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Noh SA, Kim HS, Kang SH, Yoon CH, Youn TJ, Chae IH. History and evolution of blood pressure measurement. Clin Hypertens 2024; 30:9. [PMID: 38556854 PMCID: PMC10983645 DOI: 10.1186/s40885-024-00268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Hypertension is the leading cause of morbidity and mortality worldwide. Hypertension mostly accompanies no symptoms, and therefore blood pressure (BP) measurement is the only way for early recognition and timely treatment. Methods for BP measurement have a long history of development and improvement. Invasive method via arterial cannulation was first proven possible in the 1800's. Subsequent scientific progress led to the development of the auscultatory method, also known as Korotkoff' sound, and the oscillometric method, which enabled clinically available BP measurement. However, hypertension management status is still poor. Globally, less than half of adults are aware of their hypertension diagnosis, and only one-third of them being treated are under control. Novel methods are actively investigated thanks to technological advances such as sensors and machine learning in addition to the clinical needs for easier and more convenient BP measurement. Each method adopts different technologies with its own specific advantages and disadvantages. Promises of novel methods include comprehensive information on out-of-office BP capturing dynamic short-term and long-term fluctuations. However, there are still pitfalls such as the need for regular calibration since most novel methods capture relative BP changes rather than an absolute value. In addition, there is growing concern on their accuracy and precision as conventional validation protocols are inappropriate for cuffless continuous methods. In this article, we provide a comprehensive overview of the past and present of BP measurement methods. Novel and emerging technologies are also introduced with respect to their potential applications and limitations.
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Affiliation(s)
- Su A Noh
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Hwang-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.
- Department of Internal Medicine, Seoul National University, Seoul, South Korea.
| | - Chang-Hwan Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - In-Ho Chae
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
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Ikenouchi T, Miyazaki S, Nitta J, Sekiguchi Y, Kobori A, Nakamura K, Inamura Y, Murakami M, Sagawa Y, Sasaki Y, Inaba O, Yamauchi Y, Naito S, Hirakawa A, Sasano T. Characteristics of two different cryoballoon systems for treatment of paroxysmal atrial fibrillation: study protocol for a multicenter randomized controlled trial (CONTRAST-CRYO Trial). J Interv Card Electrophysiol 2024; 67:5-12. [PMID: 38087145 DOI: 10.1007/s10840-023-01718-2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-shot pulmonary vein isolation (PVI) utilizing cryothermal energy is an effective and safe treatment for atrial fibrillation (AF) patients. A novel cryoballoon system, POLARx™, has been recently introduced. The aim of this study was to compare the efficacy, safety, and biophysical parameters of PVI between the novel cryoballoon system, POLARx™, and the standard cryoballoon system, Arctic Front Advance Pro™ (AFA-Pro), in patients with paroxysmal AF. METHODS The CONTRAST-CRYO trial is a prospective, multicenter, open-label, randomized controlled study performed at seven large cardiac centers. This study was approved by the central ethics committee or the local ethics committee of each participating hospital and has been registered at UMIN Clinical Trials Registry (UMIN000049948). The trial will assign 200 patients with paroxysmal AF undergoing PVI to POLARx™ and AFA-Pro in a 1:1 randomization. The primary endpoint is the one-shot acute success rate of the right inferior pulmonary vein. Second endpoints include freedom from documented atrial fibrillation, atrial flutter, or atrial tachycardia without antiarrhythmic drugs at 12 months after the procedure, freedom from re-do procedures, the incidence of procedure-related adverse events, freezing duration, and the biophysical parameters during applications for each PV, total procedure and fluoroscopy time, and PVI durability during re-do procedures. CONCLUSION The CONTRAST-CRYO trial is a prospective, multicenter, randomized study designed to elucidate the difference in the efficacy, safety, and biophysical parameters between POLARx™ and AFA-Pro in paroxysmal AF patients undergoing PVI. The findings from this trial may provide a valuable indication for selecting the optimal cryoballoon system. CLINICAL TRIAL REGISTRATION UMIN000049948.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Kohki Nakamura
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Masato Murakami
- Department of Cardiology, Shonankamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Shigeto Naito
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
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Honarbakhsh S, Martin CA, Mesquita J, Herlekar R, Till R, Srinivasan NT, Duncan E, Leong F, Dulai R, Veasey R, Panikker S, Paisey J, Ramgopal B, Das M, Ahmed W, Sahu J, Earley MJ, Finlay MC, Schilling RJ, Hunter RJ. Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience. Europace 2023; 25:euad286. [PMID: 37738643 PMCID: PMC10629714 DOI: 10.1093/europace/euad286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). There are limited data on the PolarX Cryoballoon. The study aimed to establish the safety, efficacy, and feasibility of same day discharge for Cryoballoon PVI. METHODS AND RESULTS Multi-centre study across 12 centres. Procedural metrics, safety profile, and procedural efficacy of the PolarX Cryoballoon with the Arctic Front Advance (AFA) Cryoballoon were compared in a cohort large enough to provide definitive comparative data. A total of 1688 patients underwent PVI with cryoablation (50% PolarX and 50% AFA). Successful PVI was achieved with 1677 (99.3%) patients with 97.2% (n = 1641) performed as day case procedures with a complication rate of <1%. Safety, procedural metrics, and efficacy of the PolarX Cryoballoon were comparable with the AFA cohort. The PolarX Cryoballoon demonstrated a nadir temperature of -54.6 ± 7.6°C, temperature at 30 s of -38.6 ± 7.2°C, time to -40°C of 34.1 ± 13.7 s, and time to isolation of 49.8 ± 33.2 s. Independent predictors for achieving PVI included time to reach -40°C [odds ratio (OR) 1.34; P < 0.001] and nadir temperature (OR 1.24; P < 0.001) with an optimal cut-off of ≤34 s [area under the curve (AUC) 0.73; P < 0.001] and nadir temperature of ≤-54.0°C (AUC 0.71; P < 0.001), respectively. CONCLUSIONS This large-scale UK multi-centre study has shown that Cryoballoon PVI is a safe, effective day case procedure. PVI using the PolarX Cryoballoon was similarly safe and effective as the AFA Cryoballoon. The cryoablation metrics achieved with the PolarX Cryoballoon were different to that reported with the AFA Cryoballoon. Modified cryoablation targets are required when utilizing the PolarX Cryoballoon.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Claire A Martin
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joao Mesquita
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Rahul Herlekar
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Richard Till
- Department of Electrophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Department of Electrophysiology, Basildon and Thurrock University Hospital NHS Foundation Trust, Essex, UK
| | - Edward Duncan
- Department of Electrophysiology, The University Hospitals Bristol and Weston NHS Foundation trust, Bristol, UK
| | - Fong Leong
- Department of Electrophysiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rajdip Dulai
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Rick Veasey
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Sandeep Panikker
- Department of Electrophysiology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - John Paisey
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Balasubramanian Ramgopal
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Moloy Das
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Wissam Ahmed
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jonathan Sahu
- Department of Electrophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
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Honarbakhsh S, Martin CA, Dhillon G, Gallagher M, Sohal M, Chow A, Ahsan S, Abbass H, Whittaker-Axon S, Lambiase PD, Davies MJ, Ginks M, Hunter RJ. Contact force and catheter stability are predictive metrics of successful pulmonary vein isolation with high-power short duration ablation in atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1141-1151. [PMID: 36808788 DOI: 10.1111/jce.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Preliminary data suggest that high power short duration (HPSD) ablation for pulmonary vein isolation (PVI) are safe. Limited data are available on its effectiveness. Aim was to evaluate HPSD ablation in AF ablation using a novel Qdot Micro catheter. METHODS AND RESULTS Prospective multi-centre study evaluating safety and efficacy of PVI with HPSD ablation. First pass isolation (FPI) and sustained PVI was assessed. If FPI was not achieved additional ablation index (AI)-guided ablation with 45W was performed and metrics predictive of this were determined. Sixty-five patients and 260 veins were treated. Procedural and LA dwell time was 93.9±30.4 and 60.5±23.1 minutes respectively. FPI was achieved in 47 (72.3%) patients and 231 veins (88.8%) with an ablation duration of 4.6±1.0 minutes. Twenty-nine veins required additional AI-guided ablation to achieve initial PVI with 24 anatomical sites ablated with the right posterior carina being the most common site (37.5%). A contact force of ≥8g (AUC 0.81; p<0.001) and catheter position variation of ≤1.2mm (AUC 0.79; p<0.001) with HPSD were strongly predictive of not requiring additional AI-guided ablation. Out of the 260 veins, only 5 (1.9%) veins showed acute reconnection. HPSD ablation was associated with shorter procedure times (93.9min vs.159.4min; p<0.001), ablation times (6.1min vs. 27.7min; p<0.001) and lower rates of PV reconnection (9.2% vs. 30.8%; p=0.004) compared to moderate power cohort. CONCLUSIONS HPSD ablation is an effective ablation modality which results in effective PVI whilst maintaining a safety profile. Its superiority needs to be evaluated in randomised controlled trials. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom.,Queen Mary's University of London, United Kingdom
| | | | - Gurpreet Dhillon
- St George's University Hospitals NHS foundation trust, London, UK
| | - Mark Gallagher
- St George's University Hospitals NHS foundation trust, London, UK
| | - Manav Sohal
- St George's University Hospitals NHS foundation trust, London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Syed Ahsan
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Hakam Abbass
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Sarah Whittaker-Axon
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
| | - Mark J Davies
- Oxford University Hospitals NHS foundation trust, Oxford, United Kingdom
| | - Matthew Ginks
- Oxford University Hospitals NHS foundation trust, Oxford, United Kingdom
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS trust, London, United Kingdom
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Honarbakhsh S, Earley MJ, Martin CA, Creta A, Sohaib A, Ang R, Butcher C, Waddingham PH, Dhinoja M, Lim W, Srinivasan NT, Providencia R, Kanthasamy V, Sporton S, Chow A, Lambiase PD, Schilling RJ, Finlay MC, Hunter RJ. PolarX Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation. Europace 2022; 24:1420-1429. [PMID: 35737685 DOI: 10.1093/europace/euac100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/10/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. METHODS AND RESULTS This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. CONCLUSIONS The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | | | - Antonio Creta
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Afzal Sohaib
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard Ang
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Charles Butcher
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Peter H Waddingham
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mehul Dhinoja
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK
| | - Rui Providencia
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Vijayabharathy Kanthasamy
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Simon Sporton
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
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Iacopino S, Stabile G, Fassini G, De Simone A, Petretta A, Moltrasio M, La Rocca V, Placentino F, Riva S, Pesce F, Rossi P, Pelargonio G, Iuliano A, Tundo F, Colella J, Tondo C. Key characteristics for effective acute pulmonary vein isolation when using a novel cryoballoon technology: insights from the CHARISMA registry. J Interv Card Electrophysiol 2021. [PMID: 34853986 DOI: 10.1007/s10840-021-01063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A new cryoballoon (CB) technology (POLARx™; Boston Scientific) for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF) has recently been introduced. The aim of this study was to evaluate procedural and biophysical parameters resulting in acute PV isolation when using this new CB. METHODS We assessed the first 69 consecutive patients indicated for AF ablation who underwent PV isolation by means of a novel CB system. Procedural metrics were prospectively recorded. RESULTS A total of 274 PVs were targeted in 69 patients. PV isolation was achieved in all patients by means of cryoablation alone. The median time to isolation (TTI) was 44 [31-68] s (median temperature at TTI = - 49 [- 53 to - 41] °C). The median duration of CB ablation was 180 [180 to 240] s. The median nadir temperature was - 56.0 [- 61 to - 52] °C, and the median thaw time to 0 °C was 18 [15-21] s. The median grade of PV occlusion was 4 [3 to 4]. On the basis of ROC analysis, we defined the following cut-off values for acute PV isolation: - 56 °C for nadir temperature (sensitivity = 73.3%, specificity = 64.6%, AUC = 0.716; positive predictive value = 88.1%), 30 s for TTT (60.2%, 53.3%, 0.578; 79.7%), thaw time > 17 s (65.3%, 70.0%, 0.709; 86.9%), and grade of PV occlusion = 4 (79.4%, 66.7%, 0.738; 88.5%). No major procedure-related adverse events were observed at 30-day post-procedure. CONCLUSIONS The new POLARx™ CB appears to be effective and safe. A nadir temperature of - 56 °C, a thaw time to 0 °C ≥ 17 s, and complete PV occlusion were the best predictors of acute PV isolation. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/Identifier : NCT03793998. Registration date: January 4, 2019.
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Su XQ, Xu K. [Technological evolution of laparoscopic gastrointestinal surgery in China]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:662-666. [PMID: 34412181 DOI: 10.3760/cma.j.cn441530-20210623-00246] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
After 30 years of development in China, laparoscopic gastrointestinal surgery has been widely accepted and popularized. In recent years, the application of a series of novel technologies, such as 3D laparoscopic system, 4k high-definition laparoscopy, near-infrared fluorescence imaging technique and telesurgery with 5G wireless system has injected new vitality to the laparoscopic gastrointestinal surgery in new era. It also well contributes to the further promotion and standardization of minimally invasive gastrointestinal surgery. This article reviews the application and development of novel techniques in minimally invasive gastrointestinal surgery. It is concluded that great progress has been made in clinical application of minimally invasive gastrointestinal surgery in China. In terms of surgical technology and equipment development, the period of mechanical imitation has passed and a new era focusing on innovation and originality is coming in China. The authors believe that Chinese laparoscopic gastrointestinal surgeons should remember their original intention, insist on the patient-centered concept in diagnosis and treatment, maintain innovative thinking and attitude and thus, push the development of minimally invasive gastrointestinal surgery to a new height in China.
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Affiliation(s)
- X Q Su
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - K Xu
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
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Abstract
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
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9
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Singh JA. Informed consent and community engagement in open field research: lessons for gene drive science. BMC Med Ethics 2019; 20:54. [PMID: 31351474 PMCID: PMC6660705 DOI: 10.1186/s12910-019-0389-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background The development of the CRISPR/Cas9 gene editing system has generated new possibilities for the use of gene drive constructs to reduce or suppress mosquito populations to levels that do not support disease transmission. Despite this prospect, social resistance to genetically modified organisms remains high. Gene drive open field research thus raises important questions regarding what is owed to those who may not consent to such research, or those could be affected by the proposed research, but whose consent is not solicited. The precise circumstances under which informed consent must be obtained, and from whom, requires careful consideration. Furthermore, appropriate engagement processes should be central to any introduction of genetically modified mosquitos in proposed target settings. Discussion In this work, international guidance documents on informed consent and engagement are reviewed and applied to the genetically modified mosquito research context. Five analogous research endeavours that involve area-wide / open field experiments are reviewed. The approach of each in respect to the solicitation of individual informed consent and community engagement are highlighted. Conclusions While the solicitation of individual informed consent in host settings of gene drive field trials may not be possible or feasible in some instances, local community and stakeholder engagement will be key to building trust towards the proposed conduct of such research. In this regard, the approaches taken by investigators and sponsors of political science field research and weather modification field research should be avoided. Rather, proponents of gene drive field research should look to the Eliminate Dengue field trials, cluster randomised trials, and pragmatic clinical trials for guidance regarding how the solicitation of individual informed consent of host communities ought to be managed, and how these communities ought to be engaged.
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Affiliation(s)
- Jerome Amir Singh
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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10
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Abstract
肿瘤异质性是恶性肿瘤的特征之一,可使肿瘤的生长速度、侵袭与转移、药物敏感性、预后等各方面产生差异。肿瘤驱动基因和靶向药物的发现发展开启了战胜肿瘤的希望之门,然而异质性的存在又让肿瘤治疗陷入了难以攻克的困境。在肿瘤复发、进展演化的过程中肿瘤异质性如影随形,纷繁复杂。凭借不断进步的检测技术认识和理解肿瘤异质性,针对肿瘤异质性的原因和表型,定制治疗方案已成为当今精准医疗领域的重点范畴。本综述对肿瘤异质性进行了分析和探讨,从而更好的帮助我们了解肿瘤异质性,有利于我们通过多种手段对抗肿瘤异质性。
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Affiliation(s)
- Rui Zhong
- Medical Oncology Translational Research Lab, Jilin Provincial Cancer Hospital, Changchun 130012, China
| | - Hui Li
- Medical Oncology Translational Research Lab, Jilin Provincial Cancer Hospital, Changchun 130012, China
| | - Shuang Zhang
- Department of Toracic Oncology, Jilin Provincial Cancer Hospital, Changchun 130012, China
| | - Jingjing Liu
- Department of Toracic Oncology, Jilin Provincial Cancer Hospital, Changchun 130012, China
| | - Ying Cheng
- Department of Toracic Oncology, Jilin Provincial Cancer Hospital, Changchun 130012, China
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11
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Abstract
PURPOSE OF REVIEW Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs. RECENT FINDINGS There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue. Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.
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Affiliation(s)
- Jesus Rodriguez-Manzano
- Centre for Bio-inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Po Ying Chia
- Communicable Diseases Centre, Institute for Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tsin Wen Yeo
- Communicable Diseases Centre, Institute for Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
| | - Alison Holmes
- Department of Medicine, Imperial College London, London, UK
| | - Pantelis Georgiou
- Centre for Bio-inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Sophie Yacoub
- Department of Medicine, Imperial College London, London, UK.
- Singapore-MIT Alliance for Research and Technology, Singapore, Singapore.
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam.
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12
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Gupta S, Bi WL, Mukundan S, Al-Mefty O, Dunn IF. Clinical applications of dynamic CT angiography for intracranial lesions. Acta Neurochir (Wien) 2018; 160:675-80. [PMID: 29353408 DOI: 10.1007/s00701-018-3465-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dynamic CT angiography (dCTA) augments traditional CTA with temporal resolution and has been demonstrated to influence operative planning in skull base surgery. METHODS Three hundred twenty-five dynamic CTA cases from a single institution were reviewed for indication of study, findings, and comparison to other modalities of imaging. RESULTS The most frequent application of dCTA was pre-operative surgical planning (59.4%); resection of skull base tumors represented the majority of these pre-operative studies (93.3%). It was also used to evaluate new neurological symptoms (20.9%). Of these, the most common symptoms prompting a dCTA study included headache (22.1%) and visual field deficit (11.8%). The most commonly visualized vascular lesions were partial (22.9%) and complete vascular occlusions (9.0%). Dynamic CTA has also been useful in post-operative imaging for vascular malformations (9.5%) and tumors (2.5%). Finally, dCTA was employed to evaluate ambiguous abnormal findings observed on other imaging modalities (7.7%). Cerebral dCTA ruled out inconclusive abnormal vascular findings visualized on other imaging modalities (64.0%) more frequently than it confirmed them (32.0%), and was inconclusive in a singular case (4.0%). CONCLUSIONS Cerebral dCTA is an evolving new technology with a diverse spectrum of potential applications. In addition to its role in guiding pre-operative planning for skull base surgical cases, dynamic CTA offers excellent spatial and temporal resolution for assessment of vascular lesions.
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13
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Jia Z, Shi Y, Zhang L, Ren Y, Wang T, Xing L, Zhang B, Gao G, Bu R. DNA methylome profiling at single-base resolution through bisulfite sequencing of 5mC-immunoprecipitated DNA. BMC Biotechnol 2018; 18:7. [PMID: 29409498 DOI: 10.1186/s12896-017-0409-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022] Open
Abstract
Background Detection of DNA methylome at single-base resolution is a significant challenge but promises to shed considerable light on human disease etiology. Current technologies could not detect DNA methylation genome-wide at single-base resolution with small amount of sequencing data and could not avoid detecting the methylation of repetitive elements which are considered as “junk DNA”. Methods In this study, we have developed a novel DNA methylome profiling technology named MB-seq with its ability to identify genome-wide 5mC and quantify DNA methylation levels by introduced an assistant adapter AluI-linker This linker can be ligated to sonicated DNA and then be digested after the bisulfite treatment and amplification, which has no effect of MeDIP enrichment. Because many researchers are interested in investigating the methylation of functional regions such as promoters and gene bodies, we have also developed a novel alternative method named MRB-seq, which can be used to investigate the DNA methylation of functional regions by removing the repeats with Cot-1 DNA. Results In this study, we have developed MB-seq, a novel DNA methylome profiling technology combining MeDIP-seq with bisulfite conversion, which can precisely detect the 5mC sites and determine their DNA methylation level at single-base resolution in a cost-effective way. In addition, we have developed a new alternative method, MRB-seq (MeDIP-repetitive elements removal-bisulfite sequencing), which interrogates 5mCs in functional regions by depleting nearly half of repeat fragments enriched by MeDIP. Comparing MB-seq and MRB-seq to whole-genome BS-seq using the same batch of DNA from YH peripheral blood mononuclear cells. We found that the sequencing data of MB-seq and MRB-seq almost reaches saturation after generating 7–8 Gbp data, whereas BS-seq requires about 100 Gbp data to achieve the same effect. In comparison to MeDIP-seq and BS-seq, MB-seq offers several key advantages, including single-base resolution, discriminating the methylated sites within a CpG and non-CpG pattern and overcoming the false positive of MeDIP-seq due to the non-specific binding of 5-methylcytidine antibody to genomic fragments. Conclusion Our novel developed method MB-seq can accelerate the decoding process of DNA methylation mechanism in human diseases because it requires 7–8 Gbp data to measure human methylome with enough coverage and sequencing depth, affording it a direct and practical application in the study of multiple samples. In addition, we have also provided a novel alternative MRB-seq method, which removes most repetitive sequences and allows researchers to genome-wide characterize DNA methylation of functional regions. Electronic supplementary material The online version of this article (10.1186/s12896-017-0409-7) contains supplementary material, which is available to authorized users.
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14
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Spaedy E, Christakopoulos GE, Tarar MNJ, Christopoulos G, Rangan BV, Roesle M, Ochoa CD, Yarbrough W, Banerjee S, Brilakis ES. Accuracy of remote chest X-ray interpretation using Google Glass technology. Int J Cardiol 2016; 219:38-40. [PMID: 27262231 DOI: 10.1016/j.ijcard.2016.05.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to explore the accuracy of remote chest X-ray reading using hands-free, wearable technology (Google Glass, Google, Mountain View, California). METHODS We compared interpretation of twelve chest X-rays with 23 major cardiopulmonary findings by faculty and fellows from cardiology, radiology, and pulmonary-critical care via: (1) viewing the chest X-ray image on the Google Glass screen; (2) viewing a photograph of the chest X-ray taken using Google Glass and interpreted on a mobile device; (3) viewing the original chest X-ray on a desktop computer screen. One point was given for identification of each correct finding and a subjective rating of user experience was recorded. RESULTS Fifteen physicians (5 faculty and 10 fellows) participated. The average chest X-ray reading score (maximum 23 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, and the original X-ray viewed on a desktop computer was 14.1±2.2, 18.5±1.5 and 21.3±1.7, respectively (p<0.0001 between Google Glass and mobile device, p<0.0001 between Google Glass and desktop computer and p=0.0004 between mobile device and desktop computer). Of 15 physicians, 11 (73.3%) felt confident in detecting findings using the photograph taken by Google Glass as viewed on a mobile device. CONCLUSION Remote chest X-ray interpretation using hands-free, wearable technology (Google Glass) is less accurate than interpretation using a desktop computer or a mobile device, suggesting that further technical improvements are needed before widespread application of this novel technology.
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Affiliation(s)
- Emily Spaedy
- University of Kansas Medical School, Kansas City, KS, USA
| | - Georgios E Christakopoulos
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhammad Nauman J Tarar
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Georgios Christopoulos
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bavana V Rangan
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michele Roesle
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cristhiaan D Ochoa
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Yarbrough
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Subhash Banerjee
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emmanouil S Brilakis
- VA North Texas Healthcare System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Kerr DA, Harray AJ, Pollard CM, Dhaliwal SS, Delp EJ, Howat PA, Pickering MR, Ahmad Z, Meng X, Pratt IS, Wright JL, Kerr KR, Boushey CJ. The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults. Int J Behav Nutr Phys Act 2016; 13:52. [PMID: 27098449 PMCID: PMC4839101 DOI: 10.1186/s12966-016-0376-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/13/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18-30 years). METHODS A three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves. RESULTS Young adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls. CONCLUSIONS Tailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults. TRIAL REGISTRATION Australian Clinical Trials Registry Registration number: ACTRN12612000250831 .
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Affiliation(s)
- Deborah A Kerr
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia.
| | - Amelia J Harray
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia.,Public Health Division, Department of Health In Western Australia, 189 Royal Street, East Perth, 6004, WA, Australia
| | - Satvinder S Dhaliwal
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia
| | - Edward J Delp
- Video and Image Processing Laboratory, School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Peter A Howat
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia
| | - Mark R Pickering
- School of Engineering and Information Technology, The University of New South Wales at the Australian Defence Force Academy, Canberra, Australia
| | - Ziad Ahmad
- Video and Image Processing Laboratory, School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Xingqiong Meng
- School of Medicine, Flinders University, Bedford Park, Australia
| | - Iain S Pratt
- Cancer Council Western Australia, Subiaco, WA, Australia
| | - Janine L Wright
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia
| | - Katherine R Kerr
- School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, WA, 6845, Australia
| | - Carol J Boushey
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.,Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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