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1. Tumor Size Differences Between Preoperative Endoscopic Ultrasound and Postoperative Pathology for Neoadjuvant-Treated Pancreatic Ductal Adenocarcinoma Predict Patient Outcome

Author: Herbert J. Zeh, Shikhar Uttam, Alessandro Paniccia, Melissa E. Hogg, Kevin McGrath, Adam Slivka, Vikram C. Gorantla, Rohit Das, Katelyn Smith, Roby Antony Thomas, Asif Khalid, Michael S. Landau, Kenneth E. Fasanella, Natalie Seiser, James F. Pingpank, Harkirat Singh, Nathan Bahary, Patrick Henn, Kenneth K. Lee, Brian K. Theisen, Melanie Ongchin, Savreet Sarkaria, Randall E. Brand, Aatur D. Singhi, Brian A. Boone, Amer H. Zureikat, Susannah G. Ellsworth, N. Paul Ohori, Anil K. Dasyam, Jennifer Chennat, Susan Shyu, and John C. Rhee
Subjects: Endoscopic ultrasound, Pathology, medicine.medical_specialty, endocrine system diseases, medicine.medical_treatment, Concordance, Article, Endosonography, Pancreatectomy, medicine, Humans, Grading (tumors), Neoadjuvant therapy, Neoplasm Staging, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, Gastroenterology, Prognosis, Neoadjuvant Therapy, digestive system diseases, Pancreatic Neoplasms, Fine-needle aspiration, medicine.anatomical_structure, CA19-9, Pancreas, business, Carcinoma, Pancreatic Ductal
Abstract: BACKGROUND & AIMS: The assessment of therapeutic response after neoadjuvant treatment and pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) has been an ongoing challenge. Several limitations have been encountered when employing current grading systems for residual tumor. Considering endoscopic ultrasound (EUS) represents a sensitive imaging technique for PDAC, differences in tumor size between preoperative EUS and postoperative pathology after neoadjuvant therapy were hypothesized to represent an improved marker of treatment response. METHODS: For 340 treatment-naïve and 365 neoadjuvant-treated PDACs, EUS and pathologic findings were analyzed and correlated with patient overall survival (OS). A separate group of 200 neoadjuvant-treated PDACs served as a validation cohort for further analysis. RESULTS: Among treatment-naïve PDACs, there was a moderate concordance between EUS imaging and postoperative pathology for tumor size (r = 0.726, P < .001) and AJCC 8(th) edition T-stage (r = 0.586, P < .001). In the setting of neoadjuvant therapy, a decrease in T-stage correlated with improved 3-year OS rates (50% vs 31%, P < .001). Through recursive partitioning, a cutoff of ≥47% tumor size reduction was also found to be associated with improved OS (67% vs 32%, P < .001). Improved OS using a ≥47% threshold was validated using a separate cohort of neoadjuvant-treated PDACs (72% vs 36%, P < .001). By multivariate analysis, a reduction in tumor size by ≥47% was an independent prognostic factor for improved OS (P = .007). CONCLUSIONS: The difference in tumor size between preoperative EUS imaging and postoperative pathology among neoadjuvant-treated PDAC patients is an important prognostic indicator and may guide subsequent chemotherapeutic management.
Published: 2022

2. Comparison of quantitative internal and external measures of performance for trainees in cytopathology fellowships

Author: Jackie Cuda, N. Paul Ohori, Juan Xing, Sara E. Monaco, Marie C. DeFrances, and Samer N. Khader
Subjects: medicine.medical_specialty, Certification, Biopsy, Cytological Techniques, Diagnostic concordance, 030209 endocrinology & metabolism, Minor (academic), Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, Pathology, medicine, Quantitative assessment, Humans, Medical physics, Fellowships and Scholarships, Medical diagnosis, Case volume, business.industry, Cell Biology, United States Medical Licensing Examination, Pathologists, Education, Medical, Graduate, Cytopathology, 030220 oncology & carcinogenesis, Educational Status, Clinical Competence, Curriculum, Educational Measurement, business, Program Evaluation, Specialization
Abstract: Introduction Cytopathology fellowships need measures to assess performance of fellows. We sought to compare several internal quantitative assessment metrics in our fellowship with external metrics, such as performance on the American Society of Cytopathology (ASC) Progressive Evaluation of Competency (PEC) examination and United States Medical Licensing Examination (USMLE). Methods Quantitative parameters generated from our laboratory information system (LIS) on cytopathology fellows were evaluated over 6 years, including case volume and diagnostic discrepancies, in addition to ASC PEC and USMLE scores. For discrepancy reports, interpretations made by the fellow were compared with that of the cytopathologist, and classified as none (concordant), minor ( Results We evaluated internal and external metrics on 13 fellows over 6 years. The program average diagnostic concordance rate was 89.9%, with an average major discrepancy rate of 1.5%, and an average monthly case volume of 260 cases. More fellows with above-average ASC PEC performance showed above-average concordant diagnoses and lower case volume, while below-average PEC scores were seen more often with higher major discrepancy rates. More fellows with above-average USMLE scores had higher case volumes, while low USMLE scores showed a trend towards higher major discrepancy rates. Conclusion Our fellowship program has used a variety of internal and external measures of performance for cytopathology fellows. Although the findings show no statistically significant finding correlating performance, these quantitative parameters generated from our LIS were helpful to identify areas of improvement, facilitate comparison to peers, and provide case volume documentation.
Published: 2021

3. Dynamical Response of Transition-Edge Sensor Microcalorimeters to a Pulsed Charged-Particle Beam

Author: Takuma Okumura, Hirofumi Noda, Kazuhiko Ninomiya, Malcolm Durkin, Joel N. Ullom, T. Azuma, Naritoshi Kawamura, Yuto Ichinohe, Daniel S. Swetz, W. Bertrand Doriese, Koichiro Shimomura, Yasushi Kino, Yasuhiro Ueno, Pietro Caradonna, Soshi Takeshita, S. Kanda, Yasuhiro Miyake, T. Hashimoto, Paul Indelicato, Joseph W. Fowler, Shin Watanabe, Kairi Mine, Johnathon D. Gard, Takahito Osawa, Carl D. Reintsema, Patrick Strasser, Gene C. Hilton, Shinji Okada, Tadayuki Takahashi, Galen C. O'Neil, Shin'ichiro Takeda, Shinya Yamada, R. Hayakawa, Tadaaki Isobe, H. Tatsuno, Hirotaka Suda, Miho Katsuragawa, Kenichi Okutsu, I-Huan Chiu, Kelsey M. Morgan, Douglas A. Bennett, Daniel Schmidt, and N. Paul
Subjects: Materials science, Muon, Physics::Instrumentation and Detectors, business.industry, Detector, X-ray detector, chemistry.chemical_element, Particle accelerator, Condensed Matter Physics, 01 natural sciences, Electronic, Optical and Magnetic Materials, law.invention, Neon, Optics, chemistry, law, 0103 physical sciences, Physics::Accelerator Physics, Electrical and Electronic Engineering, Transition edge sensor, 010306 general physics, business, Charged particle beam, Beam (structure)
Abstract: A superconducting transition-edge sensor (TES) microcalorimeter is an ideal X-ray detector for experiments at accelerator facilities because of good energy resolution and high efficiency. To study the performance of the TES detector with a high-intensity pulsed charged-particle beam, we measured X-ray spectra with a pulsed muon beam at the Japan Proton Accelerator Research Complex (J-PARC) in Japan. We found substantial temporal shifts of the X-ray energy correlated with the arrival time of the pulsed muon beam, which was reasonably explained by pulse pileup due to the incidence of energetic particles from the initial pulsed beam.
Published: 2021

4. Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

Author: Ozbil E Dumenci, N. Paul Tait, Harriet Grout-Smith, and Ali Alsafi
Subjects: medicine.medical_specialty, medicine.medical_treatment, Splenectomy, R895-920, Splenic artery, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Medical physics. Medical radiology. Nuclear medicine, 0302 clinical medicine, medicine.artery, Occlusion, medicine, Radiology, Nuclear Medicine and imaging, sinistral portal hypertension, business.industry, variceal hemorrhage, splenic artery embolization, Gastric varices, medicine.disease, Surgery, Stenosis, Splenic vein, Portal hypertension, 030211 gastroenterology & hepatology, Complication, business
Abstract: Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.
Published: 2021

5. Impact of molecular testing on detecting mimics of oncocytic neoplasms in thyroid fine‐needle aspirates diagnosed as follicular neoplasm of Hürthle cell (oncocytic) type

Author: Michael S. Landau, Simion I. Chiosea, N. Paul Ohori, and Yuri E. Nikiforov
Subjects: Thyroid nodules, Cancer Research, Pathology, medicine.medical_specialty, Biopsy, Fine-Needle, 030209 endocrinology & metabolism, Thyroid carcinoma, 03 medical and health sciences, 0302 clinical medicine, Biopsy, Follicular phase, medicine, GNAS complex locus, Humans, Thyroid Neoplasms, Thyroid Nodule, Metaplasia, Oxyphil Cells, medicine.diagnostic_test, biology, business.industry, Thyroid, medicine.disease, Fine-needle aspiration, medicine.anatomical_structure, Molecular Diagnostic Techniques, Oncology, 030220 oncology & carcinogenesis, biology.protein, Hyalinizing trabecular adenoma, business
Abstract: Background Some thyroid nodules cytologically presenting as follicular neoplasm, Hurthle cell (Oncocytic) type (FNHCT), are not oncocytic tumors and represent autonomously functioning thyroid nodules (AFTNs) with TSHR, GNAS, and EZH1 mutations or oncocytic metaplasia. A to be defined subset of FNHCT harbors genome haploidisation-type DNA copy number alterations (GH-CNA). Molecular profiling of FNHCT may distinguish oncocytic neoplasms from its mimics. Methods Consecutive fine-needle aspirates of 180 thyroid nodules over 37 months diagnosed as FNHCT and tested by ThyroSeq v3 were identified. Histologic follow-up was available for 79 of 180 nodules (44%). Results No molecular alterations were found in 76 of 180 nodules (42%), of which 15 were resected (oncocytic metaplasia, n = 7; follicular oncocytic adenoma, n = 8). Of nodules followed without surgery, 17 of 101 (17%) showed TSHR, EZH1, and GNAS mutations of AFTNs. Papillary thyroid carcinoma was identified by BRAF V600E (n = 2) and hyalinizing trabecular adenoma by PAX8-GLIS3 (n = 1). GH-CNA alone was detected in 42 of 180 FNHCT nodules (23%), of which 29 were resected and histologically diagnosed as follicular oncocytic neoplasms. All remaining resected nodules were histologically proven oncocytic neoplasms: 1) RAS-like alterations without GH-CNA (n = 25) and 2) TERT and/or TP53 mutations co-occurring with GH-CNA (n = 6), including anaplastic thyroid carcinoma arising from follicular oncocytic carcinoma with TP53, TERT mutations with GH-CNA (n = 2). Conclusions A proportion of FNHCT nodules are AFTNs and oncocytic metaplasias, which can be suspected based on characteristic mutations or lack of alterations on molecular testing. Among resected FNHCTs, GH-CNAs characterize approximately half of histologically confirmed follicular oncocytic neoplasms.
Published: 2021

6. 114 Tackling Noise Pollution in Hospitals: A Pre-Feasibility Study

Author: N Paul and A Xyrichis
Subjects: Pollution, Aging, Noise measurement, Noise pollution, business.industry, media_common.quotation_subject, Mining feasibility study, General Medicine, Noise, Patient room, Noise masking, Medicine, Geriatrics and Gerontology, Cognitive impairment, business, Environmental planning, media_common
Abstract: This study aimed to better understand appropriate interventions aimed at reducing hospital ward noise and the subsequent impact this would have on inpatient experience. Service users consistently reported that noise pollution was the most detrimental factor in their recovery in hospital, principally due to its effects on sleep. Methods To aid usability and data collection the Richards- Campbell Sleep Questionnaire (RCSQ) was adapted into an electronic format with a sliding Likert scale using QuestionPro Software3. Qualitative patient interviews, the RCSQ and ward decibel measurements were recorded on Henry and Anne wards at St. Thomas’ Hospital, London. 20 patients were interviewed (12F, 8 M), with 3 being ultimately discounted due to severe cognitive impairment. Results were collated and will be presented as part of a pre-feasibility evaluation of the tools to measure patient sleep and experience of ward noise. Results: The mean of the responses from the 17 patients interviewed were calculated and graphically displayed. Of interest, 87.5% found the questionnaire straightforward to understand, but only 18.75% found it easy to complete (due to technological unfamiliarity). Conclusion and discussion Patients reported a consistently reported a less than optimal night’s sleep on the ward, with light sleep and increased time to fall asleep being key factors. Although visits were restricted to the “quietest” times on the ward, noise measurements consistently exceeded WHO recommendations of 40 dB. Subsequently excessive night-time noise created by other patients as well as staff was cited as the principal causes of poor sleep, with ward lighting being another cause. Results from this study have provided the justification for sound-masking technology to be trialled on inpatient wards, with the view of decreasing unpleasant ward noise and improving patient rest and recovery.
Published: 2021

7. Pediatric Neurology at the Boston City Hospital: the Early Years (1969 to 1986)

Author: N. Paul Rosman
Subjects: City hospital, medicine.medical_specialty, Developmental Neuroscience, Neurology, business.industry, Family medicine, Pediatrics, Perinatology and Child Health, medicine, Neurology (clinical), Pediatric Neurology, business
Published: 2021

8. A Review on the Production and Culture Techniques of Monosex Tilapia

Author: B. N. Paul, S. K. Sau, Avishek Bardhan, Sanjib Khatua, and Madhabendu Bera
Subjects: food.ingredient, food, business.industry, Production (economics), Tilapia, Biology, business, Biotechnology
Published: 2021

9. Molecular testing and thyroid nodule management in North America

Author: N. Paul Ohori
Subjects: endocrine system, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Bethesda system, Thyroid, Cancer, 030209 endocrinology & metabolism, Nodule (medicine), medicine.disease, Review Article on Asian and Western Practice in Thyroid Pathology: Similarities and Differences, Gross examination, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030220 oncology & carcinogenesis, medicine, Atypia, Surgery, Sampling (medicine), Radiology, medicine.symptom, business, Thyroid cancer
Abstract: The incidence of thyroid cancer is rising for a variety of reasons. At the same time, the nomenclature revision of non-invasive encapsulated follicular-variant PTC to noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) has modified the incidence of thyroid cancer. Given that thyroid neoplasia is a molecular event, it is important for the thyroid physician to evaluate each patient systematically. Most thyroid cancers are sporadic; however, some are familial and may be associated with syndromes with genetic implications. Advances in radiologic imaging have made ultrasonography a near equivalent of gross examination. The American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) classifies nodules from TR1 to TR5 and is valuable in determining which patients should be guided toward fine-needle aspiration (FNA) sampling. While FNA procedures and processing may be varied, the key elements are cytologic diagnosis and collection of samples for potential molecular testing. The Bethesda System for Reporting Thyroid Cytology (BSRTC) is commonly used and categorizes each FNA specimen into one of six diagnoses. The indeterminate diagnoses with risk of malignancy (ROM) ranging from 10–75% comprise approximately 30% of thyroid FNA cases and for these, molecular testing is beneficial. In North America, the two most common molecular platforms are Veracyte Afirma GSC and ThyroSeq v3. Both panels cover an extensive array of genomic alterations associated with thyroid neoplasia and a negative result from either test effectively refines the ROM of an Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) or Follicular Neoplasm/Suspicious for a Follicular Neoplasm (FN/SFN) diagnosis to 3–4%. Given that the refined ROMs are comparable to that of a Benign BSRTC diagnosis, these patients are recommended for observation of their nodules. However, differences exist in the implication of Afirma GSC—Suspicious and ThyroSeq v3—Positive molecular results with regard to the probability of cancer. For either test, the molecular test result should be integrated with other clinical parameters to determine if surgery is indicated and, if so, the extent of surgery.
Published: 2020

10. Thyroid cytology smear slides: An untapped resource for ThyroSeq testing

Author: Cihan Kaya, Claudio Bellevicine, Umberto Malapelle, Marina N. Nikiforova, Giancarlo Troncone, Megan E. Miller, Yuri E. Nikiforov, Zubair W. Baloch, N. Paul Ohori, Lindsey A. Tolino, Marcos Lepe, Abigail I. Wald, Michael S. Landau, Nikiforova, M. N., Lepe, M., Tolino, L. A., Miller, M. E., Ohori, N. P., Wald, A. I., Landau, M. S., Kaya, C., Malapelle, U., Bellevicine, C., Troncone, G., Nikiforov, Y. E., and Baloch, Z.
Subjects: Thyroid nodules, Cancer Research, Pathology, medicine.medical_specialty, DNA Copy Number Variations, Concordance, Biopsy, Fine-Needle, Cytological Techniques, Papanicolaou stain, 030209 endocrinology & metabolism, indeterminate fine-needle aspiration, 03 medical and health sciences, 0302 clinical medicine, Nucleic Acids, Cytology, medicine, Humans, In patient, Thyroid Neoplasms, Thyroid Nodule, fine-needle aspiration (FNA), Thyroid.FNA, business.industry, Thyroid, High-Throughput Nucleotide Sequencing, medicine.disease, Patient management, medicine.anatomical_structure, Molecular Diagnostic Techniques, Oncology, 030220 oncology & carcinogenesis, ThyroSeq, Mutation, thyroid cytology smear, next-generation sequencing, business
Abstract: Background Molecular testing of thyroid nodules with indeterminate fine-needle aspiration (FNA) cytology is commonly used to guide patient management and is typically performed on freshly collected FNA samples. In this study, the authors evaluated the performance of the ThyroSeq test in cytology smear slides. Methods Air-dried Diff-Quik (DQ)-stained and alcohol-fixed Papanicolaou (Pap)-stained smears were used to determine required cellularity and sensitivity of mutation detection and to compare ThyroSeq v3 Genomic Classifier (GC) results obtained in cytology smears and fresh FNA samples from the same nodules. Results ThyroSeq testing of 31 cytology smears revealed that 25 smears (81%) were adequate for ThyroSeq analysis, including 14 Pap-stained smears (100%) and 11 DQ-stained smears (65%), whereas 6 DQ-stained smears (35%) failed RNA sequencing. The overall accuracy for detecting molecular alterations was 98%, with 100% concordance for mutations and gene expression alterations, 96% concordance for fusions, and 94% concordance for copy number alterations. Cytology smears were adequate for ThyroSeq analysis when at least 200 to 300 cells were present in 1 to 3 slides. ThyroSeq detected all studied mutations down to 5% allele frequency and BRAF mutations down to 1% allele frequency. Testing of smears yielded a positive ThyroSeq GC result in all nodules originally classified as positive. Conclusions Thyroid FNA cytology smear slides with adequate cellularity can be successfully used for ThyroSeq GC testing in approximately 80% of cases, with an even higher success rate in Pap-stained smears. Compared with FNA samples collected into preservative solution, 94% to 100% of different genetic alterations could be accurately detected in smears, validating cytology smears as an alternative for ThyroSeq testing in patients with indeterminate thyroid cytology.
Published: 2020

11. The Clinical Utility of Molecular Testing in the Management of Thyroid Follicular Neoplasms (Bethesda IV Nodules)

Author: Kelly L. McCoy, N. Paul Ohori, Pooja Manroa, Shaum Sridharan, Sally E. Carty, Raja R. Seethala, Dane A Hilko, Elena M. Morariu, Esra Karslioglu French, and Linwah Yip
Subjects: Adult, Male, medicine.medical_specialty, Biopsy, medicine.medical_treatment, Malignancy, 03 medical and health sciences, 0302 clinical medicine, Follicular neoplasms, medicine, Humans, Thyroid Nodule, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Thyroid, Thyroidectomy, Cancer, Nodule (medicine), Retrospective cohort study, Middle Aged, medicine.disease, medicine.anatomical_structure, Molecular Diagnostic Techniques, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Surgery, Radiology, medicine.symptom, business
Abstract: FN present a management quandary as they are often benign but may also be aggressive TC. Consensus recommendations have historically advised thyroidectomy for definitive diagnosis. Although MT have robust benefit in hypothetical cost analyses, under current management guidelines a real-time study of their clinical utility in FN is awaited. We investigate if MT use for FN directs appropriate thyroidectomy for TC while triaging to surveillance nodules that are likely benign.Data were analyzed for 389 consecutive patients managed from 11/14 to 9/19 for 405 FN, excluding oncocytic neoplasms. TC was defined as same-nodule histologic malignancy. When obtained, MT was performed using ThyroSeq (TS) v2 or 3.With a mean nodule size of 2.7 ± 1.3 cm, MT was used in 89% and was positive in 39%. When MT was positive, thyroidectomy was more often utilized (91% v. MT- 27%; P0.001) and more likely for histologic TC (70% vs 16%, P0.001). With preoperative MT, all American Thyroid Association intermediate, high-risk, and medullary TC were positive whereas all MT- malignancies were low-risk. With TSv3, ultrasound surveillance was more likely for MT- FN (90% vs TSv2 65%, P0.001), and occurred for a total of 174 MT- FN. With mean follow-up of 24.6 months, 82% remained stable in size.MT use for FN increased the surgical yield of cancer by 4-fold, identified all potentially aggressive malignancies, and allowed apparently safe nonoperative surveillance for80% of MT-negative patients. Thyroid nodule MT optimizes patient outcomes sufficiently to justify its incorporation into routine practice.
Published: 2020

12. Omega-3 Fatty Acids Increase Amyloid-β Immunity, Energy, and Circadian Rhythm for Cognitive Protection of Alzheimer’s Disease Patients Beyond Cholinesterase Inhibitors

Author: James Sayre, Eli Aminpour, Matteo Pellegrini, Karolina Elżbieta Kaczor-Urbanowicz, Anthony Aghajani, Meng-Wei Ko, Johnny Dang, Ketema N. Paul, India Nichols, Hayk Mirzoyan, Joslyn Santana, Sneha Bhargava, Yik Chai Charles Lau, Marco Morselli, and Milan Fiala
Subjects: Male, 0301 basic medicine, Oncology, medicine.medical_specialty, Amyloid beta, Peripheral blood mononuclear cell, Article, 03 medical and health sciences, 0302 clinical medicine, Phagocytosis, Alzheimer Disease, Internal medicine, Fatty Acids, Omega-3, mental disorders, Humans, Medicine, Dementia, Prospective Studies, Prospective cohort study, Aged, Cholinesterase, Aged, 80 and over, Amyloid beta-Peptides, biology, business.industry, Dementia with Lewy bodies, Macrophages, General Neuroscience, General Medicine, Middle Aged, Mental Status and Dementia Tests, medicine.disease, Circadian Rhythm, nervous system diseases, Psychiatry and Mental health, Clinical Psychology, 030104 developmental biology, Dietary Supplements, biology.protein, Female, Cholinesterase Inhibitors, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, ARNTL2, Frontotemporal dementia
Abstract: Background The cholinesterase inhibitor therapeutics (CI) approved for use in Alzheimer's disease (AD) are palliative for a limited time. Objective To examine the outcome of AD patients with add-on therapy of the omega-3 fatty acid drink Smartfish. Methods We performed a prospective study using Mini-Mental State Examination, amyloid-β (Aβ) phagocytosis blood assay, and RNA-seq of peripheral blood mononuclear cells in 28 neurodegenerative patients who had failed their therapies, including 8 subjective cognitive impairment (SCI), 8 mild cognitive impairment (MCI), 2 AD dementia, 1 frontotemporal dementia (FTD), 2 vascular cognitive impairment, and 3 dementia with Lewy bodies (DLB) patients. Results MCI, FTD, and DLB patients patients volunteered for the addition of a ω-3 fatty acid drink Smartfish protected by anti-oxidants to failing CI therapy. On this therapy, all MCI patients improved in the first year energy transcripts, Aβ phagocytosis, cognition, and activities of daily living; in the long term, they remained in MCI status two to 4.5 years. All FTD and DLB patients rapidly progressed to dementia. On in vivo or in vitroω-3 treatments, peripheral blood mononuclear cells of MCI patients upregulated energy enzymes for glycolysis and citric acid cycle, as well as the anti-inflammatory circadian genes CLOCK and ARNTL2. Conclusion Add-on ω-3 therapy to CI may delay dementia in certain patients who had failed single CI therapy.
Published: 2020

13. Prevalence of Keloid among Female Students with Multiple Ears Piercing in the University of Port Harcourt, Nigeria

Author: Elekima W.A. Amachree, John N Paul, and Peter D Okoh
Subjects: medicine.medical_specialty, Keloid, business.industry, Family medicine, medicine, General Medicine, Port harcourt, medicine.disease, business, Female students
Published: 2020

14. The Attitudes of Medical Students in University of Port Harcourt to Cadaveric Dissection

Author: Edna I Ogbonda, Peter D Okoh, and John N Paul
Subjects: medicine.medical_specialty, business.industry, General surgery, medicine, Cadaveric dissection, General Medicine, Port harcourt, business
Published: 2020

15. A decade into thyroid molecular testing: where do we stand?

Author: N. Paul Ohori
Subjects: Pediatrics, medicine.medical_specialty, medicine.anatomical_structure, business.industry, Thyroid, Medicine, Humans, Thyroid Neoplasms, Thyroid Nodule, business, Pathology and Forensic Medicine
Published: 2021

16. Patient Safety: Preventing Patient Harm and Building Capacity for Patient Safety

Author: Thomas M. Gallagher, Gregory Domer, Elisabeth N. Paul, Bryan Wilson, Shekiba Shahabzada, Parampreet Kaur, Kushee-Nidhi Kumar, Shilpa Salpekar, and Juliana Sotherland
Subjects: medicine.medical_specialty, Patient safety, business.industry, Patient harm, medicine, Intensive care medicine, business
Abstract: Patient safety is a global public health concern. It is a health care discipline with ever evolving advancement and complexity resulting in consequential rise in patient harm. Since the pandemic, patient safety has been threatened even more by laying bare the inadequacies of health systems. Many unsafe care practices, risks, and errors contribute to patient harm and overall economic burden. These include medical, diagnostic, and radiation errors, healthcare associated infections, unsafe surgical procedures and transfusion practices, sepsis, venous thromboembolism, and falls. Although patient safety has become an integral part of the healthcare delivery model and resources have been dedicated towards it, much still needs to be achieved. An attitude of inclusivity for all care teams and anyone in contact with the patient, including the patients themselves, would enhance patient safety. Incorporating this attitude from educational infancy will allow for better identification of medical errors and inculcate critical analysis of process improvement. Implementing the ‘Just Culture’ by health care organizations can build the infrastructure to eliminate avoidable harm. To reduce avoidable harm and improve safety, a constant flow of information and knowledge should be available to mitigate the risks. Lastly, proper communication and effective leadership can play an imperative role to engage stakeholders and reduce harm.
Published: 2021

17. Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial

Author: Supriya Chopra, Sudeep Gupta, Sadhana Kannan, Tapas Dora, Reena Engineer, Akshay Mangaj, Amita Maheshwari, T. Surappa Shylasree, Jaya Ghosh, Siji N. Paul, Reena Phurailatpam, Mayuri Charnalia, Mitali Alone, Jamema Swamidas, Umesh Mahantshetty, Kedar Deodhar, Rajendra Kerkar, and Shyam K. Shrivastava
Subjects: Cancer Research, medicine.medical_specialty, Gastrointestinal Diseases, medicine.medical_treatment, Uterine Cervical Neoplasms, Hysterectomy, law.invention, Late toxicity, Randomized controlled trial, law, medicine, Humans, Radiation Injuries, Cervical cancer, Adjuvant radiotherapy, business.industry, Radiotherapy Dosage, Middle Aged, medicine.disease, Prognosis, Combined Modality Therapy, Radiation therapy, Survival Rate, Oncology, Quality of Life, Female, Radiotherapy, Adjuvant, Intensity modulated radiotherapy, Radiology, Radiotherapy, Intensity-Modulated, business, Adjuvant, Follow-Up Studies, Radiotherapy, Image-Guided
Abstract: PURPOSE Postoperative Adjuvant Radiation in Cervical Cancer (PARCER), a phase III randomized trial, compared late toxicity after image-guided intensity-modulated radiotherapy (IG-IMRT) with three-dimensional conformal radiation therapy (3D-CRT) in women with cervical cancer undergoing postoperative radiation. METHODS Patients were randomly assigned to receive either IG-IMRT or 3D-CRT after stratification for the type of hysterectomy and use of concurrent chemotherapy. The primary end point was 3-year grade ≥ 2 late GI toxicity assessed using Common Toxicity Criteria for Adverse Events v 3.0 and estimated using time-to-event, intention-to-treat analysis, with a study level type I error of 0.05 and a nominal α of .047 after accounting for one interim analysis. Secondary end points included acute toxicity, health-related quality of life, and pelvic relapse-free, disease-free, and overall survival. RESULTS Between 2011 and 2019, 300 patients were randomly assigned (IG-IMRT 151 and 3D-CRT 149). At a median follow-up of 46 (interquartile range, 20-72) months, the 3-year cumulative incidence of grade ≥ 2 late GI toxicity in the IG-IMRT and 3D-CRT arms were 21.1% versus 42.4% (hazard ratio [HR] 0.46; 95% CI, 0.29 to 0.73; P < .001). The cumulative incidence of grade ≥ 2 any late toxicity was 28.1% versus 48.9% (HR 0.50; 95% CI, 0.33 to 0.76; P < .001), respectively. Patients reported reduced diarrhea ( P = .04), improved appetite ( P = .008), and lesser bowel symptoms ( P = .002) with IG-IMRT. However, no difference was observed in the time by treatment interaction. The 3-year pelvic relapse-free survival and disease-free survival in the IG-IMRT versus the 3D-CRT arm were 81.8% versus 84% (HR 1.17; 95% CI, 0.68 to 1.99; P = .55) and 76.9% versus 81.2% (HR 1.03; 95% CI, 0.62 to 1.71; P = .89), respectively. CONCLUSION IG-IMRT results in reduced toxicity with no difference in disease outcomes.
Published: 2021

18. Feasibility of a trial to evaluate nicotinamide for chemoprevention of skin cancers in organ transplant recipients in the <scp>UK</scp>

Author: C. M. Perrett, S.K.A. McCormack, C.E. Gollins, C. Blasdale, R.A. Abbott, S. Khan, Catherine A. Harwood, A. Shah, Rubeta N Matin, K. Sinha, Charlotte M. Proby, A. Durack, Rakesh Patalay, H. Cooper, John T. Lear, F. Ismail, L. Mackintosh, B. Meeajun, and N. Paul
Subjects: Niacinamide, Oncology, medicine.medical_specialty, Skin Neoplasms, Nicotinamide, business.industry, Organ Transplantation, Dermatology, Chemoprevention, Transplant Recipients, United Kingdom, Organ transplantation, chemistry.chemical_compound, chemistry, Internal medicine, medicine, Feasibility Studies, Humans, business
Published: 2020

19. A Half-Rotor Cipher for the Classroom

Author: N. Paul Schembari
Subjects: Computer science, business.industry, General Mathematics, Teaching method, TheoryofComputation_GENERAL, Cryptography, language.human_language, Education, law.invention, German, Cipher, law, language, Arithmetic, Cryptanalysis, Mathematics instruction, business, Coding (social sciences)
Abstract: Ciphers based on rotor machines were the state-of-the-art in the mid-1900s, with arguably the most famous being the German Enigma. We have found that students have great interest in the Enigma and ...
Published: 2019

20. Integrating next-generation sequencing to endoscopic retrograde cholangiopancreatography (ERCP)-obtained biliary specimens improves the detection and management of patients with malignant bile duct strictures

Author: Mordechai Rabinovitz, J. Wallis Marsh, Melissa E. Hogg, Asif Khalid, Rohit Das, Allan Tsung, Aatur D. Singhi, David A. Geller, Kenneth K.W. Lee, Kenneth E. Fasanella, James F. Pingpank, Abigail I. Wald, Michael A. Nalesnik, N. Paul Ohori, Adam Slivka, Amer H. Zureikat, Savreet Sarkaria, Randall E. Brand, Anil K. Dasyam, Jennifer Chennat, M. Samir Ayasso, David L. Bartlett, Nathan Bahary, Herbert J. Zeh, Marina N. Nikiforova, Abhinav Humar, Sara E. Monaco, Georgios I. Papachristou, and Kevin McGrath
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, CA-19-9 Antigen, Biliary Tract Diseases, Constriction, Pathologic, Malignancy, Sensitivity and Specificity, Gastroenterology, Specimen Handling, Primary sclerosing cholangitis, Diagnosis, Differential, Young Adult, Internal medicine, Pancreatic cancer, Biomarkers, Tumor, medicine, Humans, Prospective Studies, Pathological, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, Liver Cirrhosis, Biliary, Bile duct, business.industry, High-Throughput Nucleotide Sequencing, Middle Aged, medicine.disease, medicine.anatomical_structure, Bile Duct Neoplasms, Dysplasia, Female, Pancreas, business
Abstract: ObjectiveDespite improvements in imaging, serum CA19-9 and pathological evaluation, differentiating between benign and malignant bile duct strictures remains a diagnostic conundrum. Recent developments in next-generation sequencing (NGS) have opened new opportunities for early detection and management of cancers but, to date, have not been rigorously applied to biliary specimens.DesignWe prospectively evaluated a 28-gene NGS panel (BiliSeq) using endoscopic retrograde cholangiopancreatography-obtained biliary specimens from patients with bile duct strictures. The diagnostic performance of serum CA19-9, pathological evaluation and BiliSeq was assessed on 252 patients (57 trainings and 195 validations) with 346 biliary specimens.ResultsThe sensitivity and specificity of BiliSeq for malignant strictures was 73% and 100%, respectively. In comparison, an elevated serum CA19-9 and pathological evaluation had sensitivities of 76% and 48%, and specificities of 69% and 99%, respectively. The combination of BiliSeq and pathological evaluation increased the sensitivity to 83% and maintained a specificity of 99%. BiliSeq improved the sensitivity of pathological evaluation for malignancy from 35% to 77% for biliary brushings and from 52% to 83% for biliary biopsies. Among patients with primary sclerosing cholangitis (PSC), BiliSeq had an 83% sensitivity as compared with pathological evaluation with an 8% sensitivity. Therapeutically relevant genomic alterations were identified in 20 (8%) patients. Two patients withERBB2-amplified cholangiocarcinoma received a trastuzumab-based regimen and had measurable clinicoradiographic response.ConclusionsThe combination of BiliSeq and pathological evaluation of biliary specimens increased the detection of malignant strictures, particularly in patients with PSC. Additionally, BiliSeq identified alterations that may stratify patients for specific anticancer therapies.
Published: 2019

21. High-Performance Robust Controller Design of Plug-In Hybrid Electric Vehicle for Frequency Regulation of Smart Grid Using Linear Matrix Inequality Approach

Author: Sanjoy Kumar Paul, N. Paul, Priyo Nath Roy, Mizanur Rahman, Sajal K. Das, and Maniza Armin
Subjects: education.field_of_study, Wind power, General Computer Science, business.industry, Computer science, 020209 energy, 020208 electrical & electronic engineering, Population, Automatic frequency control, General Engineering, Linear matrix inequality, 02 engineering and technology, Linear-quadratic regulator, Smart grid, frequency control, Robustness (computer science), Control theory, 0202 electrical engineering, electronic engineering, information engineering, General Materials Science, lcsh:Electrical engineering. Electronics. Nuclear engineering, business, education, lcsh:TK1-9971, linear matrix inequality
Abstract: This paper proposes a high-performance and robust linear quadratic regulator-proportional integral derivative (LQR-PID) controller for frequency regulation in a two-area interconnected smart grid with a population of plug-in hybrid electric vehicles. Controller robustness is achieved using a linear matrix inequality approach. The proposed control framework is tested in a simulated two-area interconnected smart grid integrated with plug-in hybrid electric vehicles under load disturbances and wind power fluctuations. The performance of the proposed controller is simulated using Matlab and compared with that of a conventional linear quadratic regulator controller. Simulation results show that the proposed controller provides reliable smart grid frequency control.
Published: 2019

22. Œdème maculaire cystoïde bilatéral sous Paclitaxel : à propos d’un cas

Author: A. Jean-Charles, N Paul, and Harold Merle
Subjects: Ophthalmology, medicine.diagnostic_test, business.industry, medicine, Carcinoma, Fluorescein angiography, business, medicine.disease, Nuclear medicine
Published: 2019

23. Improvement of Alternative Non-Raster Scanning Methods for High Speed Atomic Force Microscopy: A Review

Author: Subrata K. Sarker, Md. Atikul Islam, Md. Atikur Rahman, Sajal K. Das, N. Paul, and Faisal R. Badal
Subjects: 0209 industrial biotechnology, Materials science, General Computer Science, Image quality, ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION, spiral scanning method, 02 engineering and technology, Atomic force microscopy, Scanning probe microscopy, 020901 industrial engineering & automation, Optics, sinusoidal scanning method, Cycloid, General Materials Science, Electrical and Electronic Engineering, Electrical conductor, rotational scanning method, business.industry, raster scanning method, Bandwidth (signal processing), General Engineering, computer.file_format, 021001 nanoscience & nanotechnology, Lissajous curve, cycloid scanning method, lcsh:Electrical engineering. Electronics. Nuclear engineering, Raster graphics, 0210 nano-technology, Raster scan, business, lcsh:TK1-9971, computer
Abstract: The invention of the nanotechnology adds a new branch to investigate and control the physical properties of matters at atomic level. The aim of this technology is to image the characteristics of metals, biological organs, and polymers. Scanning probe microscopy (SPM) opens a new branch to analysis the atomic properties of the matters. Atomic force microscopy (AFM), a branch of SPM, is a versatile tool of nanotechnology to image both conductive and non-conductive matters with high resolution. Commercial AFM uses raster scanning technique to produce image of the matters that is responsible for low scanning speed and image quality. The performances of AFM are hampered due to low bandwidth of the scanning unit and vertical Proportional-Integral (PI) controller and may damage the surface of the samples. Different non-raster scanning techniques such as sinusoidal, rotational, spiral, cycloid, and lissajous scanning have been proposed to overcome the limitations of raster scanning method by providing high scanning speed, image quality, and resolution. This paper presents a survey of raster and non-raster scanning methods for high speed AFM and provides a compression between them in term of scanning speed, bandwidth and highest achievable scanning frequency. The control techniques applied to the AFM for improving raster, sinusoidal, spiral, cycloid, and lissajous scanning methods are studied in this paper to find most optimum scanning technique for AFM.
Published: 2019

24. Benign call rate and molecular test result distribution of ThyroSeq v3

Author: Pooja Manroa, N. Paul Ohori, Shane O. LeBeau, Marina N. Nikiforova, Yuri E. Nikiforov, Raja R. Seethala, Michael S. Landau, Sally E. Carty, Karen E. Schoedel, and Linwah Yip
Subjects: Cancer Research, medicine.medical_specialty, Cytodiagnosis, Biopsy, Fine-Needle, Thyroid Gland, 030209 endocrinology & metabolism, Malignancy, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, medicine, Atypia, Humans, Genetic Testing, Thyroid Neoplasms, Thyroid Nodule, Pathology, Molecular, Suspicious for Malignancy, business.industry, Thyroid, breakpoint cluster region, High-Throughput Nucleotide Sequencing, Reproducibility of Results, medicine.disease, medicine.anatomical_structure, Oncology, Medullary carcinoma, Cytopathology, 030220 oncology & carcinogenesis, Mutation, Radiology, business, Indeterminate
Abstract: Background The benign call rate (BCR) is the percentage of cytomorphologically indeterminate cases with subsequent benign or negative molecular results. For rule-out tests, the BCR is an important parameter because these molecular "negative" cases may be managed similarly to those with a benign cytology diagnosis. Although earlier versions of ThyroSeq molecular tests were less effective in excluding malignancy, the extensively expanded v3 version with a high negative predictive value is considered to represent a rule-out test. In the current study, the authors evaluated the BCR and the overall molecular result distribution of ThyroSeq v3. Methods All indeterminate thyroid fine-needle aspiration cases (except those deemed suspicious for malignancy) with available ThyroSeq v3 results from November 2017 to June 2018 were retrieved from the cytopathology files. Because the ThyroSeq v3 genomic classifier was designed for thyroid follicular-derived lesions, cases in which parathyroid and medullary carcinoma molecular markers were detected and those that were inadequate or limited for molecular testing were excluded from the study. For the remaining cases, the indeterminate diagnoses were correlated with molecular and histologic results. Results Among the 224 indeterminate cases (except those deemed suspicious for malignancy), the overall ThyroSeq v3 molecular test BCR was 74.1% (166 of 224 cases). The category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) had higher BCRs compared with the other indeterminate diagnostic categories. RAS mutations were the most common positive results. Conclusions The high BCR demonstrates that ThyroSeq v3 is potentially effective in sparing the large majority of indeterminate cases with "negative" results from surgery while offering risk assessment for the positive cases and guiding clinical management.
Published: 2018

25. Accuracy of Rapid On-site Evaluation Diagnoses: Correlation with Final Cytopathologic Diagnosis as a Quality Assurance Initiative

Author: Jon M. Davison, Adrianna Walko, Beth Mosley, Daniel Geisler, N. Paul Ohori, Jacqueline Cuda, and Rick Nestler
Subjects: medicine.medical_specialty, business.industry, Medicine, Medical physics, Medical diagnosis, Site evaluation, business, Quality assurance, Pathology and Forensic Medicine
Published: 2021

26. 'Your Child Has Cerebral Palsy': Parental Understanding and Misconceptions

Author: N. Paul Rosman, Mugdha Mohanty, Shivangi Kataria, Spoorthi Sampath, Dimira Tambunan, and Forrest Beaulieu
Subjects: Adult, Male, Parents, Cerebral palsy, Terminology, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Surveys and Questionnaires, Terminology as Topic, Medicine, Humans, Aged, Aged, 80 and over, business.industry, Cerebral Palsy, Middle Aged, medicine.disease, Cross-Sectional Studies, Caregivers, Pediatrics, Perinatology and Child Health, Female, Neurology (clinical), business, Attitude to Health, 030217 neurology & neurosurgery, Clinical psychology, Boston
Abstract: Importance: Caregivers of children with cerebral palsy can best help their child if they understand the disorder and the correct terminology. Objective: To assess caregiver understanding of cerebral palsy. Design: This was a cross-sectional study from a large tertiary medical center in Boston, to assess understanding of the term cerebral palsy by primary caregivers of children and adolescents with cerebral palsy. All cases were obtained from hospital electronic medical records. Telephone surveys were conducted. Caregiver understanding of cerebral palsy was assessed by open-ended responses (50%) and success in answering true/false questions about cerebral palsy (50%). Participants: Primary caregivers of children 18 years and younger with cerebral palsy. Results: Thirty-three percent of caregivers denied ever being told that their child had cerebral palsy. Most caregivers identified cerebral palsy as a brain problem (79%), lifelong condition (73%), often caused by a perinatal (60%) or gestational (40%) insult. Fifty-two percent knew that cerebral palsy was nonprogressive. Sixty-two percent of caregivers believed they had a good, very good, or excellent understanding of cerebral palsy, whereas the investigators found 69% of caregivers had a good, very good, or excellent understanding of cerebral palsy (P = .006). Most caregivers rated very good or excellent the setting where cerebral palsy was discussed (58%), the explanations provided (55%), and the amount of time spent (45%), yet using a Pearson correlation coefficient, most important was the time spent ( r = 0.53). Conclusions: Following discussion with their child’s physician, most primary caregivers of children with cerebral palsy have a good, very good, or excellent understanding of cerebral palsy. Most critical to a good understanding of cerebral palsy was the time spent in explaining the diagnosis.
Published: 2021

27. Prevalence of diabetic and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities

Author: H Appeltants, C Boesch, I Cromarty, D Carretta, S Romanov, U Windstetter, F Mibach, Jens Refsgaard, S Lebedev, F Proietti, M Y Tamimi, M C Gamboa, M Novikova, E Prada, K H Sim, E Messas, E Zherlitsyna, A Kalampalikis, N Nevolina, N Trocan, J Cohen, G Szto, R Gilabert Gómez, M Omelchenko, A Pinzani, D Goodwin, J Umaran Sánchez, Kim Fox, S H Dong, K Kronberg, E Castillo Lueña, T Ignatieva, S Joubert, C Macchi, S Lee, S Eidelman, F Alizon, S Chandra, M Akbar, D M Colquhoun, G Yanes Bowden, J de Juan Baguda, M Sebastian, C Wernham, K Miedema, R La Greca, C Morton, B S Jheeta, A C Tran, T Q Do, O Rodrigues, J Yan, S H Kim, R Jurgaitienė, Jean-Claude Tardif, R Baleón, D Hay, V Hennebelle, F Fazekas, R Davies, P Gratia, L Sorodoc, S Y Wu, C Martínez Sánchez, L Lopes Antunes, T H T Pham, I Suliman, M J Gómez Martinez, A Pernat, S H Hur, M Alanazy, L Zhabina, M Stanley, J Rogers, Y J Kim, S Geffroy, L K Andersen, S Coman, V Pedrosa del Moral, Y Garaud, J Krupicka, O Dzhkha, C Paul, M Jeżewska, B Mahler Mioto, V Abduvalieva, P Morra, L Kucheryava, C La Rosa, B Chan, M Wrębiak-Trznadel, A Kozlowski, M Sharif, L López Barreiro, V Kolesnikov, M Lawrence, A Tucker, C Okawabata, B La Hay, E Sadauskienė, B K Nguyen, L Bui, A Said, M E Ruíz Esparza, R K Saran, M S C Ho, E Homs Espinach, J R Romo Santana, J Forte De Carvalho, I Pattison, H H Phan, L Baleeva, L Kisiel, A López Granados, C Raters, F Paganelli, R Haberl, A P T Wong, D Xu, R Jagathesan, L Grekhova, H Stursova, Q B Truong, P Raymond, Y Sosnova, N H Khong, J Zarauza Navarro, C Florescu, L Gorshkova, N Saaidin, E Gordillo Higuero, L Davin, I Budanova, C Lavicka, L Gruznykh, P Bogdański, A Dufka, I Arroja, H A R Tahir, G Wilson, G Kolios, S J Yoon, Simon Cattan, K Berdnik, A Serrano, B Sievers, A Rodríguez Almodóvar, L A Holden, F O'Reilly, D Verleyen, H Hafez, K Nehrig, S M Kang, S Berrisch-Rahmel, E Meyer-Michael, P Samama, L Soares, A K Nguyen, F Tuktarova, C Weytjens, E Sandoval Rodriguez, J Cheng, F M Villasenor, João Morais, B Sullivan, R Zimoląg, Albert V. Smith, S F Ding, J C Louchart, G Guardigli, R Furtak, P Azzolini, S Chushak, J L Delgado Prieto, S Kornienko, K K Sia, J H Shin, F Baylac Domengetroy, P Błaszczak, M Saade, N Černič-Šuligoj, K Coetzee, A Kadleckova, V Scollo, O Larina, R Pal, M M Singh, N Nosova, R Burns, B S Yoo, O Gukov, F Massari, V Antia, A Brattström, G Holt, M Scherbak, V Firastrau, Y J Li, E Mikhailova, L Machado Cesar, C García García, J Pjontek, C Everton Biglow, G Pes, C Brown, A Bumbu, S Felis, R Bosch, M Lazaro, Luigi Tavazzi, R Engel, I Romeo Castillejo, Y S Byun, F Matias, I Grushetskaya, C Mestre-Fernandes, T Kheliya, S Schlesingerova, G Theodorakis, I Tsamopoulos, R Pedretti, A Puente Barragán, M P Vo, B Lammens, T Carruthers, J S Bhatt, A Khodanov, N Pasechnaya, I Petrova, G Boutros, I A Khan, E Le Moal, D Garofalo, H R Malaterre, A Bahal, J F Martínez González, H N Dinh, N V Pham, C Barjhoux, I Gilmour, C Soriano Navarro, O D Chioncel, K Tóth, N Borodina, P Khanoyan, B Sevilla Toral, H H Kim, C M A Bui, C Dernedde, N Eliseeva, M Galinier, E Kosachek, M M Doohan, L Potapska, M Tennekoon, R Nourallah, L Perez De Isla, K H Chee, E Panova, D M Walker, G Glanowska, G Hua, A Silvestre, W Wang, Matthew A. Brown, B Luke, G Jarosiński, R Davis, S Cleron, C Liatas, I Orestis, M Dereń, J Sudnik, S X Zhou, J Fuertes Alonso, O Baranova, S Mingalaeva, T N Vo, K A Ngo, J A Rodríguez Fernández, R Ishmael, G Bode, K K Chan, G Al Radaideh, S Ramphall, H D Theron, V Montagud Saavedra, A Yusuf, G F Mazzanti Mignaqui, L Evtukhova, J Lorenc, D Beacock, O B Šlapikienė, F Alitto, J N Poujois, B Berzal Martín, M Felbermayer, V Mallamaci, T Spitsina, R Ramachandran, A Jánosi, V Dženkevičiūtė, S Gillam, V Joulie, G Esna Ashari, R Henry, E Durand, A Alam, V Fourchard, H Dreycopp, R Fressonnet, C Camossa, O Jerzykowska, M Castrucci, G Sinicropi, B K Goyal, V Vasylenko, R Grogono, M Partington, B Vaquette, R Blindt, Mª T Moreno Casquete, V Kukaleva, W Streb, P F Clavette, M Pérez Paredes, V Hadjiivanov, C Bundy, D E Manyari, A Wassef, J Kuchar, W Nisker, P S Bath, S Panpunnung, G H Choo, Datshana P Naidoo, Y Pavlova, R McManus, N Brand, E Davies, L Prunier, A Schenowitz, P Sternthal, T Sinotova, J Martínez Florez, R Sykulski, J Pinar Sopena, M Balbi, Y Pesant, D A Playford, C Villar Mariscal, F Redding Escalante, W Wongcharoen, O Grechishkina, A Girão, M Speth-Nitschke, K A Mahendran, A Bianco, A Vadavi, G Singh, L Petoin Peuch, L Sukhanova, A Y Y Fong, J L Vega Barbado, A Dzien, S Honorat, G Ansalone, G Kamensky, G McLaren, T B Kim, I Bratu, R Fillet, V Rogozhyna, L Nagy, M Malgina, M A Sheikh Abdul Kader, Z C Li, L Rotaru H Rus, D Adamczyk-Kot, J Estrella, S Serrano García, P Farto E Abreu, D Mescharekova, Su Thillai Vallal, P Seal, S Möller, A Cziráki, T T H Ta, S Davies, H Ge, M Arafah, M Ovize, A Olszewski, V Aboyans, C Roche, F Al Tamimi, L Popova, V Kazachkova, R Rennert, J Aubry, G Bourgeois, J Mackrell, F Al Kandari, N Reifart, J Bérubé, W H J Hutse, O Lysunets, I Butkuvienė, J Cotroneo, J Gdalia, J Dalle Mule, R Santos, B Singh, H Mohammed, A Birkenhagen, T Chiscaneanu, H Sullivan, Jacob A. Udell, N Bolotova, A Jankowska, M Skonieczny, B S K Ch'ng, O Aiyegbayo, S Ciaroni, N Lago, S R Coimbra, R Ellis, B K Koo, S Rostik, P Jacquier, A Conradie, N Biryukova, M Ayche, A Khripun, B Peperstraete, E Velasco Espejo-Saavedra, G Cunliffe, G Grollier, C Ceraulo, T L To, Q H Tran, M Anscombe, R Jordan, I Czuriga, P Haimes, R Ancín Viguiristi, H Q Zhang, C A Chételat, A Rafter, E Rinkūnienė, K Yang, W Gao, J Pearce, L C Fernández Léoz, L Gareeva, R Fernández Alvarez, G Verret, P Astrakhantseva, C M Chu, L Murphy, P A Do, J L Liu, A Clifford, K Woollard, N Dmitrieva, N Lousada, R Díaz Juárez, N Semenova, T Fesenko, F Henschel, R Amini, G Matuszewska, R Christodorescu, J Varaldi, S Varughese, V Lafarenko, A Ashford, J L Colomer Martín, S Assouline, H Noor Hasni, A Weatherup, T Forster, R Kaserbacher, I Caldwell, N Arabadzhi, Emmanuel Sorbets, A Rink, E C Rueda Calle, J M Stordeur, P West, V C Do, Béla Merkely, J Antunes, U Altmann, S Magheru, B Bachmann, W Parkar, M de los Reyes López, M Wazana, A Frattola, M Mospan, V Koval, E Giusti Rossi, J Vasconcelos, K B Do, A Ogorodnichuk, D Lighezan, G Mentz, J M Cherry, P Pouderou, M Moretti, C M Spinu, Emmanuelle Vidal-Petiot, N Kupstytė, P Jourdain, V Voronina, O Varezhnikova, S Williams, H AlFaleh, R Lew, P Hildebrant, J Drozd, G Muscio, T H Ashton, A Achilli, J Harinasuta, T Ghose, G Walawski, Y Arkhipova, M Alves Costa, B Day, A Suntinger, A Singh, P Sheringham, A Vázquez García, J Taggeselle, J T Dong, T H Goh, G Rojas, R Schultz, A Ballet, O Likhobabina, Z M Qian, S Sandoval Navarrete, D Manzi, S Langridge, W Haerer, C K Abdullah, L Hay, Á Herdade, A Gałuszka-Bilińska, F Biausque, V M Lai, D S Eccleston, L Nikolaeva, P Kalaras, J Martínez Redding, N P H Tran, B Wauer, Philippe Gabriel Steg, B Etcheverry, J Navarro Manchón, R Augarde, C Dixon, M Y Chen, J L Gleizes, S Pustovit, J L Farges, S Cox, G Manchet, K Shein, L Parker, C C Ang, O Sinyukova, V Veth, A Kurekhyan, N Cindea Nica, N Wittlich, J Al Yazeedi, A Pucheu, V Elliott, J Bories, K Alford, M F Ferrão E Vasconcelos, A Adamkiewicz-Piejko, R Cervenak, J F Beltrame, A Castro, L Safonova, G Koutsimpanis, C de Brito Vianna, R Wysocki, V Ginzburg, J Hernández Afonso, A Ihonor, O Golubeva, M Karachaliou, S Kleta, D d'Este, Gustavs Latkovskis, F Jäger, E Gamzatov, Y Kozhelenko, J Lippai, T T L Ong, S J Ge, A Hersi, K Kyd, S Mingam, V Yordanova, L Bardachenko, E Mozerova, S W Liu, J Zdrojewska, E Chung, M Leclair, M Nazir, S Zarechnova, A Rahman, M Sołtysiak, B Maguire, F Moreira Pinto, R Fathi, E Prieto Moriche, C Priftis, P Heno, N Sytilina, A Pladys, S Shimonenko, P Keller, J F Junior, G Amiel Oster Sauvinet, J P Kanner, L Tkachenko, J Dalal, A Liston, D Herrera Fernández, J L Bonnet, A Chirivella González, R P Shah, F A Reyes Cisneros, C Avgerinos, P Ravoala, V Albero Martínez, G Suarez, V Jouve, A Frankiewicz, A Lindsay, A De Meester, H Dau, M Pornin, J Álvarez Gil, J Murin, T Hodac, J J Gómez Barrado, Y J Wu, S Jean, P Hilti, A Dayani, R Steponėnienė, G A Somsen, H Zhang, J Moore, P Tarenidis, T H Nguyen, M Maliszewski, L Voloshyna, S Novo, A Phrommintikul, I Shanina, Roberto Ferrari, P Franklin, C Turner, W Boonyapisit, F Sepulcri, P Vandergoten, J Carvalho, J Halcox, V Rotenberger, J F Baril, M Turiel, P Shiels, P Painsipp, S Reis Monteiro, T Honsig, V Vivekaphirat, J Ardill, P Brodzicki, A Khalifa, H Audibert, T Wettstein, F Auhser, D Ezekiel, D Pella, E Simarro Martín-Ambrioso, H S Seo, J A Núñez Gamero, Gabriel Steg, M Orbán, S Bykovskaya, W Gadziński, N Rozkova, G H M Vawda, R A Motyer, B Limeres González, E Fernandez Valadez, Riyaz S. Patel, I Shaikh, E Ziak, A Estriga, P Dodemant, Dragos Vinereanu, W Miao, L Marullo, F MacNamara, S K Tan, N Giacomantonio, A Leherissier, H W Li, Arpana Agrawal, Y Moreau, F David, S K Ma, A N Jamaluddin, E Alegría Ezquerra, Scalzo, M C Ta, T T Nguyen, A Sudre, R Gupta, H Lagioia, M Haiba, P Kohan, M Szentivanyi, T Dmitrieva, N Vechtomova, C Vuille, R G Schena, P Navratil, O Tsygankov, L Saaby, P Lefebvre, S King Wong, S Maheas Morlet, N H Pham, P Bonnet, S Modi, L Gaspar, M Karlicek, S Pallie, H T Pham, S Abele, N Bizyaeva, L Facila Rubio, N Meneveau, G Poluyanova, J Calaça, S Orazi, M Emonts, A Yusufali, V Sprott, Z Vazhdaeva, M R Conte, E Bulakhova, K Giokoglu, E Page, E Kotova, G Maragoni, C Jerjes Sánchez, T Kiver, M Brunehaut Petaut, A Nagy, P Singer, Zs Sziegl, B Fontanet, S Strange, A Watson, J Föchterle, Janet A. Dunn, R Šlapikas, M Stikhurova, S Salimova, J Volmar, E Otero Chulian, S Hutchinson, R Koller, X Bonnaud, E Peris Domingo, F Marín Ortuño, E Galve Basilio, S Bongo, L Payot, C Miller, A Samothrakitis, L Silva Melchor, K Orzechowski, W Hofer, L V Nguyen, R Oliver, K T Jung, J Robb, D Sobczyk, J Muller, A Tomatti, M Gruchała, C Bradshaw, D Richmond, E Mineeva, E Smirnova, A Idrissi-Sbai, H Vial, R Balai, I Kiseleva, H Jones, M Gibbs, D Ohlmeyer, Y Al Wahshi, V d’Alessandro, S Pérez Ibiricu, V Zachos, A Chernozemova, D R Spink, J Schneider, A M Peset Cubero, M Irurita Latasa, M Migliore, G Perna, E Daniels, M H Tay, N Z Khiew, I Soin, F Bernasconi, T Garban, F Omardeen, O Rodina, L Kanagaratnam, I Blum-Decary, A Jaussi, D Romero Alvira, D Vermander, N Kanumilli, M A Romero Maldonado, M Fernández-Valls Gómez, H Tran, T P Nguyen, H Omar, R S Collette, B Kisjós, H Krause-Allmendinger, J Silva E Sá, H Topf, F Panetta, T C Do, G Roul, J Leso, A Lacroix, M Fic, C Hart, R Chan, L Lema, Y Polyanskaya, R Howlett, Lesley J. Burgess, X P Chen, Hywel C Williams, V T Le, N Gurianova, R Duchowska, V P Nair, D Mitropoulos, A Allcock, T T H Bui, M Golub, E Yakovenko, M Perry, F Belcastro, K Svolis, B H R Forge, F Fernández de la Cigoña, N Murga Eizagaechevarría, G Mariano Pêgo, V Mincheva, T N Nguyen, J Moyal, M Wei, H Vinhas, A Batalla Celorio, C Romero Menor, S Rahman, N Hassler jun, F Duclos, K Ladha, A Ordóñez España, B C Chang, R Cortés Sánchez, G Lafrance, I Mihailova, Y Riou, I Pashentseva, S Tantillo, U Casas Juarezy, Ian B. 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M Baar, P Lafontaine, C O'Dong, I Petropoulos, B-M Altevogt, D Warden, T De Backer, G Miñana Escrivá, T L Mai, U Schlesinger-Irsch, M M Gomaa, E Moksyuta, M Drexler, P Monteiro, P Grooterhorst, J Moolman, P McAlavey, J O'Shea, L P Quinn, F Crespo, K Srinivasa Reddy, T Shokina, Ellen M. Schmidt, M H Jeong, K Denef, A Pleskof, I Takács, Y Tikhonov, O Ushakov, L Stevens, J Ezcurdia Sasieta, L Nkombua, O Henne Otero, J Y Fraboulet, D S Kim, G Hoh, A Tamm, M Sardon, G Chatzioakim, M A Ulecia Martínez, S Reymond, M Myint, G Proença, R Massabie, E Foster, H Dougall, Anjan Kumar Roy, C Franco Aranda, M Getman, E Filippova, C Aguiar, X D Pu, N Voronina, L L Chen, M Szulc, L Bayakhchan, M J Pinto Vaz, C Niederberger, N Vites, I Sen, Paul R. Kalra, J A Castillo Moreno, W K Ng, C Brunschwig, D Morgan, A Concepción Clemente, N Yakimova, J M Guy, A H Jaafar, J Badarienė, N Taylor, L Compson, R Amor, A Maximovitch, J L Bardají Mayor, E Marín Araez, N H Chau, N Srtumilenko, K Kelly, A Papathanasioy, S Erofeev, B Mamez, A Ribeiro, M Micko, N Alvarenga Recalde, K Atueva, Z Sebõk, P Kycina, A K Gupta, A Laucevičius, R Ahuja, A Prokop, P Stadler, S De Ridder, L Zhang, F B Ramadan, L Kapustina, V Fedoskin, A Bateman, C A Nacht, R Musetescu, M Aparici Feal, A Büttl, S Ross, M Rau, P Federico Zaragoza, G Brisson, M Zagreanu, T T H Pham, F Dominé, N Davydova, N Petrochenko, N Paul, P H Truong, S Frickel, W Bryl, G Brouillette, A Stumpp, M Barrera Bustillos, C Ziccarelli, O Zalyzniak, M eatherhead, N Watkins, G Riccioni, l Kudryavtsev, R Carvalho, J P S Sawhney, V González Toda, P Matos Dias, M Giorgadze, I Rodriguez Marrero, W Gritsch, K Lee, G W Kellam, I Parker, V Ecina, Mª I Soto Ruiz, C Delhomme, T Ivaschenko, Y W Cheah, I Grudtsina, R Chehayeb, T Dookie, O Krasnoslobodskaya, P Jarmużek, F Van den Branden, A M F Vandeplas, A Rocha De Almeida, M Espiga De Macedo, E Łotocka, K Nagy, R Paliulionienė, J L Leyva Pons, N Fedorova, Y Yanina, O Stasuk, Z Vlasuk, P Lim, P Egloff, T Berezhna, A Faria, J Cerda Rojas, E Moser, H G Jin, S J Oh, G Arquero García, K H Karner, I Leontaridis, A Banikova, J Fridrich, H Lesseliers, I Pokrovskaya, P Astridge, H Abdul Manap, R Daniel, C A Almeida Fernández, A Nowowiejska-Wiewióra, B Carvalho De Moura, M Malden, H Rosenstein, S Dixon, G Balogh, M Adam-Blanpain, A Sandalian, H Gervas Pavón, G A Antoniadis, N Naberezhnova, A Amlaiky, P Terrosu, K K H Lau, B Chartier, X Su, O Kovyrshyna, G Beale, P Primot, M H Chen, S S Ramesh, R Chyrek, E Gómez Álvarez, J Rodríguez Collado, G Sibilio, R Jeremiasz, R Colin, C Lalla, G M Fullerton, M P Samal, H Thümmel, R P Patel, J Takhar, H M Kwon, T A Cieza Lara, F Magliari, J Morrell, M Rayo Gutiérrez, T L Orenstein-Lyall, H Choi, S Kulinich, A Aftab, A Wallace, B B Abdul Kareem, S Kwok, A Królak, A Grover, Laurent Fauchier, Mª J Pinilla Lozano, G Sengupta, D Paris, M Al Dhanki, J Milewski, F Petersen Aranguren, H Brufau Redondo, H Mayr, A Arias Mendoza, M Ducoudre, A Correia, J S Awtar Singh, P Aylward, E Brscic, J Du Plooy, J L Arenas León, G Silva Alves, L Sreenivasa Murthy, P Dendale, F La Varra, S Minkin, T Eggeling, A Jamiel, G Lebischak, E Andreev, T V A Tuong, V Chaithiraphan, O Duprez, S Higgins, F Chometon, Y Cottin, A Bonny, C Guyetand, J Matos, F Henpin Yue Cesena, L Polyaeva, M Drijfhout, J Toplak, G E Vertes, N F Wang, J Doucet, A K Trivedi, P Turek, G Chouinard, A Al Lawati, W Filip, F Kovar, T J Cha, A Belanger, H L Cong, J F Robert, D López Gómez, J L Sanz Rodríguez, H Simper, P Shetty, A Chukwu, E Bukanina, C Amoros Galito, H MacCowan, T T T Tran, A Singal, K C Vu, O Ismail, A Ardiaca Capell, P Bousquet, F Goss, Z Galeeva, Maxime Guenoun, B Rijavec, Z Lazerevic, A McCracken, A C Motoc, Y Sharapova, S Wright, A J Paule Sánchez, L Mainar Latorre, I Sirazov, X L Yang, S E Paget, G Berkenboom, J Markenvard, I Surovtseva, S K George, Matthias Simon, M L Fuantos Delgado, C Christoforidis, M Lagares Carballo, P Alvarez García, J Könemann, L Crawford, I Gonos, D Saulnier, E Szabó, L Ardouin, J Bhayat, F J Abardía Oliva, X Bernard, O Sirbu, P Boutsikos, N Khmelevskikh, E Tavlueva, P LeBouthillier, I Bourazanis, A Sequeira, M López Martínez, C P Paulus, R K M Bhaskaran, F Pellerin, B Brown, B Saleh, A Lacchè, R Sola Casado, E Kaźmierczak, M Weingrod, and G Vijayaraghavan
Subjects: medicine.medical_specialty, Cardiac & Cardiovascular Systems, Epidemiology, LONG-TERM, medicine.medical_treatment, Chronic coronary syndromes, Coronary Artery Disease, Revascularization, Ventricular Function, Left, GLUCOSE, MELLITUS, Risk Factors, Internal medicine, Diabetes mellitus, Diabetes Mellitus, Ethnicity, Prevalence, medicine, Humans, ARTERY-DISEASE, Myocardial infarction, Stroke, RISK, OUTCOMES, Ejection fraction, Science & Technology, business.industry, Proportional hazards model, CLARIFY Investigators, Hazard ratio, Diabetes, Stroke Volume, Geographical disparities, Syndrome, medicine.disease, MIDDLE-EAST, EUROPEAN-SOCIETY, Treatment Outcome, MYOCARDIAL-INFARCTION, Heart failure, CLARIFY registry, Cardiovascular System & Cardiology, HEART-FAILURE, Cardiology and Cardiovascular Medicine, business, Life Sciences & Biomedicine
Abstract: BackgroundIn contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.Methods and resultsCLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest.ConclusionIn patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.ClinicalTrials identifierISRCTN43070564
Published: 2021

28. Molecular alterations in Hürthle cell nodules and preoperative cancer risk

Author: Simion I. Chiosea, William R Doerfler, Michael S. Landau, Linwah Yip, Alyaksandr V. Nikitski, N. Paul Ohori, Pooja Manroa, Elena M. Morariu, Marina N. Nikiforova, and Yuri E. Nikiforov
Subjects: 0301 basic medicine, Thyroid nodules, Cancer Research, Pathology, medicine.medical_specialty, Carcinoma, Hepatocellular, Endocrinology, Diabetes and Metabolism, Cell, Biopsy, Fine-Needle, Malignancy, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, medicine, Adenoma, Oxyphilic, Humans, Thyroid Neoplasms, Thyroid Nodule, Thyroid cancer, Hyperplasia, Oxyphil Cells, business.industry, Liver Neoplasms, Cancer, Nodule (medicine), medicine.disease, 030104 developmental biology, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Hurthle cell carcinoma, medicine.symptom, business
Abstract: Hürthle cell carcinoma (HCC) is a distinct type of thyroid cancer genetically characterized by DNA copy number alterations (CNA), typically of genome haploidization type (GH-type). However, whether CNA also occurs in benign Hürthle cell adenomas (HCA) or Hürthle cell hyperplastic nodules (HCHN), and have diagnostic impact in fine-needle aspiration (FNA) samples, remains unknown. To address these questions, we (1) analyzed 26 HCC, 24 HCA, and 8 HCHN tissues for CNA and other mutations using ThyroSeq v3 (TSv3) next-generation sequencing panel, and (2) determined cancer rate in 111 FNA samples with CNA and known surgical outcome. We identified CNA, more often of the GH-type, in 81% of HCC and in 38% HCA, but not in HCHN. Among four HCC with distant metastasis, all had CNA and three TERT mutations. Overall, positive TSv3 results were obtained in 24 (92%) HCC, including all with ATA high risk of recurrence or metastasis. Among 111 FNA cases with CNA, 38 (34%) were malignant and 73 (66%) benign. A significant correlation between cancer rate and nodule size was observed, particularly among cases with GH-type CNA, where every additional centimeter of nodule size increased the malignancy odds by 1.9 (95% CI 1.3–2.7; P = 0.001). In summary, the results of this study demonstrate that CNA characteristic of HCC also occur in HCA, although with lower frequency, and probability of cancer in nodules with CNA increases with nodule size. Detection of CNA, in conjunction with other mutations and nodule size, is helpful in predicting malignancy in thyroid nodules.
Published: 2021

29. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST):a multicentre, prospective, randomised, open-label, non-inferiority trial

Author: Isla S Mackenzie, Ian Ford, George Nuki, Jesper Hallas, Christopher J Hawkey, John Webster, Stuart H Ralston, Matthew Walters, Michele Robertson, Raffaele De Caterina, Evelyn Findlay, Fernando Perez-Ruiz, John J V McMurray, Thomas M MacDonald, J. Aziz, G. Dobson, A.S.F. Doney, R.W.V. Flynn, J. Furnace, J.W.K. Grieve, G. Guthrie, D. Jamieson, C.G. Jennings, S. Kean, L.C. Lund, A. McConnachie, F. Pigazzani, P.L. Riches, M. Rix Hanson, A Rogers, E.D.M. Rooke, J. Thomson, M. Warren, K. Wetherall, R. Wilson, C.P. Hall, A. Maseri, H.A. Bird, G. Murray, J.W. Dear, M. Petrie, M. MacDonald, P.S. Jhund, E. Connolly, D.J. Murphy, N. Paul, A. Olsson, P.T. Koskinen, A. Fuat, A. Foster, W. Saywood, R.J. Barr, L. McConnachie, L.F. Wilson, L. Larsen Rasmussen, A.R. McGinnis, H. Birrell, M. Keiller, I.S. Bremner, G.J. Forbes, J.S. Dumbleton, J. Rhodes, and T. Waller
Subjects: medicine.medical_specialty, business.industry, Allopurinol, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Gout, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, 030212 general & internal medicine, Febuxostat, Risk factor, business, Prospective cohort study, Adverse effect, medicine.drug
Abstract: Background:\ud Febuxostat and allopurinol are urate-lowering therapies used to treat patients with gout. Following concerns about the cardiovascular safety of febuxostat, the European Medicines Agency recommended a post-licensing study assessing the cardiovascular safety of febuxostat compared with allopurinol.\ud \ud Methods:\ud We did a prospective, randomised, open-label, blinded-endpoint, non-inferiority trial of febuxostat versus allopurinol in patients with gout in the UK, Denmark, and Sweden. Eligible patients were 60 years or older, already receiving allopurinol, and had at least one additional cardiovascular risk factor. Those who had myocardial infarction or stroke in the previous 6 months or who had severe congestive heart failure or severe renal impairment were excluded. After a lead-in phase in which allopurinol dose was optimised towards achieving a serum urate concentration of less than 0·357 mmol/L (
Published: 2020

30. Establishing diagnostic criteria and treatment of subsegmental pulmonary embolism: A Delphi analysis of experts

Author: James G. Ravenel, Paul L. den Exter, C. Wu, Martine Remy-Jardin, R. D. Renapurkar, J. M. Goo, Marc Carrier, Laurent Bertoletti, Ludo F. M. Beenen, P.-M. Roy, B. Ghaye, David Jiménez, Charles S. White, R. Pedroc, P. Wells, H. C. J. Eikenboom, N. Paul, Pieter Willem Kamphuisen, M. Ferreira, Susan R. Kahn, S. Shivakumar, G. Ferretti, Nicola Sverzellati, B. Geurts, A. Lazo-Langner, Marc Philip Righini, M. Das, Stefano Barco, Jeffrey I. Zwicker, Sanjeev Bhalla, Suhny Abbara, Marco P. Donadini, M. Monreal, I. Vlahos, Ingrid Pabinger, A. Lee, Aurélien Delluc, N. J. Screaton, Olivier Sanchez, Cornelia M. Schaefer-Prokop, P. J. MacMahon, Walter Ageno, H. R. Büller, A. de Roos, Lilian J. Meijboom, E. van Beek, L. Castellucci, Paolo Prandoni, C. Dennie, L. Jara-Palomares, Thomas Frauenfelder, Marc A. Rodger, Linda B. Haramati, Carol Gonsalves, Marie-Pierre Revel, L. K. Moores, L. Duffett, Frederikus A. Klok, Peter Verhamme, Marc Blondon, J. Vogel-Claussen, F. J.M. van der Meer, B. Hunt, Helmut Prosch, F. Moustafa, Drahomir Aujesky, Cihan Ay, Mark Crowther, Grégoire Le Gal, N. van Es, Jeffrey P. Kanne, Ieneke J.C. Hartmann, Lucia J.M. Kroft, David A. Garcia, C. Tromeur, D. Siegal, E. Pena Fernandez, Menno V. Huisman, Verhamme, Peter, Radiology and nuclear medicine, Radiology and Nuclear Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, ANS - Neurovascular Disorders, Graduate School, Vascular Medicine, ACS - Amsterdam Cardiovascular Sciences, and ACS - Atherosclerosis & ischemic syndromes
Subjects: medicine.medical_specialty, pulmonary embolism, diagnosis, Delphi method, Indirect evidence, anticoagulant treatment, Delphi analysis, medicine, Computed tomography scanner, subsegmental, computer.programming_language, Segmental artery, business.industry, Hematology, medicine.disease, Original Articles ‐ Thrombosis, Pulmonary embolism, Anticoagulant therapy, Original Article, Radiology, business, Venous thromboembolism, computer, Delphi, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract: BACKGROUND: Improved imaging techniques have increased the incidence of subsegmental pulmonary embolism (ssPE). Indirect evidence is suggesting that ssPE may represent a more benign presentation of venous thromboembolism not necessarily requiring anticoagulant treatment. However, correctly diagnosing ssPE is challenging with reported low interobserver agreement, partly due to the lack of widely accepted diagnostic criteria. OBJECTIVES: We sought to derive uniform diagnostic criteria for ssPE, guided by expert consensus. METHODS: Based on an extensive literature review and expert opinion of a Delphi steering committee, two surveys including statements regarding diagnostic criteria and management options for ssPE were established. These surveys were conducted electronically among two panels, respectively: expert thoracic radiologists and clinical venous thromboembolism specialists. The Delphi method was used to achieve consensus after multiple survey rounds. Consensus was defined as a level of agreement >70%. RESULTS: Twenty-nine of 40 invited radiologists (73%) and 40 of 51 clinicians (78%) participated. Following two survey rounds by the expert radiologists, consensus was achieved on 15 of 16 statements, including on the established diagnostic criteria for ssPE (96% agreement): a contrast defect in a subsegmental artery, that is, the first arterial branch division of any segmental artery independent of artery diameter, visible in at least two subsequent axial slices, using a computed tomography scanner with a desired maximum collimator width of ≤1 mm. These criteria were approved by 83% of the clinical venous thromboembolism (VTE) specialists. The clinical expert panel favored anticoagulant treatment in case of prior VTE, antiphospholipid syndrome, pregnancy, cancer, and proximal deep vein thrombosis. CONCLUSION: The results of this analysis provide standard radiological criteria for ssPE that may be applicable in both clinical trials and practice. ispartof: RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS vol:4 issue:8 pages:1251-1261 ispartof: location:United States status: published
Published: 2020

31. Toxic epidermal necrolysis and co‐existent SARS‐CoV‐2 (COVID‐19) treated with intravenous immunoglobulin: ‘ Killing 2 birds with one stone ’

Author: R. Healy, S. Sahu, D. Collins, A. D’Cruz, D.‐A. Charles, A. Fonia, N. Paul, and M. Saha
Subjects: medicine.medical_specialty, Allopurinol, Dermatology, Malignancy, Letter to Editor, SARS‐CoV‐2, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, Lower respiratory tract infection, medicine, 030212 general & internal medicine, Multiple myeloma, Intravenous immunoglobulin, Lenalidomide, business.industry, Toxic epidermal necrolysis, Amoxicillin, medicine.disease, Rash, Infectious Diseases, medicine.symptom, business, medicine.drug
Abstract: Toxic Epidermal Necrolysis (TEN) is classified as severe cutaneous adverse reaction. It can be induced by drugs, infection, and malignancy or can be idiopathic. We present a 62‐year‐old male of Indian origin with a widespread, tender, erythematous maculo‐papular eruption and targetoid lesions on the palms and soles. He had a history of multiple myeloma and a stem cell transplant in 2008. He was recently started on amoxicillin for a suspected lower respiratory tract infection and lenalidomide, septrin and allopurinol 6 weeks prior to presentation due to a relapse of the myeloma. The rash evolved into large areas of flaccid blistering (over 30% of the body surface area) with severe mucosal involvement (Fig.1a) and a diagnosis of TEN was made.
Published: 2020
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32. The impact of microsatellite stability status in colorectal cancer

Author: Surajit Sinha, Ruby Gupta, and Rabindra N. Paul
Subjects: 0301 basic medicine, Genome instability, Oncology, Cancer Research, medicine.medical_specialty, Colorectal cancer, Disease, 03 medical and health sciences, 0302 clinical medicine, Germline mutation, Internal medicine, Chromosome instability, medicine, Animals, Humans, neoplasms, business.industry, Microsatellite instability, Prognosis, medicine.disease, digestive system diseases, Lynch syndrome, 030104 developmental biology, 030220 oncology & carcinogenesis, Microsatellite Instability, DNA mismatch repair, Colorectal Neoplasms, business
Abstract: Several forms of genomic instability are known to drive the development of colorectal cancer (CRC). Chromosomal instability is the most common type found in 85% of the CRC, while 15% patients have microsatellite instability (MSI). MSI tumors are the subset of CRC that are characterized by dysfunction of mismatch repair genes (MMR) causing failure to repair errors in repetitive DNA sequences called microsatellites. Twelve percent of MSI tumors are acquired, caused by methylation-associated silencing of a gene that encodes a DNA MMR protein, while the remaining 3% have germline mutations in one of the MMR genes (Lynch syndrome). The identification of microsatellite stability status is clinically important as studies have revealed that MSI tumors have a better stage-adjusted survival compared with microsatellite stable tumors, and they respond differently to 5FU-based adjuvant chemotherapy depending on this status. There is recent success of immunotherapy (mainly anti-PD1 drugs) in metastatic CRC with MMR dysfunction that has led to the initiation of multiple trials based on immune checkpoint inhibitors. Additionally, it is important to identify patients with Lynch syndrome so that it can guide the frequency of surveillance of CRCs and recommendations of prophylactic surgery. Even though TNM staging remains a key determinant of patient prognosis and guides management in patients with CRC, molecular tumor heterogeneity contributes to significant variability in clinical outcomes despite the same disease stage; therefore, it is vital to know the type of genomic instability pathway that the tumor harbors. In this article, we discuss the unique genetic, pathologic, and clinical characteristics of microsatellite unstable (MSI) and stable CRC (MSS), their predictive value in directing the management with conventional chemotherapy or novel-targeted agents, and their prognostic significance in patient outcomes.
Published: 2018

33. Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Author: Jitendra PS. Sawhney, Veerappa A. Kothiwale, Vikas Bisne, Rajashekhar Durgaprasad, Praveen Jadhav, Manoj Chopda, Velam Vanajakshamma, Ramdhan Meena, Govindan Vijayaraghavan, Kamaldeep Chawla, Jagan Allu, Karen S. Pieper, A. John Camm, Ajay K. Kakkar, Jean-Pierre Bassand, David A. Fitzmaurice, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Lorenzo G. Mantovani, Frank Misselwitz, Alexander G.G. Turpie, Martin van Eickels, Freek W.A. Verheugt, Gloria Kayani, Keith A.A. Fox, Bernard J. Gersh, Hector Lucas Luciardi, Harry Gibbs, Marianne Brodmann, Frank Cools, Antonio Carlos Pereira Barretto, Stuart J. Connolly, Alex Spyropoulos, John Eikelboom, Ramon Corbalan, Dayi Hu, Petr Jansky, Jørn Dalsgaard Nielsen, Hany Ragy, Pekka Raatikainen, Jean-Yves Le Heuzey, Harald Darius, Matyas Keltai, Sanjay Kakkar, Jitendra Pal Singh Sawhney, Giancarlo Agnelli, Giuseppe Ambrosio, Yukihiro Koretsune, Carlos Jerjes Sánchez Díaz, Hugo Ten Cate, Dan Atar, Janina Stepinska, Elizaveta Panchenko, Toon Wei Lim, Barry Jacobson, Seil Oh, Xavier Viñolas, Marten Rosenqvist, Jan Steffel, Pantep Angchaisuksiri, Ali Oto, Alex Parkhomenko, Wael Al Mahmeed, David Fitzmaurice, D.Y. Hu, K.N. Chen, Y.S. Zhao, H.Q. Zhang, J.Z. Chen, S.P. Cao, D.W. Wang, Y.J. Yang, W.H. Li, Y.H. Yin, G.Z. Tao, P. Yang, Y.M. Chen, S.H. He, Ying Wang, Yong Wang, G.S. Fu, X. Li, T.G. Wu, X.S. Cheng, X.W. Yan, R.P. Zhao, M.S. Chen, L.G. Xiong, P. Chen, Y. Jiao, Y. Guo, L. Xue, F.Z. Wang, H. Li, Z.M. Yang, C.L. Bai, J. Chen, J.Y. Chen, X. Chen, S. Feng, Q.H. Fu, X.J. Gao, W.N. Guo, R.H. He, X.A. He, X.S. Hu, X.F. Huang, B. Li, J. Li, L. Li, Y.H. Li, T.T. Liu, W.L. Liu, Y.Y. Liu, Z.C. Lu, X.L. Luo, T.Y. Ma, J.Q. Peng, X. Sheng, X.J. Shi, Y.H. Sun, G. Tian, K. Wang, L. Wang, R.N. Wu, Q. Xie, R.Y. Xu, J.S. Yang, L.L. Yang, Q. Yang, Y. Ye, H.Y. Yu, J.H. Yu, T. Yu, H. Zhai, Q. Zhan, G.S. Zhang, Q. Zhang, R. Zhang, Y. Zhang, W.Y. Zheng, B. Zhou, Z.H. Zhou, X.Y. Zhu, S. Kakkar, J.P.S. Sawhney, P. Jadhav, R. Durgaprasad, A.G. Ravi Shankar, R.K. Rajput, K. Bhargava, R. Sarma, A. Srinivas, D. Roy, U.M. Nagamalesh, M. Chopda, R. Kishore, G. Kulkarni, P. Chandwani, R.A. Pothiwala, M. Padinhare Purayil, S. Shah, K. Chawla, V.A. Kothiwale, B. Raghuraman, G. Vijayaraghavan, V.M. Vijan, G. Bantwal, V. Bisne, A. Khan, J.B. Gupta, S. Kumar, D. Jain, S. Abraham, D. Adak, A. Barai, H. Begum, P. Bhattacharjee, M. Dargude, D. Davies, B. Deshpande, P. Dhakrao, V. Dhyani, S. Duhan, M. Earath, A. Ganatra, S. Giradkar, V. Jain, R. Karthikeyan, L. Kasala, S. Kaur, S. Krishnappa, A. Lawande, B. Lokesh, N. Madarkar, R. Meena, P. More, D. Naik, K. Prashanth, M. Rao, N.M. Rao, N. Sadhu, D. Shah, M. Sharma, P. Shiva, S. Singhal, S. Suresh, V. Vanajakshamma, S.G. Panse, Y. Koretsune, S. Kanamori, K. Yamamoto, K. Kumagai, Y. Katsuda, K. Sadamatsu, F. Toyota, Y. Mizuno, I. Misumi, H. Noguchi, S. Ando, T. Suetsugu, M. Minamoto, Hiroshi Oda, K. Shiraishi, S. Adachi, K. Chiba, H. Norita, M. Tsuruta, T. Koyanagi, H. Ando, T. Higashi, K. Okada, S. Azakami, S. Komaki, K. Kumeda, T. Murayama, J. Matsumura, Y. Oba, R. Sonoda, K. Goto, K. Minoda, Y. Haraguchi, H. Suefuji, H. Miyagi, H. Kato, Tadashi Nakamura, Tsugihiro Nakamura, H. Nandate, R. Zaitsu, Yoshihisa Fujiura, A. Yoshimura, H. Numata, J. Ogawa, H. Tatematsu, Y. Kamogawa, K. Murakami, Y. Wakasa, M. Yamasawa, H. Maekawa, S. Abe, H. Kihara, S. Tsunoda, Katsumi Saito, Kazuyuki Saito, T. Fudo, K. Obunai, H. Tachibana, I. Oba, T. Kuwahata, S. Higa, M. Gushiken, T. Eto, H. Yoshida, D. Ikeda, Yoshitake Fujiura, M. Ishizawa, M. Nakatsuka, K. Murata, C. Ogurusu, M. Shimoyama, M. Akutsu, I. Takamura, F. Hoshino, N. Yokota, T. Iwao, K. Tsuchida, M. Takeuchi, Y. Hatori, Y. Kitami, Yoichi Nakamura, R. Oyama, M. Ageta, Hiroyuki Oda, Y. Go, K. Mishima, T. Unoki, S. Morii, Yuhei Shiga, H. Sumi, T. Nagatomo, K. Sanno, K. Fujisawa, Y. Atsuchi, T. Nagoshi, T. Seto, T. Tabuchi, M. Kameko, K. Nii, K. Oshiro, H. Takezawa, S. Nagano, N. Miyamoto, M. Iwaki, Yuichiro Nakamura, M. Fujii, M. Okawa, Masahiko Abe, Masatake Abe, Mitsunori Abe, T. Saito, T. Mito, K. Nagao, J. Minami, T. Mita, I. Sakuma, T. Taguchi, S. Marusaki, H. Doi, M. Tanaka, T. Fujito, M. Matsuta, T. Kusumoto, S. Kakinoki, K. Ashida, N. Yoshizawa, J. Agata, O. Arasaki, M. Manita, M. Ikemura, S. Fukuoka, H. Murakami, S. Matsukawa, Y. Hata, T. Taniguchi, T. Ko, H. Kubo, M. Imamaki, M. Akiyama, M. Inagaki, H. Odakura, T. Ueda, Y. Katsube, A. Nakata, H. Watanabe, M. Techigawara, M. Igarashi, K. Taga, T. Kimura, S. Tomimoto, M. Shibuya, M. Nakano, K. Ito, T. Seo, S. Hiramitsu, H. Hosokawa, M. Hoshiai, M. 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A., Andersson, A., Malmqvist, L., Martinsson, B., Bernsten, F., Engdahl, J., Thulin, J., Hot-Bjelac, A., Stalby, P., Aaröe, H., Ahbeck, E., Ahlmark, H., Al-Khalili, F., Bonkowski, G., Dzeletovic, S., Ekstrand, A. -B., Eriksson, G. -B., Floren, K., Grässjö, C., Hahn, S., Jaensson, P., Jansson, B., Jansson, J. -H., Kangert, R. -M., Koch, A., Kusiak, D., Lettenström, A., Lindberg, A., Lindholm, C. -J., Mannermyr, A., Mansson, K., Millborg, M., Nilsson, C., Ohlin, A. -M., Olofsson, A., Osberg, A., Pedersen, A., Risbecker, K., Rosenberg, K., Samuelsson, J., Shayesteh, M., Skoglund, K., Stjernberg, M., Thorsen, C., Steffel, J., Beer, J. H., Debrunner, J., Amstutz, D., Bruegger, J., Elise, G., Grau, A., Guinand, A., Henriette, I., Saga, E., Winnik, S., Parkhomenko, A., Rudyk, I., Tseluyko, V., Karpenko, O., Zhurba, S., Kraiz, I., Kupnovytska, I., Serediuk, N., Mostovoy, Y., Ushakov, O., Koval, O., Kovalskyi, I., Svyshchenko, Y., Sychov, O., Stanislavchuk, M., Kraydashenko, O., Yagensky, A., Tykhonova, S., Fushtey, I., Belegai, R., Berko, G., Burdeuna, L., Chabanna, O., Daniuk, I., Ivanov, A., Kamenska, E., Kaplan, P., Khyzhnyak, O., Kizim, S., Matova, O., Medentseva, O., Mochonyi, V., Mospan, M., Nemtsova, V., Ovdiienko, T., Palamarchuk, O., Pavelko, M., Petrovskyy, R., Plevak, D., Proshak, O., Pyvovar, S., Rasputina, L., Romanenko, O., Romanova, O., Sapatyi, A., Shumakov, O., Stets, R., Todoriuk, L., Varenov, V., Fitzmaurice, D., Chauhan, N., Goodwin, D., Saunders, P., Evans, R., Leese, J., Jhittay, P. S., Ross, A., Kainth, M. S., Pickavance, G., Mcdonnell, J., Williams, A., Gooding, T., Wagner, H., Suryani, S., Singal, A., Sircar, S., Bilas, R., Hutchinson, P., Wakeman, A., Stokes, M., Paul, N., Aziz, M., Ramesh, C., Wilson, P., Franklin, S., Fairhead, S., Thompson, J., St Joseph, V., Taylor, G., Tragen, D., Seamark, D., Paul, C., Richardson, M., Jefferies, A., Sharp, H., Jones, H., Giles, C., Page, M., Oginni, O., Aldegather, J., Wetherwell, S., Lumb, W., Evans, P., Scouller, F., Macey, N., Stipp, Y., West, R., Thurston, S., Wadeson, P., Matthews, J., Pandya, P., Gallagher, A., Railton, T., Sinha, B., Russell, D., Davies, J. A., Ainsworth, P., Jones, C. P., Weeks, P., Eden, J., Kernick, D., Murdoch, W., Lumley, L., Patel, R. P., Wong, S. W., Saigol, M., Ladha, K., Douglas, K., Cumberlidge, D. F., Bradshaw, C., Van Zon, G., Jones, K. P., Thomas, M. J., Watson, E., Sarai, B., Ahmad, N., Willcock, W., Cairns, J., Sathananthan, S., de Kare-Silver, N., Gilliland, A., Strieder, E., Howitt, A., Vishwanathan, B., Bird, N., Gray, D., Clark, M., Bisatt, J., Litchfield, J., Fisher, E., Fooks, T., Kelsall, A. R., Alborough, E., Wakeling, J., Parfitt, M., Milne, K., Rogers, S., Priyadharshan, R., Oliver, J. L., Davies, E., Abushal, S., Jacobs, M., Hutton, C., Walls, N. I., Thompson, R., Chigbo, C., Zaidi, S. M. A., Howard, M., Butter, K. C., Barrow, S., Little, H., Haq, I. U., Gibbons, L., Glencross, S., Mcleod, A. J., Poland, K., Mulholland, C., Warke, A., Conn, P., Burns, G., Smith, R. N., Lowe, S., Kamath, R., Dau, H. S., Webster, J., Hodgins, I., Vercoe, S., Roome, P. C., Pinnock, H., Patel, J. R. A., Ali, A., Hart, N., Davies, R., Stuart, E., Neden, C. A., Danielsen, M., Heath, R., Sharma, P., Galloway, S., Hawkins, C., Oliver, R., Aylward, M., Mannion, S., Braddick, M., Edwards, D., Rothwell, A. C., Sabir, A., Choudhary, F., Khalaque, S., Wilson, A., Peters, S., Coulson, W., Roberts, N., Heer, A., Coates, S., Ward, B., Jackson, D., Walton, S., Shepherd, D., Sterry, M., Wong, T., Boon, M., Bunney, R., Haria-Shah, R., Baron, R. T., Davies, S., Schatzberger, T., Hargreaves, N., Stephenson, T., Choi, H., Batson, R., Lucraft, L., Myhill, T., Estifano, S., Geatch, D., Wilkinson, J., Veale, R., Forshaw, K., Davies, T., Zaman, K., Vinson, P., Liley, C., Bandrapalli, M., Mcginty, P., Wastling, R., Mceleny, P., Beattie, A., Cooke, P., Wong, M., Gunasegaram, J., Pugsley, M., Ahmad, S., A'Court, C., Ayers, J., Bennett, J., Cartwright, S., Dobson, S., Dooldeniya, C., Flynn, A., Fox, R., Goram, J., Halpin, A., Hay, A., Jacobs, P., Jeffers, L., Lomax, L., Munro, I., Muvva, R., Nadaph, M., Powell, K., Randfield, S., Redpath, D., Reed, R., Rickenbach, M., Rogers, G., Saunders, P. B., Seamark, C., Shewring, J., Simmons, P., Simper, H., Stoddart, H., Sword, A., Thomas, N., Thomson, A., Gibbs, H., Blenkhorn, A., Singh, B., Van Gaal, W., Abhayaratna, W., Lehman, R., Roberts-Thomson, P., Kilian, J., Coulshed, D., Catanchin, A., Colquhoun, D., Kiat, H., Eccleston, D., French, J., Zimmett, L., Ayres, B., Phan, T., Blombery, P., Crimmins, D., O'Donnell, D., Choi, A., Astridge, P., Arstall, M., Jepson, N., Binnekamp, M., Lee, A., Rogers, J., Starmer, G., Carroll, P., Faunt, J., Aggarwala, A., Barry, L., Batta, C., Beveridge, R., Black, A., Bonner, M., Boys, J., Buckley, E., Campo, M., Carlton, L., Connelly, A., Conway, B., Cresp, D., Dimitri, H., Dixon, S., Dolman, M., Duroux, M., Eskandari, M., Eslick, R., Ferreira-Jardim, A., Fetahovic, T., Fitzpatrick, D., Geraghty, R., Gibbs, J., Grabek, T., Modi, M. H., Hayes, K., Hegde, M. P., Hesketh, L., Hoffmann, B., Jacobson, B., Johnson, K., Juergens, C., Kassam, I., Lawlor, V., Lehman, M., Lehman, S., Leung, D., Mackay, S., Mackenzie, M., Mccarthy, C., Mcintosh, C., Mckeon, L., Morrison, H., Mussap, C., Myers, J. -D., Nagalingam, V., Oldfield, G., O'May, V., Palmer, J., Parsons, L., Patching, K., Patching, T., Paul, V., Plotz, M., Preston, S., Rashad, H., Ratcliffe, M., Raynes, S., Rose, J., Sanders, L., Seremetkoska, M., Setio, H., Shone, S., Shrestha, P., Singh, C., Singleton, C., Stoyanov, N., Sutcliffe, S., Swaraj, K., Tarrant, J., Thompson, S., Tsay, I. M., Vorster, M., Waldman, A., Wallis, L., Wilford, E., Wong, K., Connolly, S. J., Spyropoulos, A., Eikelboom, J., Luton, R., Gupta, M., Pandey, A. S., Cheung, S., Leader, R., Beaudry, P., Ayala-Paredes, F., Berlingieri, J., Heath, J., Poirier, G., Du Preez, M., Nadeau, R., Dresser, G., Dhillon, R., Hruczkowski, T., Schweitzer, B., Coutu, B., Angaran, P., Macdonald, P., Vizel, S., Fikry, S., Parkash, R., Lavoie, A., Cha, J., Ramjattan, B., Bonet, J., Ahmad, K., Aro, L., Aves, T., Beaudry, K., Bergeron, C., Bigcanoe, J., Bignell, N., Breakwell, L., Burke, E., Carroll, L., Clarke, B., Cleveland, T., Daheb, S., Dehghani, P., Denis, I., Djaidani, Z., Dorian, P., Douglass, S., Dunnigan, J., Ewert, A., Farquhar, D., Fearon, A., Ferleyko, L., Fournier, D., Fox, B., Grenier, M. -C., Gulliver, W., Haveman, K., Hines, C., Hines, K., Jackson, A. M., Jean, C., Jethoo, G., Kahlon, R., Kelly, S., Kim, R., Korley, V., Kornder, J., Kwan, L., Largy, J., Lewis, C., Lewis, S., Mangat, I., Moor, R., Navratil, J., Neas, I., Otis, J., Otis, R., Pandey, M., Petrie, F., Pinter, A., Raines, M., Roberts, P., Robinson, M., Sas, G., Schulman, S., Snell, L., Spearson, S., Stevenson, J., Trahey, T., Wong, S., Wright, D., Ragy, H., Abd El-Aziz, A., Abou Seif, S. K., El Din, M. G., El Etriby, S., Elbahry, A., El-Etreby, A., Elkhadem, M., Katta, A., Khairy, T., Mowafy, A., Nawar, M., Ohanissian, A., Reda, A., Reda, M., Salem, H., Sami, N., Samir, S., Setiha, M., Sobhy, M., Soliman, A., Taha, N., Tawfik, M., Zaatout, E., Kettles, D., Bayat, J., Siebert, H., Horak, A., Kelfkens, Y., Garda, R., Pillay, T., Guerra, M., van Zyl, L., Theron, H., Murray, A., Louw, R., Greyling, D., Mntla, P., Ueckermann, V., Loghdey, R., Ismail, S., Ahmed, F., Engelbrecht, J., Ramdass, A., Maharajh, S., Oosthuysen, W., Angel, G., Bester, C., Booysen, M., Boshoff, C., Cannon, C., Cassimjee, S., Chami, C., Conway, G., Davids, A., de Meyer, L., Du Plessis, G., Ellis, T., Henley, L., Karsten, M., Loyd, E., Marks, J., Mavhusa, L., Mostert, M., Page, A., Rikhotso, L., Salie, M., Sasto, J., Shaik, F., Skein, A., Smith, L., Tarr, G., Tau, T., van Zyl, F., Al Mahmeed, W., Yousef, G., Agrawal, A., Nathani, M., Ibrahim, M., Esheiba, E. M., Singh, R., Naguib, A., Abu-Mahfouz, M., Al Omairi, M., Al Naeemi, A., Maruthanayagam, R., Bazargani, N., Wassef, A., Gupta, R., Khan, M., Subbaraman, B., Abdul, A., Al Mulla, A., El Bardisy, S., Haridas, P., Jadhav, S., Magdaluyo, K., Makdad, M., Maqsood, I., Mohamed, R., Sharma, N., Sharma, R., Thanzeel, M., Goldhaber, S. Z., Canosa, R., Rama, P., Blumberg, E., Garcia, J., Mullen, P., Wilson, V., Quick, A., Ferrick, K., Kutayli, W. M., Cox, M., Franco, M., Falkowski, S., Mendelson, R., Williams, M., Miller, S., Beach, S., Alfieri, A., Gutowski, T., Haque, I., Reddy, R., Ahmed, W., Delafontaine, P., Diercks, D., Theodoro, D., Remmel, K., Alberts, M., Ison, R., Noveck, H., Duffy, P., Pitta, S., Nishijima, D., Treasure, C., Asafu-Adjaye, N., Ball, K., Bartlett, M., Bentley, M., Bowers, S., Brown, A., Browne, A., Cameron-Watts, J., Canova, M., Cassidy, D., Cervellione, K., Congal, S., Depauw, J., Dickerson, A., Eley, M., Evans, L., Felpel, S., Ferdinand, K., Fielder, D., Gentry, P., Haideri, A., Hakimi, F., Harbour, T., Hartranft, E., Hawkins, B., Headlee, M., Henson, L., Herrick, C., Hicks, T., Jasinski, S., Jones, A., Jones, L., Jones, P., Karl, S., Keeling, M., Kerr, J., Knowles, P., Langdon, J., Lay, M., Lee, J. A., Lincoln, T., Malone, E., Merliss, A., Merritt, D., Minardo, J., Mooso, B., Orosco, C., Palumbo, V., Parker, M., Parrott, T., Paserchia, S., Pearl, G., Peterson, J., Pickelsimer, N., Purcell, T., Raynor, J., Raziano, S., Richard, C., Richardson, T., Robertson, C., Sage, A., Sanghera, T., Shaw, P., Shoemaker, J., Smith, K., Stephanie, B., Thatcher, A., Theobald, H., Thompson, N., Treasure, L., Tripti, T., Verdi, C., and Worthy, V.
Subjects: Registrie, Male, Time Factors, Anticoagulant therapy, Arrhythmia, Atrial fibrillation, GARFIELD-AF, 030204 cardiovascular system & hematology, Electrocardiography, 0302 clinical medicine, Risk Factors, Anticoagulant therapy, Arrhythmia, Atrial fibrillation, GARFIELD-AF, Aged, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Incidence, India, Prevalence, Prognosis, Prospective Studies, Survival Rate, Thromboembolism, Registries, Risk Assessment, Medicine, 030212 general & internal medicine, Prospective cohort study, Incidence (epidemiology), cardiovascular system, medicine.symptom, Cardiology and Cardiovascular Medicine, Risk assessment, Human, medicine.medical_specialty, Time Factor, RD1-811, Prognosi, Follow-Up Studie, 03 medical and health sciences, Internal medicine, Diseases of the circulatory (Cardiovascular) system, cardiovascular diseases, Risk factor, Survival rate, Fibrillation, business.industry, Risk Factor, ta3121, medicine.disease, Clinical trial, Prospective Studie, RC666-701, Surgery, Clinical and Preventive Cardiology, business
Abstract: Background: The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. Methods and results: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P
Published: 2018

34. Muscle, a conduit to brain for hormonal control of behavior

Author: D. Ashley Monks, Barney A. Schlinger, and Ketema N. Paul
Subjects: 0301 basic medicine, Posture, Central nervous system, Endocrine System, Birds, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Endocrinology, Feedback, Sensory, Motor system, Animals, Endocrine system, Medicine, Control (linguistics), Behavior, Animal, Endocrine and Autonomic Systems, business.industry, Muscles, Courtship, Brain, Neurosecretory Systems, Hormones, 030104 developmental biology, medicine.anatomical_structure, Nerve Net, business, Neuroscience, 030217 neurology & neurosurgery, Hormone
Abstract: SBN Elsevier Lecture Investigation into mechanisms whereby hormones control behavior often starts with actions on central nervous system (CNS) motivation and motor systems and is followed by assessment of CNS drive of coordinated striated muscle contractions. Here we turn this perspective on its head by discussing ways in which hormones might first act on muscle that then secondarily drive upstream the evolution and function of the CNS. While there is a lengthy history for consideration of this perspective, newly discovered properties of muscle signaling reveal novel mechanisms that may well be captured by endocrine systems and thus of interest to behavioral endocrinologists.
Published: 2018

35. Cancer risk and clinicopathological characteristics of thyroid nodules harboring thyroid-stimulating hormone receptor gene mutations

Author: Raja R. Seethala, Collette E. Abbott, Marina N. Nikiforova, Steven P. Hodak, Sann Y. Mon, Gregory Riedlinger, N. Paul Ohori, and Yuri E. Nikiforov
Subjects: Adult, Male, Thyroid nodules, endocrine system, Pathology, medicine.medical_specialty, Histology, endocrine system diseases, Biopsy, Fine-Needle, DNA Mutational Analysis, 030209 endocrinology & metabolism, Gene mutation, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Thyroid Nodule, Allele frequency, Aged, medicine.diagnostic_test, business.industry, Thyroid, Receptors, Thyrotropin, Nodule (medicine), General Medicine, Middle Aged, medicine.disease, eye diseases, Cell Transformation, Neoplastic, Fine-needle aspiration, medicine.anatomical_structure, Hormone receptor, 030220 oncology & carcinogenesis, Mutation, Mutation testing, Female, medicine.symptom, business
Abstract: Background Thyroid-stimulating hormone receptor (TSHR) gene mutations play a critical role in thyroid cell proliferation and function. They are found in 20%-82% of hyperfunctioning nodules, hyperfunctioning follicular thyroid cancers (FTC), and papillary thyroid cancers (PTC). The diagnostic importance of TSHR mutation testing in fine needle aspiration (FNA) specimens remains unstudied. Methods To examine the association of TSHR mutations with the functional status and surgical outcomes of thyroid nodules, we evaluated 703 consecutive thyroid FNA samples with indeterminate cytology for TSHR mutations using next-generation sequencing. Testing for EZH1 mutations was performed in selected cases. The molecular diagnostic testing was done as part of standard of care treatment, and did not require informed consent. Results TSHR mutations were detected in 31 (4.4%) nodules and were located in exons 281-640, with codon 486 being the most common. Allelic frequency ranged from 3% to 45%. Of 16 cases (12 benign, 3 FTC, 1 PTC) with surgical correlation, 15 had solitary TSHR mutations and 1 PTC had comutation with BRAF V600E. Hyperthyroidism was confirmed in all 3 FTC (2 overt, 1 subclinical). Of 5 nodules with solitary TSHR mutations detected at high allelic frequency, 3 (60%) were FTC. Those at low allelic frequency (3%-22%) were benign. EZH1 mutations were detected in 2 of 4 TSHR-mutant malignant nodules and neither of 2 benign nodules. Conclusion We report that TSHR mutations occur in ∼5% thyroid nodules in a large consecutive series with indeterminate cytology. TSHR mutations may be associated with an increased cancer risk when present at high allelic frequency, even when the nodule is hyperfunctioning. Benign nodules were however most strongly correlated with TSHR mutations at low allelic frequency.
Published: 2018

36. VP03.01: Colorectal cancer: transvaginal diagnosis

Author: W.A. Clavelli, G. Ugo, N. Paul, and V. Gonzalez Gabelloni
Subjects: Oncology, medicine.medical_specialty, Reproductive Medicine, Radiological and Ultrasound Technology, business.industry, Colorectal cancer, Internal medicine, medicine, Obstetrics and Gynecology, Radiology, Nuclear Medicine and imaging, General Medicine, business, medicine.disease
Published: 2021

37. Association of Prenatal Ultrasonography and Autism Spectrum Disorder

Author: Allison Froman, Audrey DiMauro, Gheorghe Doros, James DeRosa, N. Paul Rosman, Rachel Vassar, Jodi Abbott, and Sherry Santiago
Subjects: medicine.medical_specialty, Autism Spectrum Disorder, Prenatal care, Ultrasonography, Prenatal, Epigenesis, Genetic, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Pregnancy, medicine, Humans, Genetic Predisposition to Disease, Adverse effect, Original Investigation, Fetus, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Incidence, Medical record, Obstetrics and Gynecology, Gestational age, General Medicine, medicine.disease, Autism spectrum disorder, Prenatal Exposure Delayed Effects, Pediatrics, Perinatology and Child Health, Female, Gene-Environment Interaction, business, Mechanical index
Abstract: Importance The prevalence of autism spectrum disorder (ASD) has been increasing rapidly, with current estimates of 1 in 68 children affected. Simultaneously, use of prenatal ultrasonography has increased substantially, with limited investigation into its safety and effects on brain development. Animal studies have demonstrated that prenatal ultrasonography can adversely affect neuronal migration. Objective To quantify prenatal ultrasound exposure by the frequency, timing, duration, and strength of ultrasonographic scans in children with later ASD, developmental delay, and typical development. Design, Setting, and Participants This case-control study included 107 patients with ASD, 104 control individuals with developmental delay, and 209 controls with typical development. Participants were identified from medical records based on prenatal care and delivery at Boston Medical Center, a diverse, academic, safety-net medical center, from July 1, 2006, through December 31, 2014, with a gestational age at birth of at least 37 weeks. Data were analyzed from May 1, 2015, through November 30, 2017. Exposures Ultrasonographic exposure was quantified by the number and timing of scans, duration of exposure, mean strength (depth, frame rate, mechanical index, and thermal index), and time of Doppler and 3- and 4-dimensional imaging. Main Outcomes and Measures Among participants with ASD and controls with developmental delay and typical development, ultrasound exposure was quantified and compared per trimester and for the entire pregnancy, with adjustment for infant sex, gestational age at birth, and maternal age. Results A total of 420 participants were included in the study (328 boys [78.1%] and 92 girls [21.9%]; mean age as of January 1, 2016, 6.6 years; 95% CI, 6.5-6.8 years). The ASD group received a mean of 5.9 scans (95% CI, 5.2-6.6), which was not significantly different from the 6.1 scans (95% CI, 5.4-6.8) in the developmental delay group or the 6.3 scans (95% CI, 5.8-6.8) in the typical development group. Compared with the typical development group, the ASD group had shorter duration of ultrasound exposure during the first (290.4 seconds [95% CI, 212.8-368.0 seconds] vs 406.4 seconds [95% CI, 349.5-463.3 seconds]) and second (1687.6 seconds [95% CI, 1493.8-1881.4 seconds] vs 2011.0 seconds [95% CI, 1868.9-2153.1 seconds]) trimesters but no difference in the number of scans. The ASD group had greater mean depth of ultrasonographic penetration than the developmental delay group in the first trimester (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.1-12.1 cm]). The ASD group had greater mean depth than the typical development group during the first (12.5 cm [95% CI, 12.0-13.0 cm] vs 11.6 cm [95% CI, 11.3-12.0 cm]) and the second (12.9 cm [95% CI, 12.6-13.3 cm] vs 12.5 cm [95% CI, 12.2-12.7 cm]) trimesters. Conclusions and Relevance This study found significantly greater mean depth of ultrasonographic penetration in the ASD group compared with the developmental delay group in the first trimester and compared with the typical development group in the first and second trimesters. Further research is needed to determine whether other variables of ultrasound exposure also have adverse effects on the developing fetus.
Published: 2018

38. Intravascular Large B-Cell Lymphoma Involving Multinodular Goiter and Mimicking Carcinoma

Author: N. Paul Ohori, Bryan Rea, Min Han, Robert L. Peel, and Nidhi Aggarwal
Subjects: Pathology, medicine.medical_specialty, Goiter, Lymphoma, B-Cell, medicine.medical_treatment, Biopsy, Fine-Needle, Thyroid Gland, Pathology and Forensic Medicine, Diagnosis, Differential, Multinodular goiter, Biopsy, medicine, Carcinoma, Humans, Aged, Intravascular large B-cell lymphoma, medicine.diagnostic_test, business.industry, Thyroidectomy, medicine.disease, Lymphoma, Capillaries, Surgery, Female, Anatomy, business, Goiter, Nodular
Published: 2019

39. MRI- and PET-Guided Interstitial Brachytherapy for Postsurgical Vaginal Recurrences of Cervical Cancer: Results of Phase II Study

Author: Supriya Chopra, Reena Engineer, Sneha Shah, Richa Shukla, Tapas Dora, Priyamvada Gupta, Siji N. Paul, Palak Popat, Jamema Swamidas, Umesh Mahantshetty, Litty Varghese, Sudeep Gupta, Venkatesh Rangrajan, and Shyam Shrivastava
Subjects: Adult, Cancer Research, Neoplasm, Residual, medicine.medical_treatment, Brachytherapy, Phases of clinical research, Uterine Cervical Neoplasms, Antineoplastic Agents, Kaplan-Meier Estimate, Hysterectomy, Disease-Free Survival, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Cystitis, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Proctitis, Prospective Studies, Aged, Cervical cancer, Radiation, medicine.diagnostic_test, business.industry, Radiotherapy Planning, Computer-Assisted, Cancer, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Tumor Burden, Radiation therapy, Oncology, 030220 oncology & carcinogenesis, Positron-Emission Tomography, Quality of Life, Female, Cisplatin, Neoplasm Recurrence, Local, Radiopharmaceuticals, business, Nuclear medicine, Radiotherapy, Image-Guided
Abstract: Purpose This phase II study evaluated the utility of magnetic resonance imaging (MRI) and positron emission tomography for planning radiation and brachytherapy in patients with postsurgical recurrence of cervical cancer. Methods and Materials The study (NCT 01391065) recruited patients with residual or recurrent disease after hysterectomy. Patients underwent baseline T2 weighted (T2W) MRI, 18F-flouro-deoxyglucose (18F-FDG), 18F-flouro thymidine (18F-FLT) and 18F-flouromisonidazole (18F-F Miso) positron emission tomography (PET) and received external radiation (50 Gy/25 fractions for 5 weeks) and weekly cisplatin (40 mg/m2). MRI was performed at brachytherapy and used for delineation of clinical target volume (CTV). Patients with parametrial disease at baseline received interstitial brachytherapy (16-20 Gy/4-5 fractions) and those with vaginal disease received intracavitary brachytherapy (12-14 Gy/2-4 fractions). Kaplan-Meier analysis was performed to evaluate locoregional relapse, disease free survival, and overall survival. Common Toxicity Criteria for adverse event reporting (CTCAE) v4.1 was used for toxicity scoring and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questtionaire Core 30 (QLQC-30) and Cx 24 for quality-of-life reporting. Results Between January 2011 and February 2016, 60 patients were included, of which 50 received study treatment. The mean gross tumor volume on T2 W MR was 20 (IQR 3.6-90) cc. The metabolic tumor volume was 15 (interquartile range [IQR] 2.1-56.1) cc. The median FLT volume was 10 (IQR 0-48) cc. A total of 8 patients had 18-F F Miso uptake. The median CTV at brachytherapy was 38 (12-85) cc. The median CTVD90 and D 98 was 71 (53-74) and 74 (53-74) Gy. At a median follow-up of 60 (5-93) months, the 5-year local control, disease free survival, and overall survival were 84%, 73%, and 74.5%, respectively. Grade III and IV proctitis and cystitis were observed in 4% and 2% of patients. On multivariate analysis baseline tumor volume, on T2 W MR impacted disease free (91% vs 65%, P = .03) and overall survival (96% vs 77%, P = .06). Conclusions Image-guided assisted radiation and brachytherapy are associated with good to excellent local control and survival in patients with vaginal recurrences of cervical cancer.
Published: 2019

40. GLIS rearrangements in thyroid nodules: A key to preoperative diagnosis of hyalinizing trabecular tumor

Author: Marina N. Nikiforova, N. Paul Ohori, and Yuri E. Nikiforov
Subjects: Thyroid nodules, congenital, hereditary, and neonatal diseases and abnormalities, Cancer Research, Pathology, medicine.medical_specialty, Biopsy, Fine-Needle, Clinical Decision-Making, Thyroid Gland, 030209 endocrinology & metabolism, medicine.disease_cause, Thyroid carcinoma, Pathogenesis, Diagnosis, Differential, 03 medical and health sciences, PAX8 Transcription Factor, 0302 clinical medicine, mental disorders, medicine, Biomarkers, Tumor, Humans, Thyroid Neoplasms, Thyroid Nodule, Surgical treatment, Thyroid neoplasm, Total thyroidectomy, Suspicious for Malignancy, Hyalinizing Trabecular Tumor, business.industry, Zinc Fingers, medicine.disease, DNA-Binding Proteins, Repressor Proteins, Oncology, Thyroid Cancer, Papillary, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Thyroidectomy, Trans-Activators, Gene Fusion, business, Transcription Factors
Abstract: Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm with peculiar morphologic features that overlap with those of papillary thyroid carcinoma (PTC). Specifically, the presence of enlarged oval nuclei, nuclear grooves, and intranuclear pseudoinclusions makes precise cytopathologic diagnosis challenging. If the cytopathologic diagnosis is suspicious for malignancy (Bethesda V) or is malignant (Bethesda VI), a total thyroidectomy, which would be considered an overtreatment, may follow. The recent discovery of the strong association between GLIS fusions and HTT sheds light on its pathogenesis and offers a pathway for its presurgical identification. Although the number of cases analyzed is limited, the recent landmark study shows that GLIS fusions are highly specific for HTT and that lobectomy is the likely appropriate surgical treatment, because these neoplasms, which lack invasion, are benign. For overall success, cytopathologic recognition of the subtle features is important to avoid false-positive diagnoses and directing potential HTT cases toward indeterminate cytopathologic diagnoses, which would trigger further molecular testing. Additional studies are needed to determine whether a malignant counterpart of GLIS fusion-positive HTT exists and if more conservative approaches may be taken.
Published: 2019

41. Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts

Author: Jennifer J. Mootz, Catherine Carlson, André van Zyl, Andrew Medina-Marino, Phuti Ngwepe, Samantha L. Lammie, Sharon N. Paul, Rachel C. Shelton, Annika C. Sweetland, Milton L. Wainberg, and Kathryn L. Lovero
Subjects: Male, Mental Health Services, medicine.medical_specialty, Maternal-Child Health Services, Population, Mental disorders, Health administration, South Africa, 03 medical and health sciences, Health systems, 0302 clinical medicine, Pregnancy, Health care, medicine, Humans, Tuberculosis, 030212 general & internal medicine, Child, 10. No inequality, education, Health policy, Mixed-methods, education.field_of_study, Sub-Saharan Africa, Primary Health Care, Delivery of Health Care, Integrated, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Public health, Nursing research, lcsh:RA1-1270, Primary care, Mental illness, medicine.disease, Mental health, 3. Good health, 13. Climate action, Implementation, Family medicine, Healthcare integration, Female, Health Services Research, 0305 other medical science, business, Delivery of Health Care, Research Article
Abstract: Background The South African National Mental Health Policy Framework and Strategic Plan 2013–2020 was adopted to address the country’s substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. Methods Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. Results A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. Conclusions Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.
Published: 2019

42. How Accurate is Our FAST – 1 Year Review of FAST Exam Concordance with CT Findings in Patients with Solid Organ Injury at a Level 2-Community Hospital Trauma Center

Author: N. Paul Grewal, Chava Blivaiss, Margaret Puya, and Ari Steiner
Subjects: lcsh:R5-920, medicine.medical_specialty, business.industry, Concordance, Trauma center, Solid organ injury, Trauma, FAST concordance, Community hospital, Emergency medicine, FAST, Medicine, In patient, Solid organ, Ct findings, lcsh:Medicine (General), business
Published: 2019

43. Thyroid Fine-Needle Aspiration Cytology Molecular Testing in the USA

Author: N. Paul Ohori
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Thyroid, Thyroidectomy, Papanicolaou stain, medicine.disease, Bethesda system for reporting thyroid cytopathology, Thyroid carcinoma, medicine.anatomical_structure, Cytopathology, medicine, Anaplastic carcinoma, Radiology, business, Thyroid cancer
Abstract: Each year in the USA, approximately 57,000 thyroid cancer cases are diagnosed, and 2000 patients die from this disease [1]. Compared to other common cancers (e.g., lung, pancreas, colorectal), the ratio of mortality to incidence is very low. The main reasons for this observation are threefold—(1) most primary thyroid cancers are differentiated carcinomas with low mortality rates, (2) the presentation of differentiated carcinomas at the higher stages (e.g., stage III or IV) is uncommon, and (3) the incidence of inherently aggressive dedifferentiated carcinomas (e.g., poorly differentiated carcinoma, anaplastic carcinoma) is also very low. In general, differentiated carcinomas come in two varieties—those that are solid, hypoechoic, round, and well circumscribed or encapsulated and those that show invasion into the capsule and/or infiltration into adjacent tissues. Since the radiologic, cytologic, and histologic features of the former type overlap with those of benign hyperplastic and low-grade neoplastic nodules, preoperative distinction between some benign lesions and low-grade carcinomas is challenging (Fig. 60.1). Accordingly, approximately 30% of thyroid fine-needle aspiration (FNA) specimens are placed in one of the indeterminate Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories [2, 3]. Furthermore, heterogeneity of the nodule and variability in sampling yields from the fine-needle aspiration (FNA) procedures may preclude a definitive diagnosis. For example, some follicular variant papillary thyroid carcinoma (FVPTC) may demonstrate diagnostic cytologic features only focally. In another example, a 0.5 cm anaplastic carcinoma (AC) may be present in a 3 cm classic papillary thyroid carcinoma (PTC). Due to the focality of the lesions, these areas may or may not be sampled by FNA. Furthermore, depending on the skill of the FNA operator, slide preparation technique, and nature of the thyroid nodule, the quality and quantity of lesional cells on the cytologic preparations may vary. In the USA, thyroid FNAs are performed by endocrinologists, surgeons, radiologists, otolaryngologists, and cytopathologists, and, therefore, not all cytology specimens are generated in the same manner. Processing of the aspirated specimens also varies—direct smears (e.g., Papanicolaou stain, Diff-Quik, or other Romanowsky-type stains), liquid-based cytology, and cell-block preparation. A cytopathology laboratory may use one or a combination of these methods. While patients with benign FNA diagnoses are observed, those with a malignant diagnosis often undergo surgery and/or other oncologic treatments. For the remaining indeterminate BSRTC diagnoses, the estimated risks of malignancy are too high for observation, and many are subjected to a diagnostic lobectomy or thyroidectomy. In this regard, the application of new technologies to elucidate the biologic nature of these nodules to minimize the number of diagnostic surgeries and maintain robust quality assurance has become an area of intense interest among clinicians, cytopathologists, and molecular pathologists.
Published: 2019

44. Comparison of the collection approaches of 2 large thyroid fine-needle aspiration practices reveals differing advantages for cytology and molecular testing adequacy rates

Author: Thomas M. Pearce, Sally E. Carty, Jenna Wolfe, Kelly L. McCoy, Michael S. Landau, Mitchell Tublin, Shane O. LeBeau, Linwah Yip, and N. Paul Ohori
Subjects: medicine.medical_specialty, Large thyroid, Cytodiagnosis, Bethesda system, Biopsy, Fine-Needle, Thyroid Gland, 030209 endocrinology & metabolism, Cytology diagnosis, Pathology and Forensic Medicine, Specimen Handling, 03 medical and health sciences, 0302 clinical medicine, Cytology, Biopsy, Medicine, Humans, Thyroid Epithelial Cells, medicine.diagnostic_test, business.industry, Thyroid, medicine.anatomical_structure, Fine-needle aspiration, Logistic Models, Molecular Diagnostic Techniques, 030220 oncology & carcinogenesis, Radiology, business
Abstract: At our institution, almost all thyroid fine-needle aspiration (FNA) procedures are performed by either Endocrinology or Radiology personnel. In this study, we compared the cytology and molecular adequacy rates of these 2 thyroid FNA practices, which differ on several aspects of specimen procurement.All thyroid FNA specimens from Endocrinology and Radiology practices between September 2008 and December 2016 were included. Over this time frame, the molecular testing modality transitioned from polymerase chain reaction (PCR)-based (7-gene panel era) to next generation sequencing (NGS)-based (ThyroSeq era). In measuring cytology adequacy, the Bethesda System unsatisfactory rate was determined. Molecular adequacy was categorized as Optimal, Limited Thyroid Epithelial Cells, Limited Nucleic Acids, or Failed. These parameters were compared for the 2 practices.The study cohorts comprised 5810 specimens from Endocrinology and 4597 from Radiology. More Endocrinology specimens were satisfactory for cytology diagnosis than those from Radiology (94.7% versus 90.0%, P0.001). For molecular adequacy, fewer Endocrinology specimens were optimal than specimens from Radiology for both the 7-gene panel era (76.2% versus 82.9%, P0.001) and the ThyroSeq era (88.1% versus 91.9%, P = 0.049).The 2 thyroid FNA practices varied inversely in their adequacy rates for cytology and molecular testing. Had one practice been superior for both cytology and molecular adequacy, a recommendation for the method of choice would have been straightforward. However, our results show that optimization of FNA practice for the current practice of thyroid cytology requires further investigation due to the complex nature of specimen procurement.
Published: 2018

45. Sudhangsu assay: a scratch of green chemistry for beginners

Author: N Paul
Subjects: Green chemistry, History, business.industry, Scratch, Computer science, Chemistry (relationship), Software engineering, business, computer, Computer Science Applications, Education, Test (assessment), computer.programming_language
Abstract: Green chemistry approach is supposed to be the best attempt for saving world from the potential dangers which spread from chemistry laboratory to almost all spheres of society. In school days when budding chemists start doing hands on experiments, in most cases first scratch is done with Lassaigne’s test. The authenticity of this test in detecting special elements is unquestionable. Does this test cross hurdle, when screened through green chemistry norm? Slow generation of lethal cyanide hardly allows this test under the umbrella of Green chemistry. The current communication coined a green protocol termed Sudhangsu assay which comply with green chemistry norm for detection of special elements. Fusion described herein, takes place at a mild condition and products thereby generated, are environmentally benign molecules. In this article a green prescription for detection of special elements is compiled.
Published: 2021

46. Feasibility analysis of implementing anaerobic digestion as a potential energy source in Bangladesh

Author: N. Paul, Pobitra Halder, Mohammad U. H. Joardder, M. Sarker, and Md. Zaved Hossain Khan
Subjects: Engineering, Municipal solid waste, Waste management, Renewable Energy, Sustainability and the Environment, business.industry, 020209 energy, Biomass, 02 engineering and technology, Renewable energy, Anaerobic digestion, Biogas, Biofuel, Bioenergy, 0202 electrical engineering, electronic engineering, information engineering, Economic analysis, business
Abstract: Biogas technology is one of the prevalent alternative ways to mitigate energy crisis in Bangladesh. This approach of renewable energy is becoming popular to the rural population due to its economic viability and environmental attractiveness. The aim of this review paper is to illustrate the current status of domestic biogas plants in Bangladesh. The study also assesses the total biomass potential including livestock manure and agricultural residue available for biogas generation. The assessment shows that the total estimated amount of residues is 106.27 million tons comprises 42.49 million tons from agricultural residue, and 63.78 million tons from livestock manure and municipal solid waste (MSW) which is equivalent to 5.045 billion m3 of biogas. The economic analysis of 2.0 m3, 2.6 m3, and 3.2 m3 family size biogas plants are found to be a viable option in substitution of biomass and other commercial energy. The reliable supply of low-cost feed materials for biogas production has found to be an important factor to make the plant more feasible.
Published: 2016

47. Committee I: Indications for pulmonary cytology sampling methods

Author: Nami Azar, Jordan Kazakov, Claire W. Michael, N. Paul Ohori, Anjali Saqi, Rana S. Hoda, and Tarik M. Elsheikh
Subjects: medicine.medical_specialty, Histology, medicine.diagnostic_test, business.industry, Cytologic sampling, Papanicolaou stain, Classification scheme, General Medicine, Pathology and Forensic Medicine, 03 medical and health sciences, 0302 clinical medicine, Fine-needle aspiration, 030228 respiratory system, Cytopathology, 030220 oncology & carcinogenesis, Cytology, Diagnosis management, medicine, Medical physics, Radiology, business, Clinical evaluation
Abstract: The Papanicolaou Society of Cytopathology has developed a set of guidelines for pulmonary cytology including indications for bronchial brushings, washings and endobronchial ultrasound-guided fine needle aspiration, technical recommendations for cytologic sampling, recommended terminology and classification scheme, recommendations for ancillary testing and recommendations for postcytologic diagnosis management and follow-up. All recommendation documents are based on the expertise of the authors, extensive literature review and feedback from presentations at national and international conferences. This document selectively presents the results of these discussions. The present document summarizes the recommendations for clinical and imaging evaluation of pulmonary lesions along with the indications for cytologic studies regarding these abnormalities. Preprocedural requirements regarding brushing, washing and needle aspiration procedures are discussed also. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.
Published: 2016

48. Der autologe Bypass zu den pedalen Seitenästen zur Vermeidung der Majoramputation

Author: Christine Espinola-Klein, A. Meyer, M. Youssef, J. Dopheide, F. Dünschede, Bernhard Dorweiler, C. Fottner, C.-F. Vahl, and N. Paul
Subjects: Gynecology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Follow up studies, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Amputation, medicine, Surgery, 030212 general & internal medicine, business, Major amputation
Abstract: Zusammenfassung Hintergrund: Bei der kritischen Extremitätenischämie (CLI) liefert der pedale Bypass zur A. dorsalis pedis oder zur distalen A. tibialis posterior gute Langzeitergebnisse in Hinsicht auf Funktion und Fußerhalt. Im Einzelfall ist aber aufgrund des angiografischen Befunds ein Bypassanschluss auf pedale Seitenäste erforderlich. Methode: In einer prospektiven Datenbank untersuchten wir alle Patienten, die bei schwerer Extremitätenischämie eine Bypassanlage zu einem pedalen Seitenast erhielten. Die Patienten wurden in regelmäßigen Abständen klinisch und mittels Duplexsonografie nachuntersucht. Wesentlicher Zielparameter war die Beinerhaltungsrate. Ergebnisse: Von Januar 1998 bis Juni 2014 führten wir von insgesamt 534 pedalen Bypassanlagen 72 Bypässe zu pedalen Seitenästen bei 72 Patienten (59 Männer und 13 Frauen) durch. Die proximale Bypassanastomose lag in 30 Fällen supragenual und bei 42 Patienten infragenual. In 6 Fällen diente die A. tarsalis lateralis als Anschlussgefäß, in 15 Fällen die laterale und in 24 Fällen die mediale Plantararterie. Bei 27 Patienten erfolgte der distale Anschluss auf die Plantarbifurkation. Alle Rekonstruktionen wurden komplett autolog durchgeführt. Die Beinerhaltungsrate nach 5 und 10 Jahren lag jeweils bei 82 %. Schlussfolgerung: Der Bypass zu pedalen Seitenästen ist eine sinnvolle Methode zum Extremitätenerhalt bei kritischer Ischämie, falls kaliberstärkere Arterien nicht mehr zur Verfügung stehen.
Published: 2016

49. VP66.18: Colorectal cancer, transvaginal diagnosis

Author: N. Paul, G. Ugo, W.A. Clavelli, and V. Gonzalez Gabelloni
Subjects: Oncology, medicine.medical_specialty, Reproductive Medicine, Radiological and Ultrasound Technology, Colorectal cancer, business.industry, Internal medicine, medicine, Obstetrics and Gynecology, Radiology, Nuclear Medicine and imaging, General Medicine, medicine.disease, business
Published: 2020

50. Abstract No. 413 Tibiopedal versus radial artery calibers in a healthy patient cohort

Author: J. Smith, E. Harboldt, and N. Paul
Subjects: medicine.medical_specialty, business.industry, Caliber, medicine.artery, Internal medicine, Cohort, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Radial artery, Cardiology and Cardiovascular Medicine, business
Published: 2020

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