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6. Specific and off-target immune responses following COVID-19 vaccination with ChAdOx1-S and BNT162b2 vaccines—an exploratory sub-study of the BRACE trial

Author

Curtis, Nigel, Davidson, Andrew, Gardiner, Kaya, Gwee, Amanda, Jamieson, Tenaya, Messina, Nicole, Morawakage, Thilanka, Perlen, Susan, Perrett, Kirsten, Pittet, Laure, Sastry, Amber, Teo, Jia Wei, Orsini, Francesca, Lee, Katherine, Moore, Cecilia, Vidmar, Suzanna, Ali, Rashida, Dunn, Ross, Edler, Peta, Gell, Grace, Goodall, Casey, Hall, Richard, Krastev, Ann, La, Nathan, McDonald, Ellie, McPhate, Nick, Nguyen, Thao, Ren, Jack, Stevens, Luke, Alamrousi, Ahmed, Bonnici, Rhian, Dang, Thanh, Germano, Susie, Hua, Jenny, McElroy, Rebecca, Razmovska, Monica, Reddiex, Scott, Wang, Xiaofang, Anderson, Jeremy, Azzopardi, Kristy, Bennett-Wood, Vicki, Czajko, Anna, Mazarakis, Nadia, McCafferty, Conor, Oppedisano, Frances, Ortika, Belinda, Pell, Casey, Spry, Leena, Toh, Ryan, Velagapudi, Sunitha, Vlahos, Amanda, Wee-Hee, Ashleigh, Ramos, Pedro, De La Cruz, Karina, Gamage, Dinusha, Karunanayake, Anushka, Mezzetti, Isabella, Ong, Benjamin, Singh, Ronita, Sooriyarachchi, Enoshini, Nicholson, Suellen, Cain, Natalie, Brizuela, Rianne, Huang, Han, Abruzzo, Veronica, Bealing, Morgan, Bimboese, Patricia, Bowes, Kirsty, Burrell, Emma, Chan, Joyce, Cushnahan, Jac, Elborough, Hannah, Elkington, Olivia, Fahey, Kieran, Fernandez, Monique, Flynn, Catherine, Fowler, Sarah, Andrit, Marie Gentile, Gladanac, Bojana, Hammond, Catherine, Ma, Norine, Macalister, Sam, Milojevic, Emmah, Mojeed, Jesutofunmi, Nguyen, Jill, O’Donnell, Liz, Olivier, Nadia, Ooi, Isabelle, Reynolds, Stephanie, Shen, Lisa, Sherry, Barb, Spotswood, Judith, Wedderburn, Jamie, Younes, Angela, Legge, Donna, Bell, Jason, Cheah, Jo, Cobbledick, Annie, Lim, Kee, Elia, Sonja, Addlem, Lynne, Bourke, Anna, Brophy, Clare, Henare, Nadine, Jenkins, Narelle, Machingaifa, Francesca, Miller, Skye, Mitchell, Kirsten, Pitkin, Sigrid, Wall, Kate, Villanueva, Paola, Crawford, Nigel, Norton, Wendy, Tan, Niki, Chengodu, Thilakavathi, Dawson, Diane, Gordon, Victoria, Korman, Tony, O’Bryan, Jess, Agius, Sophie, Bannister, Samantha, Bucholc, Jess, Burns, Alison, Camesella, Beatriz, Carlin, John, Ciaverella, Marianna, Curtis, Maxwell, Firth, Stephanie, Guo, Christina, Hannan, Matthew, Hill, Erin, Joshi, Sri, Lieschke, Katherine, Mathers, Megan, Odoi, Sasha, Rak, Ashleigh, Richards, Chris, Steve, Leah, Stewart, Carolyn, Sudbury, Eva, Thomson, Helen, Watts, Emma, Williams, Fiona, Young, Angela, Glenn, Penny, Kaynes, Andrew, De Floy, Amandine Philippart, Buchanan, Sandy, Sondag, Thijs, Xie, Ivy, Edmund, Harriet, Byrne, Bridie, Keeble, Tom, Ngien, Belle, Noonan, Fran, Wearing-Smith, Michelle, Clarke, Alison, Davies, Pemma, Eastwood, Oliver, Ellinghaus, Alric, Ghieh, Rachid, Hilton, Zahra, Jennings, Emma, Kakkos, Athina, Liang, Iris, Nicol, Katie, O’Callaghan, Sally, Osman, Helen, Rajaram, Gowri, Ratcliffe, Sophia, Rayner, Victoria, Salmon, Ashleigh, Scheppokat, Angela, Stevens, Aimee, Street, Rebekah, Toogood, Nicholas, Wood, Nicholas, Bahaduri, Twinkle, Baulman, Therese, Byrne, Jennifer, Carter, Candace, Corbett, Mary, Dao, Aiken, Desylva, Maria, Dunn, Andrew, Gardiner, Evangeline, Joyce, Rosemary, Kandasamy, Rama, Munns, Craig, Pelayo, Lisa, Sharma, Ketaki, Sterling, Katrina, Uren, Caitlin, Colaco, Clinton, Douglas, Mark, Hamilton, Kate, Bartlett, Adam, McMullan, Brendan, Palasanthiran, Pamela, Williams, Phoebe, Beardsley, Justin, Bergant, Nikki, Lagunday, Renier, Overton, Kristen, Post, Jeffrey, Al-Hindawi, Yasmeen, Barney, Sarah, Byrne, Anthony, Mead, Lee, Plit, Marshall, Lynn, David, Benson, Saoirse, Blake, Stephen, Botten, Rochelle, Chern, Tee Yee, Eden, Georgina, Griffith, Liddy, James, Jane, Lynn, Miriam, Markow, Angela, Sacca, Domenic, Stevens, Natalie, Wesselingh, Steve, Doran, Catriona, Barry, Simone, Sawka, Alice, Evans, Sue, Goodchild, Louise, Heath, Christine, Krieg, Meredith, Marshall, Helen, McMillan, Mark, Walker, Mary, Richmond, Peter, Amenyogbe, Nelly, Anthony, Christina, Arnold, Annabelle, Arrowsmith, Beth, Ben-Othman, Rym, Clark, Sharon, Dunnill, Jemma, Eiffler, Nat, Ewe, Krist, Finucane, Carolyn, Flynn, Lorraine, Gibson, Camille, Hartnell, Lucy, Hollams, Elysia, Hutton, Heidi, Jarvis, Lance, Jones, Jane, Jones, Jan, Jones, Karen, Kent, Jennifer, Kollmann, Tobias, Lalich, Debbie, Lee, Wenna, Lim, Rachel, McAlister, Sonia, McDonald, Fiona, Meehan, Andrea, Minhaj, Asma, Montgomery, Lisa, O’Donnell, Melissa, Ong, Jaslyn, Ong, Joanne, Parkin, Kimberley, Perez, Glady, Power, Catherine, Rezazadeh, Shadie, Richmond, Holly, Rogers, Sally, Schultz, Nikki, Shave, Margaret, Skut, Patrycja, Stiglmayer, Lisa, Truelove, Alexandra, Wadia, Ushma, Wallace, Rachael, Waring, Justin, England, Michelle, Latkovic, Erin, Manning, Laurens, Herrmann, Susan, Lucas, Michaela, Lacerda, Marcus, Andrade, Paulo Henrique, Barbosa, Fabiane Bianca, Barros, Dayanne, Brasil, Larissa, Capella, Ana Greyce, Castro, Ramon, Costa, Erlane, de Souza, Dilcimar, Dias, Maianne, Dias, José, Ferreira, Klenilson, Figueiredo, Paula, Freitas, Thamires, Furtado, Ana Carolina, Gama, Larissa, Godinho, Vanessa, Gouy, Cintia, Hinojosa, Daniele, Jardim, Bruno, Jardim, Tyane, Junior, Joel, Lima, Augustto, Maia, Bernardo, Marins, Adriana, Mazurega, Kelry, Medeiros, Tercilene, Melo, Rosangela, Moraes, Marinete, Nascimento, Elizandra, Neves, Juliana, Oliveira, Maria Gabriela, Oliveira, Thais, Oliveira, Ingrid, Otsuka, Arthur, Paes, Rayssa, Pereira, Handerson, Pereira, Gabrielle, Prado, Christiane, Queiroz, Evelyn, Rodrigues, Laleyska, Rodrigues, Bebeto, Sampaio, Vanderson, Santos, Anna Gabriela, Santos, Daniel, Santos, Tilza, Santos, Evelyn, Sartim, Ariandra, Silva, Ana Beatriz, Silva, Juliana, Silva, Emanuelle, Simão, Mariana, Soares, Caroline, Sousa, Antonny, Trindade, Alexandre, Val, Fernando, Vasconcelos, Adria, Vasconcelos, Heline, Croda, Julio, Abreu, Carolinne, Almeida, Katya Martinez, Bitencourt de Andrade, Camila, Campos Angelo, Jhenyfer Thalyta, Gonçalvez de Araújo Arcanjo, Ghislaine, Silva Menezes Arruda, Bianca Maria, Ayala, Wellyngthon Espindola, Refosco Barbosa, Adelita Agripina, Vieira Batista, Felipe Zampieri, de Morais Batista, Fabiani, de Jesus Costa, Miriam, Croda, Mariana Garcia, Alves da Cruz, Lais, Pereira Diogo, Roberta Carolina, Dutra Escobar, Rodrigo Cezar, Fernandes, Iara Rodrigues, Figueiredo, Leticia Ramires, Cavalcanti Gonçalves, Leandro Galdino, Lahdo, Sarita, Lencina, Joyce dos Santos, Teodoro de Lima, Guilherme, Matos, Larissa Santos, Leopoldina Meireles, Bruna Tayara, Moreira, Debora Quadros, Silva Muranaka, Lilian Batista, de Oliveira, Adriely, Warszawski de Oliveira, Karla Regina, Vieira de Oliveira, Matheus, Dias de Oliveira, Roberto, Souza de Almeida dos Reis Pereira, Andrea Antonia, Puga, Marco, Ramos, Caroliny Veron, Souza da Rosa, Thaynara Haynara, Lopes dos Santos, Karla, Ribeiro dos Santos, Claudinalva, Leopoldina dos Santos, Dyenyffer Stéffany, Santos, Karina Marques, Pereira da Silva, Paulo César, Rocha da Silva, Paulo Victor, Silva, Débora dos Santos, Vieira da Silva, Patricia, Freitas da Rosa Soares, Bruno, Sperotto, Mariana Gazzoni, Tadokoro, Mariana Mayumi, Tsuha, Daniel, Ramos Vieira, Hugo Miguel, Pretti Dalcolmo, Margareth Maria, Lopes Alves da Paixão, Cíntia Maria, Corrêa E Castro, Gabriela, Collopy, Simone Silva, da Costa Silva, Renato, Almeida da Silveira, Samyra, Da-Cruz, Alda Maria, Maria da Silva Passos de Carvalho, Alessandra, de Cássia Batista, Rita, Silva De Freitas, Maria Luciana, Gerhardt de Oliveira Ferreira, Aline, Conceição de Souza, Ana Paula, Doblas, Paola Cerbino, Alcoforado da Silva dos Santos, Ayla, Cristine de Moraes dos Santos, Vanessa, Alves dos Santos Gomes, Dayane, Fortunato, Anderson Lage, Gomes-Silva, Adriano, Gonçalves, Monique Pinto, Garcia Meireless Junior, Paulo Leandro, Martins da Costa Carvalho, Estela, Motta, Fernando do Couto, Olivo de Mendonça, Ligia Maria, Pandine, Girlene dos Santos, Plácido Pereira, Rosa Maria, Maia, Ivan Ramos, Luiz da Rocha, Jorge, Paiva Romano, João Victor, Santos, Glauce dos, Fernandes da Silva, Erica, Mendonça Teixeira de Siqueira, Marilda Agudo, Prudêncio Soares, Ágatha Cristinne, Bonten, Marc, Arroyo, Sandra Franch, Besten, Henny Ophorst-den, Boon, Anna, Brakke, Karin M., Janssen, Axel, Koopmans, Marijke A.H., Lemmens, Toos, Leurink, Titia, Prat-Aymerich, Cristina, Septer-Bijleveld, Engelien, Stadhouders, Kimberly, Troeman, Darren, van der Waal, Marije, van Opdorp, Marjoleine, van Sluis, Nicolette, Wolters, Beatrijs, Kluytmans, Jan, Romme, Jannie, van den Bijllaardt, Wouter, van Mook, Linda, Rijen, M.M.L (Miranda) van, Filius, Margreet, Gisolf, Jet, Greven, Frances, Huijbens, Danique, Hassing, Robert Jan, Pon, Roos, Preijers, Lieke, van Leusen, Joke, Verheij, Harald, Boersma, Wim, Brans, Evelien, Kloeg, Paul, Molenaar-Groot, Kitty, Nguyen, Nhat Khanh, Paternotte, Nienke, Rol, Anke, Stooper, Lida, Dijkstra, Helga, Eggenhuizen, Esther, Huijs, Lucas, Moorlag, Simone, Netea, Mihai, Pranger, Eva, Taks, Esther, Oever, Jaap ten, Heine, Rob ter, Blauwendraat, Kitty, Meek, Bob, Erkaya, Isil, Harbech, Houda, Roescher, Nienke, Peeters, Rifka, Riele, Menno te, Zhou, Carmen, Calbo, Esther, Marti, Cristina Badia, Palomares, Emma Triviño, Porcuna, Tomás Perez, Barriocanal, Anabel, Barriocanal, Ana Maria, Casas, Irma, Dominguez, Jose, Esteve, Maria, Lacoma, Alicia, Latorre, Irene, Molina, Gemma, Molina, Barbara, Rosell, Antoni, Vidal, Sandra, Barrera, Lydia, Bustos, Natalia, Calderón, Ines Portillo, Campos, David Gutierrez, Carretero, Jose Manuel, Castellano, Angel Dominguez, Compagnone, Renato, Ramirez de Arellano, Encarnacion, Serna, Almudena de la, Dolores del Toro Lopez, Maria, Clement Espindola, Marie-Alix, Martin Gutierrez, Ana Belen, Hernandez, Alvaro Pascual, Jiménez, Virginia Palomo, Moreno, Elisa, Navarrete, Nicolas, Paño, Teresa Rodriguez, Rodríguez-Baño, Jesús, Tristán, Enriqueta, Rios Villegas, Maria Jose, Garces, Atsegiñe Canga, Amo, Erika Castro, Guerrero, Raquel Coya, Goikoetxea, Josune, Jorge, Leticia, Perez, Cristina, Fariñas Álvarez, María Carmen, Cuadra, Manuel Gutierrez, Arnaiz de las Revillas Almajano, Francisco, Garcia, Pilar Bohedo, Poderos, Teresa Giménez, Rico, Claudia González, Sanchez, Blanca, Valero, Olga, Vega, Noelia, Campbell, John, Barnes, Anna, Catterick, Helen, Cranston, Tim, Dawe, Phoebe, Fletcher, Emily, Fouracre, Liam, Gifford, Alison, Kirkwood, John, Martin, Christopher, McAnew, Amy, Mitchell, Marcus, Newman, Georgina, O’Connell, Abby, Onysk, Jakob, Quinn, Lynne, Rhodes, Shelley, Stone, Samuel, Symons, Lorrie, Tripp, Harry, Warris, Adilia, Watkins, Darcy, Whale, Bethany, Harding, Alex, Lockhart, Gemma, Sidaway-Lee, Kate, Hilton, Sam, Manton, Sarah, Webber-Rookes, Daniel, Winder, Rachel, Moore, James, Bateman, Freya, Gibbons, Michael, Knight, Bridget, Moss, Julie, Statton, Sarah, Studham, Josephine, Hall, Lydia, Moyle, Will, Venton, Tamsin, Messina, Nicole L., Grubor-Bauk, Branka, Lynn, David J., Perrett, Kirsten P., Pittet, Laure F., Rudraraju, Rajeev, Stevens, Natalie E., and Subbarao, Kanta

Published
2024
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11. Revealing the origins of vortex cavitation in a Venturi tube by high speed X-ray imaging

Author

Soyama, Hitoshi, Liang, Xiaoyu, Yashiro, Wataru, Kajiwara, Kentaro, Asimakopoulou, Eleni Myrto, Bellucci, Valerio, Birnsteinova, Sarlota, Giovanetti, Gabriele, Kim, Chan, Kirkwood, Henry J., Koliyadu, Jayanath C.P., Letrun, Romain, Zhang, Yuhe, Uličný, Jozef, Bean, Richard, Mancuso, Adrian P., Villanueva-Perez, Pablo, Sato, Tokushi, Vagovič, Patrik, Eakins, Daniel, and Korsunsky, Alexander M.

Published
2023
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21. Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study

Author

Wood, Anna J., Boyle, Jacqueline A., Barr, Elizabeth L.M., Barzi, Federica, Hare, Matthew J.L., Titmuss, Angela, Longmore, Danielle K., Death, Elizabeth, Kelaart, Joanna, Kirkwood, Marie, Graham, Sian, Connors, Christine, Moore, Elizabeth, O'Dea, Kerin, Oats, Jeremy J.N., McIntyre, Harold D., Zimmet, Paul Z., Lu, Zhong X., Brown, Alex, Shaw, Jonathan E., and Maple-Brown, Louise J.

Published
2021
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25. Impact of head and neck radiation on long-term outcomes after carotid revascularization.

Author

Lee, K. Benjamin, Tanenbaum, Mira T., Wang, Angela, Tsai, Shirling, Modrall, J. Gregory, Timaran, Carlos H., Kirkwood, Melissa L., and Ramanan, Bala

Abstract

Radiation-induced carotid artery stenosis (RICS) is a well-described phenomenon seen after head and neck cancer radiation. Previously published literature suggests that, compared with atherosclerotic disease, RICS may result in worse long-term outcomes and early restenosis. This study aims to evaluate the effect of radiation on long-term outcomes after various carotid revascularization techniques using a multi-center registry database. Patients in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) registry for carotid artery intervention (carotid endarterectomy [CEA]; transfemoral carotid artery stenting [CAS]; transcarotid artery revascularization [TCAR]), who are 65 years or older were included in the study. VQI Vascular Implant Surveillance and Interventional Outcomes Network (VISION) Medicare-linked database was used to obtain long-term procedure-specific outcomes. Primary endpoints were 3-year death, stroke, and reintervention. We performed propensity matching between patients with prior radiation and those without. Kaplan-Meier analysis and a multivariate logistic regression model were used to analyze the outcome variables. A total of 56,472 patients had undergone carotid revascularization (CEA, n = 48,307; TCAR, n = 4593; CAS, n = 3572), 1244 patients with prior radiation and 54,925 patients without prior radiation. The prior radiation group was more likely to be male (71.9% vs 60.3%; P <.01), to receive a stent (47.5% vs 13.5%; P <.01), and to be on P2Y12 inhibitor (55.2% vs 38.3%; P <.01). Propensity matching was performed on 1223 patients (CEA, n = 655; TCAR, n = 292; CAS, n = 287). There were no significant differences in 30-day outcomes for death, stroke, or major adverse cardiovascular events for all three procedures. The prior radiation group had higher rates of cranial nerve injury (3.7% vs 1.8%; P =.04) and 90-day readmission (23.5% vs 18.3%; P =.01) after CEA. For long-term outcomes, prior radiation significantly increased mortality risk for CEA and CAS (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.38-2.27 and HR, 1.56; 95% CI, 1.02-2.36, respectively). The 3-year risk of stroke for CEA in radiated patients was also significantly higher (HR, 1.47; 95% CI, 1.03-2.09) compared with non-radiated patients. Prior radiation did not significantly affect death and stroke in patients undergoing TCAR. Prior radiation also did not impact the rates of short and long-term reintervention after CEA, CAS, or TCAR. Prior head and neck radiation significantly increases the risk for mortality and stroke for CEA and the risk for mortality after CAS. Long-term outcomes for TCAR are not significantly affected by prior radiation. TCAR may be the preferred treatment modality for patients with radiation-induced carotid stenosis. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Assessing clonal changes in T cells over time following immunotherapy is a breeze with Cyclone.

Author

Cillo, Anthony R. and Kirkwood, John M.

Subjects
*CANCER cells, *IMMUNOTHERAPY, *MELANOMA, *CYCLONES, *METASTASIS
Abstract

Combination immunotherapy improves outcomes in metastatic melanoma, but the underlying mechanisms remain unclear. In this issue of Cancer Cell , Wang et al. 1 report dynamics and transcriptional states of CD8+ T cell clones over time in patients treated with anti-PD-1, anti-CTLA-4, or a combination of the two. These findings have important implications for understanding and monitoring combination immunotherapy. Combination immunotherapy improves outcomes in metastatic melanoma, but the underlying mechanisms remain unclear. In this issue of Cancer Cell , Wang et al. report dynamics and transcriptional states of CD8+ T cell clones over time in patients treated with anti-PD-1, anti-CTLA-4, or a combination of the two. These findings have important implications for understanding and monitoring combination immunotherapy. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Impact of chronic kidney disease and end-stage renal disease on outcomes after complex endovascular and open aortic aneurysm repair.

Author

Scott, Carla K., Pizano, Alejandro, Colon, Jesus Porras, Driessen, Anna L., Miller, R. Tyler, Timaran, Carlos H., Modrall, John G., Tsai, Shirling, Kirkwood, Melissa L., and Ramanan, Bala

Abstract

Chronic kidney disease (CKD) and end-stage renal disease are traditionally associated with worse outcomes after endovascular aortic repair (EVAR) and open aneurysm repair (OAR) of abdominal aortic aneurysms (AAAs). However, there needs to be more data on complex AAA repair involving the aorta's visceral segment. This study stratifies complex AAA repair outcomes by CKD severity and dialysis dependence. All patients undergoing elective OAR and fenestrated/branched EVAR (F-BEVAR) for complex AAA with preoperative renal function data captured by the Vascular Quality Initiative between January 2003 and September 2020 were analyzed. Patients were stratified by CKD class as follows: normal/mild (CKD 1 and 2), moderate (CKD class 3a), moderate to severe (CKD 3b), severe (CKD class 4 and 5), and dialysis. Only patients with clamp sites above one of the renal arteries were included for complex OAR. For F-BEVAR, patients with proximal landing zones below zone 5 (above celiac artery) were included, and distal landing zones between zones 1 and 5 were excluded. Primary outcomes were perioperative and 1-year mortality. Predictors of mortality were identified by Cox multivariate regression models. We identified 7849 elective complex AAA repairs: 4230 (54%) complex OARs and 3619 (46%) F-BEVARs. Most patients were White (89%) and male (74%), with an average age of 72 ± 8 years. The patients who underwent F-BEVAR were older and had more comorbidities. Elective F-BEVAR for complex AAA started in 2012 and increased from 1.4% in 2012 to 58% in 2020 (P <.001). The OAR cohort had more perioperative complications, but less 1-year mortality. The normal/mild CKD cohort had the highest 1-year survival compared with other groups after both complex OAR and F-BEVAR. On Cox regression analysis, when compared with CKD 1-2, worsening CKD stage (CKD 3b: hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.82-3.40; P <.001; CKD 4-5: HR, 1.9; 95% CI, 1.16-3.26; P =.011; and dialysis: HR, 4.4; 95% CI, 2.53-7.72; P <.001) were independently associated with 1-year survival after F-BEVAR. After complex OAR, worsening CKD stage but not dialysis was associated with 1-year mortality compared with CKD 1-2 (CKD 3b: HR, 1.6; 95% CI, 1.13-2.35; P =.009; CKD 4-5: HR, 3.4; 95% CI, 2.03-5.79; P <.001). CKD severity is an essential predictor of perioperative and 1-year mortality after complex AAA repair, irrespective of the treatment modality, which may reflect the natural history of CKD. Consideration should be given to raising the threshold for elective AAA repair in patients with moderate to severe CKD and end-stage renal disease, given the high 1-year mortality rate. [ABSTRACT FROM AUTHOR]

Published
2024
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33. The addition of a leaded arm sleeve to leaded aprons further decreases operator upper outer quadrant chest wall radiation dose during fluoroscopically guided interventions.

Author

Ramanan, Bala, Pizano, Alejandro, Solano, Antonio, Gonugunta, Amrit S., Timaran, Carlos H., Siah, Michael, Baig, Shadman, Shih, Michael, Guild, Jeffrey B., and Kirkwood, Melissa L.

Abstract

Breast cancer most commonly occurs in the upper outer quadrant (UOQ) chest wall (CW). The effectiveness of routine leaded aprons to protect this region of the body in interventionalists during fluoroscopically guided interventions (FGIs) is unknown. Given the high lifetime attributable risks of prolonged occupational exposure to ionizing radiation and the increasing number of practicing female vascular surgeons and interventionalists, we sought to determine if the use of a leaded arm shield would offer additional protection to the lateral CW and axilla in operators compared with routine leaded aprons. Effectiveness of leaded sleeves in attenuating radiation dose to the axilla and UOQ was evaluated in clinical practice and simulated scenarios. In the clinical setting, optically stimulated luminescence nanoDot detectors were placed at the UOQ lateral CW position, both over and under a standard leaded apron vest with and without the addition of an antimony/bismuth Enviro-Lite sleeve on two vascular surgeons performing FGIs. In the simulation, nanoDots were similarly placed on an anthropomorphic phantom positioned to represent a primary operator performing right femoral access. Fluorography was performed on 12-inch-thick acrylic scatter phantom at 80 kVp for an exposure of 3 Gy reference air kerma. Experiments were done with and without the sleeve. Paired Wilcoxon and χ2 tests were performed to identify the statistical significance of radiation attenuation. Operator UOQ CW dose was measured during 61 FGIs: 33 cases (54%) with and 28 cases (46%) without the sleeve. Median procedure reference air kerma and fluoroscopy time was 180 mGy (interquartile range [IQR], 85-447 mGy) and 21 minutes (IQR, 11-39 minutes) when the sleeve was worn vs 100 mGy (IQR, 67-270 mGy) and 11 minutes (IQR, 6.3-25 minutes) without the sleeve. Radiation dose to the operator's UOQ was reduced by 96% (IQR, 85%-96%) when the sleeve was present and by 62% (IQR, 44%-82%; P <.001) without the sleeve. In the simulated setting, the sleeve reduced the radiation dose to the UOQ compared with the apron alone (96% vs 67%; P <.001). Routine leaded aprons do attenuate the majority of UOQ chest wall radiation dose; however, the addition of a lead-equivalent sleeve further significantly reduces this dose. Because this area of the body has a high incidence of cancer formation, additional protection, especially to female interventionalists, seems prudent. Vascular surgeons should consider using a protective sleeve with their personal protective equipment when performing complex fluoroscopically guided procedures. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Corrigendum to “Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study” [Diabetes Res. Clin. Pract. 181 (2021) 109092]

Author

Wood, Anna J., Boyle, Jacqueline A., Barr, Elizabeth L.M., Barzi, Federica, Hare, Matthew J.L., Titmuss, Angela, Longmore, Danielle K., Death, Elizabeth, Kelaart, Joanna, Kirkwood, Marie, Graham, Sian, Connors, Christine, Moore, Elizabeth, O'Dea, Kerin, Oats, Jeremy J.N., McIntyre, Harold D., Zimmet, Paul Z., Lu, Zhong X., Brown, Alex, Shaw, Jonathan E., and Maple-Brown, Louise J.

Published
2024
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41. The Effect of Omecamtiv Mecarbil in Hospitalized Patients as Compared With Outpatients With HFrEF: An Analysis of GALACTIC-HF.

Author

DOCHERTY, KIERAN F., MCMURRAY, JOHN J.V., DIAZ, RAFAEL, FELKER, G. MICHAEL, METRA, MARCO, SOLOMON, SCOTT D., ADAMS, KIRKWOOD F., BÖHM, MICHAEL, BRINKLEY, DOUGLAS MARSHALL, ECHEVERRIA, LUIS E., GOUDEV, ASSEN R., HOWLETT, JONATHAN G., LUND, MAYANNA, PONIKOWSKI, PIOTR, YILMAZ, MEHMET B., ZANNAD, FAIEZ, CLAGGETT, BRIAN L., MIAO, ZI MICHAEL, ABBASI, SIDDIQUE A., and DIVANJI, PUNAG

Abstract

In the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil, compared with placebo, reduced the risk of worsening heart failure (HF) events, or cardiovascular death in patients with HF and reduced ejection fraction. The primary aim of this prespecified analysis was to evaluate the safety and efficacy of omecamtiv mecarbil by randomization setting, that is, whether participants were enrolled as outpatients or inpatients. Patients were randomized either during a HF hospitalization or as an outpatient, within one year of a worsening HF event (hospitalization or emergency department visit). The primary outcome was a composite of worsening HF event (HF hospitalization or an urgent emergency department or clinic visit) or cardiovascular death. Of the 8232 patients analyzed, 2084 (25%) were hospitalized at randomization. Hospitalized patients had higher N-terminal prohormone of B-type natriuretic peptide concentrations, lower systolic blood pressure, reported more symptoms, and were less frequently treated with a renin–angiotensin system blocker or a beta-blocker than outpatients. The rate (per 100 person-years) of the primary outcome was higher in hospitalized patients (placebo group = 38.3/100 person-years) than in outpatients (23.1/100 person-years); adjusted hazard ratio 1.21 (95% confidence interval 1.12–1.31). The effect of omecamtiv mecarbil versus placebo on the primary outcome was similar in hospitalized patients (hazard ratio 0.89, 95% confidence interval 0.78–1.01) and outpatients (hazard ratio 0.94, 95% confidence interval 0.86–1.02) (interaction P =.51). Hospitalized patients with HF with reduced ejection fraction had a higher rate of the primary outcome than outpatients. Omecamtiv mecarbil decreased the risk of the primary outcome both when initiated in hospitalized patients and in outpatients. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Impact of routine surveillance duplex ultrasound and subsequent reintervention after superficial femoral artery stenting.

Author

Shih, Michael, Pizano, Alejandro, Solano, Antonio, Porras-Colon, Jesus, Babb, Jackie, Timaran, Carlos H., Baig, Mirza S., Siah, Michael, Gonzalez-Guardiola, Gerardo, and Kirkwood, Melissa L.

Abstract

Superficial femoral artery (SFA) stenting is a common treatment for peripheral artery disease. It is effective in the short term; however, in-stent restenosis (ISR) limits long-term success. Surveillance with duplex ultrasound (DUS) can identify patients who develop ISR leading to early reintervention, but data to support this practice is sparce. The purpose of this study was to evaluate whether surveillance and subsequent reintervention improves outcomes in patients with SFA stents. A single-center, retrospective study was performed with patients undergoing SFA stenting between 2005 and 2020 who had a follow-up with DUS. Five groups were identified based on the presence of ISR on DUS (ISR vs no ISR [NISR]), recurrence of symptoms (symptomatic [SX] vs asymptomatic [ASX]), and if any reintervention was performed (reintervention [R] vs no reintervention [NR]): (1) ISR+SX+R; (2) ISR+SX+NR; (3) ISR+ASX+R; (4) ISR+ASX+NR; and (5) NISR+NR. The primary endpoint was amputation-free survival, and the secondary endpoint was patency. Predictors of mortality and surveillance were identified by multivariable logistic regressions and Cox multivariate regression models. Survival curves were presented as Kaplan-Meier plots using log-rank test for subgroup comparison. Two hundred fifty-seven patients were included in the analysis. The indication for intervention was claudication in 28% and chronic limb-threatening ischemia in 72%. A total of 161 patients (63%) underwent reintervention for ISR. Of patients who had restenosis on DUS, those who were symptomatic and did not undergo reintervention (ISR+SX+NR) did the worst, with 50% amputation rate. In contrast, those who were asymptomatic but did undergo reintervention (ISR+ASX+R) had the lowest amputation rate of 13%. Active smoking was a predictor of both loss of patency and amputation (1.72; 95% confidence interval [CI], 1.00-2.98; P =.050; 3.55; 95% CI, 1.53-8.25; P =.003). Post procedure dual antiplatelet therapy had a positive association with limb salvage (hazard ratio [HR], 0.23; 95% CI, 0.09-0.58; P =.001), whereas diabetes (HR, 2.61; 95% CI, 1.21-6.01; P =.019), stent occlusion (HR, 17.0; 95% CI, 5.93-63.1; P <.001), and chronic limb-threatening ischemia presentations (HR, 4.31; 95% CI, 1.86-11.7; P =.002) were negatively associated with limb salvage. Routine surveillance DUS and subsequent reintervention on ISR after SFA stenting is associated with improved patency and amputation-free survival. Surveillance DUS should be routine for patients after stenting, with reintervention strongly considered if ISR is identified for both symptomatic and asymptomatic. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Evaluating the Association between the Implementation of the PoET Southwest Spread Project and Reductions in Acute Care Transfers from Long-Term Care: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data.

Author

Hafid, Shuaib, Kirkwood, David, Elston, Dawn, Perez, Richard, Jones, Aaron, Costa, Andrew, Oliver, Jill, Chidwick, Paula, Nitti, Theresa, and Siu, Henry Yu-Hin

Subjects
*EVALUATION of human services programs, *CONFIDENCE intervals, *RESEARCH methodology, *AGE distribution, *REGRESSION analysis, *HOSPITAL admission & discharge, *NURSING care facilities, *HUMAN services programs, *COMPARATIVE studies, *SEX distribution, *MEDICAL care use, *CRITICAL care medicine, *DESCRIPTIVE statistics, *LONG-term health care, *LONGITUDINAL method, *COMORBIDITY
Abstract

To measure changes in resident-level acute care transfer rates after the PoET Southwest Spread Project (PSSP), and to identify patient and long-term care (LTC) home characteristics associated with acute care transfers after program launch. Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. Sixty publicly funded LTC homes (PSSP = 30; control = 30) in Ontario, Canada, from November 2019 to December 2021. We matched 30 PSSP homes to 30 control homes with similar characteristics and described incidence rates for resident-level acute care transfers during the 7-month post-implementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and acute care transfers during the post-implementation period. We adjusted resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent sub-cohort to measure transfer patterns during the last 2 months of life. A matched cohort of 8894 residents (PSSP = 4103; control = 4791) was captured. Incidence rates of transfers increased during the post-implementation period for both PSSP (78.8 to 80.9 transfers per 1000 person-months) and control residents (66.9 to 67.9 transfers per 1000 person-months). After adjusting for covariates of interest, PSSP exposure was associated with a reduction in acute care transfers during the post-implementation period after adjusting for covariates (incidence rate ratio, 0.73; 95% CI, 0.62–0.87; P =.0002). Older age and select health regions were associated with reduced transfers, whereas higher comorbidity status and higher COVID-19 outbreak days were associated with increases. Similar patterns persisted for transfers during the last 2 months of life. This study systematically evaluated the impact of an ethics-based health care intervention in LTC using health care utilization databases. PoET implementation is associated with reduced acute care transfer rates, especially in the last 2 months of life in LTC. [ABSTRACT FROM AUTHOR]

Published
2023
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