Showing papers by "St Thomas' Hospital published in 2018"
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Humboldt University of Berlin1, Medical University of Graz2, Hospital Kuala Lumpur3, University of Zurich4, University of Cincinnati5, University of Southern Denmark6, Medical University of Silesia7, Humanitas University8, Charité9, Penn State Milton S. Hershey Medical Center10, Federal University of São Paulo11, Autonomous University of Barcelona12, St Thomas' Hospital13, Laval University14, Hiroshima University15, Medical University of South Carolina16, Hannover Medical School17, Campbelltown Hospital18, Mahidol University19, Royal Free Hospital20, University of Bari21, University Medical Center Groningen22, Johns Hopkins University23, University of Toronto24, Technion – Israel Institute of Technology25, Aarhus University Hospital26, Peking University27
TL;DR: In this paper, an evidence-and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group.
Abstract: This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Sectionof the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
819 citations
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TL;DR: A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases, and health professionals should be alerted to ways of identifying women who are planning a pregnancy.
611 citations
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University of Calgary1, McGill University Health Centre2, Cardiovascular Institute of the South3, University of British Columbia4, Université du Québec à Trois-Rivières5, Université de Montréal6, Laval University7, McMaster University8, Alberta Health Services9, University of Alberta10, McGill University11, University of Toronto12, Heart and Stroke Foundation of Canada13, Population Health Research Institute14, Montreal General Hospital15, University of Western Ontario16, Montreal Heart Institute17, Winnipeg Regional Health Authority18, Université du Québec à Montréal19, Northern Ontario School of Medicine20, St. Michael's Hospital21, University of Manitoba22, Centre for Addiction and Mental Health23, University of Ottawa24, University Health Network25, Concordia University Wisconsin26, Ottawa Hospital Research Institute27, University of Ontario Institute of Technology28, Hôpital Maisonneuve-Rosemont29, University of Saskatchewan30, Centre Hospitalier Universitaire Sainte-Justine31, Children's Hospital of Eastern Ontario32, St Thomas' Hospital33, Mount Sinai Hospital, Toronto34, Université de Sherbrooke35, Brown University36, Concordia Hospital37, University of Pennsylvania38
TL;DR: All individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure, and an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an ang Elliotensin-converting enzyme inhibitor or angiotENSin receptor blocker in individuals with heart failure.
465 citations
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TL;DR: The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added.
Abstract: Several new treatment modalities with different mechanisms of action have been studied in patients with Behcet's syndrome (BS). The aim of the current effort was to update the recommendations in the light of these new data under the auspices of the European League Against Rheumatism (EULAR) Standing Committee for Clinical Affairs. A task force was formed that included BS experts from different specialties including internal medicine, rheumatology, ophthalmology, dermatology, neurology, gastroenterology, oral health medicine and vascular surgery, along with a methodologist, a health professional, two patients and two fellows in charge of the systematic literature search. Research questions were determined using a Delphi approach. EULAR standardised operating procedures was used as the framework. Results of the systematic literature review were presented to the task force during a meeting. The former recommendations were modified or new recommendations were formed after thorough discussions followed by voting. The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added. These updated, evidence-based recommendations are intended to help physicians caring for patients with BS. They also attempt to highlight the shortcomings of the available clinical research with the aim of proposing an agenda for further research priorities.
449 citations
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University of Messina1, Hospital Clínico San Carlos2, Charité3, St Mary's Hospital4, University of Southampton5, University Hospital Southampton NHS Foundation Trust6, University of Zurich7, University of Barcelona8, Icahn School of Medicine at Mount Sinai9, University of North Carolina at Chapel Hill10, University of Geneva11, Utrecht University12, Stanford University13, Copenhagen University Hospital14, King's College London15, St Thomas' Hospital16, Cardiff University17, University of Helsinki18, National and Kapodistrian University of Athens19, Koç University20, Transylvania University21, Odense University Hospital22, Wrocław Medical University23, Heidelberg University24, University of Edinburgh25, Medical University of Graz26, Erasmus University Rotterdam27
TL;DR: Patients and their families should be provided with information about the use of FA‐AIT for IgE‐mediated food allergy to allow them to make an informed decision about the therapy.
Abstract: Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of FA-AIT for IgE-mediated food allergy to allow them to make an informed decision about the therapy.
353 citations
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University of Southampton1, University Hospital Southampton NHS Foundation Trust2, University of Oxford3, Queen Mary University of London4, University of Manchester5, University of Texas MD Anderson Cancer Center6, University of Cambridge7, University of Leeds8, Royal Brisbane and Women's Hospital9, St Thomas' Hospital10, St George's Hospital11
TL;DR: Decisions about timing of additional surgery aimed at reducing future second primary-cancer risks should take into account patient prognosis associated with the first malignancy and patient preferences.
Abstract: Summary Background Retrospective studies provide conflicting interpretations of the effect of inherited genetic factors on the prognosis of patients with breast cancer. The primary aim of this study was to determine the effect of a germline BRCA1 or BRCA2 mutation on breast cancer outcomes in patients with young-onset breast cancer. Methods We did a prospective cohort study of female patients recruited from 127 hospitals in the UK aged 40 years or younger at first diagnosis (by histological confirmation) of invasive breast cancer. Patients with a previous invasive malignancy (except non-melanomatous skin cancer) were excluded. Patients were identified within 12 months of initial diagnosis. BRCA1 and BRCA2 mutations were identified using blood DNA collected at recruitment. Clinicopathological data, and data regarding treatment and long-term outcomes, including date and site of disease recurrence, were collected from routine medical records at 6 months, 12 months, and then annually until death or loss to follow-up. The primary outcome was overall survival for all BRCA1 or BRCA2 mutation carriers ( BRCA -positive) versus all non-carriers ( BRCA -negative) at 2 years, 5 years, and 10 years after diagnosis. A prespecified subgroup analysis of overall survival was done in patients with triple-negative breast cancer. Recruitment was completed in 2008, and long-term follow-up is continuing. Findings Between Jan 24, 2000, and Jan 24, 2008, we recruited 2733 women. Genotyping detected a pathogenic BRCA mutation in 338 (12%) patients (201 with BRCA1 , 137 with BRCA2 ). After a median follow-up of 8·2 years (IQR 6·0–9·9), 651 (96%) of 678 deaths were due to breast cancer. There was no significant difference in overall survival between BRCA -positive and BRCA -negative patients in multivariable analyses at any timepoint (at 2 years: 97·0% [95% CI 94·5–98·4] vs 96·6% [95·8–97·3]; at 5 years: 83·8% [79·3–87·5] vs 85·0% [83·5–86·4]; at 10 years: 73·4% [67·4–78·5] vs 70·1% [67·7–72·3]; hazard ratio [HR] 0·96 [95% CI 0·76–1·22]; p=0·76). Of 558 patients with triple-negative breast cancer, BRCA mutation carriers had better overall survival than non-carriers at 2 years (95% [95% CI 89–97] vs 91% [88–94]; HR 0·59 [95% CI 0·35–0·99]; p=0·047) but not 5 years (81% [73–87] vs 74% [70–78]; HR 1·13 [0·70–1·84]; p=0·62) or 10 years (72% [62–80] vs 69% [63–74]; HR 2·12 [0·82–5·49]; p=0·12). Interpretation Patients with young-onset breast cancer who carry a BRCA mutation have similar survival as non-carriers. However, BRCA mutation carriers with triple-negative breast cancer might have a survival advantage during the first few years after diagnosis compared with non-carriers. Decisions about timing of additional surgery aimed at reducing future second primary-cancer risks should take into account patient prognosis associated with the first malignancy and patient preferences. Funding Cancer Research UK, the UK National Cancer Research Network, the Wessex Cancer Trust, Breast Cancer Now, and the PPP Healthcare Medical Trust Grant.
279 citations
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National and Kapodistrian University of Athens1, University of Tennessee Health Science Center2, German National Metrology Institute3, Ruhr University Bochum4, GE Healthcare5, Omron6, Stanford University7, National Institute for Health Research8, Green Templeton College9, Newcastle University10, Sunnybrook Health Sciences Centre11, University of Padua12, University of Milano-Bicocca13, St Thomas' Hospital14, Shanghai Jiao Tong University15, National Institutes of Health16, University College Dublin17
TL;DR: The AAMI/ESH/ISO standard as mentioned in this paper was developed by the International Organization for Standardization (ISO) and developed by AAMI, ESH and ISO experts who agreed to develop a universal standard for device validation.
Abstract: Copyright © 2018 Wolters Kluwer Health, Inc., and American Heart Association, Inc. This article has been copublished in Hypertension. In the last 30 years, several organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and the International Organization for Standardization (ISO) have developed protocols for clinical validation of BP measuring devices. However, it is recognized that science, as well as patients, consumers and manufacturers would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Therefore, an international initiative was taken by AAMI, ESH and ISO experts who agreed to develop a universal standard for device validation. This statement presents the key aspects of a validation procedure, which were agreed by the AAMI, ESH and ISO representatives as the basis for a single universal validation protocol. As soon as the AAMI/ESH/ISO standard is fully developed, this will be regarded as the single universal standard and will replace all other previous standards/protocols.
272 citations
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University of São Paulo1, Laval University2, St. Paul's Hospital3, St Thomas' Hospital4, Cedars-Sinai Medical Center5, Federal University of São Paulo6, University of British Columbia7, Vita-Salute San Raffaele University8, University of Padua9, University Hospital Bonn10, University of Miami11, Intermountain Healthcare12, Hospital Clínico San Carlos13, Leiden University Medical Center14, St. Boniface General Hospital15, Rabin Medical Center16, University of Washington17
TL;DR: Coronary obstruction following aortic ViV procedures is a life-threatening complication that occurred more frequently in patients with prior stentless or stented bioprostheses with externally mounted leaflets and in those with a short VTC.
Abstract: Aims: There are limited data on coronary obstruction following transcatheter valve-in-valve (ViV) implantation inside failed aortic bioprostheses The objectives of this study were to determine the incidence, predictors, and clinical outcomes of coronary obstruction in transcatheter ViV procedures
Methods and results: A total of 1612 aortic procedures from the Valve-in-Valve International Data (VIVID) Registry were evaluated Data were subject to centralized blinded corelab computed tomography (CT) analysis in a subset of patients The virtual transcatheter valve to coronary ostium distance (VTC) was determined A total of 37 patients (23%) had clinically evident coronary obstruction Baseline clinical characteristics in the coronary obstruction patients were similar to controls Coronary obstruction was more common in stented bioprostheses with externally mounted leaflets or stentless bioprostheses than in stented with internally mounted leaflets bioprostheses (61% vs 37% vs 08%, respectively; P < 0001) CT measurements were obtained in 20 (54%) and 90 (54%) of patients with and without coronary obstruction, respectively VTC distance was shorter in coronary obstruction patients in relation to controls (324 ± 222 vs 630 ± 234, respectively; P < 0001) Using multivariable analysis, the use of a stentless or stented bioprosthesis with externally mounted leaflets [odds ratio (OR): 767; 95% confidence interval (CI): 314-187; P < 0001] associated with coronary obstruction for the global population In a second model with CT data, a shorter VTC distance predicted this complication (OR: 022 per 1 mm increase; 95% CI: 009-051; P < 0001), with an optimal cut-off level of 4 mm (area under the curve: 0943; P < 0001) Coronary obstruction was associated with a high 30-day mortality (529% vs 39% in the controls, respectively; P < 0001)
Conclusion: Coronary obstruction following aortic ViV procedures is a life-threatening complication that occurred more frequently in patients with prior stentless or stented bioprostheses with externally mounted leaflets and in those with a short VTC
241 citations
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TL;DR: Lower IOP with use of fewer glaucoma medications was achieved after trabeculectomy with MMC compared with tube shunt surgery during the first year of follow-up.
237 citations
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University Hospitals Birmingham NHS Foundation Trust1, University of Birmingham2, Royal National Hospital for Rheumatic Diseases3, Central Manchester University Hospitals NHS Foundation Trust4, University of Manchester5, Guy's Hospital6, Freeman Hospital7, University of Cambridge8, St Thomas' Hospital9, King's College London10, Imperial College London11, University College London12
TL;DR: NICE has accredited the process used by the BSR to produce its guidance on the management of systemic lupus erythematosus in adults, valid for 5 years from 10 June 2013.
Abstract: NICE has accredited the process used by the BSR to produce its guidance on the management of systemic lupus erythematosus in adults. Accreditation is valid for 5 years from 10 June 2013. More information on accreditation can be viewed at www.nice.org.uk/accreditation. For full details on our accreditation visit: www.nice.org.uk/accreditation. Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Royal National Hospital for Rheumatic Diseases, Bath, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Louise Coote Lupus Unit, Guy’s Hospital, London, Laurie Pike Health Centre, Modality Partnership, Birmingham, Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Department of Medicine, University of Cambridge, Lupus and Vasculitis Unit, Addenbrooke’s Hospital, Cambridge, Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, Division of Women’s Health, King’s College London, Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London, LUPUS UK, Romford, Essex and Centre for Rheumatology, University College London, London, UK
235 citations
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St George's, University of London1, University of Padua2, Leiden University Medical Center3, Seconda Università degli Studi di Napoli4, University of Siena5, Oslo University Hospital6, St Thomas' Hospital7, University of Naples Federico II8, University of Hasselt9, Erasmus University Rotterdam10, Utrecht University11, University of Liège12
TL;DR: This is a list of winners and nominees for the 2016 Paralympic Games in Rio de Janeiro, Brazil.
Abstract: Antonio Pelliccia (Chairperson), Stefano Caselli (Co-chairperson)*, Sanjay Sharma, Cristina Basso, Jeroen J. Bax, Domenico Corrado, Antonello D’Andrea, Flavio D’Ascenzi, Fernando M. Di Paolo, Thor Edvardsen, Sabiha Gati, Maurizio Galderisi, Hein Heidbuchel, Alain Nchimi, Koen Nieman, Michael Papadakis, Cataldo Pisicchio, Christian Schmied, Bogdan A. Popescu, Gilbert Habib, Diederick Grobbee, and Patrizio Lancellotti (Chairperson)
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TL;DR: A meta-analysis of 139,555 Europeans identifies 68 new genomic loci associated with intraocular pressure, 68 of which are novel, which suggest a strong role for angiopoietin-receptor tyrosine kinase signaling, lipid metabolism, mitochondrial function and developmental processes underlying risk for elevated IOP.
Abstract: Glaucoma is the leading cause of irreversible blindness globally 1 . Despite its gravity, the disease is frequently undiagnosed in the community 2 . Raised intraocular pressure (IOP) is the most important risk factor for primary open-angle glaucoma (POAG)3,4. Here we present a meta-analysis of 139,555 European participants, which identified 112 genomic loci associated with IOP, 68 of which are novel. These loci suggest a strong role for angiopoietin-receptor tyrosine kinase signaling, lipid metabolism, mitochondrial function and developmental processes underlying risk for elevated IOP. In addition, 48 of these loci were nominally associated with glaucoma in an independent cohort, 14 of which were significant at a Bonferroni-corrected threshold. Regression-based glaucoma-prediction models had an area under the receiver operating characteristic curve (AUROC) of 0.76 in US NEIGHBORHOOD study participants and 0.74 in independent glaucoma cases from the UK Biobank. Genetic-prediction models for POAG offer an opportunity to target screening and timely therapy to individuals most at risk.
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TL;DR: Congenital myopathies are a group of early-onset, non-dystrophic neuromuscular conditions with characteristic muscle biopsy findings, variable severity and a stable or slowly progressive course as discussed by the authors.
Abstract: The congenital myopathies are a group of early-onset, non-dystrophic neuromuscular conditions with characteristic muscle biopsy findings, variable severity and a stable or slowly progressive course Pronounced weakness in axial and proximal muscle groups is a common feature, and involvement of extraocular, cardiorespiratory and/or distal muscles can implicate specific genetic defects Central core disease (CCD), multi-minicore disease (MmD), centronuclear myopathy (CNM) and nemaline myopathy were among the first congenital myopathies to be reported, and they still represent the main diagnostic categories However, these entities seem to belong to a much wider phenotypic spectrum To date, congenital myopathies have been attributed to mutations in over 20 genes, which encode proteins implicated in skeletal muscle Ca2+ homeostasis, excitation-contraction coupling, thin-thick filament assembly and interactions, and other mechanisms RYR1 mutations are the most frequent genetic cause, and CCD and MmD are the most common subgroups Next-generation sequencing has vastly improved mutation detection and has enabled the identification of novel genetic backgrounds At present, management of congenital myopathies is largely supportive, although new therapeutic approaches are reaching the clinical trial stage
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TL;DR: Members of all the trial management groups collaborated to generate a consensus document on appropriate organ at risk dose constraints and it is hoped that this unified approach will facilitate standardised implementation of SABR across the UK and will allow meaningful toxicity comparisons between S ABR studies and internationally.
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University of Southern California1, University of Surrey2, Royal Surrey County Hospital3, University of Florida4, Veterans Health Administration5, University of Chicago6, Vanderbilt University Medical Center7, Fudan University8, University of Massachusetts Medical School9, University of Zagreb10, University of Minnesota11, Mayo Clinic12, Johns Hopkins University13, University of California, San Francisco14, University of California, San Diego15, St Thomas' Hospital16, University of Alberta17, Radboud University Nijmegen18, Imperial College London19, Boston Children's Hospital20, Cleveland Clinic21, University of Münster22, University of Pittsburgh23
TL;DR: Acute kidney injury (AKI) occurs in 7% to 18% of hospitalized patients and complicates the course of 50% to 60% of those admitted to the intensive care unit, carrying both significant mortality and morbidity.
Abstract: Acute kidney injury (AKI) occurs in 7% to 18% of hospitalized patients and complicates the course of 50% to 60% of those admitted to the intensive care unit, carrying both significant mortality and morbidity.[1][1] Even though many cases of AKI are reversible within days to weeks of occurrence, data
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Ghent University Hospital1, National Institutes of Health2, Baylor College of Medicine3, Johns Hopkins University4, Children's Hospital at Westmead5, Centre Hospitalier Universitaire Sainte-Justine6, Paris Diderot University7, University of Texas Health Science Center at Houston8, Harvard University9, Tokyo University of Technology10, King Edward Memorial Hospital11, St Thomas' Hospital12, University of Antwerp13, Johns Hopkins University School of Medicine14, Ghent University15
TL;DR: The ClinGen framework is useful to semiquantitatively assess the strength of gene-disease relationships for HTAAD and may inform clinical laboratories in the development, interpretation, and subsequent clinical implications of genetic testing for patients with aortic disease.
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TL;DR: This first human observation linking the gut microbiome to arterial stiffness suggests that targeting the microbiome may be a way to treat arterial ageing, and Gut microbiome diversity is inversely associated with arterials stiffness in women.
Abstract: Aims The gut microbiome influences metabolic syndrome (MetS) and inflammation and is therapeutically modifiable. Arterial stiffness is poorly correlated with most traditional risk factors. Our aim was to examine whether gut microbial composition is associated with arterial stiffness. Methods and results We assessed the correlation between carotid-femoral pulse wave velocity (PWV), a measure of arterial stiffness, and gut microbiome composition in 617 middle-aged women from the TwinsUK cohort with concurrent serum metabolomics data. Pulse wave velocity was negatively correlated with gut microbiome alpha diversity (Shannon index, Beta(SE)= -0.25(0.07), P = 1 × 10-4) after adjustment for covariates. We identified seven operational taxonomic units associated with PWV after adjusting for covariates and multiple testing-two belonging to the Ruminococcaceae family. Associations between microbe abundances, microbe diversity, and PWV remained significant after adjustment for levels of gut-derived metabolites (indolepropionate, trimethylamine oxide, and phenylacetylglutamine). We linearly combined the PWV-associated gut microbiome-derived variables and found that microbiome factors explained 8.3% (95% confidence interval 4.3-12.4%) of the variance in PWV. A formal mediation analysis revealed that only a small proportion (5.51%) of the total effect of the gut microbiome on PWV was mediated by insulin resistance and visceral fat, c-reactive protein, and cardiovascular risk factors after adjusting for age, body mass index, and mean arterial pressure. Conclusions Gut microbiome diversity is inversely associated with arterial stiffness in women. The effect of gut microbiome composition on PWV is only minimally mediated by MetS. This first human observation linking the gut microbiome to arterial stiffness suggests that targeting the microbiome may be a way to treat arterial ageing.
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TL;DR: Hypertension Canada's inaugural evidence-based Canadian recommendations for the management of hypertension in pregnancy provide guidance for the threshold for initiation of antihypertensive therapy, blood pressure targets, as well as first- and second-line anti Hypertensive medications.
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University College Hospital1, European Centre for Disease Prevention and Control2, Public Health England3, University of Turku4, University of London5, Rega Institute for Medical Research6, Karolinska University Hospital7, Royal Oldham Hospital8, Cardiff University9, Ghent University Hospital10, University Medical Center Groningen11, Carlos III Health Institute12, University of Milan13, Robert Koch Institute14, Leipzig University15, National Institutes of Health16, University of Valencia17, University of Pavia18, National Institute for Biological Standards and Control19, Norwegian Institute of Public Health20, John Radcliffe Hospital21, University of Liverpool22, The Cyprus Institute of Neurology and Genetics23, University College Dublin24, University of Düsseldorf25, Imperial College London26, St Thomas' Hospital27, University of Amsterdam28, Qatar Airways29, University of Oxford30, University of Groningen31
TL;DR: It is recommended that respiratory and stool samples in addition to cerebrospinal fluid and blood samples are submitted for EV testing from patients with suspected neurological infections and reverse transcriptase PCR targeting the 5'noncoding regions (5'NCR) should be used for diagnosis of EVs.
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Royal Devon and Exeter Hospital1, University of Queensland2, Queen Mary University of London3, University of Exeter4, Northwestern University5, University of Oxford6, Wellcome Trust Centre for Human Genetics7, Statens Serum Institut8, Norwegian Institute of Public Health9, University of Bristol10, Erasmus University Rotterdam11, Children's Hospital of Philadelphia12, University of Copenhagen13, Copenhagen University Hospital14, University of Oulu15, St Thomas' Hospital16, Boston University17, QIMR Berghofer Medical Research Institute18, VU University Amsterdam19, VU University Medical Center20, Centre Hospitalier Universitaire de Sherbrooke21, University of Southampton22, Pompeu Fabra University23, University of Western Australia24, Newcastle University25, March of Dimes26, Cincinnati Children's Hospital Medical Center27, UCL Institute of Child Health28, Université de Sherbrooke29, University of Pennsylvania30, University of Helsinki31, University of Bergen32, Jinan University33, University of Potsdam34, University Hospital Southampton NHS Foundation Trust35, University of Ferrara36, University of Iowa37, Haukeland University Hospital38, University of Southern Denmark39, Charité40, Health Protection Agency41, Sahlgrenska University Hospital42, University of Crete43, Stanford University44, National Institute for Health Research45, Harvard University46, University of South Australia47
TL;DR: The identified associations indicate that genetic effects on maternal glucose, cytochrome P450 activity and gestational duration, and potentially on maternal blood pressure and immune function, are relevant for fetal growth.
Abstract: Genome-wide association studies (GWAS) of birth weight have focused on fetal genetics, while relatively little is known about the role of maternal genetic variation. We aimed to identify maternal genetic variants associated with birth weight that could highlight potentially relevant maternal determinants of fetal growth. We meta-analysed data on up to 8.7 million SNPs in up to 86,577 women of European descent from the Early Growth Genetics (EGG) Consortium and the UK Biobank. We used structural equation modelling (SEM) and analyses of mother-child pairs to quantify the separate maternal and fetal genetic effects. Maternal SNPs at 10 loci (MTNR1B, HMGA2, SH2B3, KCNAB1, L3MBTL3, GCK, EBF1, TCF7L2, ACTL9, CYP3A7) were associated with offspring birth weight at P<5x10-8. In SEM analyses, at least 7 of the 10 associations were consistent with effects of the maternal genotype acting via the intrauterine environment, rather than via effects of shared alleles with the fetus. Variants, or correlated proxies, at many of the loci had been previously associated with adult traits, including fasting glucose (MTNR1B, GCK and TCF7L2) and sex hormone levels (CYP3A7), and one (EBF1) with gestational duration. The identified associations indicate genetic effects on maternal glucose, cytochrome P450 activity and gestational duration, and potentially on maternal blood pressure and immune function, are relevant for fetal growth. Further characterization of these associations in mechanistic and causal analyses will enhance understanding of the potentially modifiable maternal determinants of fetal growth, with the goal of reducing the morbidity and mortality associated with low and high birth weights.
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TL;DR: The relief of key OAB symptoms produced by mirabegron 50mg is significantly better than placebo, and similar to a range of common antimuscarinics, with the benefit of significantly fewer bothersome anticholinergic side effects such as dry mouth.
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TL;DR: In vitro and in aged mice aorta, it is shown that inhibition of LC3 lipidation under conditions of oxidative stress causes oxidation of Atg3 and Atg7, preventing autophagosome maturation.
Abstract: Macroautophagy (autophagy) is a crucial cellular stress response for degrading defective macromolecules and organelles, as well as providing bioenergetic intermediates during hypoxia and nutrient deprivation. Here we report a thiol-dependent process that may account for impaired autophagy during aging. This is through direct oxidation of key autophagy-related (Atg) proteins Atg3 and Atg7. When inactive Atg3 and Atg7 are protected from oxidation due to stable covalent interaction with their substrate LC3. This interaction becomes transient upon activation of Atg3 and Atg7 due to transfer of LC3 to phosphatidylethanolamine (lipidation), a process crucial for functional autophagy. However, loss in covalent-bound LC3 also sensitizes the catalytic thiols of Atg3 and Atg7 to inhibitory oxidation that prevents LC3 lipidation, observed in vitro and in mouse aorta. Here findings provide a thiol-dependent process for negatively regulating autophagy that may contribute to the process of aging, as well as therapeutic targets to regulate autophagosome maturation.
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TL;DR: Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted.
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TL;DR: In the 16 years since the first pioneering procedure, transcatheter aortic valve implantation (TAVI) has come of age and become a routine strategy for valve replacement, increasingly performed under conscious sedation via transfemoral access.
Abstract: In the 16 years since the first pioneering procedure, transcatheter aortic valve implantation (TAVI) has come of age and become a routine strategy for aortic valve replacement, increasingly performed under conscious sedation via transfemoral access. Simplification of the procedure, accumulation of clinical experience, and improvements in valve design and delivery systems have led to a dramatic reduction in complication rates. These advances have allowed transition to lower risk populations, and outcome data from the PARTNER 2A and SURTAVI trials have established a clear evidence base for use in intermediate risk patients. Ongoing studies with an expanding portfolio of devices seem destined to expand indications for TAVI towards lower risk, younger and asymptomatic populations. In this article, we outline recent advances, new devices and current guidelines informing the use of TAVI, and describe remaining uncertainties that need to be addressed.
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TL;DR: IGRA-based or BCG-stratified TST strategies appear most suited to screening for potential disease progression among high-risk groups, and positive results for these tests were significantly better predictors of progression than TST-10 and T ST-5.
Abstract: Summary Background Tackling tuberculosis requires testing and treatment of latent tuberculosis in high-risk groups. The aim of this study was to estimate the predictive values of the tuberculin skin test (TST) and two interferon-γ release assays (IGRAs) for the development of active tuberculosis in high-risk groups—ie, people in recent contact with active tuberculosis cases and from high-burden countries. Method In this prospective cohort study, we recruited participants from 54 centres (eg, clinics, community settings) in London, Birmingham, and Leicester in the UK. Participants were eligible if they were aged 16 years or older and at high risk for latent tuberculosis infection (ie, recent contact with someone with active tuberculosis [contacts] or a migrant who had arrived in the UK in the past 5 years from—or who frequently travelled to—a country with a high burden of tuberculosis [migrants]). Exclusion criteria included prevalent cases of tuberculosis, and participants who were treated for latent tuberculosis after a positive test result in this study. Each participant received three tests (QuantiFERON-TB Gold-In Tube, T-SPOT. TB , and a Mantoux TST). A positive TST result was reported using three thresholds: 5 mm (TST-5), 10 mm (TST-10), and greater than 5 mm in BCG-naive or 15 mm in BCG-vaccinated (TST-15) participants. Participants were followed up from recruitment to development of tuberculosis or censoring. Incident tuberculosis cases were identified by national tuberculosis databases, telephone interview, and review of medical notes. Our primary objective was to estimate the prognostic value of IGRAs compared with TST, assessed by the ratio of incidence rate ratios and predictive values for tuberculosis development. The study was registered with ClinicalTrials.gov, NCT01162265, and is now complete. Findings Between May 4, 2010, and June 1, 2015, 10 045 people were recruited, of whom 9610 were eligible for inclusion. Of this cohort, 4861 (50·6%) were contacts and 4749 (49·4%) were migrants. Participants were followed up for a median of 2·9 years (range 21 days to 5·9 years). 97 (1·0%) of 9610 participants developed active tuberculosis (77 [1·2%] of 6380 with results for all three tests). In all tests, annual incidence of tuberculosis was very low in those who tested negatively (ranging from 1·2 per 1000 person-years, 95% CI 0·6–2·0 for TST-5 to 1·9 per 1000 person-years, 95% CI 1·3–2·7, for QuantiFERON-TB Gold In-Tube). Annual incidence in participants who tested positively were highest for T-SPOT. TB (13·2 per 1000 person-years, 95% CI 9·9–17·4), TST-15 (11·1 per 1000 person-years, 8·3–14·6), and QuantiFERON-TB Gold In-Tube (10·1 per 1000 person-years, 7·4–13·4). Positive results for these tests were significantly better predictors of progression than TST-10 and TST-5 (eg, ratio of test positivity rates in those progressing to tuberculosis compared with those not progressing T-SPOT. TB vs TST-5: 1·99, 95% CI 1·68–2·34; p Interpretation IGRA-based or BCG-stratified TST strategies appear most suited to screening for potential disease progression among high-risk groups. Further work will be needed to assess country-specific cost-effectiveness of each screening test, and in the absence of highly specific diagnostic tests, cheap non-toxic treatments need to be developed that could be given to larger groups of people at potential risk. Funding National Institute for Health Research Health Technology Assessment Programme 08-68-01.
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TL;DR: Network analysis revealed a close and direct relationship between bioenergetic impairment and reduction in muscle mass and between intramuscular inflammation and impaired anabolic signaling.
Abstract: Objectives To characterise the sketetal muscle metabolic phenotype during early critical illness. Methods Vastus lateralis muscle biopsies and serum samples (days 1 and 7) were obtained from 63 intensive care patients (59% male, 54.7±18.0 years, Acute Physiology and Chronic Health Evaluation II score 23.5±6.5). Measurements and main results From day 1 to 7, there was a reduction in mitochondrial beta-oxidation enzyme concentrations, mitochondrial biogenesis markers (PGC1α messenger mRNA expression (−27.4CN (95% CI −123.9 to 14.3); n=23; p=0.025) and mitochondrial DNA copy number (−1859CN (IQR −5557–1325); n=35; p=0.032). Intramuscular ATP content was reduced compared tocompared with controls on day 1 (17.7mmol/kg /dry weight (dw) (95% CI 15.3 to 20.0) vs. 21.7 mmol/kg /dw (95% CI 20.4 to 22.9); p Conclusions Decreased mitochondrial biogenesis and dysregulated lipid oxidation contribute to compromised skeletal muscle bioenergetic status. In addition, intramuscular inflammation was associated with impaired anabolic recovery with lipid delivery observed as bioenergetically inert. Future clinical work will focus on these key areas to ameliorate acute skeletal muscle wasting. Trial registration number NCT01106300.
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TL;DR: The gut microbiomes of Raute and Raji reveal an intermediate state between the Chepang and Tharu, indicating that divergence from a stereotypical foraging microbiome can occur within a single generation, and environmental factors such as drinking water source and solid cooking fuel are significantly associated with the gut microbiome.
Abstract: The composition of the gut microbiome in industrialized populations differs from those living traditional lifestyles. However, it has been difficult to separate the contributions of human genetic and geographic factors from lifestyle. Whether shifts away from the foraging lifestyle that characterize much of humanity’s past influence the gut microbiome, and to what degree, remains unclear. Here, we characterize the stool bacterial composition of four Himalayan populations to investigate how the gut community changes in response to shifts in traditional human lifestyles. These groups led seminomadic hunting–gathering lifestyles until transitioning to varying levels of agricultural dependence upon farming. The Tharu began farming 250–300 years ago, the Raute and Raji transitioned 30–40 years ago, and the Chepang retain many aspects of a foraging lifestyle. We assess the contributions of dietary and environmental factors on their gut-associated microbes and find that differences in the lifestyles of Himalayan foragers and farmers are strongly correlated with microbial community variation. Furthermore, the gut microbiomes of all four traditional Himalayan populations are distinct from that of the Americans, indicating that industrialization may further exacerbate differences in the gut community. The Chepang foragers harbor an elevated abundance of taxa associated with foragers around the world. Conversely, the gut microbiomes of the populations that have transitioned to farming are more similar to those of Americans, with agricultural dependence and several associated lifestyle and environmental factors correlating with the extent of microbiome divergence from the foraging population. The gut microbiomes of Raute and Raji reveal an intermediate state between the Chepang and Tharu, indicating that divergence from a stereotypical foraging microbiome can occur within a single generation. Our results also show that environmental factors such as drinking water source and solid cooking fuel are significantly associated with the gut microbiome. Despite the pronounced differences in gut bacterial composition across populations, we found little differences in alpha diversity across lifestyles. These findings in genetically similar populations living in the same geographical region establish the key role of lifestyle in determining human gut microbiome composition and point to the next challenging steps of determining how large-scale gut microbiome reconfiguration impacts human biology.
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TL;DR: To introduce a methodology for the reconstruction of multi‐shot, multi‐slice magnetic resonance imaging able to cope with both within‐plane and through‐plane rigid motion and to describe its application in structural brain imaging.
Abstract: Purpose
To introduce a methodology for the reconstruction of multi-shot, multi-slice magnetic resonance imaging able to cope with both within-plane and through-plane rigid motion and to describe its application in structural brain imaging.
Theory and Methods
The method alternates between motion estimation and reconstruction using a common objective function for both. Estimates of three-dimensional motion states for each shot and slice are gradually refined by improving on the fit of current reconstructions to the partial k-space information from multiple coils. Overlapped slices and super-resolution allow recovery of through-plane motion and outlier rejection discards artifacted shots. The method is applied to T2 and T1 brain scans acquired in different views.
Results
The procedure has greatly diminished artifacts in a database of 1883 neonatal image volumes, as assessed by image quality metrics and visual inspection. Examples showing the ability to correct for motion and robustness against damaged shots are provided. Combination of motion corrected reconstructions for different views has shown further artifact suppression and resolution recovery.
Conclusion
The proposed method addresses the problem of rigid motion in multi-shot multi-slice anatomical brain scans. Tests on a large collection of potentially corrupted datasets have shown a remarkable image quality improvement. Magn Reson Med, 2017. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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TL;DR: Patients with a previous history of infective endocarditis had the highest risk of recurrence or dying during an IE admission and Congenital heart conditions repaired with prosthetic material had lower risk than all ‘moderate-risk’ conditions—even in the first 6 months.
Abstract: Aims: There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions. Methods and results: English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered 'moderate risk') had similar levels of risk (OR 66 and 57) and risks in other 'moderate-risk' conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered 'high risk' for 6 months following surgery) had lower risk than all 'moderate-risk' conditions-even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices. Conclusion: These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some 'moderate-risk' patients was similar to that of several 'high-risk' conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.
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TL;DR: Pools of morphologically, antigenically, and topographically diverse neural progenitor cells are present in the human hippocampus from early developmental stages until adulthood, including in AD patients, while their neurogenic potential seems negligible in the adult.
Abstract: Neuropathological conditions might affect adult granulogenesis in the adult human dentate gyrus. However, radial glial cells (RGCs) have not been well characterized during human development and aging. We have previously described progenitor and neuronal layer establishment in the hippocampal pyramidal layer and dentate gyrus from embryonic life until mid-gestation. Here, we describe RGC subtypes in the hippocampus from 13 gestational weeks (GW) to mid-gestation and characterize their evolution and the dynamics of neurogenesis from mid-gestation to adulthood in normal and Alzheimer's disease (AD) subjects. In the pyramidal ventricular zone (VZ), RGC density declined with neurogenesis from mid-gestation until the perinatal period. In the dentate area, morphologic and antigenic differences among RGCs were observed from early ages of development to adulthood. Density and proliferative capacity of dentate RGCs as well as neurogenesis were strongly reduced during childhood until 5 years, few DCX+ cells are seen in adults. The dentate gyrus of both control and AD individuals showed Nestin+ and/or GFAPδ+ cells displaying different morphologies. In conclusion, pools of morphologically, antigenically, and topographically diverse neural progenitor cells are present in the human hippocampus from early developmental stages until adulthood, including in AD patients, while their neurogenic potential seems negligible in the adult.