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1. Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Author: Abuabara, Katrina, Ye, Morgan, Margolis, David J, McCulloch, Charles E, Mulick, Amy R, Silverwood, Richard J, Sullivan, Alice, Williams, Hywel C, and Langan, Sinéad M
Subjects: Clinical Research, Genetics, Prevention, Pediatric, 2.3 Psychological, social and economic factors, 2.2 Factors relating to the physical environment, Aetiology, Good Health and Well Being, Adult, Asthma, Birth Cohort, Cohort Studies, Dermatitis, Atopic, Eczema, Female, Humans, Infant, Newborn, Male, Prevalence, Risk Factors, Clinical Sciences, Oncology and Carcinogenesis
Abstract: ImportanceAtopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood.ObjectiveThis study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood.Design, setting, and participantsThis study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020.Main outcomes and measuresSubtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health.ResultsLatent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife.Conclusions and relevanceThe findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.
Published: 2021

2. Four childhood atopic dermatitis subtypes identified from trajectory and severity of disease and internally validated in a large UK birth cohort

Author: Mulick, AR, Mansfield, KE, Silverwood, RJ, Budu‐Aggrey, A, Roberts, A, Custovic, A, Pearce, N, Irvine, AD, Smeeth, L, Abuabara, K, and Langan, SM
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Genetics, 2.1 Biological and endogenous factors, Aetiology, Adolescent, Child, Child, Preschool, Dermatitis, Atopic, Eczema, Female, Filaggrin Proteins, Humans, Infant, Intermediate Filament Proteins, Longitudinal Studies, Male, Mutation, Severity of Illness Index, United Kingdom, Oncology and Carcinogenesis, Dermatology & Venereal Diseases, Clinical sciences
Abstract: BackgroundAtopic dermatitis (AD) disease activity and severity is highly variable during childhood. Early attempts to identify subtypes based on disease trajectory have assessed AD presence over time without incorporating severity.ObjectivesTo identify childhood AD subtypes from symptom severity and trajectories, and determine associations with genetic risk factors, comorbidities and demographic and environmental variables.MethodsWe split data from children in the Avon Longitudinal Study of Parents and Children birth cohort into development and validation sets. To identify subtypes, we ran latent class analyses in the development set on AD symptom reports up to age 14 years. We regressed identified subtypes on nongenetic variables in mutually adjusted, multiply imputed (genetic: unadjusted, complete case) multinomial regression analyses. We repeated analyses in the validation set and report confirmed results.ResultsThere were 11 866 children who contributed to analyses. We identified one Unaffected/Rare class (66% of children) and four AD subtypes: Severe-Frequent (4%), Moderate-Frequent (7%), Moderate-Declining (11%) and Mild-Intermittent (12%). Symptom patterns within the first two subtypes appeared more homogeneous than the last two. Filaggrin (FLG) null mutations, an AD polygenic risk score (PRS), being female, parental AD and comorbid asthma were associated with higher risk for some or all subtypes; FLG, AD-PRS and asthma associations were stronger along a subtype gradient arranged by increasing severity and frequency; FLG and AD-PRS further differentiated some phenotypes from each other.ConclusionsConsidering severity and AD trajectories leads to four well-defined and recognizable subtypes. The differential associations of risk factors among and between subtypes is novel and requires further research.
Published: 2021

3. Intracranial self-stimulation and concomitant behaviors following systemic methamphetamine administration in Hnrnph1 mutant mice

Author: Borrelli, Kristyn N, Langan, Carly R, Dubinsky, Kyra R, Szumlinski, Karen K, Carlezon, William A, Chartoff, Elena H, and Bryant, Camron D
Subjects: Biological Psychology, Psychology, Methamphetamine, Neurosciences, Behavioral and Social Science, Drug Abuse (NIDA only), Genetics, Basic Behavioral and Social Science, Brain Disorders, Substance Misuse, Good Health and Well Being, Animals, Dopamine Agents, Dose-Response Relationship, Drug, Female, Heterogeneous-Nuclear Ribonucleoproteins, Locomotion, Male, Medial Forebrain Bundle, Mice, Mice, Inbred C57BL, Mice, Transgenic, Reward, Self Administration, Self Stimulation, Intracranial self-stimulation, Addiction, Behavioral genetics, Psychostimulants, Mouse, Forward genetics, QTL, Sensitization, Medical and Health Sciences, Psychology and Cognitive Sciences, Psychiatry, Biological psychology
Abstract: RationaleMethamphetamine (MA) addiction is a major public health issue in the USA, with a poorly understood genetic component. We previously identified heterogeneous nuclear ribonucleoprotein H1 (Hnrnph1; H1) as a quantitative trait gene underlying sensitivity to MA-induced behavioral sensitivity. Mice heterozygous for a frameshift deletion in the first coding exon of H1 (H1+/-) showed reduced MA phenotypes including oral self-administration, locomotor activity, dopamine release, and dose-dependent differences in MA conditioned place preference. However, the effects of H1+/- on innate and MA-modulated reward sensitivity are not known.ObjectivesWe examined innate reward sensitivity and facilitation by MA in H1+/- mice via intracranial self-stimulation (ICSS).MethodsWe used intracranial self-stimulation (ICSS) of the medial forebrain bundle to assess shifts in reward sensitivity following acute, ascending doses of MA (0.5-4.0 mg/kg, i.p.) using a within-subjects design. We also assessed video-recorded behaviors during ICSS testing sessions.ResultsH1+/- mice displayed reduced normalized maximum response rates in response to MA. H1+/- females had lower normalized M50 values compared to wild-type females, suggesting enhanced reward facilitation by MA. Finally, regardless of genotype, there was a dose-dependent reduction in distance to the response wheel following MA administration, providing an additional measure of MA-induced reward-driven behavior.ConclusionsH1+/- mice displayed a complex ICSS phenotype following MA, displaying indications of both blunted reward magnitude (lower normalized maximum response rates) and enhanced reward sensitivity specific to H1+/- females (lower normalized M50 values).
Published: 2021

4. The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

Author: Chan, Leslie N, Magyari, Alexa, Ye, Morgan, Al-Alusi, Noor A, Langan, Sinead M, Margolis, David, McCulloch, Charles E, and Abuabara, Katrina
Subjects: Health Services and Systems, Biomedical and Clinical Sciences, Public Health, Health Sciences, Clinical Research, Pediatric, Aging, Aetiology, 2.4 Surveillance and distribution, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Dermatitis, Atopic, Female, Humans, Infant, Infant, Newborn, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prevalence, Severity of Illness Index, United Kingdom, Young Adult, General Science & Technology
Abstract: BackgroundAtopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults.ObjectiveTo evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort.MethodsThis was a cohort study of 9,154,936 individuals aged 0-99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0-17 years), adults (18-74 years), and older adults (75-99 years).ResultsPhysician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70-0.76) and was more likely to be active (59.7%, 95% CI 59.5-59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups.ConclusionIn a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0-17 and adults ages 18-74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.
Published: 2021

5. Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife.

Author: Abuabara, Katrina, Ye, Morgan, McCulloch, Charles E, Sullivan, Alice, Margolis, David J, Strachan, David P, Paternoster, Lavinia, Yew, Yik Weng, Williams, Hywel C, and Langan, Sinéad M
Subjects: Humans, Dermatitis, Atopic, Cohort Studies, Longitudinal Studies, Adolescent, Adult, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, England, Female, Male, Young Adult, Self Report, Filaggrin Proteins, Atopic eczema, atopic dermatitis, epidemiology, natural history, Clinical Research, Pediatric, Prevention, 2.3 Psychological, social and economic factors, Aetiology, 2.1 Biological and endogenous factors, 2.4 Surveillance and distribution, Skin, Immunology, Allergy
Abstract: BackgroundAtopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial.ObjectiveWe sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset.MethodsWe conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave.ResultsThe annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease.ConclusionRates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.
Published: 2019

6. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis.

Author: Ramirez, Faustine D, Chen, Shelley, Langan, Sinéad M, Prather, Aric A, McCulloch, Charles E, Kidd, Sharon A, Cabana, Michael D, Chren, Mary-Margaret, and Abuabara, Katrina
Subjects: Humans, Dermatitis, Atopic, Severity of Illness Index, Cohort Studies, Longitudinal Studies, Mothers, Adult, Child, Child, Preschool, Infant, Infant, Newborn, Female, Male, Young Adult, Sleep Wake Disorders, United Kingdom, Prevention, Sleep Research, Clinical Research, Clinical Trials and Supportive Activities, Pediatric, Behavioral and Social Science, Good Health and Well Being, Clinical Sciences, Oncology and Carcinogenesis
Abstract: ImportanceThe well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking.ObjectivesTo compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances.Design, setting, and participantsIn the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years.Main outcomes and measuresTime-varying binary measures of maternal sleep duration (
Published: 2019

7. Systematic review of atopic dermatitis disease definition in studies using routinely collected health data

Author: Dizon, MP, Yu, AM, Singh, RK, Wan, J, Chren, M‐M, Flohr, C, Silverberg, JI, Margolis, DJ, Langan, SM, and Abuabara, K
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Brain Disorders, Good Health and Well Being, Adult, Algorithms, Child, Clinical Coding, Data Collection, Dermatitis, Atopic, Electronic Health Records, Female, Humans, Male, Prevalence, Terminology as Topic, Oncology and Carcinogenesis, Dermatology & Venereal Diseases, Clinical sciences
Abstract: BackgroundRoutinely collected electronic health data obtained for administrative and clinical purposes are increasingly used to study atopic dermatitis (AD). Methods for identifying AD patients in routinely collected electronic health data differ, and it is unknown how this might affect study results.ObjectivesTo evaluate how patients with AD have been identified in studies using routinely collected electronic health data, to determine whether these methods were validated and to estimate how the method for identifying patients with AD affected variability in prevalence estimates.MethodsWe systematically searched PubMed, Embase and Web of Science for studies using routinely collected electronic health data that reported on AD as a primary outcome. Studies of localized AD and other types of dermatitis were excluded. The protocol for this review was registered in PROSPERO (CRD42016037968).ResultsIn total, 59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code and prescription data were used to identify patients with AD. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0·18% to 38·33% (median 4·91%) and up to threefold variation in prevalence was introduced by differences in the method for identifying patients with AD.ConclusionsThis systematic review highlights the need for clear reporting of methods for identifying patients with AD in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.
Published: 2018

8. The relationship of health literacy to diabetes status differs by sex in older adults

Author: Quartuccio, Michael, Simonsick, Eleanor M, Langan, Susan, Harris, Tamara, Sudore, Rebecca L, Thorpe, Roland, Rosano, Caterina, Hill-Briggs, Felicia, Golden, Sherita, and Kalyani, Rita R
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, Aging, Cardiovascular, Clinical Research, Behavioral and Social Science, Nutrition, Prevention, Diabetes, Metabolic and endocrine, Good Health and Well Being, Aged, Blood Glucose, Chronic Disease, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Health Literacy, Health Status, Humans, Hyperglycemia, Male, Self Care, Sex Factors, Health literacy, Diabetes mellitus, Sex differences, Older adults, Endocrinology & Metabolism, Clinical sciences
Abstract: ObjectiveLower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex.Research design and methodsWe performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose).ResultsAmong participants in the Health ABC cohort, 429 had diabetes. Mean age was 76years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p=0.02). Similar results were seen among women (14.7% versus 6.1%, p
Published: 2018

9. The prevalence of atopic dermatitis beyond childhood: A systematic review and meta-analysis of longitudinal studies.

Author: Abuabara, K, Yu, AM, Okhovat, J-P, Allen, IE, and Langan, SM
Subjects: Humans, Dermatitis, Atopic, Prevalence, Longitudinal Studies, Adolescent, Adult, Child, Child, Preschool, Infant, Female, Male, Young Adult, atopic dermatitis, atopic eczema, eczema, natural history, prevalence, Dermatitis, Atopic, Preschool, Allergy, Immunology
Abstract: BackgroundThere are sparse and conflicting data regarding the long-term clinical course of atopic dermatitis (AD). Although often described as a childhood disease, newer population-based estimates suggest the prevalence of pediatric and adult disease may be similar.MethodsOur objective was to determine whether there is a decline in the prevalence of AD in population-based cohorts of patients followed longitudinally beyond childhood. We conducted a systematic review and meta-analysis including studies assessing AD prevalence across 3 or more points in time. The primary outcome was weighted overall risk difference (percentage decrease in AD prevalence).ResultsOf 2080 references reviewed, 7 studies with 13 515 participants were included. Participants were assessed at 3-6 time points, ranging from age 3 months to 26 years. The percentage decrease in prevalence after age 12 was 1%, which was not significantly different from zero (95% confidence interval -2%-5%). Similar results were found with other age cut-offs.ConclusionThe prevalence of AD in longitudinal birth cohort studies is similar in childhood and adolescence/early adulthood.
Published: 2018

10. Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK

Author: Abuabara, Katrina, Magyari, Alexa M, Hoffstad, Ole, Jabbar-Lopez, Zarif K, Smeeth, Liam, Williams, Hywel C, Gelfand, Joel M, Margolis, David J, and Langan, Sinead M
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, 4.2 Evaluation of markers and technologies, Good Health and Well Being, Adolescent, Adult, Algorithms, Child, Databases, Factual, Dermatitis, Atopic, Electronic Health Records, Female, Follow-Up Studies, Humans, Male, Primary Health Care, Surveys and Questionnaires, Time Factors, United Kingdom, Young Adult, Oncology and Carcinogenesis, Dermatology & Venereal Diseases, Clinical sciences
Abstract: Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.
Published: 2017

11. 228 The prevalence of eczema beyond childhood: A systematic review and meta-analysis of longitudinal studies

Author: Yu, AM, Okhovat, J, Allen, IE, Langan, SM, and Abuabara, K
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Eczema / Atopic Dermatitis, 2.4 Surveillance and distribution, Adolescent, Adult, Child, Child, Preschool, Dermatitis, Atopic, Female, Humans, Infant, Longitudinal Studies, Male, Prevalence, Young Adult, atopic dermatitis, atopic eczema, eczema, natural history, prevalence, Oncology and Carcinogenesis, Dermatology & Venereal Diseases, Clinical sciences
Abstract: BackgroundThere are sparse and conflicting data regarding the long-term clinical course of atopic dermatitis (AD). Although often described as a childhood disease, newer population-based estimates suggest the prevalence of pediatric and adult disease may be similar.MethodsOur objective was to determine whether there is a decline in the prevalence of AD in population-based cohorts of patients followed longitudinally beyond childhood. We conducted a systematic review and meta-analysis including studies assessing AD prevalence across 3 or more points in time. The primary outcome was weighted overall risk difference (percentage decrease in AD prevalence).ResultsOf 2080 references reviewed, 7 studies with 13 515 participants were included. Participants were assessed at 3-6 time points, ranging from age 3 months to 26 years. The percentage decrease in prevalence after age 12 was 1%, which was not significantly different from zero (95% confidence interval -2%-5%). Similar results were found with other age cut-offs.ConclusionThe prevalence of AD in longitudinal birth cohort studies is similar in childhood and adolescence/early adulthood.
Published: 2017

12. Normalising the conversation: a qualitative analysis of player and stakeholder perceptions of menstrual health support within elite female soccer

Author: Samuel J. McHaffie, Carl Langan-Evans, James C. Morehen, Juliette A. Strauss, José L. Areta, Christopher Rosimus, Martin Evans, Kirsty J. Elliott-Sale, Colum J. Cronin, and James P. Morton
Subjects: Athletes, Soccer, Humans, Female, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Menstrual Cycle, Qualitative Research, Menstruation
Abstract: This qualitative study explores player and stakeholder perceptions of menstrual health support in elite female soccer.Semi-structured interviews were conducted with 47 participants including players (n = 12), parents (n = 9), coaches (n = 9), sport scientists (n = 7), nutritionists (n = 5) and medical staff (n = 5).Via thematic analysis, data demonstrate that elite female soccer players experience a range of physical and psychological symptoms primarily at the onset of and during menses (as also perceived by stakeholders), with most participants perceiving these symptoms to impact performance. Nonetheless, menstrual health support is perceived as minimal and although players have their menstrual status tracked, they report little understanding as to why or how this information is used. This confusion was also present among stakeholders, often as a result of uncertainty about the evidence supporting the need for menstrual health support. The perceived lack of support may also be reflective of a culture where conversations about the menstrual cycle are not normalised. Overall, this may result in failure to identify and treat menstrual irregularities despite non-coaching staff members perceiving them to be common amongst players.These data support the need for individualised support based on the lived experiences of individual players and support staff. Furthermore, our research identifies the need for organisational, stakeholder, and player centred education programmes (led by experts in female athlete health) that create an environment where players receive personalised menstrual health support.
Published: 2022
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13. Hormonal contraceptive use, menstrual cycle characteristics and training/nutrition related profiles of elite, sub-elite and amateur athletes and exercisers: One size is unlikely to fit all.

Author: Langan-Evans, Carl, Hearris, Mark A, McQuilliam, Stephen, Burke, Louise M, Stellingwerff, Trent, Elliott-Sale, Kirsty J, and Morton, James P
Abstract: The aim of the present study was to simultaneously audit hormonal contraceptive (HC) use, menstrual cycle characteristics and training/nutrition related profiles in pre-menopausal women from varying athletic and exercise backgrounds. Elite (n = 51), sub-elite (n = 118) and amateur (n = 392) female athletes and exercisers were examined via an anonymous quantitative/qualitative survey tool. All analyses for ratio data were conducted utilising one- and two-way ANOVA/ANCOVA and odds ratio models, with ordinal data analysed via Pearson's Chi-squared tests. HC use was similar across elite, sub-elite and amateurs (34–44%). Menstrual cycle length was not different (P = 0.08) between competitive levels (28 ± 13 days), but 66% of respondents reported cycle variability (10 ± 11 days). Training profiles were not different based on contraceptive status (P > 0.05) yet were across competitive groups (P < 0.05). Daily meal/snack intakes were not different between contraceptive status (P > 0.05), though elite and sub-elite groups reported a higher daily meal consumption compared to amateurs (P < 0.01). Forty percent of all respondents skipped meals, attributed to lack of time, schedule and alterations in appetite, with reported changes in taste preferences during pre-menses (14–35%) and menses (15–25%) towards sweet foods (60%), with cravings for chocolate and other confectionary (25%). Prevalence of dietary supplement use was not influenced by contraceptive status (P = 0.31), though elites (76%) reported higher use (P = 0.04) than amateurs (63%). Data demonstrates that in female athletes and exercisers, competitive level appears to affect simple markers of training and nutrition practice, yet contraceptive status does not. Graphical abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]
Published: 2024
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14. Comparison of Hormonal Response to a Mixed-Meal Challenge in Hypoglycemia After Sleeve Gastrectomy vs Gastric Bypass

Author: Clare J Lee, Jeanne M Clark, Josephine M Egan, Olga D Carlson, Michael Schweitzer, Susan Langan, and Todd Brown
Subjects: Blood Glucose, Male, Endocrinology, Diabetes and Metabolism, Biochemistry (medical), Clinical Biochemistry, Gastric Bypass, Gastric Inhibitory Polypeptide, Middle Aged, Glucagon, Incretins, Biochemistry, Hypoglycemia, Obesity, Morbid, Glucose, Endocrinology, Gastrectomy, Glucagon-Like Peptide 1, Humans, Insulin, Female
Abstract: Context Exaggerated postprandial incretin and insulin responses are well documented in postbariatric surgery hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB). However, less is known about PBH after sleeve gastrectomy (SG). Objective We sought to compare meal-stimulated hormonal response in those with PBH after SG vs RYGB. Methods We enrolled 23 post-SG (12 with and 11 without PBH) and 20 post-RYGB (7 with and 13 without PBH) individuals who underwent bariatric surgery at our institution. PBH was defined as plasma glucose less than 60 mg/dL on 4-hour mixed-meal tolerance test (MTT). Islet and incretin hormones were compared across the 4 groups. Results Participants (N = 43) were on average 5 years post surgery, with a mean age of 48 years, mean preoperative body mass index of 48.4, 81% female, 61% White, and 53% post SG. Regardless of PBH, the SG group showed lower glucose, glucagon, and glucagon-like peptide 1 (GLP-1) responses to MTT and similar insulin and glucose-dependent insulinotropic polypeptide (GIP) responses compared to the RYGB group. Among those with PBH, the SG group following the MTT showed a lower peak glucose (P = .02), a similar peak insulin (90.3 mU/L vs 171mU/L; P = .18), lower glucagon (P Conclusion Among individuals with PBH, those who underwent SG were significantly different compared to RYGB in meal-stimulated hormonal responses, including lower glucagon and GLP-1 responses, but similar insulin and GIP responses. Future studies are needed to better understand the differential contribution of insulin and non–insulin-mediated mechanisms behind PBH after SG vs RYGB.
Published: 2022
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15. The impact of psoriasis and sexual orientation on mental and physical health among adults in the United States

Author: Matthew Mansh, Sinead Langan, and Amy Mulick
Subjects: Adult, Male, business.industry, Sexual Behavior, Physical health, Dermatology, medicine.disease, United States, Mental Health, Psoriasis, medicine, Sexual orientation, Humans, Female, business, Clinical psychology
Published: 2022
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16. Phosphate dysregulation via the XPR1–KIDINS220 protein complex is a therapeutic vulnerability in ovarian cancer

Author: Daniel P. Bondeson, Brenton R. Paolella, Adhana Asfaw, Michael V. Rothberg, Thomas A. Skipper, Carly Langan, Gabriel Mesa, Alfredo Gonzalez, Lauren E. Surface, Kentaro Ito, Mariya Kazachkova, William N. Colgan, Allison Warren, Joshua M. Dempster, John M. Krill-Burger, Maria Ericsson, Andrew A. Tang, Iris Fung, Emily S. Chambers, Mai Abdusamad, Nancy Dumont, John G. Doench, Federica Piccioni, David E. Root, Jesse Boehm, William C. Hahn, Michael Mannstadt, James M. McFarland, Francisca Vazquez, and Todd R. Golub
Subjects: Ovarian Neoplasms, Cancer Research, Oncology, Humans, Membrane Proteins, Receptors, Virus, Female, Nerve Tissue Proteins, Xenotropic and Polytropic Retrovirus Receptor, Phosphates, Receptors, G-Protein-Coupled
Abstract: Despite advances in precision medicine, the clinical prospects for patients with ovarian and uterine cancers have not substantially improved. Here, we analyzed genome-scale CRISPR-Cas9 loss-of-function screens across 851 human cancer cell lines and found that frequent overexpression of SLC34A2-encoding a phosphate importer-is correlated with sensitivity to loss of the phosphate exporter XPR1, both in vitro and in vivo. In patient-derived tumor samples, we observed frequent PAX8-dependent overexpression of SLC34A2, XPR1 copy number amplifications and XPR1 messenger RNA overexpression. Mechanistically, in SLC34A2-high cancer cell lines, genetic or pharmacologic inhibition of XPR1-dependent phosphate efflux leads to the toxic accumulation of intracellular phosphate. Finally, we show that XPR1 requires the novel partner protein KIDINS220 for proper cellular localization and activity, and that disruption of this protein complex results in acidic "vacuolar" structures preceding cell death. These data point to the XPR1-KIDINS220 complex and phosphate dysregulation as a therapeutic vulnerability in ovarian cancer.
Published: 2022
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17. Obstetric Cholestasis: Investigation of a suspected high incidence in the West of Ireland

Author: Aoife, Corcoran and Heather, Langan
Subjects: Pregnancy Complications, Reproductive Medicine, Pregnancy, Incidence, Infant, Newborn, Pregnancy Outcome, Humans, Obstetrics and Gynecology, Female, Cholestasis, Intrahepatic, Ireland, Retrospective Studies
Abstract: To identify the incidence of Obstetric Cholestasis in a Maternity unit. To compare our investigation, criteria for diagnosis and management plan with National Guidelines. To assess adverse maternal and neonatal outcomes associated with this condition.Serum Bile Acid requests are sent to an external laboratory, Biomnis in Dublin, for processing. A log of 2018 requests was obtained from Biochemistry. The pregnant patients with values 8 mmol/L were selected. A data collection proforma was designed and retrospective chart review performed.Of the 1302 births in SUH in 2018, 42 women met the criteria resulting in a suspected incidence of 3.2% (n = 42). 9.5%(n = 4) of patients had a history of OC in a previous pregnancy. Bile acid values ranged from 8.1 to 124 mmol/L. LFTs were deranged in 81% (n = 34) of patients. Gestation at delivery ranged from 35 weeks to 40 + 9. OC alone was the indication for induction in 57%9n = 24). CS in 43% (n = 20) and Vaginal birth in 57% (n = 25). Neonatal outcome: 7% (n = 3) reduced APGAR, 7% (n = 3) passed meconium, 9% (n = 4) NICU admission, no stillbirths.Suspected incidence of 3.2% (n = 42) is significantly higher than the stated 0.7% across multi-ethnic populations. Greater congruence is required on the BA cut off value for diagnosis as there is no specified value in guidelines. While we may be over diagnosing patients based on BA level, we are also undertreating them, with 55% (n = 23) receiving Ursofalc. There was no neonatal mortality.
Published: 2022
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18. Novel multimorbidity clusters in people with eczema and asthma:a population-based cluster analysis

Author: Amy R. Mulick, Alasdair D. Henderson, David Prieto-Merino, Kathryn E. Mansfield, Julian Matthewman, Jennifer K. Quint, Ronan A. Lyons, Aziz Sheikh, David A. McAllister, Dorothea Nitsch, and Sinéad M. Langan
Subjects: Male, Adult, Eczema/epidemiology, Multidisciplinary, Prevalence, Asthma/epidemiology, Humans, Multimorbidity, Cluster Analysis, Female, Middle Aged
Abstract: Eczema and asthma are allergic diseases and two of the commonest chronic conditions in high-income countries. Their co-existence with other allergic conditions is common, but little research exists on wider multimorbidity with these conditions. We set out to identify and compare clusters of multimorbidity in people with eczema or asthma and people without. Using routinely-collected primary care data from the U.K. Clinical Research Practice Datalink GOLD, we identified adults ever having eczema (or asthma), and comparison groups never having eczema (or asthma). We derived clusters of multimorbidity from hierarchical cluster analysis of Jaccard distances between pairs of diagnostic categories estimated from mixed-effects logistic regressions. We analysed 434,422 individuals with eczema (58% female, median age 47 years) and 1,333,281 individuals without (55% female, 47 years), and 517,712 individuals with asthma (53% female, 44 years) and 1,601,210 individuals without (53% female, 45 years). Age at first morbidity, sex and having eczema/asthma affected the scope of multimorbidity, with women, older age and eczema/asthma being associated with larger morbidity clusters. Injuries, digestive, nervous system and mental health disorders were more commonly seen in eczema and asthma than control clusters. People with eczema and asthma of all ages and both sexes may experience greater multimorbidity than people without eczema and asthma, including conditions not previously recognised as contributing to their disease burden. This work highlights areas where there is a critical need for research addressing the burden and drivers of multimorbidity in order to inform strategies to reduce poor health outcomes.
Published: 2022
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19. The association of serum vitamin D with incident diabetes in an African American population

Author: Joshua J. Joseph, Susan Langan, Joseph Lunyera, Bjorn Kluwe, Amaris Williams, Haiying Chen, Michael C. Sachs, Kristin G. Hairston, Alain G. Bertoni, Willa A. Hsueh, and Sherita H. Golden
Subjects: Adult, Glycated Hemoglobin, Male, Melanins, Endocrinology, Diabetes and Metabolism, Vitamins, Middle Aged, Black or African American, Glucose, Diabetes Mellitus, Internal Medicine, Humans, Female, Vitamin D, Aldosterone, Calcifediol
Abstract: BackgroundIncident diabetes risk is inversely proportional to 25-hydroxyvitamin D [25(OH)D] levels among non-Hispanic white but is unclear among African American (AA) populations. Serum 25(OH)D2 may be an important component of total 25(OH)D among AA populations due to higher levels of melanin.ObjectiveTo assess the association of serum 25(OH)D with incident diabetes among AAs and stratify by detectable 25(OH)D2.DesignSerum 25(OH)D2 and 25(OH)D3 were collected from 2000 to 2004 among AA participants in the Jackson Heart Study. A cosinor model was used to adjust for the seasonality of 25(OH)D3; 25(OH)D3 and 25(OH)D2 were combined to ascertain total 25(OH)D. Incident diabetes (fasting glucose ≥126 mg/dl, use of diabetes drugs, or HbA1c ≥6.5%) was assessed over 12 years among adults without diabetes at baseline. Participants with missing baseline covariates or diabetes follow-up were excluded. Hazard ratios (HR) were estimated using Cox modeling, adjusting for age, sex, education, occupation, smoking, physical activity, alcohol use, aldosterone, and body-mass index.ResultsAmong 3311 adults (mean age 53.3 years, 63% female) 584 participants developed diabetes over a median of 7.7 years. After adjustment, 25(OH)D ≥20 compared to n = 1671), 25(OH)D ≥ 20 ng/ml compared to ConclusionsHigher levels of 25(OH)D may be protective against the development of diabetes among AA individuals, particularly among those with detectable 25(OH)D2 and 25(OH)D3.
Published: 2022
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20. Low-dose ipilimumab combined with anti-PD-1 immunotherapy in patients with metastatic melanoma following anti-PD-1 treatment failure

Author: Gina Klee, Patrick Terheyden, Jonas K. Kurzhals, Victoria Hagelstein, Detlef Zillikens, Ewan A. Langan, and Andreas Recke
Subjects: Male, Cancer Research, medicine.medical_specialty, Skin Neoplasms, medicine.medical_treatment, Programmed Cell Death 1 Receptor, Ipilimumab, Dermatology, Antibodies, Monoclonal, Humanized, Gastroenterology, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, In patient, Stage (cooking), Colitis, Prospective cohort study, Adverse effect, Melanoma, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Immunotherapy, Middle Aged, Prognosis, medicine.disease, Survival Rate, Nivolumab, Oncology, Lymphatic Metastasis, Female, business, Follow-Up Studies, medicine.drug
Abstract: Combined immunotherapy is associated with a significant risk of severe and potentially fatal immune-related adverse events (irAEs). Therefore, we retrospectively analyzed the side profile and efficacy of low-dose ipilimumab (1 mg/kg, IPI1) combined with anti-PD-1 immunotherapy in patients who progressed after anti-PD-1 monotherapy. Nine patients with unresectable stage III or IV melanoma treated with combined low-dose ipilimumab (1 mg/kg, IPI1) and anti-PD-1 immunotherapy, following progression after anti-PD-1 treatment, were identified. Treatment response and irAEs were recorded. Grade 3 irAEs occurred in one-third of patients. Interestingly, there were no grade 4 or 5 irAEs. In fact, four out of the nine patients experienced no irAEs at all. One patient discontinued combined immunotherapy due to immune-related colitis. The mean time to the onset of grade 3 irAEs was 14.3 weeks. The objective response rate was 33.3% and a disease control rate of 66.7% was achieved. Median progression-free survival (PFS) was 5.7 months and median overall survival (OS) was 21.6 months. The median PFS when IPI1 and anti-PD-1 treatment was administered in the second-line setting was not reached, but only 2.8 months when used in subsequent treatment settings. Combined IPI1 and anti-PD-1 immunotherapy was well tolerated. Its use in the third-line or above setting was associated with a significantly poorer prognosis than in the second-line setting. Larger, prospective studies are required to evaluate the safety and efficacy of this dosing regimen following anti-PD-1 treatment failure.
Published: 2021
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21. Patient satisfaction following total knee arthroplasty using restricted kinematic alignment

Author: Austin F. Smith, Thomas M Hsing, Max M Malkani, Arthur L. Malkani, Michael A. Mont, Langan S. Smith, and Sarag Abhari
Subjects: Adult, Male, musculoskeletal diseases, medicine.medical_specialty, Total knee arthroplasty, Kinematics, Prosthesis Design, Patient satisfaction, Physical medicine and rehabilitation, Genu Varum, Humans, Medicine, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Middle Aged, musculoskeletal system, Biomechanical Phenomena, Patient Satisfaction, Female, Surgery, Knee Prosthesis, business
Abstract: AimsAlternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment.MethodsA total of 121 consecutive TKAs performed between 11 February 2018 to 11 June 2019 with preoperative varus deformity were reviewed at minimum one-year follow-up. Three knees were excluded due to severe preoperative varus deformity greater than 15°, and a further three due to requiring revision surgery, leaving 109 patients and 115 knees to undergo primary TKA using the concept of restricted kinematic alignment with advanced technology. Patients were stratified into three groups based on the preoperative limb varus deformity: Group A with 1° to 5° varus (43 knees); Group B between 6° and 10° varus (56 knees); and Group C with varus greater than 10° (16 knees). This study group was compared with a matched cohort of 115 TKAs and 115 patients using a neutral mechanical alignment target with manual instruments performed from 24 October 2016 to 14 January 2019.ResultsMean overall patient satisfaction for the entire cohort was 4.7 (SE 0.1) on a 5-point Likert scale, with 93% being either very satisfied or satisfied compared with a Likert of 4.3 and patient satisfaction of 81% in the mechanical alignment group (p < 0.001 and p < 0.006 respectively). At mean follow-up of 17 months (11 to 27), the mean overall Likert, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and Knee Society Knee and Function Scores were significantly better in the kinematic group than in the neutral mechanical alignment group. The most common complication in both groups was contracture requiring manipulation under anaesthesia, involving seven knees (6.1%) in the kinematic group and nine knees (7.8%) in the mechanical alignment group.ConclusionWith the advent of advanced technology, and the ability to obtain accurate bone cuts, the target limb alignment, and soft-tissue balance within millimetres, using a restricted kinematic alignment concept demonstrated excellent patient satisfaction following primary TKA. Longer-term analysis is required as to the durability of this method. Cite this article: Bone Joint J 2021;103-B(6 Supple A):59–66.
Published: 2021
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22. Organizational Readiness for Intimate Partner Violence Response among Supportive Housing Providers: A Capacity Assessment in Maryland

Author: Langan Denhard, Charvonne N. Holliday, Karen Trister Grace, Michele R. Decker, Arshdeep Kaur, and Janice Miller
Subjects: Capacity assessment, Population, Intimate Partner Violence, 03 medical and health sciences, Cronbach's alpha, Nursing, Surveys and Questionnaires, Humans, Transitional housing, 0501 psychology and cognitive sciences, education, Applied Psychology, education.field_of_study, 030505 public health, Maryland, 05 social sciences, Reproducibility of Results, Capacity building, Clinical Psychology, Ill-Housed Persons, Organizational readiness, Domestic violence, Female, Supportive housing, 0305 other medical science, Psychology, 050104 developmental & child psychology
Abstract: Intimate partner violence (IPV) frequently leads to housing instability and homelessness among survivors. While the client populations of many housing support programs are likely to include IPV survivors who have unique safety needs, the organizational readiness of these housing providers to identify and support IPV survivors is not clear. This study assessed organizational readiness for IPV response among Rapid Re-Housing (RRH) and Transitional Housing (TH) providers in Maryland, whose client populations include women ( n = 32). We adapted the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to create the Housing provider Readiness to Manage IPV Survey (H-REMIS), inclusive of IPV-related perceptions, policies, staff training and capability, and resources. The 12-point H-REMIS demonstrated acceptable internal consistency reliability (Cronbach’s α = 0.748). Descriptive and comparative analyses domains by IPV-specific ( n = 4) and general ( n = 28) housing providers assessed readiness and identified areas for improvement. IPV-specific providers had higher mean organizational readiness for IPV response scores relative to non-IPV specific providers (11.3 and 7.5, respectively). High readiness areas included perceiving the importance of IPV and staff having adequate time, space, and comfort level to address IPV. Areas of low readiness included development and use of IPV response policies as well as staff training on IPV. This assessment documents concerning gaps in organizational readiness for IPV response among supportive housing providers, and pinpoints areas where training and capacity building can be most valuable. The process of improving readiness in the supportive housing sector must involve capacity building and a systems-level approach in order to ensure that all supportive housing providers are prepared to meet the needs of IPV survivors among their client population.
Published: 2021
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23. Four childhood atopic dermatitis subtypes identified from trajectory and severity of disease and internally validated in a large UK birth cohort

Author: Katrina Abuabara, Alan D. Irvine, Liam Smeeth, Neil Pearce, Sinead Langan, A. Buddu-Aggrey, Kathryn E. Mansfield, Amanda Roberts, Amy Mulick, Richard J. Silverwood, and Adnan Custovic
Subjects: Male, Longitudinal study, medicine.medical_specialty, Adolescent, Clinical Sciences, Oncology and Carcinogenesis, Eczema, Dermatitis, Dermatology, Disease, Filaggrin Proteins, Severity of Illness Index, Atopic, Dermatitis, Atopic, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Intermediate Filament Proteins, Internal medicine, Genetics, medicine, 2.1 Biological and endogenous factors, Humans, Longitudinal Studies, Aetiology, Preschool, Child, Multinomial logistic regression, Asthma, Pediatric, business.industry, Dermatology & Venereal Diseases, Infant, Atopic dermatitis, medicine.disease, United Kingdom, 3. Good health, Child, Preschool, Mutation, Female, business, Birth cohort, Childhood atopic dermatitis, Filaggrin
Abstract: BACKGROUND: Atopic dermatitis (AD) disease activity and severity is highly variable during childhood. Early attempts to identify subtypes based on disease trajectory have assessed AD presence over time without incorporating severity. OBJECTIVES: To identify childhood AD subtypes from symptom severity and trajectories, and determine associations with genetic risk factors, comorbidities and demographic and environmental variables. METHODS: We split data from children in the Avon Longitudinal Study of Parents and Children birth cohort into development and validation sets. To identify subtypes, we ran latent class analyses in the development set on AD symptom reports up to age 14 years. We regressed identified subtypes on nongenetic variables in mutually adjusted, multiply imputed (genetic: unadjusted, complete case) multinomial regression analyses. We repeated analyses in the validation set and report confirmed results. RESULTS: There were 11 866 children who contributed to analyses. We identified one Unaffected/Rare class (66% of children) and four AD subtypes: Severe-Frequent (4%), Moderate-Frequent (7%), Moderate-Declining (11%) and Mild-Intermittent (12%). Symptom patterns within the first two subtypes appeared more homogeneous than the last two. Filaggrin (FLG) null mutations, an AD polygenic risk score (PRS), being female, parental AD and comorbid asthma were associated with higher risk for some or all subtypes; FLG, AD-PRS and asthma associations were stronger along a subtype gradient arranged by increasing severity and frequency; FLG and AD-PRS further differentiated some phenotypes from each other. CONCLUSIONS: Considering severity and AD trajectories leads to four well-defined and recognizable subtypes. The differential associations of risk factors among and between subtypes is novel and requires further research.
Published: 2021
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24. Barriers and financial impact of same‐day discharge after atrial fibrillation ablation

Author: Chi Zhang, Subbarao Choudry, Georgios Syros, Marc A. Miller, Vivek Y. Reddy, Edward Chu, William Whang, Srinivas R. Dukkipati, Daniel Musikantow, Aamir Sofi, Noelle Langan, Mohit K. Turagam, and Jacob S. Koruth
Subjects: Male, musculoskeletal diseases, medicine.medical_specialty, Multivariate analysis, medicine.medical_treatment, 030204 cardiovascular system & hematology, Chest pain, Single Center, 03 medical and health sciences, 0302 clinical medicine, Atrial Fibrillation, Ambulatory Care, medicine, Humans, 030212 general & internal medicine, Retrospective Studies, Ejection fraction, business.industry, Financial impact, Patient Selection, Atrial fibrillation, General Medicine, Length of Stay, Middle Aged, Ablation, medicine.disease, Patient Discharge, Emergency medicine, Cohort, Catheter Ablation, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND Same-day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly being considered. This study examined the barriers and financial impact associated with SDD in a contemporary cohort of patients undergoing elective AF ablation. METHODS A single center retrospective review was conducted of the 249 first case-of-the-day outpatient AF ablations performed in 2019 to evaluate the proportion of patients that could have undergone SDD. Barriers to SDD were defined as any intervention that prevented SDD by 8 p.m. The financial impact of SDD was based on savings from avoidance of the overnight hospital stay and revenue related to management of chest pain facilitated by a vacant hospital bed. RESULTS SDD could have occurred in 157 patients (63%) without change in management and in up to 200 patients (80%) if avoidable barriers were addressed. Barriers to SDD included non-clinical logistical issues (43%), prolonged post-procedure recovery (42%) and minor procedural complications (15%). On multivariate analysis, factors associated with barriers to SDD included increasing age (P = .01), left ventricular ejection fraction ≤ 35% (P = .04), and severely dilated left atrium (P = .04). The financial gain from SDD would have ranged from $1,110,096 (assuming discharge of 63% of eligible patients) to $1,480,128 (assuming 80% discharge) over the course of a year. CONCLUSIONS Up to 80% of patients undergoing outpatient AF ablation were amenable to SDD if avoidable delays in care had been anticipated. Based on reduced hospital operating expenses and increased revenue from management of individuals with chest pain, this would translate to a financial savings of ∼$1.5 million.
Published: 2021
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25. Carbohydrate fear, skinfold targets and body image issues: a qualitative analysis of player and stakeholder perceptions of the nutrition culture within elite female soccer

Author: Samuel J. McHaffie, Carl Langan-Evans, James C. Morehen, Juliette A. Strauss, José L. Areta, Christopher Rosimus, Martin Evans, Kirsty J. Elliott-Sale, Colum J. Cronin, and James P. Morton
Subjects: RC1200, Male, Soccer, Body Image, Nutritional Requirements, Carbohydrates, BF, Humans, Nutritional Status, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Female, Nutrition
Abstract: This qualitative study explores player and stakeholder perceptions of the role of nutrition in supporting player development and performance in elite female soccer. Semi-structured interviews (36 ± 18 mins in length) were conducted with 47 participants, including players (n = 12), parents (n = 9), coaches (n = 9), sport scientists (n = 7), nutritionists (n = 5) and medical staff (n = 5). Via thematic analysis, data provided an insight into the nutrition culture within elite women's soccer. Data demonstrate that considerable confusion and misconceptions exist amongst players and stakeholders regarding the theoretical underpinning and practical application of meeting energy requirements, colloquially referred to as "fuelling". As such, it is perceived that players "under-fuel", which is likely caused by misunderstandings about the impact of carbohydrate intake on body composition, a fear of weight gain and the associated impacts upon body image. The "carbohydrate fear" that is experienced by players is exacerbated by external pressures arising from social media, key stakeholders (e.g., coaches) and the skinfold culture surrounding measurement of body composition. Such cultural issues are amplified by the lack of full-time professionally accredited nutritionists overseeing the provision of nutrition support. Indeed, the infrastructure supporting the women's game (e.g. staffing resource, on-site food provision, player education programmes etc.) was considered incomparable to the men's game. When taken together, our data provide a platform for which to develop organisational, stakeholder and player centred education and behaviour change interventions that strive to promote a positive performance nutrition culture within the women's game.
Published: 2022

26. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. 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Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. 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Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. 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Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.
Subjects: Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract: Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020
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27. Current Outcomes of Blunt Vertebral Artery Injuries

Author: Andrew Sticco, Christopher G. Carsten, Sagar S. Gandhi, Eugene M. Langan, Bryan Knoedler, Geoff Marston, and Alex Ewing
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Vertebral artery, 030204 cardiovascular system & hematology, Wounds, Nonpenetrating, Time-to-Treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Blunt, Trauma Centers, medicine.artery, Humans, Medicine, Registries, Stroke, Vertebral Artery, Aged, Retrospective Studies, Aspirin, business.industry, Incidence, Trauma center, Glasgow Coma Scale, Anticoagulants, Retrospective cohort study, General Medicine, Middle Aged, Vascular System Injuries, medicine.disease, Embolization, Therapeutic, Polytrauma, Surgery, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract: Background There is no consensus on the treatment of blunt vertebral artery injuries, and studies are limited to small case series. We assessed the natural history and current management of these injuries. Methods We performed a retrospective study of a prospectively collected registry at a level I trauma center over a 5-year period. Additional information was gathered from patient charts and imaging review from electronic medical records. We analyzed demographics, mechanism of injury, Glasgow Coma Score, mortality, length of stay, associated injuries, Denver grading scale, neurological findings, level and laterality of injury, delay in diagnosis, treatment, and follow-up imaging. Results There were 13,080 trauma admissions during this time period yielding 141 patients with blunt vertebral artery injuries from 2013 to 2018 (1.1% incidence). Mean injury severity score (ISS) was 22 with a 30-day mortality of 14 (9.9%). An ISS of greater than 15 is associated with polytrauma and increased mortality. There were 112 (79.4%) associated cervical fractures. C6 and C7 were both equally the most common locations. There was one symptomatic injury manifesting as a cerebellar ischemic infarct. The degree of arterial injury was classified by the Denver grading scale. There were 61 (43.3%) instances of Denver grade I injuries, followed by grade IV at 36 (25.5%), grade II at 34 (24.1%), grade III at 8 (5.7%), and grade V at 1 (0.7%). The level of injury was recorded as follows: V2 = 67 (47.5%), V3 = 56 (39.7%), V1 = 48 (34%), V4 = 14 (9.9%). Medical therapy included aspirin in 93 patients (66%), 31 patients (22%) received systemic anticoagulation with heparin drip, and 2 patients (1%) were administered therapeutic Lovenox. A total of 15 patients (11%) received no medical treatment. There was one intervention in our series. Our only grade V injury was coil embolized. A total of 118 patients (84%) had follow-up imaging. Seventy-eight patients (96%) with grade I and grade II injuries did not worsen, and complete radiographic resolution was found in 50 patients (62%). Grade IV injuries persisted in 22 patients (75.9%). Median time to resolution for grade I and grade II injuries was 7 and 8 days, respectively. Most follow-up scans for grade I and II injuries occurred within 50 days. Conclusions Posterior circulation stroke due to blunt vertebral artery injury is rare. In our experience, the natural course of blunt vertebral artery injury was benign and neither delay in medical treatment nor choice of antithrombotic had a significant impact on outcomes. In our series, only 3 (3.7%) grade I and II injuries worsened and were without any clinical sequelae. We suggest that routine serial imaging in grade I and II blunt vertebral injuries is not warranted.
Published: 2021
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28. Atopic dermatitis and risk of atrial fibrillation or flutter: A 35-year follow-up study

Author: Sigrún Alba Jóhannesdóttir Schmidt, Morten Schmidt, Mette Deleuran, Sinead Langan, Christian Vestergaard, Morten Olsen, and Jette Lindorff Riis
Subjects: Male, Denmark, DNPR, Danish National Patient Registry, Severity of Illness Index, 030207 dermatology & venereal diseases, 0302 clinical medicine, Risk Factors, Atrial Fibrillation, Prospective Studies, Registries, Child, Skin, validation, education.field_of_study, atopic dermatitis, Incidence, Hazard ratio, Absolute risk reduction, Atrial fibrillation, Atopic dermatitis, Middle Aged, atrial flutter, Child, Preschool, 030220 oncology & carcinogenesis, Female, Original Article, Cohort study, Adult, medicine.medical_specialty, Adolescent, Population, Dermatology, Risk Assessment, Dermatitis, Atopic, Young Adult, 03 medical and health sciences, Internal medicine, cohort study, medicine, Humans, Risk factor, education, Proportional Hazards Models, Inflammation, business.industry, Infant, medicine.disease, HR, hazard ratio, CI, confidence interval, body regions, business, Atrial flutter, Follow-Up Studies
Abstract: BACKGROUND: Atopic dermatitis is characterized by chronic inflammation, which is a risk factor for atrial fibrillation.OBJECTIVE: To examine the association between hospital-diagnosed atopic dermatitis and atrial fibrillation.METHODS: Using linked population-based Danish registries, we identified persons with an inpatient or outpatient hospital diagnosis of atopic dermatitis during 1977-2013 and a comparison cohort individually matched to the atopic dermatitis cohort. We followed cohorts until death, emigration, atrial fibrillation diagnosis, or end of study (January 1, 2013). We compared 35-year risk of atrial fibrillation and estimated hazard ratios with 95% confidence intervals using Cox regression, adjusting for birth year and sex. We validated 100 atopic dermatitis diagnoses from a dermatologic department through medical record review.RESULTS: We included 13,126 persons with atopic dermatitis and 124,211 comparators and followed them for a median of 19.3 years. The 35-year risk of atrial fibrillation was 0.81% and 0.67%, respectively. The positive predictive value of atopic dermatitis diagnoses was 99%. The hazard ratio was 1.2 (95% confidence interval 1.0-1.6) and remained increased after adjusting for various atrial fibrillation risk factors.LIMITATIONS: Analyses were limited to persons with moderate-to-severe atopic dermatitis, and we had no lifestyle data.CONCLUSION: Patients with hospital-diagnosed atopic dermatitis have a 20% increased long-term risk of atrial fibrillation, but the absolute risk remains low.
Published: 2020
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29. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Author: Abbafati, C., Machado, D.B., Cislaghi, B., Salman, O.M., Karanikolos, M., McKee, M., Abbas, K.M., Brady, O.J., Larson, H.J., Trias-Llimós, S., Cummins, S., Langan, S.M., Sartorius, B., Hafiz, A., Jenabi, E., Mohammad Gholi Mezerji, N., Borzouei, S., Azarian, G., Khazaei, S., Abbasi, M., Asghari, B., Masoumi, S., Komaki, H., Taherkhani, A., Adabi, M., Abbasifard, M., Bazmandegan, G., Kamiab, Z., Vakilian, A., Anjomshoa, M., Mokari, A., Sabour, S., Shahbaz, M., Saeedi, R., Ahmadieh, H., Yousefinezhadi, T., Haj-Mirzaian, A., Nikbakhsh, R., Safi, S., Asgari, S., Irvani, S.N., Jahanmehr, N., Ramezanzadeh, K., Abbasi-Kangevari, M., Khayamzadeh, M., Abbastabar, H., Shirkoohi, R., Fazlzadeh, M., Janjani, H., Hosseini, M., Mansournia, M., Tohidinik, H., Bakhtiari, A., Fazaeli, A., Mousavi, S., Hasanzadeh, A., Nabavizadeh, B., Malekzadeh, R., Hashemian, M., Pourshams, A., Salimzadeh, H., Sepanlou, S.G., Afarideh, M., Esteghamati, A., Esteghamati, S., Ghajar, A., Heidari, B., Rezaei, N., Mohamadi, E., Rahimi-Movaghar, A., Rahim, F., Eskandarieh, S., Sahraian, M., Mohebi, F., Aminorroaya, A., Ebrahimi, H., Farzadfar, F., Mohajer, B., Pishgar, F., Saeedi Moghaddam, S., Shabani, M., Zarafshan, H., Abolhassani, H., Hafezi-Nejad, N., Heidari-Soureshjani, R., Abdollahi, M., Farahmand, M., Salamati, P., Mehrabi Nasab, E., Tajdini, M., Aghamir, S., Mirzaei, R., Dibaji Forooshani, Z., Khater, M.M., Abd-Allah, F., Abdelalim, A., Abualhasan, A., El-Jaafary, S.I., Hassan, A., Elsharkawy, A., Khater, A.M., Elhabashy, H.R., Salem, M.R.R., Salem, H., Sadeghi, M., Jafarinia, M., Amini-Rarani, M., Mohammadifard, N., Sarrafzadegan, N., Abdollahpour, I., Sarveazad, A., Tehrani-Banihashemi, A., Yoosefi Lebni, J., Manafi, N., Pazoki Toroudi, H., Dorostkar, F., Alipour, V., Sheikhtaheri, A., Arabloo, J., Azari, S., Ghashghaee, A., Rezapour, A., Naserbakht, M., Kabir, A., Mehri, F., Yousefifard, M., Asadi-Aliabadi, M., Babaee, E., Eshrati, B., Goharinezhad, S., Moradi-Lakeh, M., Abedi, P., Rashedi, V., Kumar, V., Elgendy, I.Y., Basu, S., Park, J., Pereira, A., Norheim, O.F., Eagan, A.W., Cahill, L.E., Sheikh, A., Abushouk, A.I., Kraemer, M.U.G., Thakur, B., Bärnighausen, T.W., Shrime, M.G., Abedi, A., Doshi, C.P., Abegaz, K.H., Geberemariyam, B.S., Aynalem, Y.A., Shiferaw, W.S., Abosetugn, A.E., Aboyans, V., Abrams, E.M., Gitimoghaddam, M., Kissoon, N., Stubbs, J.L., Brauer, M., Iyamu, I.O., Kopec, J.A., Pourmalek, F., Ribeiro, A.P., Malta, D.C., Gomez, R.S., Abreu, L.G., Abrigo, M.R.M., Almulhim, A.M., Dahlawi, S.M.A., Pottoo, F.H., Menezes, R.G., Alanzi, T.M., Alumran, A.K., Abu Haimed, A.K., Madadin, M., Alanezi, F.M., Abu-Gharbieh, E., Saddik, B., Abu-Raddad, L.J., Samy, A.M., El Nahas, N., Shalash, A.S., Nabhan, A.F., Kamath, A.M., Kassebaum, N.J., Aravkin, A.Y., Kochhar, S., Sorensen, R.J.D., Afshin, A., Burkart, K., Cromwell, E.A., Dandona, L., Dharmaratne, S.D., Gakidou, E., Hay, S.I., Kyu, H.H., Lopez, A.D., Lozano, R., Misganaw, A.T., Mokdad, A.H., Naghavi, M., Pigott, D.M., Reiner Jr, R.C., Roth, G.A., Stanaway, J.D., Vollset, S., Vos, T., Wang, H., Lim, S.S., Murray, C.J.L., Kalani, R., Ikuta, K.S., Cho, D.Y., Kneib, C.J., Crowe, C.S., Massenburg, B.B., Morrison, S.D., Acebedo, A., Adelson, J.D., Agesa, K.M., Alam, T., Albertson, S.B., Anderson, J.A., Antony, C.M., Ashbaugh, C., Assmus, M., Azhar, G., Balassyano, S., Bannick, M.S., Barthelemy, C.M., Bender, R.G., Bennitt, F.B., Bertolacci, G.J., Biehl, M.H., Bisignano, C., Boon-Dooley, A.S., Briant, P.S., Bryazka, D., Bumgarner, B.R., Callender, C.S., Cao, J., Castle, C.D., Castro, E., Causey, K., Cercy, K.M., Chalek, J., Charlson, F.J., Cohen, A.J., Comfort, H., Compton, K., Croneberger, A.J., Cruz, J.A., Cunningham, M., Dandona, R., Dangel, W.J., Dean, F.E., DeCleene, N.K., Deen, A., Degenhardt, L., Dingels, Z.V., Dippenaar, I.N., Dirac, M.A., Dolgert, A.J., Emmons-Bell, S., Estep, K., Farag, T., Feigin, V.L., Feldman, R., Ferrara, G., Ferrari, A.J., Fitzgerald, R., Force, L.M., Fox, 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Maria, Borzouei, Shiva, Brady, Oliver J, Braithwaite, Dejana, Brauer, Michael, Briko, Andrey Nikolaevich, Briko, Nikolay Ivanovich, Bumgarner, Blair R, Burugina Nagaraja, Sharath, Butt, Zahid A, Caetano dos Santos, Florentino Luciano, Cai, Tianji, Callender, Charlton SKH, Cámera, Luis LA Alberto, Campos-Nonato, Ismael R, Cárdenas, Rosario, Carreras, Giulia, Carrero, Juan J, Carvalho, Felix, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Castro, Franz, Catalá-López, Ferrán, Cederroth, Christopher R, Cerin, Ester, Chattu, Vijay Kumar, Chin, Ken Lee, Chu, Dinh-Toi, Ciobanu, Liliana G, Cirillo, Massimo, Comfort, Haley, Costa, Vera Marisa, Cowden, Richard G, Cromwell, Elizabeth A, Croneberger, Andrew J, Cunningham, Matthew, Dahlawi, Saad M A, Damiani, Giovanni, D'Amico, Emanuele, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I, Darwesh, Aso Mohammad, Daryani, Ahmad, Das Gupta, Rajat, das Neves, José, Davletov, Kairat, De Leo, Diego, Denova-Gutiérrez, Edgar, Deribe, Kebede, Dervenis, Nikolao, Desai, Rupak, Dhungana, Govinda Prasad, Dias da Silva, Diana, Diaz, Daniel, Dippenaar, Ilse N, Djalalinia, Shirin, Do, Hoa Thi, Dokova, Klara, Doku, David Teye, Dorostkar, Fariba, Doshi, Chirag P, Doshmangir, Leila, Doyle, Kerrie E, Dubljanin, Eleonora, Duraes, Andre Rodrigue, Edvardsson, David, Effiong, Andem, El Sayed, Iman, El Tantawi, Maha, Elbarazi, Iffat, El-Jaafary, Shaimaa I, Emamian, Mohammad Hassan, Eskandarieh, Sharareh, Esmaeilzadeh, Firooz, Estep, Kara, Farahmand, Mohammad, Faraj, Anwar, Fareed, Mohammad, Faridnia, Roghiyeh, Faro, Andre, Farzadfar, Farshad, Fattahi, Nazir, Fazaeli, Ali Akbar, Fazlzadeh, Mehdi, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, Ferreira, Manuela L, Filip, Irina, Fischer, Florian, Flohr, Carsten, Foigt, Nataliya A, Folayan, Morenike Oluwatoyin, Fomenkov, Artem Alekseevich, Freitas, Marisa, Fukumoto, Takeshi, Fuller, John E, Furtado, João M, Gad, Mohamed M, Gakidou, Emmanuela, Gallus, Silvano, Gebrehiwot, Abiyu Mekonnen, Gebremedhin, Ketema Bizuwork, Gething, Peter W, Ghamari, Farhad, Ghashghaee, Ahmad, Gholamian, Asadollah, Gilani, Syed Amir, Gitimoghaddam, Mojgan, Glushkova, Ekaterina Vladimirovna, Gnedovskaya, Elena V, Gopalani, Sameer Vali, Goulart, Alessandra C, Gugnani, Harish Chander, Guo, Yuming, Gupta, Rajeev, Gupta, Subodh Sharan, Haagsma, Juanita A, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Halvaei, Iman, Hamadeh, Randah R, Hamagharib Abdullah, Kanaan, Han, Chieh, Handiso, Demelash Woldeyohanne, Hankey, Graeme J, Haririan, Hamidreza, Haro, Josep Maria, Hasaballah, Ahmed I, Hassanipour, Soheil, Hassankhani, Hadi, Hay, Simon I, Heibati, Behzad, Heidari-Soureshjani, Reza, Henny, Kiana, Henry, Nathaniel J, Herteliu, Claudiu, Heydarpour, Fatemeh, Hole, Michael K, Hoogar, Praveen, Hosgood, H Dean, Hossain, Naznin, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Househ, Mowafa, Hoy, Damian G, Hu, Guoqing, Huda, Tanvir M, Ibitoye, Segun Emmanuel, Ikuta, Kevin S, Ilesanmi, Olayinka Stephen, Ilic, Irena M, Ilic, Milena D, Imani-Nasab, Mohammad Hasan, Islam, Mdmohaimenul, Iso, Hiroyasu, Iwu, Chinwe Juliana, Jaafari, Jalil, Jacobsen, Kathryn H, Jahagirdar, Deepa, Jahanmehr, Nader, Jalali, Amir, Jalilian, Farzad, James, Spencer L, Janjani, Hosna, Jenabi, Ensiyeh, Jha, Ravi Prakash, Jha, Vivekanand, Ji, John S, Jonas, Jost B, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kabir, Zubair, Kalani, Hamed, Kalankesh, Leila R, Kamiab, Zahra, Kanchan, Tanuj, Kapoor, Neeti, Karch, André, Karimi, Salah Eddin, Karimi, Seyed Asaad, Kassebaum, Nicholas J, Katikireddi, Srinivasa Vittal, Kawakami, Norito, Kayode, Gbenga A, Keiyoro, Peter Njenga, Keller, Cathleen, Khader, Yousef Saleh, Khalid, Nauman, Khan, Ejaz Ahmad, Khan, Maseer, Khang, Young-Ho, Khater, Amir M, Khater, Mona M, Khazaei, Salman, Khazaie, Habibolah, Khodayari, Mohammad Taghi, Khubchandani, Jagdish, Kianipour, Neda, Kim, Cho-il, Kim, Young-Eun, Kim, Yun Jin, Kinfu, Yohanne, Kisa, Adnan, Kisa, Sezer, Kissimova-Skarbek, Katarzyna, Kivimäki, Mika, Komaki, Hamidreza, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael A, Krishan, Kewal, Krohn, Kris J, Kuate Defo, Barthelemy, Kumar, G Anil, Kumar, Manasi, Kumar, Pushpendra, Kumar, Vivek, Kusuma, Dian, Kyu, Hmwe Hmwe, La Vecchia, Carlo, Lacey, Ben, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lami, Faris Hasan, Lansky, Sonia, Larson, Samantha Leigh, Larsson, Anders O, Lasrado, Savita, Lassi, Zohra S, Lazarus, Jeffrey V, Lee, Paul H, Lee, Shaun Wen Huey, Leever, Andrew T, Legrand, Kate E, Leonardi, Matilde, Li, Shanshan, Lim, Lee-Ling, Lim, Stephen S, Linn, Shai, Lodha, Rakesh, Logroscino, Giancarlo, Lopez, Alan D, Lopukhov, Platon D, Lotufo, Paulo A, Lozano, Rafael, Lu, Alton, Lunevicius, Raimunda, Madadin, Mohammed, Maddison, Emilie R, Magdy Abd El Razek, Hassan, Magdy Abd El Razek, Muhammed, Mahasha, Phetole Walter, Mahdavi, Mokhtar Mahdavi, Malekzadeh, Reza, Mamun, Abdullah A, Manafi, Navid, Mansour-Ghanaei, Fariborz, Mansouri, Borhan, Mansournia, Mohammad Ali, Mapoma, Chabila Christopher, Martini, Santi, Martins-Melo, Francisco Rogerlândio, Masaka, Anthony, Mastrogiacomo, Claudia I, Mathur, Manu Raj, May, Erin A, Mcalinden, Colm, Mcgrath, John J, Mckee, Martin, Mehndiratta, Man Mohan, Mehri, Fereshteh, Mehta, Kala M, Meitei, Wahengbam Bigyananda, Memiah, Peter T N, Mendoza, Walter, Menezes, Ritesh G, Mengesha, Endalkachew Worku, Mensah, George A, Meretoja, Atte, Meretoja, Tuomo J, Mestrovic, Tomislav, Michalek, Irmina Maria, Mihretie, Kebadnew Mulatu, Miller, Ted R, Mills, Edward J, Milne, George J, Mirrakhimov, Erkin M, Mirzaei, Hamed, Mirzaei, Maryam, Mirzaei-Alavijeh, Mehdi, Misganaw, Awoke Temesgen, Moazen, Babak, Moghadaszadeh, Masoud, Mohamadi, Efat, Mohammad, Dara K, Mohammad, Yousef, Mohammad Gholi Mezerji, Naser, Mohammadbeigi, Abolfazl, Mohammadian-Hafshejani, Abdollah, Mohammadpourhodki, Reza, Mohammed, Hussen, Mohammed, Shafiu, Mohebi, Farnam, Mohseni Bandpei, Mohammad A, Mokari, Amin, Mokdad, Ali H, Momen, Natalie C, Monasta, Lorenzo, Mooney, Meghan D, Moradi, Ghobad, Moradi, Masoud, Moradi-Joo, Mohammad, Moradi-Lakeh, Maziar, Moradzadeh, Rahmatollah, Moraga, Paula, Moreno Velásquez, Ilai, Morgado-da-Costa, Joana, Morrison, Shane Dougla, Mosser, Jonathan F, Mouodi, Simin, Mousavi, Seyyed Meysam, Mousavi Khaneghah, Amin, Mueller, Ulrich Otto, Musa, Kamarul Imran, Muthupandian, Saravanan, Nabavizadeh, Behnam, Naderi, Mehdi, Nagarajan, Ahamarshan Jayaraman, Naghavi, Mohsen, Naghshtabrizi, Behshad, Naik, Gurudatta, Najafi, Farid, Nangia, Vinay, Nansseu, Jobert Richie, Ndwandwe, Duduzile Edith, Negoi, Ionut, Negoi, Ruxandra Irina, Ngunjiri, Josephine W, Nguyen, Huong Lan Thi, Nguyen, Trang Huyen, Nigatu, Yeshambel T, Nikbakhsh, Rajan, Nikpoor, Amin Reza, Nixon, Molly R, Nnaji, Chukwudi A, Nomura, Shuhei, Noubiap, Jean Jacque, Nouraei Motlagh, Soraya, Nowak, Christoph, Oţoiu, Adrian, Odell, Christopher M, Oh, In-Hwan, Oladnabi, Morteza, Olagunju, Andrew T, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Omar Bali, Ahmed, Ong, Kanyin L, Onwujekwe, Obinna E, Ortiz, Alberto, Otstavnov, Nikita, Otstavnov, Stanislav S, Øverland, Simon, Owolabi, Mayowa O, P A, Mahesh, Padubidri, Jagadish Rao, Pakshir, Keyvan, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Park, Jame, Pasupula, Deepak Kumar, Patel, Jenil R, Patel, Sangram Kishor, Patton, George C, Paulson, Katherine R, Pazoki Toroudi, Hamidreza, Pease, Spencer A, Peden, Amy E, Pepito, Veincent Christian Filipino, Peprah, Emmanuel K, Pereira, Alexandre, Pereira, David M, Perico, Norberto, Pigott, David M, Pilgrim, Thoma, Pilz, Tessa M, Piradov, Michael A, Pirsaheb, Meghdad, Pokhrel, Khem Narayan, Postma, Maarten J, Pourjafar, Hadi, Pourmalek, Farshad, Pourshams, Akram, Poznańska, Anna, Prada, Sergio I, Prakash, Sanjay, Preotescu, Liliana, Quazi Syed, Zahiruddin, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiei, Alireza, Raggi, Alberto, Rahman, Muhammad Aziz, Rajabpour-Sanati, Ali, Ram, Pradhum, Ranabhat, Chhabi Lal, Rao, Sowmya J, Rasella, Davide, Rashedi, Vahid, Rastogi, Prateek, Rathi, Priya, Rawal, Lal, Remuzzi, Giuseppe, Renjith, Vishnu, Renzaho, Andre M N, Resnikoff, Serge, Rezaei, Nima, Rezai, Mohammad sadegh, Rezapour, Aziz, Rickard, Jennifer, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rostamian, Morteza, Rubagotti, Enrico, Rwegerera, Godfrey M, Sabour, Siamak, Saddik, Basema, Sadeghi, Ehsan, Sadeghi, Masoumeh, Saeedi Moghaddam, Sahar, Safari, Yahya, Safi, Sare, Safiri, Saeid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, S Mohammad, Salahshoor, Mohammad Reza, Salama, Joseph S, Salamati, Payman, Salem, Marwa R Rashad, Salimi, Yahya, Salomon, Joshua A, Salz, Inbal, Samad, Zainab, Samy, Abdallah M, Sanabria, Juan, Santric-Milicevic, Milena M, Saraswathy, Sivan Yegnanarayana Iyer, Sartorius, Benn, Sarveazad, Arash, Sathian, Brijesh, Sathish, Thirunavukkarasu, Sattin, Davide, Saylan, Mete, Schaeffer, Lauren E, Schiavolin, Silvia, Schwebel, David C, Schwendicke, Falk, Sekerija, Mario, Senbeta, Anbissa Muleta, Senthilkumaran, Subramanian, Sepanlou, Sadaf G, Serván-Mori, Edson, Shabani, Mahsima, Shahabi, Saeed, Shahbaz, Mohammad, Shaheen, Amira A, Shaikh, Masood Ali, Shalash, Ali S, Shams-Beyranvand, Mehran, Shamsi, Mohammadbagher, Shamsizadeh, Morteza, Shannawaz, Mohammed, Sharafi, Kiomar, Sharafi, Zeinab, Sharara, Fablina, Sharma, Rajesh, Shaw, David H, Sheikh, Aziz, Shin, Jae Il, Shiri, Rahman, Shrime, Mark G, Shuval, Kerem, Siabani, Soraya, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silva, Diego Augusto Santo, Simonetti, Biagio, Simpson, Kyle E, Singh, Jasvinder A, Skiadaresi, Eirini, Skryabin, Valentin Yurievich, Soheili, Amin, Sokhan, Anton, Sorensen, Reed J D, Soriano, Joan B, Sorrie, Muluken Bekele, Soyiri, Ireneous N, Spurlock, Emma Elizabeth, Sreeramareddy, Chandrashekhar T, Stockfelt, Leo, Stokes, Mark A, Stubbs, Jacob L, Sudaryanto, Agu, Sufiyan, Mu'awiyyah Babale, Suliankatchi Abdulkader, Rizwan, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Tadakamadla, Santosh Kumar, Taherkhani, Amir, Tang, Muming, Taveira, Nuno, Taylor, Heather Jean, Teagle, Whitney L, Tehrani-Banihashemi, Arash, Teklehaimanot, Berhane Fseha, Tessema, Zemenu Tadesse, Thankappan, Kavumpurathu Raman, Thomas, Nihal, Thrift, Amanda G, Titova, Mariya Vladimirovna, Tohidinik, Hamid Reza, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tovani-Palone, Marcos Roberto Roberto, Traini, Eugenio, Tran, Bach Xuan, Travillian, Ravensara, Trias-Llimós, Sergi, Truelsen, Thomas Clement, Tudor Car, Lorainne, Unnikrishnan, Bhaskaran, Upadhyay, Era, Vacante, Marco, Vakilian, Alireza, Valdez, Pascual R, Valli, Alessandro, Vardavas, Constantine, Vasankari, Tommi Juhani, Vasconcelos, Ana Maria Nogale, Vasseghian, Yasser, Veisani, Yousef, Venketasubramanian, Narayanaswamy, Vidale, Simone, Violante, Francesco S, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vujcic, Isidora S, Vukovic, Ana, Vukovic, Rade, Waheed, Yasir, Wallin, Mitchell Taylor, Walters, Magdalene K, Wang, Hongbo, Wang, Yuan-Pang, Watson, Stefanie, Wei, Jingkai, Weiss, Jordan, Weldesamuel, Girmay Teklay, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wiangkham, Taweewat, Wiens, Kirsten E, Wijeratne, Tissa, Wiysonge, Charles Shey, Wojtyniak, Bogdan, Wolfe, Charles D A, Wondmieneh, Adam Belay, Wool, Eve E, Wu, Ai-Min, Wu, Junjie, Xu, Gelin, Yamada, Tomohide, Yamagishi, Kazumasa, Yano, Yuichiro, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yearwood, Jamal A, Yeheyis, Tomas Y, Yilgwan, Christopher Sabo, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Yoosefi Lebni, Javad, York, Hunter W, Younis, Mustafa Z, Younker, Theodore Patrick, Yousefi, Zabihollah, Yousefinezhadi, Taraneh, Yousuf, Abdilahi Yousuf, Yusefzadeh, Hasan, Zahirian Moghadam, Telma, Zakzuk, Josefina, Zaman, Sojib Bin, Zamani, Mohammad, Zamanian, Maryam, Zandian, Hamed, Zhang, Zhi-Jiang, Zheng, Peng, Zhou, Maigeng, Ziapour, Arash, Murray, Christopher J L, Collaborators, GBD 2019 Demographics, GBD 2019 Demographics Collaborator, Violante FS, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), Department of Earth Systems Analysis, Biomechanical Engineering, TechMed Centre, Biomolecular Nanotechnology, Research Methodology, Measurement and Data Analysis, Materials Science and Technology of Polymers, Inorganic Materials Science, MESA+ Institute, Biomedical and Environmental Sensorsystems, Mesoscale Chemical Systems, Faculty of Engineering Technology, Nonlinear Solid Mechanics, Digital Society Institute, Pervasive Systems, Nanobiophysics, Faculty of Geo-Information Science and Earth Observation, Multi Scale Mechanics, Engineering Fluid Dynamics, Physics of Complex Fluids, Developmental BioEngineering, Physics of Fluids, Elastomer Technology and Engineering, Medical Cell Biophysics, European Membrane Institute, Department of Earth Observation Science, Biomaterials Science and Technology, Sustainable Process Technology, Department of Urban and Regional Planning and Geo-Information Management, Department of Natural Resources, XUV Optics, Databases (Former), Department of Water Resources, Psychology, Health & Technology, Membrane Science & Technology, Department of Public Health, Clinicum, HUS Neurocenter, HUS Comprehensive Cancer Center, and Environmental Sciences
Subjects: Male, very elderly, Demographic transition, HALE, 030204 cardiovascular system & hematology, preschool child, Global Burden of Disease, Carga Global de Enfermedades, 0302 clinical medicine, newborn, Risk Factors, Surveys and Questionnaires, and Risk Factors Study, 80 and over, 030212 general & internal medicine, Birth Rate, Child, Migration, 11 Medical and Health Sciences, Aged, 80 and over, education.field_of_study, Injuries, Geography, Mortality rate, 1. No poverty, DEATH, Censuses, General Medicine, SDG 10 - Reduced Inequalities, Middle Aged, Demographic analysis, 3142 Public health care science, environmental and occupational health, 3. Good health, demographic analysis, Estilo de Vida Saludable, risk factor, Child, Preschool, Demography/statistics & numerical data, Global Burden of Diseases, Injuries, Risk Factors, Fertility, Mortality, Migration, Population, epidemiology, Female, A990 Medicine and Dentistry not elsewhere classified, CHILD-MORTALITY, Live Birth, Global Health Metrics, TRANSITION, demographics, GBD, fertility, mortality, hale, Adult, Adolescent, Total fertility rate, Population, Global Burden of Diseases, Injuries, and Risk Factors Study, Birth rate, 03 medical and health sciences, Young Adult, Life Expectancy, SDG 3 - Good Health and Well-being, General & Internal Medicine, SYSTEMATIC ANALYSIS, Demografía, Humans, Global Burden of Disease Study, human, Mortality, education, Preschool, Aged, Demography, Spatial Analysis, questionnaire, Infant, Newborn, Klinisk medicin, HIV, Infant, Global Burden of Diseases, sex-specific fertility, Live Birth/epidemiology, purl.org/pe-repo/ocde/ford#3.02.00 [https], MODEL, Fertilidad, Fertility, Demographic change, Life expectancy, NA, global disease burden, Clinical Medicine, population research
Abstract: Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2.72 (95% uncertainty interval [UI] 2.66-2.79) in 2000 to 2.31 (2.17-2.46) in 2019. Global annual livebirths increased from 134.5 million (131.5-137.8) in 2000 to a peak of 139.6 million (133.0-146.9) in 2016. Global livebirths then declined to 135.3 million (127.2-144.1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2.1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27.1% (95% UI 26.4-27.8) of global livebirths. Global life expectancy at birth increased from 67.2 years (95% UI 66.8-67.6) in 2000 to 73.5 years (72.8-74.3) in 2019. The total number of deaths increased from 50.7 million (49.5-51.9) in 2000 to 56.5 million (53.7-59.2) in 2019. Under-5 deaths declined from 9.6 million (9.1-10.3) in 2000 to 5.0 million (4.3-6.0) in 2019. Global population increased by 25.7%, from 6.2 billion (6.0-6.3) in 2000 to 7.7 billion (7.5-8.0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58.6 years (56.1-60.8) in 2000 to 63.5 years (60.8-66.1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020
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30. A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy

Author: Michael Dabrowski, Jaimie Bell, Amber L. Turner, Andrew Nguyen, Patrick Hilden, Russell C. Langan, Subroto Paul, Kalyna Leshchuk, and Joanna Sesti
Subjects: Male, Pulmonary and Respiratory Medicine, End results, medicine.medical_specialty, Lung Neoplasms, Time Factors, Demographics, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Matched cohort, Robotic Surgical Procedures, Randomized controlled trial, law, Carcinoma, Non-Small-Cell Lung, Epidemiology, Long term survival, Overall survival, medicine, Humans, Pneumonectomy, Propensity Score, Aged, Retrospective Studies, Aged, 80 and over, New Jersey, Thoracic Surgery, Video-Assisted, business.industry, Surgery, Survival Rate, 030228 respiratory system, Female, Non small cell, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Background Minimally invasive lobectomy can be performed robotically or thoracoscopically. Short-term outcomes between the 2 approaches are reported to be similar; however, the comparative oncological effectiveness is not known. We sought to compare long-term survival after robotic and thoracoscopic lobectomy. Methods We performed a propensity-matched analysis of SEER (Surveillance, Epidemiology and End Results)-Medicare patients with non-small cell lung cancer from 2008 to 2013 who underwent minimally invasive lobectomy using either a thoracoscopic (n = 3881) or a robotic-assisted (n = 426) approach. Patients in the 2 groups were propensity matched 1:1 based on demographics, comorbidities, treatment, and tumor characteristics. We compared the overall survival (OS) and cancer-specific mortality (CSM) between the 2 groups. Results Within the matched cohort (n = 409 per group), the median age at surgery was 73 (range, 65-91) years, with a median follow-up of 35 months postsurgery. There was no difference in OS or CSM between the thoracoscopic and robotic-assisted groups (OS: 71.4% vs 73.1% at 3 years, overall P = .366; CSM: 16.6% vs 14.9% at 3 years, overall P = .639). Conclusions Our propensity-matched analysis demonstrates that patients undergoing robotic-assisted lobectomy have similar OS and CSM compared with those patients undergoing thoracoscopic lobectomy. Oncologic outcomes are similar between the 2 minimally invasive approaches. These results demonstrate that further investigation is needed in the form of a randomized control trial, its variations, or additional large-scale registry analyses to verify these results.
Published: 2020
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31. Safety Profile Associated With Calcaneal Autograft Harvesting Using a Reaming Graft Harvester

Author: Rona Law, Mark A. Prissel, Christopher F. Hyer, Travis M Langan, Devon Consul, and James Steriovski
Subjects: Adult, Male, medicine.medical_specialty, Arthrodesis, medicine.medical_treatment, Nonunion, Bone healing, Transplantation, Autologous, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Foot Joints, medicine, Humans, Orthopedics and Sports Medicine, Aged, Retrospective Studies, 030222 orthopedics, Bone Transplantation, business.industry, Foot and ankle surgery, 030229 sport sciences, Middle Aged, medicine.disease, Surgery, Calcaneus, Safety profile, Primary bone, Female, business
Abstract: Background: Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft. Methods: A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester. Results: In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%). Conclusion: The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing. Level of Evidence: Therapeutic level IV, case series.
Published: 2020
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32. Unexpected Cardiomyopathy and Cardiac Dysfunction after Administration of Sulfadiazine-trimethoprim Medicated Diet to ICR mice (Mus musculus)

Author: Gene Kim, Nicole M Pach, Kerith R Luchins, Betty Theriault, and George Langan
Subjects: 040301 veterinary sciences, Cardiomyopathy, Administration, Oral, Sulfadiazine, Physiology, Trimethoprim, General Biochemistry, Genetics and Molecular Biology, Cardiac dysfunction, 0403 veterinary science, Mice, Case Studies, medicine, Animals, Mice, Inbred ICR, General Veterinary, business.industry, Histology, 04 agricultural and veterinary sciences, Sulfadiazine - trimethoprim, bacterial infections and mycoses, medicine.disease, Anti-Bacterial Agents, Drug Combinations, Sequential monitoring, Female, Myocardial fibrosis, Decreased cardiac function, Cardiomyopathies, business, Immunocompetence, Icr mice
Abstract: For many years, the University of Chicago administered sulfamethoxazole-trimethoprim sulfate (SMZ-TMP) oral suspension to select immunocompromised mouse colonies via the drinking water. In 2014, SMZ-TMP oral suspension was placed on back-order and medicated diet with a different sulfonamide, sulfadiazine-trimethoprim (SDZ-TMP) was used as a replacement. Months after this transition, sentinel mice from the same room as one of the remaining immunocompromised colonies on this diet were found dead or appeared sick. Necropsies revealed cardiomegaly, and histology confirmed myocardial fibrosis in the first 4 sentinel mice examined, consistent with cardiomyopathy. Subsequent sequential monitoring of 2 sentinel mice via echocardiography showed their progression toward decreased cardiac function. Investigation of the housing room revealed that the sentinel mice had been accidently placed on SDZ-TMP diet upon entering the colony housing room. This case report describes cardiomyopathy in 6 ICR mice after long term consumption of SDZ-TMP medicated feed.
Published: 2020
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33. Use of ketogenic diet therapy in infants with epilepsy: A systematic review and meta‐analysis

Author: Laura Lyons, J. Helen Cross, Dean Langan, and Natasha E. Schoeler
Subjects: Male, 0301 basic medicine, Drug Resistant Epilepsy, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, medicine, Humans, Randomized Controlled Trials as Topic, business.industry, Incidence (epidemiology), Infant, medicine.disease, Confidence interval, 030104 developmental biology, Neurology, Tolerability, Meta-analysis, Female, Neurology (clinical), Diet, Ketogenic, business, 030217 neurology & neurosurgery, Dyslipidemia, Cohort study, Ketogenic diet
Abstract: Objective Ketogenic diet therapy (KDT) is a group of high-fat, low-carbohydrate diets used as an effective treatment option for children and adults with drug-resistant epilepsy. There is limited research on the efficacy of KDT in infants, where there is the highest incidence of onset of the epilepsy. We aimed to systematically review studies that have reported on response to KDT in infants with epilepsy. Methods An online comprehensive literature search was performed, including studies that provided seizure frequency data for at least one infant younger than 2 years of age who was treated with KDT for ≥1 month. The proportions of infants achieving ≥50% seizure reduction, seizure-freedom rates, retention rates, and reported side effects were extracted from studies. Meta-analyses were performed using a random-effects model, and subgroup analyses were performed to investigate possible between-study heterogeneity. Results Thirty-three studies met inclusion criteria and were included in the final analysis, with a total of 534 infants with efficacy data. Two studies were randomized-controlled trials, and the remainder were uncontrolled cohort studies. All studies were categorized as low quality. Meta-analyses of uncontrolled studies estimate 59% (95% confidence interval [CI] 53-65) of infants achieved ≥50% seizure reduction and 33% (95% CI 26-43) of infants achieved seizure freedom. Retention rates ranged from 84% at 3 months to 27% at 24 months. The most commonly reported side effects were dyslipidemia (20/171, 12%), vomiting (11/171, 6%), constipation (7/171, 4%), gastroesophageal reflux (6/171, 4%), and diarrhea (6/171, 4%). Significance This review indicates that KDT is safe and tolerable and that it can be an effective treatment option for infants with drug-resistant epilepsy. However, there are few studies focusing on infants treated with KDT, and high-quality evidence is lacking. High-quality randomized-controlled trials are needed to confirm the effectiveness, safety, and tolerability of dietary treatment in this vulnerable age group.
Published: 2020
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34. Self-reported sleep quality is associated with central hemodynamics in healthy individuals

Author: Stephen M. Ratchford, Gregory J. Grosicki, Ja'Deon D Carreker, Sean P. Langan, Andrew A. Flatt, and Meral N. Culver
Subjects: Adult, Male, Risk, Sleep Wake Disorders, medicine.medical_specialty, Neurology, Diastole, Hemodynamics, Blood Pressure, Disease, Pittsburgh Sleep Quality Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Internal medicine, medicine, Humans, Aged, business.industry, Middle Aged, medicine.disease, Sleep in non-human animals, Pulse pressure, 030228 respiratory system, Otorhinolaryngology, Cardiovascular Diseases, Arterial stiffness, Cardiology, Female, Self Report, Neurology (clinical), Sleep, business, 030217 neurology & neurosurgery
Abstract: Insufficient sleep is associated with arterial stiffness and elevated cardiovascular disease risk. Central hemodynamics are influenced by arterial stiffness, yet independently predict cardiovascular risk. Relationships between sleep characteristics and central hemodynamic parameters are largely unexplored. We aimed to characterize the relationship between self-reported sleep quality and central hemodynamics in healthy individuals. To explore the secondary hypothesis that impairments in glucose metabolism may underlie relationships between sleep and central hemodynamic variables, we also explored associations between self-reported sleep quality and fasting blood glucose values.Thirty-one healthy study subjects (20 to 69 years, 17 men) were free from metabolic or cardiovascular disease and did not take sleep medication. Self-reported sleep quality was obtained using the Pittsburgh Sleep Quality Index (PSQI) with normal sleepers defined by PSQI scores 0-5 and poor sleepers by PSQI score 5. Relationships were assessed between PSQI, central hemodynamic profiles (systolic and diastolic blood pressures, pulse and augmentation pressures, augmentation index) estimated from oscillometric pulse wave analysis, and blood glucose values.Central pulse pressure was significantly elevated in poor (PSQI score 5) compared with that in normal (PSQI scores 0-5) sleepers (P 0.05). Linear regression models, adjusted for age, gender, and body mass index, demonstrated PSQI score to be an independent predictor (P 0.05) of both central pulse (β = 0.469) and augmentation (β = 0.364) pressures. Global PSQI scores were not related to fasting blood glucose values (r = 0.045; P 0.05).Significant relationships between central pulse and augmentation pressures and self-reported sleep quality highlight the importance of considering sleep when examining lifestyle contributors to central hemodynamics.
Published: 2020
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35. Surgical Treatment and Management for Chronic Dislocated Subtalar Joint

Author: Daniel R. Elbert, Patrick R. Burns, and Travis M. Langan
Subjects: Adult, Male, medicine.medical_specialty, Limb salvage, medicine.medical_treatment, Joint Dislocations, Arthrodesis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Subtalar joint, medicine, Deformity, Humans, Orthopedics and Sports Medicine, Aged, Retrospective Studies, 030222 orthopedics, business.industry, Medical record, Disease Management, Subtalar Joint, 030229 sport sciences, Middle Aged, Limb Salvage, Charcot neuroarthropathy, Surgery, Radiography, Treatment Outcome, medicine.anatomical_structure, Amputation, Chronic Disease, Etiology, Female, Ankle, medicine.symptom, business
Abstract: Lateral dislocation of the subtalar joint is a relatively uncommon pathology. It has previously been described in the literature secondary to acute trauma. This form of dislocation can also be acquired and seen in severe long-standing cases of flatfoot and Charcot neuroarthropathy. This study aims to describe this "sidecar" deformity, etiologies of the deformity, and the surgical options for correction. This study was performed by reviewing medical records of a single foot and ankle surgeon for patients who met inclusion criteria and underwent surgical correction. The study period was from October 2010 to July 2017. Statistical analysis was performed using chart-review information to examine variables affecting selected outcome measures. The outcome measures evaluated were minor and major complications, as well as functional limb status. A total of 16 patients were included in the study. Etiology included 10 severe flatfoot deformities and 6 Charcot deformities. Seven patients underwent staged reconstruction, and 9 underwent a single-stage reconstruction. Seven patients (44%) had complications; all were major and required unplanned reoperation. In all 16 patients (100%), limb salvage and a functional limb resulted. We conclude that patients with a limb-threatening sidecar deformity can be successfully treated with reconstruction. This is challenging and associated with a high complication rate. Patients with a history of infection should be counseled on the possibility of requiring a staged reconstruction with multiple surgeries as well as the possibility of amputation.
Published: 2020
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36. Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

Author: Beat P. Müller-Stich, Oliver Strobel, Adrian T. Billeter, Franck Billmann, Tobias Keck, Oliver Thomusch, Ewan A. Langan, Aylin Pfeiffer, and Felix Nickel
Subjects: Insufflation, Adult, Male, medicine.medical_treatment, Retroperitoneal space, Article, Minimally invasive surgical procedures, Pressure, Medicine, Humans, Prospective Studies, Prospective cohort study, Propensity Score, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Adrenalectomy, Incidence (epidemiology), Retrospective cohort study, Perioperative, Middle Aged, Anesthesia, Propensity score matching, Surgery, Female, Laparoscopy, business, Abdominal surgery
Abstract: Background Insufflation pressures of or in excess of 25 mm Hg CO2 are routinely used during posterior retroperitoneoscopic adrenalectomy (PRA) in most centres. A critical analysis of the surgical literature provides limited evidence to support this strategy. Objective To determine whether high pressure (≥ 25 mm Hg) compared with lower pressure ( Methods A multi-centre retrospective cohort study was performed using data collected over a period of almost one decade (1st November 2008 until 1st February 2018) from surgical centres in Germany. A total of 1032 patients with benign adrenal tumours were identified. We compared patients undergoing PRA with insufflation pressures of Results The baseline patient characteristics were similar in both groups, with the exception of tumour size, BMI and surgeon's experience in PRA. After propensity score matching, perioperative outcomes, especially perioperative complications (3.7% vs. 5.5% in G20 and G25, respectively; p = 0.335) and operation duration (47 min vs. 45 min in G20 and G25, respectively; p = 0.673), did not significantly differ between the groups. Conclusion Neither patient safety nor operative success was compromised when PRA was performed with insufflation pressures below 25 mm Hg. Prospective studies are required to determine whether an optimal insufflation pressure exists that maximizes patient safety and minimizes the risks of post-surgical complications. Nevertheless, our results call for a careful re-evaluation of the routine use of high insufflation pressures during PRA. In the absence of prospective data, commencing PRA with lower insufflation pressures, with the option of increasing insufflation pressures to counter intraoperative bleeding or exposition difficulties, may represent a reasonable strategy.
Published: 2020

37. Secondary attack rates in primary and secondary school bubbles following a confirmed case: Active, prospective national surveillance, November to December 2020, England

Author: Annabel A. Powell, Georgina Ireland, Frances Baawuah, Joanne Beckmann, Ifeanyichukwu O. Okike, Shazaad Ahmad, Joanna Garstang, Andrew J. Brent, Bernadette Brent, Felicity Aiano, James Hargreaves, Sinéad M. Langan, Punam Mangtani, Patrick Nguipdop-Djomo, Joanna Sturgess, William Oswald, Katherine Halliday, Emma Rourke, Fiona Dawe, Zahin Amin-Chowdhury, Meaghan Kall, Maria Zambon, John Poh, Samreen Ijaz, Angie Lackenby, Joanna Elli, Kevin E. Brown, Sir Ian Diamond, Mary E. Ramsay, and Shamez N. Ladhani
Subjects: Adult, Male, History, 2019-20 coronavirus outbreak, Adolescent, Polymers and Plastics, Coronavirus disease 2019 (COVID-19), Secondary infection, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Science, education, Antibodies, Viral, Industrial and Manufacturing Engineering, Nasopharynx, Humans, Infection control, Medicine, Prospective Studies, Transmission risks and rates, Business and International Management, Child, Students, Schools, Multidisciplinary, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, business.industry, Incidence, COVID-19, England, RNA, Viral, Oral fluid, Female, Contact Tracing, business, Demography
Abstract: Background Following the full re-opening of schools in England and emergence of the SARS-CoV-2 Alpha variant, we investigated the risk of SARS-CoV-2 infection in students and staff who were contacts of a confirmed case in a school bubble (school groupings with limited interactions), along with their household members. Methods Primary and secondary school bubbles were recruited into sKIDsBUBBLE after being sent home to self-isolate following a confirmed case of COVID-19 in the bubble. Bubble participants and their household members were sent home-testing kits comprising nasal swabs for RT-PCR testing and whole genome sequencing, and oral fluid swabs for SARS-CoV-2 antibodies. Results During November-December 2020, 14 bubbles were recruited from 7 schools, including 269 bubble contacts (248 students, 21 staff) and 823 household contacts (524 adults, 299 children). The secondary attack rate was 10.0% (6/60) in primary and 3.9% (4/102) in secondary school students, compared to 6.3% (1/16) and 0% (0/1) among staff, respectively. The incidence rate for household contacts of primary school students was 6.6% (12/183) and 3.7% (1/27) for household contacts of primary school staff. In secondary schools, this was 3.5% (11/317) and 0% (0/1), respectively. Household contacts were more likely to test positive if their bubble contact tested positive although there were new infections among household contacts of uninfected bubble contacts. Interpretation Compared to other institutional settings, the overall risk of secondary infection in school bubbles and their household contacts was low. Our findings are important for developing evidence-based infection prevention guidelines for educational settings.
Published: 2022

38. GLOBAL RETROSPECTIVE ANALYSIS OF PATHOLOGICAL FINDINGS IN ZOO-MANAGED GOELDI'S MONKEYS (

Author: Jenna, Epstein, Jennifer N, Langan, Mark R, Warneke, Matthew C, Allender, and Michael J, Kinsel
Subjects: Europe, Male, Longevity, North America, Animals, Female, Callimico, Retrospective Studies
Abstract: As part of the collaborative efforts and goals of managing zoo-housed Goeldi's monkeys, or callimicos (
Published: 2022

39. Differences in Muscle Quantity and Quality by HIV Serostatus and Sex

Author: K.M. Erlandson, S. Langan, J.E. Lake, J. Sun, A. Sharma, S. Adrian, A. Scherzinger, F. Palella, L. Kingsley, S.J. Gange, P.C. Tien, M.T. Yin, and T.T. Brown
Subjects: Cohort Studies, Male, Aging, Thigh, Humans, Female, HIV Infections, General Medicine, Muscle, Skeletal, Article, Aged
Abstract: OBJECTIVE: People aging with HIV (PWH) experience greater declines in both muscle function and muscle mass with aging. Whether changes in muscle quality and quantity with aging differ between men and women with HIV and the implications on muscle function are not established. DESIGN: In coordinated substudies of the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study, participants completed physical function and falls assessments; total trunk/thigh density, inversely related to fatty infiltration, and area were quantified from computed tomography (CT) scans. METHODS: Generalized linear models were used to explore variables affecting density/area, and associations between area/density and physical function and falls. RESULTS: CT scans were available on 387 men (198 PWH) and 184 women (118 PWH). HIV serostatus was associated with greater lateralis, paraspinal, and hamstring area, but lower psoas area and density. Older age and female sex were associated with smaller trunk muscle area and lower density. Both lower muscle area and muscle density were associated with several measures of impaired physical function. The odds of falling were lower with greater hamstring density, but not associated with other measurers of muscle area or density. CONCLUSIONS: In summary, older adults with HIV appear to have smaller and less dense (fattier) psoas, a key component in truncal stability and hip flexion that could have implications on physical function. The longitudinal associations of muscle area and density with physical function require careful investigation, with a particular focus on characteristics and interventions that can preserve muscle area, density, and function over time.
Published: 2022

40. Complications associated with total hip arthroplasty in four large nondomestic felids

Author: Lauren P. Kane, James L. Cook, Kate E. Archibald, W. Kirk Suedmeyer, Jennifer N. Langan, and Michael J. Adkesson
Subjects: Male, Fractures, Bone, Treatment Outcome, General Veterinary, Arthroplasty, Replacement, Hip, Animals, Female, Hip Joint, General Medicine, Tigers, Retrospective Studies
Abstract: CASE DESCRIPTION A 9-year-old 37-kg sexually intact male snow leopard (Panthera uncia) with no history of lameness but radiographic evidence of right femoral subluxation and flattening of both femoral heads, 2 juvenile (< 1 year old) 25-kg sexually intact male cheetahs (Acinoynx jubatus) with unilateral hind limb lameness resulting from trauma, and an 11-year-old 110-kg sexually intact female Amur tiger (Panthera tigris altaica) with a 2-year history of left hip joint osteoarthritis were examined. CLINICAL FINDINGS No clinically relevant clinical findings other than hip joint problems were identified. All 4 felids underwent staged bilateral (snow leopard) or unilateral (cheetahs and tiger [Panthera tigris]) total hip arthroplasty (THA). TREATMENT AND OUTCOME In the snow leopard, both femoral THA components were found to be luxated 1 year after surgery. Treatment consisted of autogenous corticocancellous rib graft augmentation of the dorsal acetabular rims and synthetic suture capsulorrhaphies. The snow leopard lived for an additional 4 years with no additional THA-related complications. In the other 3 animals, catastrophic complications (luxation in the cheetahs and femoral fracture in the tiger) occurred shortly after THA. The THA implants were removed, and excision arthroplasty was performed. Long-term outcomes were good in all 3. CLINICAL RELEVANCE Findings underscore the challenges associated with THA in large nondomestic felids. Given the high risk for early catastrophic failure as a result of luxation or fracture, plans must be made and resources must be available in case revision surgery or implant removal with excision arthroplasty becomes necessary.
Published: 2021

41. Primary THA Using Thin Polyethylene Liners and Large Femoral Heads: A Minimum 5-Year Follow-Up

Author: Dallas S. Hagman, Austin F. Smith, Terry L. Presley, Langan S. Smith, Madhusudhan R. Yakkanti, Matthew R. Price, and Arthur L. Malkani
Subjects: Male, Arthroplasty, Replacement, Hip, Femur Head, Osteolysis, Prosthesis Design, Prosthesis Failure, Polyethylene, Humans, Orthopedics and Sports Medicine, Female, Hip Prosthesis, Aged, Follow-Up Studies, Retrospective Studies
Abstract: Large femoral head sizes are commonly used in total hip arthroplasty (THA) to minimize the risk of instability. With small acetabular cup-size, large femoral head diameter often results in the use of thin polyethylene liners. The purpose of this study was to evaluate clinical and radiographic results of large femoral heads against thin polyethylene liners with minimum 5-year follow-up.This was a retrospective review identifying 58 primary THAs utilizing thin polyethylene inserts from one manufacturer (X3 polyethylene, Stryker, Mahwah, NJ) and large femoral heads (36 mm or greater) with minimum 5-year follow-up. A total of 3 patients were deceased and 11 lost to follow-up, leaving 44 patients for review. All patients were female with mean age 65.7 (range 26-85) and mean body mass index (BMI) 29.9 (range 19.6-45.4). Average length of follow-up was 8.5 years (range 5.1-11.3). Outcome measures included survivorship, complications, PROMs and radiographic analysis.There were four revisions: two aseptic loosening, one prosthetic joint infection, and one recurrent dislocation. Average HOOS-Jr, FJS-12, and patient satisfaction using Likert score was 94.3/100, 92.9/100, and 4.69/5.00, respectively, with 94% of patients reporting being satisfied or very satisfied. Radiographic analysis at average of 8.5 years demonstrated well-fixed implants without evidence of progressive radiolucent lines, osteolysis, or failure of the polyethylene liner. Survivorship using failure of the thin polyethylene liner as the endpoint was 100% at an average of 8.5 years.Thin polyethylene liners used with large femoral head sizes in small acetabular cups demonstrated excellent results at average 8.5-year follow-up with no cases of liner fracture or osteolysis.
Published: 2021

42. Immunization with desmoglein 3 induces non-pathogenic autoantibodies in mice

Author: Ralf Ludwig, Sabrina Patzelt, Christoph Hudemann, Rüdiger Eming, Christoph M. Hammers, Katja Bieber, Sören Dräger, Detlef Zillikens, Katharina Boch, Ewan A. Langan, and Enno Schmidt
Subjects: Male, B Cells, Physiology, Toxicology, Pathology and Laboratory Medicine, Biochemistry, White Blood Cells, Mice, Animal Cells, Immune Physiology, Medicine and Health Sciences, Toxins, Enzyme-Linked Immunoassays, Fluorescent Antibody Technique, Indirect, education.field_of_study, Multidisciplinary, Immune System Proteins, biology, Desmoglein 3, Animal Models, Exfoliatins, Experimental Organism Systems, Research Design, Fluorescent Antibody Technique, Direct, Medicine, Female, Antibody, Cellular Types, Research Article, Clinical Research Design, Science, Immune Cells, Immunology, Toxic Agents, chemical and pharmacologic phenomena, Mouse Models, Enzyme-Linked Immunosorbent Assay, Research and Analysis Methods, Desmoglein, Antibodies, Model Organisms, Antigen, medicine, Animals, education, Immunoassays, Antibody-Producing Cells, Immunohistochemistry Techniques, Autoantibodies, Blood Cells, business.industry, Pemphigus vulgaris, Autoantibody, Biology and Life Sciences, Proteins, Cell Biology, medicine.disease, Histochemistry and Cytochemistry Techniques, Mice, Inbred C57BL, Immunization, biology.protein, Animal Studies, Immunologic Techniques, Adverse Events, business, Pemphigus, Conformational epitope
Abstract: Background Pemphigus vulgaris (PV) is a rare autoimmune blistering disease characterized by the development of autoantibodies targeting desmoglein (Dsg) 3, but also against Dsg1 in mucocutaneous disease. Given that existing PV animal models only recapitulate aspects of the disease, we aimed to establish a more comprehensive disease model based on the immunization of mice with PV autoantigen(s). Methods The following immunization strategies were tested: (i) C57Bl/6J, B6.SJL-H2s C3c/1CyJ, DBA2/J, or SJL/J mice were immunized with recombinant murine Dsg3 (mDsg3), (ii) DBA2/J and SJL/J mice were immunized with mDsg3 and additionally injected a single non-blister inducing dose of exfoliative toxin A (ETA), and (iii) DBA2/J and SJL/J mice were immunized with human Dsg (hDsg) 1 and 3. Results Despite the induction of autoantibodies in each immunization protocol, the mice did not develop a clinical phenotype. Tissue-bound autoantibodies were not detected in the skin or mucosa. Circulating autoantibodies did not bind to the native antigen in indirect immunofluorescence microscopy using monkey esophagus as a substrate. Conclusion Immunization with PV autoantigens induced non-pathogenic Dsg1/3 antibodies, but did not cause skin/mucous membrane disease in mice. These findings, confirmed by failure of binding of the induced autoantibodies to their target in the skin, suggest that the autoantibodies which were formed were unable to bind to the conformational epitope present in vivo.
Published: 2021

43. Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study

Author: Silvia Pérez-Barrio, Lucy Moorhead, Manpreet Lakhan, Saskia Reeken, Vito Zeeshaan Hasab, Rogelio Mercado-Seda, Gustavo Anibal Cardozo, Georgi Popov, Enrique Loayza, Marie-Louise Svensson, Emmanuel Mahe, Fernando Valenzuela, Victoria King, Michela Magnano, Danielle Brassard, Annette Essex, Deanna Cummings, Manisha Panchal, Trupti V. Desai, Jennifer E. Carolan, Areti Makrygeorgou, Zenas Z N Yiu, Teena Mackenzie, Esteban Daudén, Emmanuel Toni, Ian Pearson, Andrea Carugno, Lorraine Gribben, Leontien de Graaf, Liv Eidsmo, Esther A. Balogh, Gloria Aparicio, Andrew Pink, Manel Velasco, Adrienne J. van Geest, Steven R. Feldman, Tiago Torres, Elzbieta Klujszo, Malcolm H.A. Rustin, Ignacio Yanguas, Anthony Bewley, Eliseo Martínez-García, Benhadou Farida, Emily Dwyer, Susannah Hoey, Richard B. Warren, Esther E. Freeman, Diana Ruiz Genao, Rohima Khatun, Giulia Rech, Elena B. Hawryluk, Zahira Koreja, Ricardo Romiti, Gonzalez A. Cesar, Alice Mwale, Charlotte Barclay, Aadarsh Shah, Catherine Quinlan, Kathryn G. Kerisit, Christopher E.M. Griffiths, Carla Tubau Prims, Lone Skov, Céline Phan, Vincent Descamps, Jenny Hughes, Siew Eng Choon, Shanti Ayob, Efrossini Carras, Girard Celine, Jo Lambert, Alberto Barea, Jonathan Barker, Reinhart Speeckaert, Raquel Rivera, Portia Goldsmith, Nick Dand, Beatriz Pérez-Suárez, Andrew DeCrescenzo, F. Meynell, Francesca Capon, Toomas Talme, Teresa Tsakok, Deepti Kolli, Stefano Piaserico, Jamie Weisman, Manuel D. Franco, K.J. Mason, Pablo De Caso, Catriona Maybury, Rachel Bak, Ann Sergeant, Keith Wu, Graham A. Johnston, Alexandra Paolino, Cécile Lesort, Mark Vandaele, H. McAteer, Birgitta Wilson Claréus, Sinead Langan, Jose-Manuel Carrascosa, Enikö Sonkoly, Claudia de la Cruz, Maruska Marovt, Luigi Naldi, Leila Asfour, Paola Di Meglio, Jose-Maria Ortiz-Salvador, Alekya Singapore, Peter Jenkin, Romana Ceovic, R. Taberner, P.J. Hampton, Alberto Romero-Maté, Russell W. Cohen, Omid Zargari, Maria Teresa Rossi, Devon E. McMahon, Denis Jullien, Bola Coker, Carrie Davis, Georgie King, Catherine H. Smith, Richard Woolf, Luis Puig, Ann Jones, Astrid van Huizen, Joseph J. Schwartz, Paolo Gisondi, Phyllis I. Spuls, Satveer K. Mahil, Sarah Kirk, Paulo Varela, K. Jackson, Ana Maria Morales Callaghan, Vito Di Lernia, Lieve Meuleman, Claudio Greco, Simina Stefanescu, Hervé Bachelez, Ana Martinez, Dermatology, AII - Inflammatory diseases, APH - Methodology, APH - Quality of Care, Mahil, S, Dand, N, Mason, K, Yiu, Z, Tsakok, T, Meynell, F, Coker, B, Mcateer, H, Moorhead, L, Mackenzie, T, Rossi, M, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, E, Feldman, S, De La Cruz, C, Choon, S, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, Mcmahon, D, Freeman, E, Gisondi, P, Puig, L, Warren, R, Di Meglio, P, Langan, S, Capon, F, Griffiths, C, Barker, J, Smith, C, Shah, A, Barea, A, Romero-Mate, A, Singapore, A, Paolino, A, Mwale, A, Morales Callaghan, A, Martinez, A, Decrescenzo, A, Pink, A, Jones, A, Sergeant, A, Essex, A, Bewley, A, Makrygeorgou, A, van Huizen, A, Perez-Suarez, B, Farida, B, Clareus, B, Prims, C, Davis, C, Quinlan, C, Maybury, C, Cesar, G, Barclay, C, Greco, C, Brassard, D, Cummings, D, Kolli, D, Descamps, V, Genao, D, Carras, E, Hawryluk, E, Martinez-Garcia, E, Klujszo, E, Dwyer, E, Toni, E, Sonkoly, E, Loayza, E, Dauden, E, Valenzuela, F, Popov, G, King, G, Celine, G, Aparicio, G, Johnston, G, Cardozo, G, Pearson, I, Yanguas, I, Weisman, J, Carolan, J, Hughes, J, Ortiz-Salvador, J, Carrascosa, J, Schwartz, J, Jackson, K, Kerisit, K, Wu, K, Asfour, L, de Graaf, L, Lesort, C, Meuleman, L, Eidsmo, L, Skov, L, Gribben, L, Rustin, M, Velasco, M, Panchal, M, Lakhan, M, Franco, M, Svensson, M, Vandaele, M, Marovt, M, Zargari, O, De Caso, P, Varela, P, Jenkin, P, Phan, C, Hampton, P, Goldsmith, P, Bak, R, Speeckaert, R, Romiti, R, Woolf, R, Mercado-Seda, R, Khatun, R, Ceovic, R, Taberner, R, Cohen, R, Stefanescu, S, Kirk, S, Reeken, S, Ayob, S, Perez-Barrio, S, Piaserico, S, Hoey, S, Torres, T, Talme, T, Desai, T, van Geest, A, King, V, Di Lernia, V, Koreja, Z, and Hasab, V
Subjects: Male, IMID, immune-mediated inflammatory disease, immunosuppressant, BMI, body mass index, ACEi, angiotensin-converting enzyme inhibitor, PsoProtect, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion, Logistic regression, Systemic therapy, 030207 dermatology & venereal diseases, 0302 clinical medicine, RC705, Interquartile range, COVID-19, biologics, hospitalization, immunosuppressants, psoriasis, risk factors, Risk Factors, Epidemiology, Immunology and Allergy, 030212 general & internal medicine, Registries, NSAID, non-steroidal anti-inflammatory drug, 610 Medicine & health, COVID-19, Coronavirus disease 2019, TNF, tumor necrosis factor, Age Factors, Middle Aged, Hospitalization, risk factor, 95% CI, 95% confidence interval, Female, JAK, Janus kinase, biologic, Adult, medicine.medical_specialty, Immunology, Lower risk, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, 03 medical and health sciences, Sex Factors, Internal medicine, Psoriasis, medicine, Humans, SARS-CoV-2, IFN, interferon, IQR, interquartile range, psoriasi, business.industry, Odds ratio, medicine.disease, ARB, angiotensin II receptor blocker, IL, interleukin, OR, odds ratio, business, Body mass index
Abstract: Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies., Capsule summary: In this global registry-based study, risk factors for COVID-19-related hospitalization in psoriasis patients were older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic treatment.
Published: 2021
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44. The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

Author: M. Ye, Katrina Abuabara, Alexa Magyari, David J. Margolis, Sinead Langan, Charles E. McCulloch, Noor A. Al-Alusi, Leslie N. Chan, and Yon, Dong Keon
Subjects: Male, Pediatrics, Aging, Epidemiology, Health Care Providers, Eczema, Prevalence, Dermatitis, Atopic Dermatitis, Disease, Severity of Illness Index, 030207 dermatology & venereal diseases, Medical Conditions, Elderly, 0302 clinical medicine, Allergies, 80 and over, Medicine and Health Sciences, Medical Personnel, 030212 general & internal medicine, Aetiology, Child, Aged, 80 and over, Pediatric, education.field_of_study, Multidisciplinary, Allergic Diseases, Age Factors, Atopic dermatitis, Middle Aged, 3. Good health, Professions, Child, Preschool, Cohort, Medicine, Female, Diagnosis code, Research Article, Cohort study, Adult, medicine.medical_specialty, Adolescent, General Science & Technology, Science, Immunology, Population, Dermatology, Rashes, Skin Diseases, Atopic, Dermatitis, Atopic, Young Adult, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Clinical Research, Physicians, medicine, Humans, Adults, Preschool, education, Aged, business.industry, Infant, Newborn, Infant, Biology and Life Sciences, Newborn, medicine.disease, United Kingdom, Health Care, body regions, Logistic Models, Age Groups, Multivariate Analysis, People and Places, Clinical Immunology, Population Groupings, Clinical Medicine, business, 2.4 Surveillance and distribution
Abstract: Background Atopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults. Objective To evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort. Methods This was a cohort study of 9,154,936 individuals aged 0–99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0–17 years), adults (18–74 years), and older adults (75–99 years). Results Physician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70–0.76) and was more likely to be active (59.7%, 95% CI 59.5–59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups. Conclusion In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0–17 and adults ages 18–74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.
Published: 2021

45. Retrospective analysis of the clinical characteristics and patient-reported outcomes in vulval lichen planus: Results from a single-center study

Author: Ewan A. Langan, Khalaf Kridin, Detlef Zillikens, Ralf Ludwig, and Katharina Boch
Subjects: medicine.medical_specialty, Erythema, business.industry, Lichen Planus, Hydroxychloroquine, Clitoris, Dermatology, General Medicine, Dermatology Life Quality Index, Single Center, Acitretin, Vulva, medicine.anatomical_structure, Quality of life, Labia minora, medicine, Quality of Life, Humans, Female, Patient Reported Outcome Measures, medicine.symptom, business, medicine.drug, Retrospective Studies
Abstract: Vulval lichen planus (VLP) is a rare, but often chronic, inflammatory disease whose symptoms include genital pain, discomfort, and dyspareunia. The clinical manifestations include erythema, erosions, and scarring. The aim of this study was to longitudinally investigate patient-reported outcomes and clinical findings in patients with VLP. Patients (>18 years) with histologically confirmed VLP were included in the retrospective analysis. Patient demographics, clinical features, symptomatology, quality of life, management, clinical outcomes, and comorbidities associated with VLP were analyzed. Twenty-four patients were identified with a mean (standard deviation [SD]) follow-up time of 19.3 (13.8) months. Classical VLP with glazed erythema was found in seven (29.2%) patients, erosive VLP was present in 15 (62.5%) patients, and hypertrophic VLP in two (8.3%). Seven patients had additional cutaneous involvement, while six patients had both vulval and oral mucosal involvement. The labia minora was the most frequently affected anatomical site (83.3%), followed by the clitoris (58.3%). Scarring lesions were found in 62.5% (n = 15) of patients. All study participants received treatment with potent and/or superpotent topical corticosteroids but 50% required systemic therapy (acitretin, corticosteroids, or hydroxychloroquine). Five (20.8%) patients underwent surgery due to adhesions and scarring resulting from VLP. One patient was diagnosed with a vulval squamous cell carcinoma during long-term follow-up. The mean (SD) Dermatology Life Quality Index score was 8.4 (5.5) at presentation and 8.9 (6.8) at the end of follow-up. In conclusion, VLP was associated with moderate quality of life impairments which persisted despite treatment, suggesting that current treatments for VLP are inadequate.
Published: 2021

46. Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Author: Sinead Langan, Charles E. McCulloch, Katrina Abuabara, David J. Margolis, Hywel C Williams, M. Ye, Amy Mulick, Alice Sullivan, and Richard J. Silverwood
Subjects: Adult, Male, Population, Clinical Sciences, Oncology and Carcinogenesis, Prevalence, Eczema, Dermatitis, Dermatology, Atopic, Article, Dermatitis, Atopic, Cohort Studies, Clinical Research, 2.3 Psychological, Risk Factors, medicine, Genetics, 2.2 Factors relating to the physical environment, Humans, Aetiology, education, Asthma, 1970 British Cohort Study, Pediatric, education.field_of_study, business.industry, Prevention, Infant, Newborn, Infant, Odds ratio, Atopic dermatitis, medicine.disease, Newborn, Good Health and Well Being, Birth Cohort, Female, Age of onset, social and economic factors, business, Demography, Cohort study
Abstract: Importance Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. Objective This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. Design, Setting, and Participants This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020. Main Outcomes and Measures Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health. Results Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife. Conclusions and Relevance The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.
Published: 2021

47. Adverse outcomes after partner bereavement in people with reduced kidney function:Parallel cohort studies in England and Denmark

Author: Angel Y S Wong, Sigrún Alba Jóhannesdóttir Schmidt, Christian Fynbo Christiansen, Sinead Langan, Søren Viborg Vestergaard, Susan Lyon, Anders Kjærsgaard, Admire Hlupeni, Patrick Bidulka, and Dorothea Nitsch
Subjects: Male, Epidemiology, Denmark, Myocardial Infarction, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Kidney, Kidney Function Tests, Geographical locations, 0302 clinical medicine, Medical Conditions, Chronic Kidney Disease, Medicine and Health Sciences, 030212 general & internal medicine, Aged, 80 and over, education.field_of_study, Multidisciplinary, Acute kidney injury, Acute Kidney Injury, 3. Good health, Europe, Hospitalization, Treatment Outcome, England, Nephrology, Cardiovascular Diseases, language, Medicine, Female, Anatomy, Cohort study, Research Article, Glomerular Filtration Rate, medicine.medical_specialty, Science, Population, Cardiology, Renal function, Sensitivity and Specificity, Danish, 03 medical and health sciences, medicine, Renal Diseases, Humans, European Union, Medical prescription, education, Adverse effect, Aged, Heart Failure, business.industry, Biology and Life Sciences, Kidneys, Renal System, medicine.disease, language.human_language, United Kingdom, Medical Risk Factors, Case-Control Studies, Emergency medicine, People and places, business, Kidney disease, Bereavement
Abstract: Objectives To investigate whether partner bereavement is associated with adverse cardiovascular and kidney-related events in people with reduced kidney function. Design Two parallel matched cohort studies using linked routinely collected health data. Setting England (general practices and hospitals using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics) and Denmark (hospitals and community pharmacies using the Danish National Patient, Prescription and Education Registries and the Civil Registration System). Participants Bereaved people with reduced kidney function (estimated glomerular filtration rate (eGFR) 2 (England) or hospital-coded chronic kidney disease (Denmark)) and non-bereaved people with reduced kidney function similarly defined, matched on age, sex, general practice (England), and county of residence (Denmark) and followed-up from the bereavement date of the exposed person. Main outcome measures Cardiovascular disease (CVD) or acute kidney injury (AKI) hospitalization, or death. Results In people with reduced kidney function, we identified 19,820 (England) and 5,408 (Denmark) bereaved individuals and matched them with 134,828 (England) and 35,741 (Denmark) non-bereaved individuals. Among the bereaved, the rates of hospitalizations (per 1000 person-years) with CVD were 31.7 (95%-CI: 30.5–32.9) in England and 78.8 (95%-CI: 74.9–82.9) in Denmark; the rates of hospitalizations with AKI were 13.2 (95%-CI: 12.5–14.0) in England and 11.2 (95%-CI: 9.9–12.7) in Denmark; and the rates of death were 70.2 (95%-CI: 68.5–72.0) in England and 126.4 (95%-CI: 121.8–131.1) in Denmark. After adjusting for confounders, we found increased rates of CVD (England, HR 1.06 [95%-CI: 1.01–1.12]; Denmark, HR 1.10 [95%-CI: 1.04–1.17]), of AKI (England, HR 1.20 [95%-CI: 1.10–1.31]; Denmark HR 1.36 [95%-CI: 1.17–1.58]), and of death (England, HR 1.10 [95%-CI: 1.05–1.14]; Denmark HR 1.20 [95%-CI: 1.15–1.25]) in bereaved compared with non-bereaved people. Conclusions Partner bereavement is associated with an increased rate of CVD and AKI hospitalization, and death in people with reduced kidney function. Additional supportive care for this at-risk population may help prevent serious adverse events.
Published: 2021
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48. Isolated Patellofemoral Joint Arthroplasty: Can Preoperative Bone Scans Predict Survivorship?

Author: Thomas J. Schlierf, David N.M. Caborn, Langan S. Smith, Trevor B. Fain, James F. Baker, and Arthur L. Malkani
Subjects: Male, Knee arthritis, medicine.medical_specialty, medicine.medical_treatment, Population, Arthritis, Survivorship, Osteoarthritis, Patellofemoral Joint, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, education, Retrospective Studies, 030222 orthopedics, education.field_of_study, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Middle Aged, Osteoarthritis, Knee, medicine.disease, Arthroplasty, Treatment Outcome, Orthopedic surgery, Female, Radiology, Range of motion, business
Abstract: Background Isolated patellofemoral joint arthritis has been identified in 10% of the population presenting with symptomatic knee osteoarthritis. Patient selection is important in order to improve survivorship following PF arthroplasty. The purpose of this study is to compare the use of a preoperative bone scan vs a magnetic resonance imaging (MRI) to identify the patient with isolated PF arthritis. Methods This is a retrospective review of 32 patients undergoing isolated PF arthroplasty for PF arthritis using the same implant design. Sixteen consecutive patients received a preoperative bone scan to confirm isolated PF arthritis. These patients were matched by age and gender to patients where an MRI was used to determine isolated PF arthritis. The bone scan cohort contained 13 females and three males with an average age of 48 years and average follow-up of 52 months. There was no significant difference in age, body mass index, follow-up, or preoperative range of motion between the groups. The MRI and bone scan results were reported by a radiologist specializing in orthopedic radiology. Results Survivorship was 100% in the PF arthroplasty group selected using a preoperative bone scan. Revision surgery with conversion to TKA was required in 5 of 16 patients (31%) when an MRI was used to identify isolated PF arthritis. Revision in all patients in the MRI group was due to progression of knee arthritis in the tibial-femoral joint. There were no cases of implant-related failures. Conclusion Patellofemoral arthroplasty using a modern design implant demonstrated 100% survivorship when a preoperative bone scan was used for patient selection to confirm isolated PF arthritis. In the group where only an MRI was used, there was a 31% failure due to progression of the disease. Based on this study, we would recommend the use of a bone scan as a tool in the selection criteria for patients undergoing PF arthroplasty.
Published: 2020
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49. Disparities in Follow-Up After Low-Dose Lung Cancer Screening

Author: Dusty Turner, Amber L. Turner, Andrew B. Nguyen, Joanna Sesti, Timothy J. Sikora, Russell C. Langan, and Subroto Paul
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, 030204 cardiovascular system & hematology, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Mass Screening, Lung cancer, Early Detection of Cancer, Smokers, business.industry, Smoking, Low dose, General Medicine, medicine.disease, Former Smoker, 030228 respiratory system, Cohort, Marital status, Female, Surgery, Smoking status, Cardiology and Cardiovascular Medicine, business, Lung cancer screening, Follow-Up Studies
Abstract: The National Lung Cancer Screening Trial (NLST) demonstrated an improvement in overall survival with lung cancer screening. Achieving follow-up for a positive screen is essential to impact early intervention for lung cancer. The objective of this study was to determine predictors of follow-up after a positive lung cancer screening test. The NLST database was queried for participants with a positive lung cancer screening exam. This cohort was then subdivided into patients who had follow-up and those who did not. Pairwise comparison was performed within different subgroups. A logistic regression model was then utilized to identify predictive factors associated with follow-up. Of the 53,454 patients who participated in the study, we identified 14,000 patients who had a positive lung cancer screening test. Of those patients, 12,503 followed up appropriately (89.3%). Women had a statistically higher follow-up rate compared to men (90% vs 88.8%, P ≤ 0.05). Patients reported as married or living as married also showed a higher rate of follow-up compared to patients reported as never married, divorced, separated, or widowed (90.2% vs 87.5%, P ≤ 0.05). The rate of follow-up among African-American patients was 82.8%, while those in white patients was 89.6%, this was statistically significant (P ≤ 0.05). Education level was not a significant factor in follow-up rates. Current smokers followed up at lower rates compared to former smokers (87.9 % vs 90.6%, P ≤ 0.05). Logistic regression determined gender, marital status, race, and smoking status to be predictors of follow-up. Follow-up rates after a positive lung cancer screening test were associated with a patient's gender, marital status, race, and smoking status.
Published: 2020
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50. Talectomy as Part of Chronic Foot and Ankle Deformity Correction Procedure: A Retrospective Study

Author: Trapper Lalli, Clair N. Smith, Travis M. Langan, and Dane K. Wukich
Subjects: Adult, Foot Deformities, Male, medicine.medical_specialty, medicine.medical_treatment, Arthrodesis, Talus, Young Adult, 03 medical and health sciences, symbols.namesake, Postoperative Complications, 0302 clinical medicine, Quality of life, Deformity, medicine, Humans, Orthopedics and Sports Medicine, Fisher's exact test, Aged, Retrospective Studies, 030222 orthopedics, business.industry, Retrospective cohort study, Recovery of Function, 030229 sport sciences, Middle Aged, Surgery, Treatment Outcome, medicine.anatomical_structure, Amputation, symbols, Female, medicine.symptom, Ankle, Complication, business, Ankle Joint, Foot (unit)
Abstract: Severe foot and ankle deformities can be associated with high complication rates and impaired quality of life in patients. Surgical correction using a talectomy procedure has previously been described in many lower extremity pathologies and is a powerful tool for the correction of severe foot and ankle deformity. This study aimed to describe the role of talectomy and the outcomes of this procedure in patients presenting with severe foot and ankle deformity. A review of 45 patients undergoing talectomy by a single surgeon was completed. Data extracted included the cause of deformity, history of infection, body mass index, and relevant comorbidities. Outcome measures of interest were minor or major complications and limb functionality at final follow-up. Statistical analysis was performed by using a Wilcoxon rank sum test and a Fisher exact test looking at variables affecting selected outcome measures. Limb salvage occurred in 38 of 45 patients (84.4%). Patients with an infection history had 89% lower odds of a functional limb at final follow-up (p = .0389). Six of 7 patients (85.7%) who ultimately underwent amputation had a history of prior infection. Women had 8.25 times higher odds of having a functional limb compared with men (p = .047). All 13 patients with major complications had neuropathy (p = .024). Patients with chronic lower extremity deformities can successfully be treated with a talectomy as a part of the reconstructive procedure. This is a challenging patient population that is associated with a high complication rate. Patients with a history of infection should be counseled on the possibility of requiring major amputation.
Published: 2020
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