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Brown J, Paggiosi MA, Rathbone E, Gregory W, Bertelli G, Din O, McCloskey E, Dodwell D, Cameron D, Eastell R, Coleman R. Prolonged bone health benefits for breast cancer patients following adjuvant bisphosphonate therapy: the BoHFAB study. J Bone Miner Res 2024; 39:8-16. [PMID: 38630878 DOI: 10.1093/jbmr/zjad006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/22/2023] [Accepted: 11/01/2023] [Indexed: 04/19/2024]
Abstract
Adjuvant bisphosphonates are often recommended in postmenopausal women with early breast cancer at intermediate-to-high risk of disease recurrence, but the magnitude and duration of their effects on bone mineral density (BMD) and bone turnover markers (BTMs) are not well described. We evaluated the impact of adjuvant zoledronate on areal BMD and BTMs in a sub-group of patients who had completed the large 5-yr randomized Adjuvant Zoledronic Acid to Reduce Recurrence (AZURE) trial. About 224 women (recurrence free) who had completed the AZURE trial within the previous 3 mo were recruited from 20 UK AZURE trial sites. One hundred twenty had previously been randomized to zoledronate (19 doses of 4 mg over 5 yr) and 104 to the control arm. BMD and BTMs were assessed at sub-study entry, 6 (BTMs only), 12, 24, and 60 mo following the completion of AZURE. As expected, mean BMD, T-scores, and Z-scores at sub-study entry were higher in the zoledronate vs the control arm. At the lumbar spine, the mean (SD) standardized BMD (sBMD) was 1123 (201) and 985 (182) mg/cm2 in the zoledronate and control arms, respectively (P < .0001). The baseline differences in sBMD persisted at all assessed skeletal sites and throughout the 5-yr follow-up period. In patients completing zoledronate treatment, BTMs were significantly lower than those in the control arm (α- and β-urinary C-telopeptide of type-I collagen, both P < .00001; serum intact pro-collagen I N-propeptide, P < .00001 and serum tartrate-resistant acid phosphatase 5b, P = .0001). Some offset of bone turnover inhibition occurred in the 12 mo following the completion of zoledronate treatment. Thereafter, during the 60 mo of follow-up, all BTMs remained suppressed in the zoledronate arm relative to the control arm. In conclusion, in addition to the known anti-cancer benefits of adjuvant zoledronate, there are likely to be positive, lasting benefits in BMD and bone turnover.
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Affiliation(s)
- Janet Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - Margaret A Paggiosi
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
| | - Emma Rathbone
- Huddersfield Royal Infirmary, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, HD3 3EA, United Kingdom
| | - Walter Gregory
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Gian Bertelli
- Sussex Cancer Centre, University Hospitals Sussex NHS Trust, Bristol Gate, Brighton, BN2 5BD, United Kingdom
| | - Omar Din
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - Eugene McCloskey
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - David Dodwell
- Leeds General Infirmary, LeedsTeaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - David Cameron
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Crewe Road South, University of Edinburgh, Edinburgh, Edinburgh EH4 2XR, United Kingdom
| | - Richard Eastell
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - Robert Coleman
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, S10 2JF, United Kingdom
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Campbell DJ, Magliano DJ, Shaw JE. Prediction of cardiovascular death and non-fatal cardiovascular events by the Kidney age-Chronological age Difference (KCD) score in men and women of different ages in a community-based cohort. BMJ Open 2023; 13:e068494. [PMID: 36882235 PMCID: PMC10008409 DOI: 10.1136/bmjopen-2022-068494] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE We examined the utility of the Kidney age-Chronological age Difference (KCD) score, an age-adapted measure of kidney function, to identify increased cardiovascular (CV) death or non-fatal CV event risk in participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), a community-based cohort aged 23-95 years. DESIGN Cohort study. SETTING Community. PARTICIPANTS 11205 randomly selected participants from urban and nonurban areas across Australia. OUTCOME MEASURES Mortality status and underlying and contributory causes of death obtained from the Australian National Death Index, and non-fatal CV events from adjudicated hospital records. The association of CV death or non-fatal CV event risk with KCD score was examined using penalised spline curve analysis. RESULTS Of 11 180 participants with serum creatinine measurement at baseline and 5-year outcome data, there were 308 CV deaths or non-fatal CV events after 5 years. Penalised spline curve analysis showed similar progressive increase in CV death or non-fatal CV event risk with increasing KCD score in men and women, and participants aged <50 years to ≥80 years. Receiver operating characteristic curve analysis showed optimal discrimination at a KCD score ≥20 years (KCD20) for all participants. Among 148 participants aged<70 years with CV death or non-fatal CV event, KCD20 identified 24 (16%) participants, whereas estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 identified 8 (5%) participants (p=0.0001), with specificities of 95% and 99%, respectively (p<0.0001). CONCLUSION KCD20 predicted CV death or non-fatal CV event risk similarly in men and women of different ages in this population-based cohort. The higher sensitivity for prediction of CV death or non-fatal CV event risk in participants aged <70 years by KCD20 than by eGFR <60 mL/min/1.73 m2 offers opportunity for earlier renoprotective therapy in individuals with eGFR-associated increased CV death or non-fatal CV event risk.
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Affiliation(s)
- Duncan J Campbell
- Department of Molecular Cardiology, St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Nissen SE, Wolski K, Cho L, Nicholls SJ, Kastelein J, Leitersdorf E, Landmesser U, Blaha M, Lincoff AM, Morishita R, Tsimikas S, Liu J, Manning B, Kozlovski P, Lesogor A, Thuren T, Shibasaki T, Matei F, Silveira FS, Meunch A, Bada A, Vijan V, Bruun NE, Nordestgaard BG. Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease. Open Heart 2022; 9:e002060. [PMID: 36252994 PMCID: PMC9577925 DOI: 10.1136/openhrt-2022-002060] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Lipoprotein(a) (Lp(a)) is an important genetically determined risk factor for atherosclerotic vascular disease (ASCVD). With the development of Lp(a)-lowering therapies, this study sought to characterise patterns of Lp(a) levels in a global ASCVD population and identify racial, ethnic, regional and gender differences. METHODS A multicentre cross-sectional epidemiological study to estimate the prevalence of elevated Lp(a) in patients with a history of myocardial infarction, ischaemic stroke or peripheral artery disease conducted at 949 sites in 48 countries in North America, Europe, Asia, South America, South Africa and Australia between April 2019 and July 2021. Low-density lipoprotein cholesterol (LDL-C) and Lp(a) levels were measured either as mass (mg/dL) or molar concentration (nmol/L). RESULTS Of 48 135 enrolled patients, 13.9% had prior measurements of Lp(a). Mean age was 62.6 (SD 10.1) years and 25.9% were female. Median Lp(a) was 18.0 mg/dL (IQR 7.9-57.1) or 42.0 nmol/L (IQR 15.0-155.4). Median LDL-C was 77 mg/dL (IQR 58.4-101.0). Lp(a) in women was higher, 22.8 (IQR 9.0-73.0) mg/dL, than in men, 17.0 (IQR 7.1-52.2) mg/dL, p<0.001. Black patients had Lp(a) levels approximately threefold higher than white, Hispanic or Asian patients. Younger patients also had higher levels. 27.9% of patients had Lp(a) levels >50 mg/dL, 20.7% had levels >70 mg/dL, 12.9% were >90 mg/dL and 26.0% of patients exceeded 150 nmol/L. CONCLUSIONS Globally, Lp(a) is measured in a small minority of patients with ASCVD and is highest in black, younger and female patients. More than 25% of patients had levels exceeding the established threshold for increased cardiovascular risk, approximately 50 mg/dL or 125 nmol/L. TRIAL REGISTRATION NUMBER
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Affiliation(s)
- Steven E Nissen
- Cleveland Clinic Cardiovascular Coordinating Center, Cleveland, Ohio, USA
| | - Kathy Wolski
- Cleveland Clinic Cardiovascular Coordinating Center, Cleveland, Ohio, USA
| | - Leslie Cho
- Cleveland Clinic Cardiovascular Coordinating Center, Cleveland, Ohio, USA
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | | | - Eran Leitersdorf
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
- Israel and Faculty of Medicine, the Hebrew University, Jerusalem, Israel
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin Institute of Health, Berlin, Germany
| | - Michael Blaha
- Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - A Michael Lincoff
- Cleveland Clinic Cardiovascular Coordinating Center, Cleveland, Ohio, USA
| | - Ryuichi Morishita
- Center of Medical Innovation and Translational Research School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Sotirios Tsimikas
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Junhao Liu
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | - Brian Manning
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | | | | | - Tom Thuren
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | - Taro Shibasaki
- Saitama Sekishinkai Hospital, Sayama-city, Saitama, Japan
| | | | | | | | - Aysha Bada
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Vinod Vijan
- Vijan Cardiac & Critical Care Centre, Maharashtra, India
| | | | - Borge G Nordestgaard
- Copenhagen University Hospital - Herlev Gentofte, University of Copenhagen, Copenhagen, Denmark
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Cooksey R, Rahman MA, Kennedy J, Brophy S, Choy E. Biologic use in psoriatic arthritis and ankylosing spondylitis patients: a descriptive epidemiological study using linked, routine data in Wales, UK. Rheumatol Adv Pract 2021; 5:rkab042. [PMID: 34632260 PMCID: PMC8496109 DOI: 10.1093/rap/rkab042] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES PsA and AS are chronic diseases associated with significant morbidities. National and international management guidelines include treatment with biologic therapies to improve outcomes and quality of life. There are limited real-world data on the patients' journey from symptom onset to diagnosis and treatment in the UK. We use real-life, linked health data to explore patient pathways and the impact of biologics on patient outcomes. METHODS Data from the Secure Anonymised Information Linkage databank in Wales were used to assess diagnosis and treatment of patients ≥18 years of age with at least one International Classification of Diseases, Tenth Revision code present for PsA/AS in rheumatology clinic data and at least one Read code present in primary care records. We investigated the use of biologics while exploring demographics, comorbidities and surgical procedures of 641 AS patients and 1312 PsA patients. RESULTS AS patients were significantly younger at diagnosis and were predominantly male. The average time from presenting symptoms to diagnosis of AS and PsA was 7.9 (s.d. 5.5) and 9.3 (s.d. 5.5) years, respectively. The proportion of patients receiving biologic treatment was significantly higher in AS (46%) compared with PsA patients (28.8%); of these, 23.1% of AS and 22.2% of PsA patients stopped/switched a biologic. There was a significant reduction in primary care involvement, sick notes and disability living allowance for both AS and PsA patients following biologic initiation. CONCLUSION This real-world descriptive study confirms that patients treated with biologics have reduced disability and time off work despite being initiated ∼13 years after the first symptoms and 6 years after diagnosis.
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Affiliation(s)
- Roxanne Cooksey
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | | | - Jonathan Kennedy
- Health Data Research UK, Swansea University Medical
School, Swansea
| | - Sinead Brophy
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | - Ernest Choy
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
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Huusko J, Tuominen S, Studer R, Corda S, Proudfoot C, Lassenius M, Ukkonen H. Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure. ESC Heart Fail 2020; 7:2406-2417. [PMID: 32667143 PMCID: PMC7524224 DOI: 10.1002/ehf2.12792] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/29/2020] [Revised: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS The proportion of patients hospitalized for heart failure (HF) with preserved left ventricular ejection fraction (LVEF) is rising, but no approved treatment exists, in part owing to incomplete characterization of this particular HF phenotype. In order to better define the characteristics of HF phenotypes in Finland, a large cohort with 12 years' follow-up time was analysed. METHODS AND RESULTS Patients diagnosed between 2005 and 2017 at the Hospital District of Southwest Finland were stratified according to LVEF measure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. For this retrospective registry study, previously diagnosed HF patients were defined as follows: patients with reduced ejection fraction (HFrEF; LVEF ≤ 40%; n = 4042), mid-range ejection fraction (HFmrEF; LVEF > 40-50% and NT-proBNP ≥ 125 pg/mL; n = 1468), and preserved ejection fraction (HFpEF; LVEF > 50% and NT-proBNP ≥ 125 pg/mL; n = 3122) and followed up for 15 022, 4962, and 10 097 patient-years, respectively. Cardiovascular (CV) hospitalization and mortality, influence of pre-selected covariates on hospitalization and mortality, and the proportion of HFpEF and HFmrEF patients with a drop in LVEF to HFrEF phenotype were analysed. All data were extracted from the electronic patient register. HFrEF patients were rehospitalized slightly earlier than HFpEF/HFmrEF patients, but the second, third, and fourth rehospitalization rates did not differ between the subgroups. Female gender and better kidney function were associated with reduced rehospitalizations in HFmrEF and HFrEF, with a non-significant trend in HFpEF. Each additional hospitalization was associated with a two-fold increased risk of death and 2.2- to 2.3-fold increased risk of CV death. All-cause mortality was higher in patients with HFpEF. Although CV mortality was less frequent in HFpEF patients, it was associated with increased NT-proBNP concentrations at index in all patient groups. During the 10 years following the index date, 26% of HFmrEF patients and 10% of HFpEF patients progressed to an HFrEF phenotype. CONCLUSIONS These findings suggest that disease progression, in terms of increased frequency of hospitalizations, and the relationship between increased number of hospitalizations and mortality are similar by LVEF phenotypes. These data highlight the importance of effective treatments that can reduce hospitalizations and suggest a role for monitoring NT-proBNP levels in the management of HFpEF patients in particular.
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Zeymer U, Clark AL, Barrios V, Damy T, Drożdż J, Fonseca C, Lund LH, Comite GD, Hupfer S, Maggioni AP. Management of heart failure with reduced ejection fraction in Europe: design of the ARIADNE registry. ESC Heart Fail 2020; 7:727-736. [PMID: 32027782 PMCID: PMC7160498 DOI: 10.1002/ehf2.12569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/08/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The introduction of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor) is likely to change the approach to the management of patients with chronic heart failure with reduced ejection fraction (HFrEF). The Assessment of Real Life Care-Describing European Heart Failure Management (ARIADNE) registry will evaluate patient characteristics, practice patterns, outcomes, and healthcare resource utilization in the outpatient setting across Europe, with the main focus on factors that guide physicians' decisions to start and continue sacubitril/valsartan in patients with HFrEF. METHODS AND RESULTS ARIADNE, a prospective, observational registry will enrol 9000 ambulatory patients with HFrEF in 23 European countries Supplement 1. The study will describe 4500 patients treated with conventional treatment (including an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker), and 4500 patients started on sacubitril/valsartan. In each country, patients will be enrolled consecutively over an expected period of 12 months, and followed-up for 12 months. The primary objective is to describe the baseline clinical and demographic characteristics of patients with chronic HFrEF, which guide the decision of the treating physician to initiate sacubitril/valsartan or to continue conventional treatment. A co-primary objective is to identify the baseline characteristics that are associated with the likelihood of reaching the target dose of sacubitril/valsartan 97/103 mg twice daily during follow-up. CONCLUSIONS The ARIADNE registry will provide a comprehensive profile of patients with chronic HFrEF in Europe, will elucidate how management varies between countries, and will help clarify the usage and outcomes associated with use of sacubitril/valsartan in real life.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung LudwigshafenBremserstrasse 79Ludwigshafen67063Germany
| | - Andrew L. Clark
- Department of CardiologyHull York Medical School, Castle Hill HospitalKingston upon HullUK
| | | | - Thibaud Damy
- Department of CardiologyHenri Mondor HospitalCreteilFrance
| | | | - Candida Fonseca
- S. Francisco Xavier Hospital, NOVA Medical School, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
| | - Lars H. Lund
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
| | | | | | - Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research CenterFlorenceItaly
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Foreman J, Xie J, Keel S, Taylor HR, Dirani M. Treatment coverage rates for refractive error in the National Eye Health survey. PLoS One 2017; 12:e0175353. [PMID: 28407009 PMCID: PMC5391052 DOI: 10.1371/journal.pone.0175353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/08/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To present treatment coverage rates and risk factors associated with uncorrected refractive error in Australia. METHODS Thirty population clusters were randomly selected from all geographic remoteness strata in Australia to provide samples of 1738 Indigenous Australians aged 40 years and older and 3098 non-Indigenous Australians aged 50 years and older. Presenting visual acuity was measured and those with vision loss (worse than 6/12) underwent pinhole testing and hand-held auto-refraction. Participants whose corrected visual acuity improved to be 6/12 or better were assigned as having uncorrected refractive error as the main cause of vision loss. The treatment coverage rates of refractive error were calculated (proportion of participants with refractive error that had distance correction and presenting visual acuity better than 6/12), and risk factor analysis for refractive correction was performed. RESULTS The refractive error treatment coverage rate in Indigenous Australians of 82.2% (95% CI 78.6-85.3) was significantly lower than in non-Indigenous Australians (93.5%, 92.0-94.8) (Odds ratio [OR] 0.51, 0.35-0.75). In Indigenous participants, remoteness (OR 0.41, 0.19-0.89 and OR 0.55, 0.35-0.85 in Outer Regional and Very Remote areas, respectively), having never undergone an eye examination (OR 0.08, 0.02-0.43) and having consulted a health worker other than an optometrist or ophthalmologist (OR 0.30, 0.11-0.84) were risk factors for low coverage. On the other hand, speaking English was a protective factor (OR 2.72, 1.13-6.45) for treatment of refractive error. Compared to non-Indigenous Australians who had an eye examination within one year, participants who had not undergone an eye examination within the past five years (OR 0.08, 0.03-0.21) or had never been examined (OR 0.05, 0.10-0.23) had lower coverage. CONCLUSION Interventions that increase integrated optometry services in regional and remote Indigenous communities may improve the treatment coverage rate of refractive error. Increasing refractive error treatment coverage rates in both Indigenous and non-Indigenous Australians through at least five-yearly eye examinations and the provision of affordable spectacles will significantly reduce the national burden of vision loss in Australia.
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Affiliation(s)
- Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Hugh R. Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
- Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
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Alroughani R, Deleu D, El Salem K, Al-Hashel J, Alexander KJ, Abdelrazek MA, Aljishi A, Alkhaboori J, Al Azri F, Al Zadjali N, Hbahbih M, Sokrab TE, Said M, Rovira À. A regional consensus recommendation on brain atrophy as an outcome measure in multiple sclerosis. BMC Neurol 2016; 16:240. [PMID: 27881095 PMCID: PMC5121973 DOI: 10.1186/s12883-016-0762-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/07/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory and neurodegenerative processes leading to irreversible neurological impairment. Brain atrophy occurs early in the course of the disease at a rate greater than the general population. Brain volume loss (BVL) is associated with disability progression and cognitive impairment in patients with MS; hence its value as a potential target in monitoring and treating MS is discussed. METHODS A group of MS neurologists and neuro-radiologists reviewed the current literature on brain atrophy and discussed the challenges in assessing and implementing brain atrophy measurements in clinical practice. The panel used a voting system to reach a consensus and the votes were counted for the proposed set of questions for cognitive and brain atrophy assessments. RESULTS The panel of experts was able to identify recent studies, which demonstrated the correlation between BVL and future worsening of disability and cognition. The current evidence revealed that reduction of BVL could be achieved with different disease-modifying therapies (DMTs). BVL provided a better treatment and monitoring strategy when it is combined to the composite measures of "no evidence of disease activity" (NEDA). The panel recommended a set of cognitive assessment tools and MRI methods and software applications that may help in capturing and measuring the underlying MS pathology with high degree of specificity. CONCLUSION BVL was considered to be a useful measurement to longitudinally assess disease progression and cognitive function in patients with MS. Brain atrophy measurement was recommended to be incorporated into the concept of NEDA. Consequently, a consensus recommendation was reached in anticipation for implementation of the use of cognitive assessment and brain atrophy measurements on a regional level.
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Affiliation(s)
- Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait.
- Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait.
| | - Dirk Deleu
- Division of Neurology (Neuroscience Institute), Hamad General Hospital, Doha, Qatar
| | - Khalid El Salem
- Department of Neurology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | | | | | - Adel Aljishi
- Department of Neurology, Salmaniya Hospital & AGU, Manama, Bahrain
| | | | - Faisal Al Azri
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Tag Eldin Sokrab
- Division of Neurology (Neuroscience Institute), Hamad General Center, Doha, Qatar
| | - Mohamed Said
- Medical Manger-Gulf Countries, Novartis pharmaceuticals, Dubai, United Arab Emirates
| | - Àlex Rovira
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Moulton CR, House MJ, Lye V, Tang CI, Krawiec M, Joseph DJ, Denham JW, Ebert MA. Registering prostate external beam radiotherapy with a boost from high-dose-rate brachytherapy: a comparative evaluation of deformable registration algorithms. Radiat Oncol 2015; 10:254. [PMID: 26666538 PMCID: PMC4678702 DOI: 10.1186/s13014-015-0563-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 10/15/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Registering CTs for patients receiving external beam radiotherapy (EBRT) with a boost dose from high-dose-rate brachytherapy (HDR) can be challenging due to considerable image discrepancies (e.g. rectal fillings, HDR needles, HDR artefacts and HDR rectal packing materials). This study is the first to comparatively evaluate image processing and registration methods used to register the rectums in EBRT and HDR CTs of prostate cancer patients. The focus is on the rectum due to planned future analysis of rectal dose-volume response. METHODS For 64 patients, the EBRT CT was retrospectively registered to the HDR CT with rigid registration and non-rigid registration methods in VelocityAI. Image processing was undertaken on the HDR CT and the rigidly-registered EBRT CT to reduce the impact of discriminating features on alternative non-rigid registration methods applied in the software suite for Deformable Image Registration and Adaptive Radiotherapy Research (DIRART) using the Horn-Schunck optical flow and Demons algorithms. The propagated EBRT-rectum structures were compared with the HDR structure using the Dice similarity coefficient (DSC), Hausdorff distance (HD) and average surface distance (ASD). The image similarity was compared using mutual information (MI) and root mean squared error (MSE). The displacement vector field was assessed via the Jacobian determinant (JAC). The post-registration alignments of rectums for 21 patients were visually assessed. RESULTS The greatest improvement in the median DSC relative to the rigid registration result was 35 % for the Horn-Schunck algorithm with image processing. This algorithm also provided the best ASD results. The VelocityAI algorithms provided superior HD, MI, MSE and JAC results. The visual assessment indicated that the rigid plus deformable multi-pass method within VelocityAI resulted in the best rectum alignment. CONCLUSIONS The DSC, ASD and HD improved significantly relative to the rigid registration result if image processing was applied prior to DIRART non-rigid registrations, whereas VelocityAI without image processing provided significant improvements. Reliance on a single rectum structure-correspondence metric would have been misleading as the metrics were inconsistent with one another and visual assessments. It was important to calculate metrics for a restricted region covering the organ of interest. Overall, VelocityAI generated the best registrations for the rectum according to the visual assessment, HD, MI, MSE and JAC results.
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Affiliation(s)
- Calyn R Moulton
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Michael J House
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Victoria Lye
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Colin I Tang
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Michele Krawiec
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - David J Joseph
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
- School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - James W Denham
- School of Medicine and Population Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Martin A Ebert
- School of Physics (M013), University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
- Radiation Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
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