Oscar A MacLean
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Craig Wilkie
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Giuditta De Lorenzo
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Wilhelm Furnon
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Diego Cantoni
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Sam Scott
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Shirin Ashraf
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Maria Manali
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Agnieszka Szemiel
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Vanessa Cowton
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Elen Vink
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - William T Harvey
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Patawee Asamaphan
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Katherine Smollett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Lily Tong
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Richard Orton
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - David J Pascall
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Ana da Silva Filipe
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - Matthew T G Holden
- Public Health Scotland, Glasgow, UK
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rute Maria Pinto
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | - Pablo R Murcia
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Arvind H Patel
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | | | | | | | - David L Robertson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Massimo Palmarini
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Surajit Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
- NHS Greater Glasgow & Clyde, Glasgow, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
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19
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Jones KA, Small AD, Ray S, Hamilton DJ, Martin W, Robinson J, Goodfield NER, Paterson CA. Radionuclide ventriculography phase analysis for risk stratification of patients undergoing cardiotoxic cancer therapy. J Nucl Cardiol 2022; 29:581-589. [PMID: 32748278 PMCID: PMC8993717 DOI: 10.1007/s12350-020-02277-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accurate diagnostic tools to identify patients at risk of cancer therapy-related cardiac dysfunction (CTRCD) are critical. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function. METHODS In this retrospective study, approximate entropy (ApEn), synchrony, entropy, and standard deviation from the phase histogram (phase SD) were investigated as potential early markers of LV dysfunction to predict CTRCD. These phase parameters were calculated from the baseline RNVG phase image for 177 breast cancer patients before commencing cardiotoxic therapy. RESULTS Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. CONCLUSIONS The results suggest that RNVG phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - J Robinson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
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20
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Biswas S, Mukherjee A, Chakraborty S, Chaturvedi A, Samanta B, Khanra D, Ray S, Sharma RK. Impact of plasma glucose and duration of type 2 diabetes mellitus on SYNTAX Score II in patients suffering from non ST-elevation myocardial infarction. Kardiologiia 2022; 62:40-48. [PMID: 35414360 DOI: 10.18087/cardio.2022.3.n1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
Aim The objective was to assess the correlation of fasting plasma glucose (FPG), HbA1c, and the duration of type 2 diabetes mellitus (T2DM) with SYNTAX score (SS) II in patients with non-ST elevation myocardial infarction (NSTEMI).Material and methods FPG and HbA1C were measured in 398 patients presenting with NSTEMI at admission. SS II was calculated using an online calculator. Patients were stratified according to SS II (≤21.5, 21.5-30.6, and ≥30.6), defined as SS II low, mid, and high, respectively.Results 37.7 % of subjects were diabetic. Correlations of FPG (R=0.402, R2=0.162, p<0.001) and HbA1c (R=0.359, R2=0.129, p<0.001) with SS II were weak in the overall population. Duration of T2DM showed very strong correlation with SS II (R=0.827, R2=0.347). For the prediction of high SS II in the study population, FPG≥98.5 mg / dl demonstrated a sensitivity of 58 % and a specificity of 60 %, and HbA1c ≥6.05 demonstrated a sensitivity of 63 % and a specificity of 69 %. Duration of T2DM (adjusted odds ratio (OR): 1.182; 95 % confidence interval (CI): 1.185-2.773) and FPG (OR: 0.987; 95 % CI: 0.976-0.9959) were significantly associated with high SS II after controlling for other risk factors. Duration of T2DM (Beta=0.439) contributed strongly to variance of SS II, whereas HbA1c (Beta=0.063) contributed weakly.Conclusion Duration of T2DM is a very important risk factor for severity of coronary artery disease.
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Affiliation(s)
- S Biswas
- Nilratan Sircar Medical College and Hospital
| | - A Mukherjee
- Nilratan Sircar Medical College and Hospital
| | | | | | - B Samanta
- Nilratan Sircar Medical College and Hospital
| | - D Khanra
- Heart and Lung Centre, Royal Wolverhampton NHS Trust
| | - S Ray
- Jagannath Gupta Institute of Medical Sciences and Hospitals
| | - R K Sharma
- Nilratan Sircar Medical College and Hospital
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21
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Chakraborty K, Jena P, Mondal S, Dash GK, Ray S, Baig MJ, Swain P. Relative contribution of different members of OsDREB gene family to osmotic stress tolerance in indica and japonica ecotypes of rice. Plant Biol (Stuttg) 2022; 24:356-366. [PMID: 34939275 DOI: 10.1111/plb.13379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Drought/osmotic stress is the single largest production constraint in rain-fed rice cultivation. Different members of the DREB gene family are known to contribute to osmotic stress tolerance. In this study, an attempt was made to understand their relative contribution towards osmotic stress tolerance in indica and japonica ecotypes of rice. Two genotypes (one tolerant and one susceptible) from each ecotype were grown hydroponically, and 21-day-old seedlings were subjected to polyethylene glycol-induced osmotic stress (15% PEG-6000, equivalent to -3.0 bars osmotic potential). The tolerant genotypes CR143 and Moroberekan were found to have superior root traits (total root length, surface area and volume), better plant water status and increased total dry biomass as compared to their susceptible counterparts after 10 days of osmotic stress. Different members of the DREB gene family were differentially induced in response to osmotic shock (1 h after stress) and osmotic stress (24 h after stress), which also differed between the two rice ecotypes. From the gene expression profiles of 10 DREB genes (both DREB1 and DREB2 families), in indica two DREB genes, DREB1B and DREB1G, were significantly correlated with stress tolerance indices, whereas in japonica significant correlations with five DREB genes (DREB1A, DREB1B, DREB1D, DREB1E and DREB2B) were observed. We found that only one member, i.e. DREB1B, showed a significant correlation with drought tolerance indices in both indica and japonica ecotypes. This study provides an overview of the relative contribution of different members of the DREB gene family and their association with drought/osmotic stress tolerance in rice.
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Affiliation(s)
- K Chakraborty
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
| | - P Jena
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
| | - S Mondal
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
| | - G K Dash
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
| | - S Ray
- Division of Plant Physiology, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - M J Baig
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
| | - P Swain
- Division of Crop Physiology & Biochemistry, ICAR-National Rice Research Institute, Cuttack, India
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22
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Mamalakis M, Swift AJ, Vorselaars B, Ray S, Weeks S, Ding W, Clayton RH, Mackenzie LS, Banerjee A. DenResCov-19: A deep transfer learning network for robust automatic classification of COVID-19, pneumonia, and tuberculosis from X-rays. Comput Med Imaging Graph 2021; 94:102008. [PMID: 34763146 PMCID: PMC8539634 DOI: 10.1016/j.compmedimag.2021.102008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) is continuing to have a significant effect on the well-being of the global population, thus increasing the demand for rapid testing, diagnosis, and treatment. As COVID-19 can cause severe pneumonia, early diagnosis is essential for correct treatment, as well as to reduce the stress on the healthcare system. Along with COVID-19, other etiologies of pneumonia and Tuberculosis (TB) constitute additional challenges to the medical system. Pneumonia (viral as well as bacterial) kills about 2 million infants every year and is consistently estimated as one of the most important factor of childhood mortality (according to the World Health Organization). Chest X-ray (CXR) and computed tomography (CT) scans are the primary imaging modalities for diagnosing respiratory diseases. Although CT scans are the gold standard, they are more expensive, time consuming, and are associated with a small but significant dose of radiation. Hence, CXR have become more widespread as a first line investigation. In this regard, the objective of this work is to develop a new deep transfer learning pipeline, named DenResCov-19, to diagnose patients with COVID-19, pneumonia, TB or healthy based on CXR images. The pipeline consists of the existing DenseNet-121 and the ResNet-50 networks. Since the DenseNet and ResNet have orthogonal performances in some instances, in the proposed model we have created an extra layer with convolutional neural network (CNN) blocks to join these two models together to establish superior performance as compared to the two individual networks. This strategy can be applied universally in cases where two competing networks are observed. We have tested the performance of our proposed network on two-class (pneumonia and healthy), three-class (COVID-19 positive, healthy, and pneumonia), as well as four-class (COVID-19 positive, healthy, TB, and pneumonia) classification problems. We have validated that our proposed network has been able to successfully classify these lung-diseases on our four datasets and this is one of our novel findings. In particular, the AUC-ROC are 99.60, 96.51, 93.70, 96.40% and the F1 values are 98.21, 87.29, 76.09, 83.17% on our Dataset X-Ray 1, 2, 3, and 4 (DXR1, DXR2, DXR3, DXR4), respectively.
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Affiliation(s)
- Michail Mamalakis
- Department of Computer Science, University of Sheffield, Sheffield, UK; Insigneo Institute for in-silico Medicine, Sheffield, UK.
| | - Andrew J Swift
- Insigneo Institute for in-silico Medicine, Sheffield, UK; Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Bart Vorselaars
- School of Mathematics and Physics, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow G12 8QW, UK
| | - Simonne Weeks
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK
| | - Weiping Ding
- School of Information Science and Technology, Nantong University, Nantong 226019, China
| | - Richard H Clayton
- Department of Computer Science, University of Sheffield, Sheffield, UK; Insigneo Institute for in-silico Medicine, Sheffield, UK
| | - Louise S Mackenzie
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK
| | - Abhirup Banerjee
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK.
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23
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Jadhav U, Nair T, Bansal S, Ray S. Efficacy and safety of bisoprolol compared to other selective beta-1 blockers in the treatment of hypertension: a systematic review and meta-analysis of randomized parallel clinical trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2363] [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
Bisoprolol, a highly cardioselective beta-1 blocker (s-BB) has theoretical advantage over other cardio selective betablockers by way of better potency and tolerability in treating hypertension (HT). Individual published trials comparing s-BB are typically small. Meta-analysis of such trials clarifies the issue and position of bisoprolol in HT therapy.
Purpose
This meta-analysis compares bisoprolol with other s-BBs (Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol, Nebivolol) for their efficacy and safety in patients with HT.
Methods
Literature databases PubMed, Embase, Cochrane Library, Clinicaltrials.gov, Surveillance, Epidemiology and End Results Program and 12 PV databases were searched systematically to identify randomized, parallel clinical trials published from inception to October 2019. Studies which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects meta-analyses were conducted to assess mean difference (MD) and 95% confidence interval (95% CI) for blood pressure (BP), heart rate (HR) and lipid profile.
Results
13 studies compared bisoprolol with other s-BBs (metoprolol, atenolol) were included in this meta-analysis. Bisoprolol reported significant reduction in aortic systolic BP [MD: −8.00; 95% CI: −11.57, −4.43; P<0.01] and diastolic BP [MD: −2.90; 95% CI: −4.98, −0.82; P<0.01] during 8 weeks (w) treatment compared to other s-BBs. Bisoprolol treatment for 12w showed significant change in ambulatory heart rate (AHR) [MD: −5.22; 95% CI: −8.37, −2.07; P<0.01], daytime AHR [MD: −5.75; 95% CI: −9.16, 2.34; P<0.01] and nighttime AHR [MD: −3.22; 95% CI: −6.18, −0.26; P=0.03] in comparison to other s-BBs. Significant increase in low frequency HR variability [MD: 100.79; 95% CI: 16.66, 184.91; P=0.02] was reported with bisoprolol treated for 8w compared to other s-BBs. Baroreflex sensitivity significantly favored bisoprolol treated for 8w [MD: 1.01; 95% CI: 0.03, 1.98; P=0.04] in comparison to other s-BBs. HDL-C significantly increased with bisoprolol treated for 52w [MD: 6.80; 95% CI: 3.01, 10.60; P<0.01], 104w [MD: 12.00; 95% CI: 5.04, 18.96; P<0.01] and 156w [MD: 8.00; 95% CI: 0.58, 15.42; P=0.03]. There were no significant changes in total cholesterol [MD: −3.06; P=0.38], LDL-C [MD: −3.60; P=0.18] and triglyceride [MD: −21.00; P=0.26] on treatment with bisoprolol. Serious adverse events did not differ significantly on treatment with bisoprolol compared to other s-BBs.
Conclusion
The results of this meta-analysis reveal that bisoprolol showed a significant reduction of BP, HR, baroreflex sensitivity and improved HDL cholesterol levels compared to other s-BBs. Our results highlight the heterogeneity amongst the s-BBs and highlights the benefit of choosing bisoprolol in comparison to other s-BB in the management of HT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Jadhav
- MGM New Bombay Hospital, New Mumbai, India
| | - T Nair
- P R S Hospital, Trivandrum, India
| | - S Bansal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
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24
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Jadhav U, Ray S, Bansal S, Nair T. Effectiveness of bisoprolol versus selective beta-1 blockers in the management of hypertension: a systematic review and meta-analysis of randomized cross-over trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2364] [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
Cross-over trials carry a higher weightage in choosing a therapeutic agent in clinical practice. A meta-analysis of cross-over trials involving the use of bisoprolol in hypertension (HT) would bring about clarity in positioning this drug.
Purpose
The present study aimed to clarify the underlying benefits of bisoprolol in the reduction of blood pressure (BP) in HT patients when compared to selective beta-1 blockers (s-BBs - Atenolol, Betaxolol hydrochloride, Esmolol, Acebutolol hydrochloride, Metoprolol succinate, Nebivolol) by performing a meta-analysis of “cross-over” trials published in literature.
Methods
Systematic search was undertaken in PubMed, Embase, Cochrane Library, Clinicaltrials.gov registry, Surveillance, Epidemiology and End Results Program and 12 pharmacovigilance databases. Randomized, cross-over studies published up to October 2019 which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was performed using random effects model in terms of mean difference (MD) and 95% confidence intervals (95% CI) for BP, heart rate (HR) and lipid profile.
Results
Nine randomized cross-over studies which compared bisoprolol with other s-BBs (atenolol and nebivolol) were included in this meta-analysis. Bisoprolol reported significant reduction of sitting BP [MD: −3.35, 95% CI: −6.75, 0.05; P=0.05] and reduction of diastolic BP [MD: −2.00; 95% CI: −8.04, 4.04; P=0.52, non-significant] among patients with HT when compared to other s-BBs. Heart rate (HR) decreased significantly among HT patients in bisoprolol group treated for 2 w [MD: −6.00; 95% CI: −11.30, −0.70; P=0.03] when compared to those treated with other s-BBs. Analysis of lipid profile showed non-significant reduction of serum cholesterol [MD: −7.74; 95% CI: −17.18, 1.70; P=0.11] and triglyceride [MD: −26.57; 95% CI: −64.34, 11.20; P=0.17] levels in the bisoprolol group compared to other s-BBs. Bisoprolol treatment for 8 w resulted in a slight but statistically significant change in potassium levels [MD: −0.10; 95% CI: −0.16, −0.04; P<0.01] among HT patients.
Conclusion
The results of this meta-analysis reported significant efficacy of bisoprolol on BP and HR in comparison to other s-BBs in a meta-analysis of cross-over trials. Our findings show that use of bisoprolol as a therapeutic option is efficacious and safe compared to other s-BBs in this patient population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Jadhav
- MGM New Bombay Hospital, New Mumbai, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - S Bansal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - T Nair
- P R S Hospital, Trivandrum, India
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25
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Lilien C, Baranello G, Coratti G, Edel L, Germanenko O, Krstic M, Mazurkiewicz-Bełdzińska M, Ray S, Shatillo A, Taytard J, Vlodavets D, Vuillerot C, Cruz L, Tachibana G, Viljoen C, Servais L. SMA – OUTCOME MEASURES AND REGISTRIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.286] [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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26
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Hima Bindu V, Chandaliya VK, Siddiqi H, Dash P, Ray S, Meikap B. Role of kinematic viscosity on removal of Quinoline Insolubles from coal tar using wash oil and mixed solvent. SEP SCI TECHNOL 2021. [DOI: 10.1080/01496395.2020.1812651] [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: 10/23/2022]
Affiliation(s)
- V.N.V Hima Bindu
- Department of Chemical Engineering, Indian Institute of Technology (IIT) Kharagpur, Kharagpur, West Bengal, India
| | | | - H. Siddiqi
- Department of Chemical Engineering, Indian Institute of Technology (IIT) Kharagpur, Kharagpur, West Bengal, India
| | - P.S. Dash
- Research and Development, Tata Steel, Jamshedpur, India
| | - S Ray
- Department of Chemical Engineering, Indian Institute of Technology (IIT) Kharagpur, Kharagpur, West Bengal, India
| | - B.C. Meikap
- Department of Chemical Engineering, Indian Institute of Technology (IIT) Kharagpur, Kharagpur, West Bengal, India
- Department of Chemical Engineering, School of Engineering, Howard College, University of Kwazulu-Natal, Durban, South Africa
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27
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Al Basir F, Kyrychko YN, Blyuss KB, Ray S. Effects of Vector Maturation Time on the Dynamics of Cassava Mosaic Disease. Bull Math Biol 2021; 83:87. [PMID: 34184133 PMCID: PMC8238769 DOI: 10.1007/s11538-021-00921-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
Many plant diseases are caused by plant viruses that are often transmitted to plants by vectors. For instance, the cassava mosaic disease, which is spread by whiteflies, has a significant negative effect on plant growth and development. Since only mature whiteflies can contribute to the spread of the cassava mosaic virus, and the maturation time is non-negligible compared to whitefly lifetime, it is important to consider the effects this maturation time can have on the dynamics. In this paper, we propose a mathematical model for dynamics of cassava mosaic disease that includes immature and mature vectors and explicitly includes a time delay representing vector maturation time. A special feature of our plant epidemic model is that vector recruitment is negatively related to the delayed ratio between vector density and plant density. We identify conditions of biological feasibility and stability of different steady states in terms of system parameters and the time delay. Numerical stability analyses and simulations are performed to explore the role of various parameters, and to illustrate the behaviour of the model in different dynamical regimes. We show that the maturation delay may stabilise epidemiological dynamics that would otherwise be cyclic.
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Affiliation(s)
- F Al Basir
- Department of Mathematics, Asansol Girls' College, Asansol, West Bengal, 713304, India
| | - Y N Kyrychko
- Department of Mathematics, University of Sussex, Falmer, Brighton, BN1 9QH, UK
| | - K B Blyuss
- Department of Mathematics, University of Sussex, Falmer, Brighton, BN1 9QH, UK.
| | - S Ray
- Systems Ecology and Ecological Modeling Laboratory, Department of Zoology, Visva-Bharati, Santiniketan, 731235, India
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28
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Ghosh A, Ray S, Garg MK, Chowdhury S, Mukhopadhyay S. The role of infrared dermal thermometry in the management of neuropathic diabetic foot ulcers. Diabet Med 2021; 38:e14368. [PMID: 32743838 DOI: 10.1111/dme.14368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
AIM This prospective observational study evaluated the role of infrared (IR) dermal thermometry in the management of diabetic foot ulcers. METHODS Thirty participants with unilateral neuropathic diabetic foot ulcers of University of Texas grade 1 or 2 (stage A) were followed up monthly for 1 year. At each visit, skin temperatures were measured with an IR dermal thermometer at corresponding sites on both feet, using the contralateral feet without ulcers as controls. RESULTS Average temperature and ulcer temperature in affected feet were significantly higher than in unaffected feet, with a mean difference of 1.2 °C [95% confidence interval (CI) 0.7 to 1.7] and 3.1 °C (95% CI 2.3 to 3.9), respectively. Although the gradient between average temperature of affected foot and that of unaffected foot normalized (mean difference 0.2 °C, 95% CI -0.2 to 0.7) at healing, the temperature gradient between the ulcer and a corresponding site on the unaffected foot decreased but did not normalize (mean difference 2.1 °C, 95% CI 1.2 to 3.1) even at healing, as documented by skin closure, and persisted for up to 1 month after skin closure. A gradient of ≥1 °C between average temperature of affected foot and that of unaffected foot at initial presentation or at any time during ulcer healing was found to predict impaired healing and should alert clinicians to ulcers requiring more attention. An incremental trend in temperature gradient (median difference 2.2 °C; range 0.1-6.3 °C) at a site on the foot was predictive of a recurrent ulcer involving the same site. CONCLUSIONS IR dermal thermometry may have a role in predicting diabetic foot ulcer healing, in determining the completeness of healing and in guiding the duration of offloading. Serial monitoring of the temperature gradient may predict the development of recurrent diabetic foot ulcers.
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Affiliation(s)
- A Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - S Ray
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - M K Garg
- Department of General Medicine and Endocrinology and Metabolism, All India Institute of Medical Sciences, Jodhpur, India
| | - S Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - S Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India
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29
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Power N, Chick W, Tan A, Gamlin W, Calisti G, Watt V, Price F, Dobson L, Ray S. Discrepancies between the decisions of an endocarditis team and the modified Duke's Criteria for the diagnosis of infective endocarditis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The 2015 ESC endocarditis guidelines recommend that a multi-disciplinary endocarditis team should be involved in caring for patients with endocarditis. This approach recognises the heterogeneity of infective endocarditis, and the difficulty in distinguishing endocarditis from other infective and non-infective diseases.
Purpose
This study looks at suspected cases of infective endocarditis discussed at the endocarditis MDT, discrepancies between MDT outcome and the modified Duke's criteria in diagnosing endocarditis, and number of referrals to MDT over time.
Methods
Patients were identified by review of MDT outcome forms. Demographic data, predisposing conditions, imaging findings, microbiology results and final diagnosis were identified by reviewing MDT forms and electronic charts.
Results
234 patients were identified from MDT outcome forms. 118 (50.4%) patients were over 65, 165 (70.5%) were male, and 65 (27.8%) had previous valve surgery. Crosstabulation of MDT decision against outcome by modified Duke's criteria are seen in Table 1. The endocarditis team identified 7 patients with definite or possible endocarditis who were excluded by applying the modified Duke's criteria. 1 of these patients required aortic valve replacement. 2 patients with disseminated Staphylococcal infections without endocarditis were classed as definite endocarditis by the modified Duke's criteria. Referral data and outcomes are included in Figure 1.
Conclusions
The endocarditis team can be used to improve the sensitivity and specificity of the modified Duke's criteria. As the endocarditis team became established the volume of referrals has increased, along with the number of patients who have alternate diagnoses. Practitioners should bear this in mind when establishing endocarditis teams.
Figure 1. Referrals over time by outcome
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Power
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - W Chick
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - A Tan
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - W Gamlin
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - G Calisti
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - V Watt
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - F Price
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - L Dobson
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - S Ray
- University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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Santosham R, Chatterjee S, Chakraborty S, Mahata A, Mandal S, Das A, Kumari A, Ray S, Ahmed R. PO-0985: Hypofractionated radiotherapy with SIB in advanced incurable breast cancer-HYPORT B study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01003-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jeste S, Hyde C, Distefano C, Halladay A, Ray S, Porath M, Wilson RB, Thurm A. Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. J Intellect Disabil Res 2020; 64:825-833. [PMID: 32939917 DOI: 10.1111/jir.12776] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND COVID-19 restrictions have significantly limited access to in-person educational and healthcare services for all, including individuals with intellectual and developmental disabilities (IDDs). The objectives of this online survey that included both national and international families were to capture changes in access to healthcare and educational services for individuals with IDDs that occurred shortly after restrictions were initiated and to survey families on resources that could improve services for these individuals. METHODS This was an online survey for caregivers of individuals with (1) a genetic diagnosis and (2) a neurodevelopmental diagnosis, including developmental delay, intellectual disability, autism spectrum disorder or epilepsy. The survey assessed (1) demographics, (2) changes in access to educational and healthcare services and (3) available and preferred resources to help families navigate the changes in service allocation. RESULTS Of the 818 responses (669 within the USA and 149 outside of the USA), most families reported a loss of at least some educational or healthcare services. Seventy-four per cent of parents reported that their child lost access to at least one therapy or education service, and 36% of respondents lost access to a healthcare provider. Only 56% reported that their child received at least some continued services through tele-education. Those that needed to access healthcare providers did so primarily through telemedicine. Telehealth (both tele-education and telemedicine) was reported to be helpful when available, and caregivers most often endorsed a need for an augmentation of these remote delivery services, such as 1:1 videoconference sessions, as well as increased access to 1:1 aides in the home. CONCLUSIONS COVID-19 restrictions have greatly affected access to services for individuals with syndromic IDDs. Telehealth may provide opportunities for delivery of care and education in a sustainable way, not only as restrictions endure but also after they have been lifted.
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Affiliation(s)
- S Jeste
- Semel Institute for Neuroscience, UCLA, Los Angeles, CA, USA
| | - C Hyde
- Semel Institute for Neuroscience, UCLA, Los Angeles, CA, USA
| | - C Distefano
- Semel Institute for Neuroscience, UCLA, Los Angeles, CA, USA
| | - A Halladay
- Autism Science Foundation, New York, NY, USA
- Department of Pharmacology and Toxicology, Rutgers University, Newark, NJ, USA
| | - S Ray
- The Mighty, Glendale, CA, USA
| | | | - R B Wilson
- Semel Institute for Neuroscience, UCLA, Los Angeles, CA, USA
| | - A Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, NIH, DHHS, Bethesda, MD, USA
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Ray S. Mobile Teaching Kitchen Project – eradicating and preventing malnutrition through nutrition education. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Global malnutrition, affecting over 2.6 billion people globally, represents a triple burden to health in the form of micronutrient deficiencies, under-and over-nutrition. Malnutrition reaches all parts of society, with those undernourished and deficient in vitamins and minerals often thought to be the poorer in society, whilst overnourished those wealthier. NNEdPro, an international think-tank working to develop nutrition capacity, performed a landscaping activity in Kolkata, India and noted significant undernutrition within the slum dwelling population and overnutrition among the inner-city workers.
Results
NNEdPro' s Mobile Teaching Kitchen (MTK) project was developed as a nutritional education tool to improve awareness of diet diversity and disease prevention amongst marginalised communities by using locally sourced foods and cooking skills. Local volunteers trained in healthy cooking transfers core principles through cooking demonstrations of sustainable, nutritional, and affordable meals. They follow a 'See One, Do One, Teach One' (S1D1T1) model to transfer knowledge to their peers. This model aims to create a sustainable solution that will enable the rural-urban slum dwellers across regions of the world to challenge food insecurity and malnutrition.
Conclusions
The potential of the Teaching Kitchen can extend beyond creating powerful behavior change for improved health and nutrition within local communities of both developing and developed countries. In addition to improving the wellbeing of the community, the project can also potentially create livelihood opportunities through empowering women with catering skills and having a positive impact on the health and nutritional status of the wider community. After successful impacts in India, the Mobile Teaching Kitchen model has been proposed to other 8 existing regional networks of NNEdPro such as Australia & New Zealand, Brazil, Italy, Mexico, Morocco, Switzerland, USA, and UK.
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Affiliation(s)
- S Ray
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
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Banerjee A, Ray S, Vorselaars B, Kitson J, Mamalakis M, Weeks S, Baker M, Mackenzie LS. Use of Machine Learning and Artificial Intelligence to predict SARS-CoV-2 infection from Full Blood Counts in a population. Int Immunopharmacol 2020; 86:106705. [PMID: 32652499 PMCID: PMC7296324 DOI: 10.1016/j.intimp.2020.106705] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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: 05/15/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
Since December 2019 the novel coronavirus SARS-CoV-2 has been identified as the cause of the pandemic COVID-19. Early symptoms overlap with other common conditions such as common cold and Influenza, making early screening and diagnosis are crucial goals for health practitioners. The aim of the study was to use machine learning (ML), an artificial neural network (ANN) and a simple statistical test to identify SARS-CoV-2 positive patients from full blood counts without knowledge of symptoms or history of the individuals. The dataset included in the analysis and training contains anonymized full blood counts results from patients seen at the Hospital Israelita Albert Einstein, at São Paulo, Brazil, and who had samples collected to perform the SARS-CoV-2 rt-PCR test during a visit to the hospital. Patient data was anonymised by the hospital, clinical data was standardized to have a mean of zero and a unit standard deviation. This data was made public with the aim to allow researchers to develop ways to enable the hospital to rapidly predict and potentially identify SARS-CoV-2 positive patients. We find that with full blood counts random forest, shallow learning and a flexible ANN model predict SARS-CoV-2 patients with high accuracy between populations on regular wards (AUC = 94-95%) and those not admitted to hospital or in the community (AUC = 80-86%). Here, AUC is the Area Under the receiver operating characteristics Curve and a measure for model performance. Moreover, a simple linear combination of 4 blood counts can be used to have an AUC of 85% for patients within the community. The normalised data of different blood parameters from SARS-CoV-2 positive patients exhibit a decrease in platelets, leukocytes, eosinophils, basophils and lymphocytes, and an increase in monocytes. SARS-CoV-2 positive patients exhibit a characteristic immune response profile pattern and changes in different parameters measured in the full blood count that are detected from simple and rapid blood tests. While symptoms at an early stage of infection are known to overlap with other common conditions, parameters of the full blood counts can be analysed to distinguish the viral type at an earlier stage than current rt-PCR tests for SARS-CoV-2 allow at present. This new methodology has potential to greatly improve initial screening for patients where PCR based diagnostic tools are limited.
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Affiliation(s)
- Abhirup Banerjee
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, OX3 7DQ, UK.
| | - Surajit Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow G12 8QW, UK.
| | - Bart Vorselaars
- School of Mathematics and Physics, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK.
| | - Joanne Kitson
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Maths, University of Bristol, Merchant Venturers Building, Woodland Rd, Clifton, Bristol BS8 1UB, UK
| | - Michail Mamalakis
- School of Computer Science, University of Sheffield, 211 Portobello, Sheffield City Centre, Sheffield S1 4DP, UK
| | - Simonne Weeks
- School of Pharmacy and Biomedical Sciences, University of Brighton, BN2 4GJ, UK
| | - Mark Baker
- Hypatia Solutions Ltd, Impact Hub King's Cross, 34b York Way, King's Cross, London, XGL N1, UK
| | - Louise S Mackenzie
- School of Pharmacy and Biomedical Sciences, University of Brighton, BN2 4GJ, UK.
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Gupta R, Das MK, Mohanan PP, Deb PK, Parashar SK, Chopra HK, Shrivastava S, Guha S, Goswami KC, Yadav R, Alagesan R, Amuthan V, Bansal M, Chakraborty RN, Chakraborti N, Chandra S, Chatterjee A, Chatterjee D, Chatterjee SS, Dutta AL, De A, Garg A, Garg VK, Goyal A, Goyal NK, Govind SC, Gupta VK, Hasija PK, Jabir A, Jain P, Jain V, Jayagopal PB, Kasliwal RR, Katyal VK, Kerkar PG, Khan AK, Khanna NN, Mandal M, Majumder B, Mishra SS, Meena CB, Naik N, Narain VS, Pancholia AK, Pathak LA, Ponde CK, Raghu K, Ray S, Roy D, Sarma D, Shanmugasundarum S, Singh BP, Tyagi S, Vijayaraghavan G, Wander GS, Wardhan H, Nanda NC. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19. Indian Heart J 2020; 72:145-150. [PMID: 32768012 PMCID: PMC7250084 DOI: 10.1016/j.ihj.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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Affiliation(s)
- Rakesh Gupta
- JROP Institute of Echocardiography, Ultrasound & Vascular Doppler, JROP Healthcare Pvt. Ltd., C-1/16, Ashok Vihar-II, Delhi, 110052, India; JROP Charak Heart City, MD City Hospital, Model Town Northex, Delhi, 110009, India.
| | - Mrinal Kanti Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - S K Parashar
- Metro Heart Hospital, Lajpat Nagar, New Delhi, India
| | | | | | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | - V Amuthan
- Jeyalakshmi Heart Center, Madurai, Tamilnadu, India
| | - M Bansal
- Medanta, The Medicity, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - N Chakraborti
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - D Chatterjee
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - A De
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Garg
- Jaipur Heart Institute, Jaipur, India
| | - V K Garg
- R D Gardi Medical College, Ujjain, India
| | - A Goyal
- Bani Park Hospital, Jaipur, India
| | - N K Goyal
- BLK Superspeciality Hospital, New Delhi, India
| | | | - V K Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, India
| | | | - A Jabir
- Lisie Hospital Kochi, Kerala, India
| | - P Jain
- Lifeline Superspeciality Hospital, Jhansi, India
| | - V Jain
- Choithram Hospital &R.C., Indore, India
| | | | | | | | | | | | | | - M Mandal
- NRS Medical College, Kolkata, India
| | - B Majumder
- R.G. Kar Medical College & Hospital, Kolkata, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan
| | | | - V S Narain
- King George's Medical University, Lucknow, India
| | | | - L A Pathak
- Nanavati Heart Institute, Nanavati Superspeciality Hospital, Mumbai, India
| | - C K Ponde
- PD Hinduja National Hospital & RC, Mumbai, India
| | - K Raghu
- Care Hospital, Hyderabad, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - N C Nanda
- University of Alabama at Birmingham, Birmingham, AL, USA
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Kerkar PG, Naik N, Alexander T, Bahl VK, Chakraborty RN, Chatterjee SS, Chopra HK, Dani SI, Deb PK, Goswami KC, Guha S, Gupta R, Gupta V, Hasija PK, Jayagopal PB, Justin Paul G, Kahali D, Katyal VK, Khanna NN, Mandal M, Mishra SS, Mohanan PP, Mullasari A, Mehta S, Pancholia AK, Ray S, Roy D, Shanmugasundarm S, Sharma S, Singh BP, Tewari S, Tyagi SK, Venugopal KN, Wander GS, Yadav R, Das MK. Cardiological Society of India: Document on acute MI care during COVID-19. Indian Heart J 2020; 72:70-74. [PMID: 32534693 PMCID: PMC7201231 DOI: 10.1016/j.ihj.2020.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.
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Affiliation(s)
- P G Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Naik
- All India Institute of Medical Sciences, New Delhi, India
| | - T Alexander
- Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - V K Bahl
- All India Institute of Medical Sciences, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S S Chatterjee
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | | | - S I Dani
- Apollo Hospital, Ahmedabad, Gujarat, India
| | - P K Deb
- Daffodil Hospital, Kolkata, West Bengal, India
| | - K C Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | - S Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | - R Gupta
- JROP Healthcare, New Delhi, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, India
| | - P K Hasija
- Armed Forces Medical College, Pune, Maharashtra, India
| | | | | | - D Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | - V K Katyal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - N N Khanna
- Indraprastha Apollo Hospital, New Delhi, India
| | - M Mandal
- NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | - A Mullasari
- Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - S Mehta
- University of Miami, Florida, USA
| | | | - S Ray
- Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
| | - D Roy
- Rabindranath Tagore International Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - K N Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - G S Wander
- Dayanand Medical College, Ludhiana, Punjab, India
| | - R Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - M K Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India.
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Harikrishnan S, Mohanan PP, Chopra VK, Ambuj R, Sanjay G, Bansal M, Chakraborty RN, Chandra S, Chattarjee SS, Chopra HK, Mathew C, Deb PK, Goyal A, Goswami KC, Gupta R, Guha S, Gupta V, Hasija PK, Wardhan H, Jabir A, Jayagopal PB, Kahali D, Katyal VK, Kerkar PG, Khanna NN, Majumder B, Mandal M, Meena CB, Naik N, Narain VK, Pathak LA, Ray S, Roy D, Routray SN, Sarma D, Shanmugasundaram S, Singh BP, Tyagi SK, Venugopal K, Wander GS, Yadav R, Das MK. Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart J 2020; 72:75-81. [PMID: 32405088 PMCID: PMC7219407 DOI: 10.1016/j.ihj.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | | | | | | | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | - P K Deb
- Daffodil Hospitals, Kolkata, India
| | - A Goyal
- Bani Park Hospital, D-9, Kabir Marg, Bani Park, JAIPUR, 302016, Rajasthan, India
| | | | - R Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | - S Guha
- Medical College, Kolkata, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, Punjab, India
| | - P K Hasija
- MH Chennai, Armed Forces Medical Services, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - D Kahali
- C.K.Birla Group of Hospitals (BMB), Kolkata, India
| | | | | | - N N Khanna
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - B Majumder
- R.G. Kar Medical College, Kolkata, India
| | - M Mandal
- NRS Medical College, Kolkata, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan, India
| | | | - V K Narain
- King George's Medical University, Lucknow, India
| | - L A Pathak
- Nanavati Superspeciality Hospital, Mumbai, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S K Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | | | | | - M K Das
- C.K. Birla Group of Hospitals (BMB/CMRI), Kolkata, India
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Loeb S, Ray S, Salter C, Wittmann D, Nelson C, Mulhall J. 163 Sexual Concerns of Female Partners of Prostate Cancer Patients: Novel Data from an Online Health Community. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.109] [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: 10/25/2022]
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Yadav R, Ray S, Kumar G, Pal P, Kutty B. Sleep and other non motor abnormalities in Indian patients with cervical dystonia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1197] [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: 11/17/2022]
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Bhat S, Mocciaro G, Ray S. The association of dietary patterns and carotid intima-media thickness: A synthesis of current evidence. Nutr Metab Cardiovasc Dis 2019; 29:1273-1287. [PMID: 31669106 DOI: 10.1016/j.numecd.2019.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
AIMS Dietary pattern (DP) analysis has emerged as a holistic method to understand the effects of food intake on health outcomes. Though dietary intake has been associated with cardiovascular disease, the association of DPs and carotid intima-media thickness (CIMT), a robust early marker of cardiovascular disease progression has not been comprehensively investigated. This study systematically explores the association of a posteriori and a priori DPs and CIMT. DATA SYNTHESIS Through a systematic search of MEDLINE, CINAHL, and Web of Science, twenty studies that derived DPs using a posteriori or a priori methods with CIMT as an outcome were included. Four cross-sectional studies and 1 cohort paper reported a statistically significant association between increased consumption of 'unhealthy' foods (i.e processed meat, soda drinks and refined grain) and increased CIMT. While four cross-sectional studies reported a statistically significant association of DPs characterized by increased consumption of 'healthy' foods (i.e fruit and vegetables, fish) and decreased CIMT. DPs derived from each study varied depending on derivation method, study design and use of dietary data collection method. CONCLUSION Findings from this review are generally supportive of a trend between DPs with higher consumption of 'healthy' foods and lower consumption of 'unhealthy' foods and decreased CIMT; however, the association was largely not statistically significant. Evidence was overwhelmingly heterogeneous due to differences seen in DPs based on location and culture, sample characteristics and adjustment for confounders. Long-term prospective observational and interventional studies with standardized sample selection and dietary data collection are needed to significantly establish the role of DPs on CIMT.
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Affiliation(s)
- S Bhat
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, SE1 1UL, UK; MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, CB4 0WS, UK.
| | - G Mocciaro
- MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, CB4 0WS, UK
| | - S Ray
- MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, CB4 0WS, UK
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Bang CN, Greve AM, Boman K, Egstrup K, Olsen MH, Kober L, Nienaber CA, Ray S, Rossebo AM, Nielsen OW, Willenheimer R, Wachtell K. P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0628] [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
Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied.
Methods
We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF.
Results
During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05).
Figure 1
Conclusions
In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.
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Affiliation(s)
- C N Bang
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - A M Greve
- Rigshospitalet - Copenhagen University Hospital, Clinical Biochemistry, Copenhagen, Denmark
| | - K Boman
- Skelleftea Hospital, Department of Medicine, Skeleftaa Laseratt, Umeå University Hospital, Skelleftea, Sweden
| | - K Egstrup
- Svendborg Hospital, Department of Medicine, Svendborg, Denmark
| | - M H Olsen
- Holbaek Hospital, Cardiology, Holbaek, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - C A Nienaber
- University Hospital Rostock, Cardiology, Rostock, Germany
| | - S Ray
- Manchester Academic Health Sciences Centre, Cardiology, Manchester, United Kingdom
| | - A M Rossebo
- Ulleval University Hospital, Cardiology, Oslo, Norway
| | - O W Nielsen
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | | | - K Wachtell
- Oslo University Hospital, Cardiology, Oslo, Norway
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Ray S, Sanyal S, Das S, Jana K, Das AK, Khamrui S. Outcomes of surgery for post-cholecystectomy bile duct injuries: An audit from a tertiary referral center. J Visc Surg 2019; 157:3-11. [PMID: 31427102 DOI: 10.1016/j.jviscsurg.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY Bile duct injury (BDI) after cholecystectomy is a serious complication. It often requires surgical repair. The aim of this study was to report on the short and long-term outcomes of surgery for post-cholecystectomy BDI. PATIENTS AND METHODS All the patients, who underwent surgery for post-cholecystectomy BDI between August 2007 and September 2017, were retrospectively reviewed. McDonald grading system was used to assess the long-term outcome. The risk factors for unsatisfactory long-term outcome were analyzed by univariate and multivatiate logistic regression analysis. RESULTS In total, 228 patients had a Roux-en-Y hepaticojejunostomy. Open cholecystectomy was the major cause of BDI (61%). The median time from injury to definitive repair was 6 months. The types of BDI were as follows: E1 in 13 (5.7%), E2 in 68 (29.82%), E3 in 108 (47.36%), E4 in 28 (12.28%), and E5 in 11 (4.82%) patients respectively. Postoperative morbidity and mortality were 25% and 1.31% respectively. After a median follow-up of 58 months, 90% patients had excellent to good outcome. Recurrent stricture developed in 6 (3%) patients. On multivariate analysis, long injury-repair interval and previous attempt at repair were independent predictors for unsatisfactory long-term outcome. CONCLUSION Surgical reconstruction affords excellent to good results for majority of the patients with post-cholecystectomy BDI. As longer delay in definitive repair and previous attempt at repair were associated with unsatisfactory long-term outcome, early referral to a specialized hepatobiliary surgery unit is recommended.
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Affiliation(s)
- S Ray
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India.
| | - S Sanyal
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - S Das
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - K Jana
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - A K Das
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - S Khamrui
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
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Hackman J, Falade-Nwulia O, Mehta S, Downing Z, Kirk G, Ray S, Thomas D, Laeyendecker O. A23 Population level diversification of hepatitis C viral strains over time among people who inject drugs in Baltimore, MD. Virus Evol 2019. [PMCID: PMC6736091 DOI: 10.1093/ve/vez002.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Hepatitis C virus (HCV) infection occurs in 30–90 per cent of people who inject drugs (PWID). Although cure rates can exceed 95 per cent, treatment access is limited and approximately 400,000 people die each year due to complications of chronic infection. A temporal analysis of cluster networks among PWID can be used to inform strategies to interdict transmission. In Baltimore, PWID have been recruited for The AIDS Linked to the IntraVenous Experience (ALIVE) cohort. A demographic questionnaire was administered and recorded for baseline and recent participants. Viral RNA underwent PCR with primers targeting the core and envelope-1 protein (CE1) and sequenced via Sanger sequencing. Sequences with > 400 bp reads and Q-scores >370 were used for downstream analysis resulting in 322 ALIVE baseline participants (1988–9) and 548 recently diagnosed subjects enrolled approximately two decades later (2005–16). Cluster networks were rendered with a threshold of 4 per cent in MicrobeTRACE, and statistical analyses were performed in R Studio. Of the 1988–9 subjects, the majority (259/317, 81.7%) were a part of cluster. There were nine clusters and fifty-eight singletons, with two large clusters containing most sequences of genotype 1a (73.5%). Two decades later, a minority of recently diagnosed individuals (235/512, 44.1%) were part of a cluster. There were seventeen clusters with 286 singletons with two large clusters containing 1a genotype individuals (21.5%). Additional clustering was done by parsing the two datasets by subtype 1a (n = 714) and 1b (n = 151). The genotype 1a network demonstrates a majority, 65.8 per cent, of participants in clusters. Moreover, two large clusters can be observed with baseline participants towards the center and recent participants on the outskirts indicative of high linkage at baseline. The genotype 1b network produced a single large cluster but subclusters were observed. The sequences between the two time points co-mingled but subclusters were also observed. Interestingly, the two large clusters from 1988 to 1989 were still evident in the 2005–16 viral sequences. We observed greater cluster diversity in more recently diagnosed individuals, indicative of a less connected network of individuals sharing transmission risk, though major viral strains did persist over time in this cohort.
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Affiliation(s)
- J Hackman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Mehta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Z Downing
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Kirk
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Ray
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Laeyendecker
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Deng X, Ray S, Sinha S, Shlyapnikov GV, Santos L. One-Dimensional Quasicrystals with Power-Law Hopping. Phys Rev Lett 2019; 123:025301. [PMID: 31386526 DOI: 10.1103/physrevlett.123.025301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/04/2019] [Indexed: 06/10/2023]
Abstract
One-dimensional quasiperiodic systems with power-law hopping, 1/r^{a}, differ from both the standard Aubry-André (AA) model and from power-law systems with uncorrelated disorder. Whereas in the AA model all single-particle states undergo a transition from ergodic to localized at a critical quasidisorder strength, short-range power-law hops with a>1 can result in mobility edges. We find that there is no localization for long-range hops with a≤1, in contrast to the case of uncorrelated disorder. Systems with long-range hops rather present ergodic-to-multifractal edges and a phase transition from ergodic to multifractal (extended but nonergodic) states. Both mobility and ergodic-to-multifractal edges may be clearly revealed in experiments on expansion dynamics.
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Affiliation(s)
- X Deng
- Institut für Theoretische Physik, Leibniz Universität Hannover, Appelstr. 2, 30167 Hannover, Germany
| | - S Ray
- Indian Institute of Science Education and Research, Kolkata, Mohanpur, Nadia 741246, India
| | - S Sinha
- Indian Institute of Science Education and Research, Kolkata, Mohanpur, Nadia 741246, India
| | - G V Shlyapnikov
- LPTMS, CNRS, Universite Paris Sud, Universite Paris-Saclay, Orsay 91405, France
- SPEC, CEA, CNRS, Universite Paris-Saclay, CEA Saclay, Gif sur Yvette 91191, France
- Russian Quantum Center, Skolkovo, Moscow 143025, Russia
- Van der Waals-Zeeman Institute, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
- Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, 430071 Wuhan, China
| | - L Santos
- Institut für Theoretische Physik, Leibniz Universität Hannover, Appelstr. 2, 30167 Hannover, Germany
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Cherian R, Sandeman S, Ray S, Savina I, J. A, P.V. M. Green synthesis of Pluronic stabilized reduced graphene oxide: Chemical and biological characterization. Colloids Surf B Biointerfaces 2019; 179:94-106. [DOI: 10.1016/j.colsurfb.2019.03.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Alagboso FI, Budak M, Sommer U, Ray S, Kaiser A, Kampschulte M, Henss A, Dürselen L, Biehl C, Lips KS, Heiss C, Thormann U, Alt V. Establishment of a clinically relevant large animal model to assess the healing of metaphyseal bone. Eur Cell Mater 2019; 37:444-466. [PMID: 31219613 DOI: 10.22203/ecm.v037a27] [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: 01/31/2023] Open
Abstract
Despite the high incidence of metaphyseal bone fractures in patients, the mechanisms underlying the healing processes are poorly understood due to the lack of suitable experimental animal models. Hence, the present study was conducted to establish and characterise a clinically relevant large-animal model for metaphyseal bone healing. Six female adult Merino sheep underwent full wedge-shaped osteotomy at the distal left femur metaphysis. The osteotomy was stabilised internally with a customised anatomical locking titanium plate that allowed immediate post-operative full-weight bearing. Bone healing was evaluated at 12 weeks post-fracture relative to the untouched right femur. Histological and quantitative micro-computed tomography results revealed an increased mineralised bone mass with a rich bone microarchitecture. New trabeculae healed by direct intramembranous ossification, without callus and cartilaginous tissue formation. Stiffness at the cortical and trabecular regions was comparable in both groups. Functional morphological analysis of the osteocyte lacunae revealed regularly arranged spherically shaped lacunae along with the canalicular network. Bone surface biochemical analysis using time-of-flight secondary-ion mass spectrometry showed high and homogeneously distributed levels of calcium and collagenous components. Ultrastructure imaging of the new trabeculae revealed a characteristic parallel arrangement of the collagen fibrils, evenly mineralised by the dense mineral substance. The specialised bone cells were also characterised by their unique structural features. Bone remodelling in the fractured femur was evident in the higher expression levels of prominent bone formation and resorption genes. In conclusion, the novel metaphyseal fracture model is beneficial for studying healing and treatment options for the enhancement of metaphyseal bone defects.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - V Alt
- Department of Trauma Surgery, University Medical Centre, Regensburg,
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Matettore A, Ray S, Harrison DA, Brick T, Macrae D, Peters MJ, Inwald DP. Paediatric intensive care admission blood pressure and risk of death in 30,334 children. Intensive Care Med 2019; 45:1482-1483. [PMID: 31087115 DOI: 10.1007/s00134-019-05638-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- A Matettore
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.
| | - S Ray
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.,Respiratory, Critical Care and Anaesthesia Section, UCL GOS Institute of Child Health, London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Network, London, UK
| | - T Brick
- Cardiac Critical Care, Great Ormond Street Hospital NHS Trust, London, UK
| | - D Macrae
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - M J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, WC1N 3JH, UK.,Respiratory, Critical Care and Anaesthesia Section, UCL GOS Institute of Child Health, London, UK
| | - D P Inwald
- Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Squiers L, Lynch M, Dolina S, Ray S, Kelly B, Herrington J, Turner M, Chawla D, Becker-Dreps S, Stamm L, McCormack L. Zika and travel in the news: a content analysis of US news stories during the outbreak in 2016-2017. Public Health 2019; 168:164-167. [PMID: 30772009 DOI: 10.1016/j.puhe.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/08/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to understand what information the US media communicated about Zika virus (ZIKV) and travel in 2016 and 2017. STUDY DESIGN We conducted a content analysis of news coverage about ZIKV and travel from April 5, 2016 to March 31, 2017. METHODS We obtained a stratified, random sample of English language, US print newspaper and television news coverage about ZIKV and travel. We developed a coding scheme to assess key messages in the news, including how ZIKV is transmitted, the symptoms and outcomes of ZIKV infection, and recommended prevention behaviors. RESULTS Almost all news stories mentioned mosquito-borne transmission (96.8%) and just over half mentioned sexual transmission (55.3%). News stories were more likely to talk about ZIKV outcomes (78.8%) than ZIKV symptoms (40.6%). However, outcomes affecting babies were mentioned more frequently than outcomes affecting adults. Recommendations included a wide array of protective behaviors, such as delaying or avoiding travel (77.6%) and using mosquito repellent (41.0%). However, few studies (10.9%) mentioned barriers to practicing ZIKV prevention behaviors. CONCLUSIONS Public health organizations and professionals can use these findings to help improve communication about future outbreaks of mosquito-borne illnesses. We also recommend conducting real-time monitoring of news media and frequent content analysis of news stories to ensure coverage provides the information the public needs.
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Affiliation(s)
- L Squiers
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - M Lynch
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - S Dolina
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - S Ray
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - B Kelly
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
| | - J Herrington
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - M Turner
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - D Chawla
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - S Becker-Dreps
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA; University of North Carolina School of Medicine, University of North Carolina, 321 S Columbia St., Chapel Hill, NC, USA.
| | - L Stamm
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC, USA.
| | - L McCormack
- RTI International, P.O. Box 12194, Research Triangle Park, NC, USA.
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Roy B, Basu S, Guha S, Manir K, Ahmed M, Ray S, Gangopadhayay M. Feasibility of cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei in a rural hospital in India. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.488] [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: 10/27/2022] Open
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Adak M, Aditya TL, Adnan M, Ahmad S, Ahmed M, Akram R, Alam M, Hossain MA, Alharby HF, Ali MA, Ali M, Ali S, Amanullah, Amin A, Amitha Mithra S, Anee TI, Ansar Ali M, Arif M, Arif MS, Ashraf MA, Bakhat HF, Banerjee A, Bararpour T, Basir A, Bhandari H, Bhuiyan TF, Biswas JC, Biswas JK, Biswas PS, Borgohain D, Bukhari SA, Chakraborty K, Chattopadhyay K, Chaturvedi V, Choudhury S, Datir S, De AK, Dubey RS, Fahad S, Fahimirad S, Farooq MA, Fujita M, Ghorbanpour M, Ghosh A, Gill RA, Gupta M, Gupta P, Gupta S, Hakeem KR, Halder T, Hammad HM, Hannan F, Hasanuzzaman M, Hasnu S, Hassan S, Hidayatullah, Hu L, Huang J, Hussain I, Hussain S, Hussain S, Iftekharuddaula K, Ihsan MZ, Ihtisham M, Ijaz M, Ijaz M, Iqbal M, Islam F, Ismail A, Jamal Y, Jan A, Jan M, Jan T, Jini D, Joseph B, Kabir MS, Kadir NA, Kaleem S, Kalita J, Kamran M, Kasajima I, Kaur G, Kaur N, Khan IA, Khan MH, Khan MJ, Khan MA, Khan SU, Khare T, Khatun H, Korres NE, Kumar N, Kumar V, Lahkar L, Lam SS, Li L, Li M, Long M, Ma NL, Mahalder BK, Mahmood R, Mahmood-ur-Rahman, Malik K, Mallick S, Maqbool MM, Masood N, Mian IA, Mohammed AR, Morita S, Mubarik MS, Mubeen M, Mwamba TM, Nahar K, Naher U, Nasim W, Nessa B, Niazi NK, Noor M, Nordin MMA, Nyong’a TM, Panda D, Panda SK, Pandey P, Panthri M, Pareek A, Parmar B, Pati PK, Pradhan AK, Prakash C, Price AJ, Qamar S, Rahman IU, Rahman MS, Rasheed R, Rashid MM, Rasool A, Rasul F, Ray S, Rehman A, Riaz M, Rizwan M, Roychoudhury A, Roychowdhury R, Saha I, Salam MU, Saleem I, Sandhu N, Sarkar B, Sarkar MAR, Sarkar R, Saud S, Sevanthi AM, Shah K, Shah Z, Shahzad B, Shahzad SM, Shakoor MB, Shalahuddin A, Shandilya ZM, Shanmugavadivel P, Shriram V, Sihag MK, Singh V, Singla-Pareek SL, Slaton NA, Sultana SR, Tan SH, Tanti B, Tanveer M, Tarpley L, Turan V, Ullah H, Upadhyaya H, ur Rahman MH, Varanasi VK, Wahid F, Wan G, Wang D, Wang J, Wu C, Xu L, Yadav C, Yang C, Yang P, Yasmeen R, Yasmeen T, Zhou W. List of Contributors. Advances in Rice Research for Abiotic Stress Tolerance 2019:xxix-xli. [DOI: 10.1016/b978-0-12-814332-2.00053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Grosso G, Godos J, Lafranconi A, Ray S. Major food groups and health: evidence from umbrella reviews of observational studies. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Grosso
- University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - J Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - A Lafranconi
- The Research Centre on Public Health, University Milano-Bicocca, Milano, Italy
| | - S Ray
- The Need for Nutrition Education/Innovation Programme, Cambridge, UK
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