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120. Watermarking of Space Curves using Wavelet Decomposition.

Author

Motwani, R. C., Motwani, M. C., and Harris Jr., F. C.

Subjects
DIGITAL image watermarking, THREE-dimensional imaging, CURVES, COMPUTER systems
Abstract

This paper describes an imperceptible, non-blind, fragile watermarking technique for space curves. The proposed technique employs a wavelet-based approach, and computes a multi-resolution representation of the space curve to embed a watermark so that it has widespread presence in the curve. Watermarks that are widely spread within the host data cannot be easily damaged by cropping and replacement attacks that result in localized alteration of the host data. A variety of wavelet families are exploited and experimental results provide a comparison of the performance of different wavelets in terms of the watermark's imperceptibility and tolerance to attacks. To quantify space curve distortion, a signal-to-noise ratio is used, and a linear correlation measure is employed to determine the resistance of the watermark to modifications. Results indicate that watermark insertion using wavelet packet decomposition outperforms orthogonal wavelet decomposition in terms of imperceptibility and diversified presence of the embedded watermark. [ABSTRACT FROM AUTHOR]

Published
2011

121. Pulmonary edema in severe pre-eclampsia (a case report)

Author

Motwani M, Shah S, and Mehta A

Subjects
Adult, complications, Pre-Eclampsia, Pregnancy, etiology, Chronic Disease, Hypertension, lcsh:R, lcsh:Medicine, Case Report, Female, Pulmonary Edema, Human
Published
1989

135. OC-049 Exaggerated acute inflammation in ulcerative colitis, and promotion of its resolution by 5-aminosalicylates through anti-inflammatory hydroxy fatty acid biosynthesis

Author

Marks, DJ, Wysoczanski, R, Kendall, AC, Motwani, M, Vega, R, Rahman, FZ, McCartney, S, Bloom, SL, Nicolaou, A, Gilroy, DW, and Segal, AW

Abstract

IntroductionAcute inflammation in ulcerative colitis (UC) is protracted. Using an in vivobacterial challenge model, we characterised the cellular and molecular determinants and consequences of the early inflammatory response in UC, and the functional impacts of 5-ASA on this process.MethodAcute inflammation was provoked in 23 healthy controls (HC) and 26 UC patients off treatment or on 5-ASAs, by intradermal injection with killed E. colior S. pneumoniae. Local vascular reactions were quantified by laser Doppler. Early and resolving inflammatory exudates were sampled by raising suction blisters over inoculation sites after 4 hour or 48 hour. Cells were characterised by polychromatic flow cytometry; cytokines by multiplex array; and lipid mediators by mass spectrometry. In vivofindings were confirmed by in vitrostimulation of cultured peripheral blood-derived macrophages with killed E. coli.ResultsUC patients had enhanced local blood flow within 24 hour of bacterial exposure, and impaired inflammation resolution, to both Gram-negative and Gram-positive bacteria (p=0.01). Neutrophil accumulation (p=0.04) and PGE2production (p=0.02) were increased within 4 hour, and were not cytokine-driven phenomena. At 48 hour, UC patients had persistent neutrophils (p=0.001) and T lymphocytes (p=0.03). Findings were replicated in cultured macrophages, which also exhibited higher COX-1 up-regulation, supporting the primary impact of these abnormalities. Exaggerated onset was normalised in patients taking 5-ASAs, although these individuals had greater numbers of macrophages at 48 hour (p=0.03). This was accompanied by increased concentrations of the hydroxy fatty acids 9-oxo-octadecadienoic acid (OxoODE) and 13-OxoODE. To characterise their effects, macrophages were co-incubated with E. coliand these mediators. Both led to dose-dependent suppression of TNF-α (p=0.0001 and p=0.01, respectively), at concentrations reflective of those in vivo. These effects were completely reversed by GW9662, a PPARγ antagonist (p=0.006). The in vivoprofile of lipid mediators in HC treated with 5-ASAs differed from UC, with subtle differences in resolving inflammatory cellular and cytokine constituents; this has important implications for understanding generation of these hydroxy fatty acids in vivo.ConclusionAcute inflammation in UC is exaggerated and slow to resolve, associated with perturbed production of inflammatory lipid mediators. 5-ASAs normalise this reaction, partly through generation of hydroxy fatty acids that act through the PPAR-γ receptor.Disclosure of InterestNone Declared

Published
2017
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137. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

Author

Andrew J. Einstein, Cole Hirschfeld, Michelle C. Williams, Joao V. Vitola, Nathan Better, Todd C. Villines, Rodrigo Cerci, Leslee J. Shaw, Andrew D. Choi, Sharmila Dorbala, Ganesan Karthikeyan, Bin Lu, Valentin Sinitsyn, Alexey A. Ansheles, Takashi Kudo, Chiara Bucciarelli-Ducci, Bjarne Linde Nørgaard, Pál Maurovich-Horvat, Roxana Campisi, Elisa Milan, Lizette Louw, Adel H. Allam, Mona Bhatia, Lorenzo Sewanan, Eli Malkovskiy, Yosef Cohen, Michael Randazzo, Jagat Narula, Olga Morozova, Thomas N.B. Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Gerd Hinterleitner, Yao Lu, Zhuoran Xu, Cole B. Hirschfeld, Ikenna Erinne, Mrinali Shetty, Andrew Choi, Juan Lopez-Mattei, Purvi Parwani, Artan Goda, Ervina Shirka, Salah Bouyoucef, Lydia Chelghoum, Farouk Mansouri, Abdelkader Medjahedi, Qais Naili, Mokhtar Ridouh, Diego Alasia, Lucia Alberghina, Natalia Aramayo, Diego Buchara, Franco Gabriel Busso, Jose Javier Bustos Rivadero, Jorge Camilletti, Hugo Campanelli, Ricardo Belisario Castro, Mariana Daicz, Horacio del Riego, Laura Dragonetti, Diego Echazarreta, Juan Erriest, Fernando Faccio, Adolfo Facello, Hugo Gallegos, Ricardo Geronazzo, Horacio Glait, Victor Hasbani, Victor Jäger, Julio Manuel Lewkowicz, Jose Lotti, Neiva Maciel, Osvaldo Masoli, Edgardo Mastrovito, Maria Medus, Maria Fernanda Merani, Susana Molteni, Marcos Montecinos, Gustavo Parisi, Claudio Pereyra Sueldo, Diego Perez de Arenaza, Luis Quintana, Alejandro Radzinschi, Marcela Redruello, Marina Rodríguez, Horacio Rojas, Arturo Romero Acuña, Daniel Schere, Sonia Traverso, Gustavo Vazquez, Susana Zeffiro, Mari Sakanyan, Scott Beuzeville, Raef Boktor, Michael Crowley, D'Arne Downie, Girish Dwivedi, Barry Elison, Omar Farouque, Kim Jasper, Subodh Joshi, Joseph Lee, Kenneth Lee, Elaine Lui, Peter Mcconachie, Joanne Meaker, Dee Nandurkar, Johanne Neill, Edward O'Rourke, Patricia O'Sullivan, George Pandos, Manuja Premaratne, David Prior, Natalie Rutherford, Connor Saunders, Kim Taubman, Andrew Tauro, Andrew Taylor, James Theuerle, Paul Thomas, Jonathan Tow, Anthony Upton, Shankar Vamadevan, Victor Wayne, Eva Alina Wegner, David Wong, John Younger, Dietrich Beitzke, Gudrun Feuchtner, Oliver Sommer, Konrad Weiss, Natallia Maroz-Vadalazhskaya, Uladzimir Tserakhau, Filip Homans, Caroline M. Van De Heyning, Raúl Araujo, Valentina Soldat-Stankovic, Sinisa Stankovic, Augusto Almeida, Carlos Anselmi, Guilherme S.A. Azevedo, Marcio Sommer Bittencourt, Diego Bromfman Pianta, Estevan Cabeda, Lara Carreira, Igor Coelho, Fernando de Amorim Fernandes, Andrea de Lorenzo, Roberta Delgado, Fernanda Erthal, Fabio Fernandes, Juliano Fernandes, Thiago Ferreira de Souza, Murilo Foppa, Wilson Furlan Matos Alves, Cibele Gontijo, Ilan Gottlieb, Gabriel Grossman, Maria Helena Albernaz Siqueira, Cesar Higa Nomura, Katia Hiromoto Koga, Ronaldo Lima, Rafael Lopes, Hugo Humberto Marçal Filho, Paulo Masiero, Luiz Mastrocola, Maria Eduarda Menezes de Siqueira, Claudio Mesquita, Danilo Naves, Filipe Penna, Ibraim Pinto, Thércio Rocha, Juliana Leal Rocha, Alfredo Rodrigues, Leila Salioni, Adelina Sanches, Marcelo Santos, Leonardo Sara Da Silva, Paulo Schvartzman, Cristina Sebastião Matushita, Tiago Senra, Marcelo Silva, Carlos Eduardo Soares, Bernardo Spiro, Carlos Eduardo Suaide Silva, Rafael Torres, Guilherme Urpia Monte, Andrea Vilela, Alexandre Volney Villa, Joao Vitola, Themissa Voss, Roberto Waltrick, Marcello Zapparoli, Hamid Naseer, Marina Garcheva-Tsacheva, Tiémégna Florence Ouattara, Sarameth Thou, Soley Varoeun, Gad Abikhzer, Rob Beanlands, Michael Chetrit, Dominique Dabreo, Carole Dennie, Matthias Friedrich, Mohmmed Nassoh Hafez, Kate Hanneman, Robert Miller, Anastasia Oikonomou, Idan Roifman, Gary Small, Vikas Tandon, Adwait Trivedi, James White, Katherine Zukotynski, Rita Alay, Carmen Concha, Teresa Massardo, Pedro Abad, Kelly Anzola, Harold Arturo, Luis Benitez, Alberto Cadena, Carlos Caicedo Zamudio, Antonio Calderón, Claudia T. Gutierrez Villamil, Claudia Jaimes, Juan L. Londono, Nelson Lopez, Sonia Merlano-Gaitan, Ramon Murgieitio-Cabrera, Manuel Valencia, Damiana Vergel, Alejandro Zuluaga Santamaria, Felix Solis, Tonci Batinic, Maja Franceschi, Maja Hrabak Paar, Marina Prpic, Cuba: Juan Felipe Batista, Lazaro Omar Cabrera, Amalia Peix, Yamilé Peña, Luis Manuel Rochela Vázquez, Ioannis Ntalas, Milan Kaminek, Vladimir Kincl, Otto Lang, Jawdat Abdulla, Morten Bøttcher, Martin Busk, Uka Geisler, Lars C. Gormsen, Nicolaj Hansson, Søren Hess, Jens Hove, Lars Thorbjoern Jensen, Magnus T. Jensen, Kristian Hay Kragholm, Bjarne L. Nørgaard, Kristian Øvrehus, Jan Rasmussen, Niels Peter Rønnow Sand, Hanne Sondergaard, Tomas Zaremba, Herwin Speckter, Nelson Amores, Mayra Sanchez Velez, Taghreed Abd Alrahman, Sherif Abd Elsamad, Alia Abdelfattah, Adel Allam, Sameh Elkaffas, Mona Hassan, Elshaymaa Hussein, Ahmed Ibrahim, Ahmed Kandeel, Mohamed Mandour Ali, Mahmoud Shaaban, Camila Flores, Verónica Vanesa Gómez Leiva, Anita Liiver, Martti Larikka, Valtteri Uusitalo, Denis Agostini, Clothilde Berger, Matthieu Dietz, Fabien Hyafil, Mickaël Ohana, Kevin Prigent, Hamza Regaieg, Laure Sarda-Mantel, Darach O. H-Ici, Harold Ayetey, George Angelidis, Christina Fragkaki, Chrysoula Fragkiadaki, Panagiotis Georgoulias, Maria Koutelou, Elena Kyrozi, Niki Lama, Vassilis Prassopoulos, Michael Spartalis, Theodora Zaglavara, Carla Gonzalez, Goleat Gutierrez, Alejandro Maldonado, Yassine Martinez, Attila Kovács, Bálint Szilveszter, Nilesh Banthia, Vivek Bhat, Partha Choudhury, Vijay Sai Chowdekar, Johann Christopher, Tushar Garg, Naresh Kumar Goyal, Ripen Kumar Gupta, Abhishek Gupta, Julie Hephzibah, Shashank Jain, Jesu Krupa, Parveen Kumar, Sukriti Kumar, Arati Lalchandani, Animesh Mishra, Vivaswan Dutt Mishra, Parul Mohan, Ahmad Ozair, Shivani Pandey, Ramanathapuram Parameswaran, Chetan Patel, Tapan Patel, Shivani Patel, Leena Robinson Vimala, Dr Pradosh Kumar Sarangi, Shantanu Sengupta, Arvind Sethi, Amit Sharma, Awadhesh Kumar Sharma, Punit Sharma, Apurva Shrigiriwar, Santosh Singh, Harpreet Singh, Ashwani Sood, Atul Verma, Ajay Vyas, Erwin Affandi Soeriadi, Edison Bun, Febby Hutomo, Hilman Syawaluddin, Ryan Yudistiro, Amjed Albadr, Majid Assadi, Farshad Emami, Alireza Emami-Ardekani, Saeed Farzanehfar, Ramezan Jafari, Reyhaneh Manafi-Farid, Maryam Tajik, Yoav Arnson, Shmuel Fuchs, Ronen Goldkorn, John Kennedy, Marina Leitman, Aryeh Shalev, Wanda Acampa, Domenico Albano, Pierpaolo Alongi, Gaspare Arnone, Roberta Assante, Anna Baritussio, Matteo Bauckneht, Francesco Bianco, Rachele Bonfiglioli, Francesco Bovenzi, Isabella Bruno, Andrea Bruno, Elena Busnardo, Elena Califaretti, Roberta Casoni, Vittorio Censullo, Franca Chierichetti, Marcello Chiocchi, Corrado Cittanti, Alberto Clemente, Alberto Cuocolo, Maria Luisa De Rimini, Giuseppe De Vincentis, Veronica Della Tommasina, Santo Dellegrottaglie, Paola Anna Erba, Laura Evangelista, Lara Faggi, Evelina Faragasso, Luigia Florimonte, Viviana Frantellizzi, Marco Gatti, Angela Gaudiano, Fabrizia Gelardi, Alberto Gerali, Alessia Gimelli, Marco Guglielmo, Lucia Leccisotti, Riccardo Liga, Carlo Liguori, Giampiero Longo, Margherita Maffione, Claudio Marcassa, Giovanni Matassa, Donato Mele, Luca Mircoli, Andrea Paccagnella, Sara Pacella, Federica Padovano, Dario Pellegrini, Valeria Pergola, Luca Pugliese, Natale Quartuccio, Lucia Rampin, Fabrizio Ricci, Giuseppe Rubini, Vincenzo Russo, Gianmario Sambuceti, Alessandra Scatteia, Roberto Sciagrà, Gianluca Spidalieri, Antonella Stefanelli, Carlo Tedeschi, Guido Ventroni, Dainia Baugh, Ernest Madu, Tadao Aikawa, Hiroshi Asano, Shinichiro Fujimoto, Koichiro Fujise, Yoshimitsu Fukushima, Kae Fukuyama, Yasutaka Ichikawa, Reiko Ideguchi, Nobuo Iguchi, Masamichi Imai, Hayato Ishimura, Satoshi Isobe, Kimiteru Ito, Yu Izawa, Toshiaki Kadokami, Tokuo Kasai, Takao Kato, Takashi Kawamoto, Shigeru Kiryu, Shinichiro Kumita, Osamu Manabe, Hirotaka Maruno, Naoya Matsumoto, Masao Miyagawa, Masao Moroi, Shigeki Nagamachi, Kenichi Nakajima, Ryo Nakazato, Mamoru Nanasato, Masanao Naya, Takashi Norikane, Yasutoshi Ohta, Yoichi Otomi, Hideki Otsuka, Noriko Oyama-Manabe, Masaki Saito, Masayoshi Sarai, Junichi Sato, Daisuke Sato, Shinya Shiraishi, Kentaro Takanami, Kazuya Takehana, Yasuyo Taniguchi, Hiroki Teragawa, Nobuo Tomizawa, Kyoko Umeji, Yasushi Wakabayashi, Shinichiro Yamada, Shinya Yamazaki, Tatsuya Yoneyama, Mohammad Rawashdeh, Tairkhan Dautov, Khalid Makhdomi, Mostafa Abass, Masoud Garashi, Qaisar Siraj, Marika Kalnina, Mohamad Haidar, Renata Komiagiene, Giedre Kviecinskiene, Donatas Vajauskas, Noor Khairiah A. Karim, Mady Doucoure, Luise Reichmuth, Anthony Samuel, Mohamed Lemine Dieng, Ambedhkar Shantaram Naojee, Estrella Aguilera Hernandez, Cesar Rene Alducin Tellez, Erick Alexánderson-Rosas, Erika Barragan, Manuel Cabada, Daniel Calderón, Isabel Carvajal-Juarez, José Esparza, Manlio Gerardo Gama-Moreno, Virginia Garcia Quinto, Nelsy Coromoto Gonzalez, Mary Carmen Herrera-Zarza, Aloha Meave, Jesus Gregorio Medina Verdugo, Gabriela Melendez, Rafael Humberto Morales Murguia, Carlos Salvador Navarro Quiroz, Mario Ornelas, Andres Preciado-Anaya, Oscar Ulises Preciado-Gutiérrez, Adriana Puente, Aristóteles Ramírez Salazar, Sandra Graciela Rosales Uvera, Sandra Rosales-Uvera, Jose Antonio Serna Macias, Lilia Sierra-Galan, Lilia M. Sierra-Galan, Juan Carlos Tirado Alderete, Enrique Vallejo, Marc Faraggi, Erdenechimeg Sereegotov, Nouzha Ben Rais, Nadia Ismaili Alaoui, Thiri Kyiphyu, Su Thet Oo, Soe Myat Win, Htin Zar, Ram Ghimire, Madhu Neupane, Andor Glaudemans, Riemer Slart, Derk Verschure, Berry Allen, John Edmond, Clare Mckenzie, Stuart Tie, Niels Van Pelt, Kirsten Worthington, Calum Young, Idrissa Adamou Soli, Shehu Kana, Uchenna Onubogu, Mahmoud Sani, Anders Tjellaug Bråten, Arve Jørgensen, Hanne-Elin Vassbotn, Humoud Al Dhuhli, Zabah Jawa, Naima Tag, Shazia Fatima, Muhammad Babar Imran, Muhammad Numair Younis, Mohammad Saadullah, Yariela Herrera Malo, Dora Lenturut-Katal, Manuel Castillo, José Ortellado, Afroza Akhter, F. Aaysha Cader, Raihan Hussain, Saidur Rahman Khan, Tapati Mandal, Faria Nasreen, Yunqiang An, Dianbo Cao, Lianggeng Gong, Yang Hou, Chongfu Jia, Tao Li, Caiying Li, Hui Liu, Wenya Liu, Jinkang Liu, Ming-Yen Ng, Heshui Shi, Chunxiang Tang, Ximing Wang, Zhaoqian Wang, Yining Wang, Jiang Wu, Yan Yi, Li Yuan, Tong Zhang, Longjiang Zhang, Edith Chavez, Carlos Cruz, Christian Llontop, Rosanna Morales, Paz Abrihan, Asela Bustos-Barroso, Michele Duldulao-Ogbac, Christopher Eduarte, Jerry Obaldo, Alvin Quinon, Belinda San Juan, Carlo Joe San Juan, Marie Rhiamar Sauler-Gomez, Mila Uy, Magdalena Kostkiewicz, Jolanta Kunikowska, Anna Teresinska, Tomasz Urbanik, Nuno Bettencourt, Ricardo Fontes-Carvalho, Cristina Gavina, Lino Gonçalves, Filipe Macedo, Nuno Moreno, Carla Sousa, Ana Teresa Timoteo, Maria João Vidigal, Mahmoud Al Heidous, Subramaniyan Ramanathan, Samer Arnous, Said Aytani, Angela Byrne, Tadhg Gleeson, David Kerins, Julie O'Brien, Ji-In Bang, Henry Bom, Miju Cheon, Gi Jeong Cheon, Sang-Geon Cho, Chae Moon Hong, Yong Hyu Jeong, Won Jun Kang, Yeon-Koo Kang, Ji-Young Kim, So Won Oh, Young So, Ho-Chun Song, Kyoung Sook Won, Soo Woong Yoo, Irena Mitevska, Marija Vavlukis, Barbara Gužic Salobir, Monika Štalc, Theodora Benedek, Marian Pop, Claudiu Stan, Alexey Ansheles, Olga Dariy, Nina Gagarina, Irina Itskovich, Anatoliy Karalkin, Alexander Kokov, Gulya Marina, Ekaterina Migunova, Viktor Pospelov, Daria Ryzhkova, Guzaliya Sayfullina, Vladimir Sergienko, Irina Shurupova, Margarita Vakhromeeva, Nailia Valiullina, Konstantin Zavadovsky, Kirill Zhuravlev, Rami Abazid, Turki Al Garni, Mirvat Alasnag, Ahmed Aljizeeri, Hamid Amer, Ahmad Amro, Hesham Hamdy, Osama Smettei, Dragana Sobic Saranovic, Marina Vlajkovic, Felix Keng, Jason See, Zuzana Berecova, Jana Polakova Mistinova, Osayande Evbuomwan, Nerisha Govender, Jonathan Hack, Bawinile Hadebe, Khanyisile Hlongwa, Mitchell Kaplan, Hoosen Lakhi, Katarina Milos, Moshe Modiselle, Stuart More, Ntanganedzeni Muambadzi, Leonie Scholtz, Manuel Barreiro-Perez, Isabel Blanco, Jordi Broncano, Alicia Camarero, Irene Casáns-Tormo, Javier De Haro, Albert Flotats, Elia García, Ceferino Gutierrez Mendiguchia, Amelia Jimenez-Heffernan, Ruben Leta, Javier Lopez Diaz, Luis Lumbreras Vega, Ana Manovel-Sánchez, Amparo Martinez Monzonis, Bianca Patrut, Virginia Pubul, Ricardo Ruano Perez, Nahla Zeidan, Damayanthi Nanayakkara, Ahmed Suliman, Henrik Engblom, Mustafa Murtadha, Ellen Ostenfeld, Magnus Simonsson, Hatem Alkadhi, Ronny Ralf Buechel, Peter Burger, Christoph Gräni, Christel Kamani, Nadine Kawel-Böhm, Bernd Klaeser, Robert Manka, John Prior, Tawika Kaewchur, Benjapa Khiewvan, Arpakorn Kositwattanarerk, Sirianong Namwongprom, Tanyaluck Thientunyakit, Haluk Burcak Sayman, Mahmut Yüksel, Mugisha Julius Sebikali, Emmy Okello, Pavlo Korol, Iryna Noverko, Maryna Satyr, Tahir Ahmad, Khaled Alfakih, Ivo Andrade, Susan Buckingham, Anda Bularga, John-Paul Carpenter, Graham Cole, David Cusack, Sarojini David, Patrick Davis, Timothy Fairbairn, Arjun Ghosh, Prasad Guntur Ramkumar, Mark Hamilton, Faisal Haque, Benjamin Hudson, Annette Johnstone, V.J. Karthikeyan, Mike Kay, Mohammad Ali Khan, Jamie Kitt, Chen Sheng Low, Elisa Mcalindon, David Mccreavy, Brian Morrissey, Manish Motwani, Dilip Na, Edward Nicol, Dilip Patel, Jonathan Rodrigues, Chris Rofe, Rebecca Schofield, Thomas Semple, Azeem Sheikh, Apurva Sinha, Deepak Subedi, William Topping, Katherine Tweed, Stephen Richard Underwood, Jonathan Weir-Mccall, Hamed Zuhairy, Taimur Abbasi, Shady Abohashem, Sandra Abramson, Mouaz Al-Mallah, Mohan Ashok Kumar, Mallory Balmer-Swain, Daniel Berman, Adam Bernheim, Sabha Bhatti, Robert Biederman, Erik Bieging, Scott Bingham, Stephen Bloom, Sean Blue, Andressa Borges, Kelley Branch, Paco Bravo, Sujatha Buddhe, Matthew Budoff, Renée Bullock-Palmer, Michael Cahill, Candace Candela, Jane Cao, Saurav Chatterjee, Yiannis Chatzizisis, Nita Ray Chaudhuri, Michael Cheezum, Anjali Chelliah, Tiffany Chen, Marcus Chen, Lu Chen, Aalap Chokshi, Jina Chung, Sorin Danciu, William DeSisto, Michael Dilorenzo, Rami Doukky, William Duvall, Maros Ferencik, Cameron Foster, Anthon Fuisz, Michael Gannon, David German, Myron Gerson, Jeffrey Geske, Fadi Hage, Agha Haider, Sofia Haider, Yasmin Hamirani, Karen Hassen, Robert Hendel, Jacqueline Henkel, Stephen Horgan, Mark Hyun, Rajesh Janardhanan, Scott Jerome, Dinesh Kalra, David Kassop, Mona Kinkhabwala, George Kinzfogl, Bernard Koch, Lynne Koweek, Joseph Krepp, Younghoon Kwon, Jay Layer, John Lesser, Steve Leung, Bernadette Lisske, Kathleen Magurany, Jeremy Markowitz, Brenda Mccullough, Azita Moalemi, Chanan Moffitt, Juan Montanez, Warren Moore, Shamil Morayati, Mahmud Mossa-Basha, Zorana Mrsic, Venkatesh Murthy, Prashant Nagpal, Katarina Nelson, Prabhjot Nijjar, Rupal O’Quinn, Edward Passen, Toral Patel, Pravin Patil, Amit Pursnani, Nancy Quachang, Mark Rabbat, Pragya Ranjan, Patricia Rodriguez Lozano, Mary Schemmer, Rebecca Seifried, Nishant Shah, Amee Shah, Sujata Shanbhag, Gaurav Sharma, Robert Skotnicki, Michael Sobczak, Prem Soman, Vincent Sorrell, Monvadi Srichai, Jim Streeter, Leah Strickland, Suliman Suliman, Naghmeh Tebyanian, Dustin Thomas, Randall Thompson, Seth Uretsky, Srikanth Vallurupalli, Marian Vandyck-Acquah, Vikas Verma, Todd Villines, Joseph Weinstein, David Wolinsky, Karolina Zareba, Michael Zgaljardic, Mario Beretta, Rodolfo Ferrando, Miguel Kapitan, Fernando Mut, Omoa Djuraev, Gulnora Rozikhodjaeva, Luisa Vera, Binh Duong Duc, Xuan Canh Nguyen, Phuoc Minh Hiep Nguyen, Translational Immunology Groningen (TRIGR), Cardiovascular Centre (CVC), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Molecular Pharmacology, Drug Design, Einstein, A, Hirschfeld, C, Williams, M, Vitola, J, Better, N, Villines, T, Cerci, R, Shaw, L, Choi, A, Dorbala, S, Karthikeyan, G, Lu, B, Sinitsyn, V, Ansheles, A, Kudo, T, Bucciarelli-Ducci, C, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Sewanan, L, Malkovskiy, E, Cohen, Y, Randazzo, M, Narula, J, Morozova, O, Pascual, T, Pynda, Y, Dondi, M, Paez, D, Hinterleitner, G, Lu, Y, Xu, Z, Erinne, I, Shetty, M, Lopez-Mattei, J, Parwani, P, Goda, A, Shirka, E, Bouyoucef, S, Chelghoum, L, Mansouri, F, Medjahedi, A, Naili, Q, Ridouh, M, Alasia, D, Alberghina, L, Aramayo, N, Buchara, D, Busso, F, Bustos Rivadero, J, Camilletti, J, Campanelli, H, Castro, R, Daicz, M, del Riego, H, Dragonetti, L, Echazarreta, D, Erriest, J, Faccio, F, Facello, A, Gallegos, H, Geronazzo, R, Glait, H, Hasbani, V, Jager, V, Lewkowicz, J, Lotti, J, Maciel, N, Masoli, O, Mastrovito, E, Medus, M, Merani, M, Molteni, S, Montecinos, M, Parisi, G, Sueldo, C, Perez de Arenaza, D, Quintana, L, Radzinschi, A, Redruello, M, Rodriguez, M, Rojas, H, Acuna, A, Schere, D, Traverso, S, Vazquez, G, Zeffiro, S, Sakanyan, M, Beuzeville, S, Boktor, R, Crowley, M, Downie, D, Dwivedi, G, Elison, B, Farouque, O, Jasper, K, Joshi, S, Lee, J, Lee, K, Lui, E, Mcconachie, P, Meaker, J, Nandurkar, D, Neill, J, O'Rourke, E, O'Sullivan, P, Pandos, G, Premaratne, M, Prior, D, Rutherford, N, Saunders, C, Taubman, K, Tauro, A, Taylor, A, Theuerle, J, Thomas, P, Tow, J, Upton, A, Vamadevan, S, Wayne, V, Wegner, E, Wong, D, Younger, J, Beitzke, D, Feuchtner, G, Sommer, O, Weiss, K, Maroz-Vadalazhskaya, N, Tserakhau, U, Homans, F, Van De Heyning, C, Araujo, R, Soldat-Stankovic, V, Stankovic, S, Almeida, A, Anselmi, C, Azevedo, G, Bittencourt, M, Pianta, D, Cabeda, E, Carreira, L, Coelho, I, de Amorim Fernandes, F, de Lorenzo, A, Delgado, R, Erthal, F, Fernandes, F, Fernandes, J, Ferreira de Souza, T, Foppa, M, Matos Alves, W, Gontijo, C, Gottlieb, I, Grossman, G, Albernaz Siqueira, M, Nomura, C, Koga, K, Lima, R, Lopes, R, Marcal Filho, H, Masiero, P, Mastrocola, L, Menezes de Siqueira, M, Mesquita, C, Naves, D, Penna, F, Pinto, I, Rocha, T, Rocha, J, Rodrigues, A, Salioni, L, Sanches, A, Santos, M, Da Silva, L, Schvartzman, P, Matushita, C, Senra, T, Silva, M, Soares, C, Spiro, B, Suaide Silva, C, Torres, R, Monte, G, Vilela, A, Villa, A, Voss, T, Waltrick, R, Zapparoli, M, Naseer, H, Garcheva-Tsacheva, M, Ouattara, T, Thou, S, Varoeun, S, Abikhzer, G, Beanlands, R, Chetrit, M, Dabreo, D, Dennie, C, Friedrich, M, Hafez, M, Hanneman, K, Miller, R, Oikonomou, A, Roifman, I, Small, G, Tandon, V, Trivedi, A, White, J, Zukotynski, K, Alay, R, Concha, C, Massardo, T, Abad, P, Anzola, K, Arturo, H, Benitez, L, Cadena, A, Zamudio, C, Calderon, A, Gutierrez Villamil, C, Jaimes, C, Londono, J, Lopez, N, Merlano-Gaitan, S, Murgieitio-Cabrera, R, Valencia, M, Vergel, D, Santamaria, A, Solis, F, Batinic, T, Franceschi, M, Paar, M, Prpic, M, Felipe Batista, C, Cabrera, L, Peix, A, Pena, Y, Rochela Vazquez, L, Ntalas, I, Kaminek, M, Kincl, V, Lang, O, Abdulla, J, Bottcher, M, Busk, M, Geisler, U, Gormsen, L, Hansson, N, Hess, S, Hove, J, Jensen, L, Jensen, M, Kragholm, K, Ovrehus, K, Rasmussen, J, Ronnow Sand, N, Sondergaard, H, Zaremba, T, Speckter, H, Amores, N, Velez, M, Alrahman, T, Elsamad, S, Abdelfattah, A, Elkaffas, S, Hassan, M, Hussein, E, Ibrahim, A, Kandeel, A, Ali, M, Shaaban, M, Flores, C, Gomez Leiva, V, Liiver, A, Larikka, M, Uusitalo, V, Agostini, D, Berger, C, Dietz, M, Hyafil, F, Ohana, M, Prigent, K, Regaieg, H, Sarda-Mantel, L, H-Ici, D, Ayetey, H, Angelidis, G, Fragkaki, C, Fragkiadaki, C, Georgoulias, P, Koutelou, M, Kyrozi, E, Lama, N, Prassopoulos, V, Spartalis, M, Zaglavara, T, Gonzalez, C, Gutierrez, G, Maldonado, A, Martinez, Y, Kovacs, A, Szilveszter, B, Banthia, N, Bhat, V, Choudhury, P, Chowdekar, V, Christopher, J, Garg, T, Goyal, N, Gupta, R, Gupta, A, Hephzibah, J, Jain, S, Krupa, J, Kumar, P, Kumar, S, Lalchandani, A, Mishra, A, Mishra, V, Mohan, P, Ozair, A, Pandey, S, Parameswaran, R, Patel, C, Patel, T, Patel, S, Vimala, L, Kumar Sarangi, D, Sengupta, S, Sethi, A, Sharma, A, Sharma, P, Shrigiriwar, A, Singh, S, Singh, H, Sood, A, Verma, A, Vyas, A, Soeriadi, E, Bun, E, Hutomo, F, Syawaluddin, H, Yudistiro, R, Albadr, A, Assadi, M, Emami, F, Emami-Ardekani, A, Farzanehfar, S, Jafari, R, Manafi-Farid, R, Tajik, M, Arnson, Y, Fuchs, S, Goldkorn, R, Kennedy, J, Leitman, M, Shalev, A, Acampa, W, Albano, D, Alongi, P, Arnone, G, Assante, R, Baritussio, A, Bauckneht, M, Bianco, F, Bonfiglioli, R, Bovenzi, F, Bruno, I, Bruno, A, Busnardo, E, Califaretti, E, Casoni, R, Censullo, V, Chierichetti, F, Chiocchi, M, Cittanti, C, Clemente, A, Cuocolo, A, De Rimini, M, De Vincentis, G, Della Tommasina, V, Dellegrottaglie, S, Erba, P, Evangelista, L, Faggi, L, Faragasso, E, Florimonte, L, Frantellizzi, V, Gatti, M, Gaudiano, A, Gelardi, F, Gerali, A, Gimelli, A, Guglielmo, M, Leccisotti, L, Liga, R, Liguori, C, Longo, G, Maffione, M, Marcassa, C, Matassa, G, Mele, D, Mircoli, L, Paccagnella, A, Pacella, S, Padovano, F, Pellegrini, D, Pergola, V, Pugliese, L, Quartuccio, N, Rampin, L, Ricci, F, Rubini, G, Russo, V, Sambuceti, G, Scatteia, A, Sciagra, R, Spidalieri, G, Stefanelli, A, Tedeschi, C, Ventroni, G, Baugh, D, Madu, E, Aikawa, T, Asano, H, Fujimoto, S, Fujise, K, Fukushima, Y, Fukuyama, K, Ichikawa, Y, Ideguchi, R, Iguchi, N, Imai, M, Ishimura, H, Isobe, S, Ito, K, Izawa, Y, Kadokami, T, Kasai, T, Kato, T, Kawamoto, T, Kiryu, S, Kumita, S, Manabe, O, Maruno, H, Matsumoto, N, Miyagawa, M, Moroi, M, Nagamachi, S, Nakajima, K, Nakazato, R, Nanasato, M, Naya, M, Norikane, T, Ohta, Y, Otomi, Y, Otsuka, H, Oyama-Manabe, N, Saito, M, Sarai, M, Sato, J, Sato, D, Shiraishi, S, Takanami, K, Takehana, K, Taniguchi, Y, Teragawa, H, Tomizawa, N, Umeji, K, Wakabayashi, Y, Yamada, S, Yamazaki, S, Yoneyama, T, Rawashdeh, M, Dautov, T, Makhdomi, K, Abass, M, Garashi, M, Siraj, Q, Kalnina, M, Haidar, M, Komiagiene, R, Kviecinskiene, G, Vajauskas, D, Karim, N, Doucoure, M, Reichmuth, L, Samuel, A, Dieng, M, Naojee, A, Hernandez, E, Alducin Tellez, C, Alexanderson-Rosas, E, Barragan, E, Cabada, M, Calderon, D, Carvajal-Juarez, I, Esparza, J, Gama-Moreno, M, Quinto, V, Gonzalez, N, Herrera-Zarza, M, Meave, A, Medina Verdugo, J, Melendez, G, Morales Murguia, R, Navarro Quiroz, C, Ornelas, M, Preciado-Anaya, A, Preciado-Gutierrez, O, Puente, A, Salazar, A, Rosales Uvera, S, Rosales-Uvera, S, Serna Macias, J, Sierra-Galan, L, Tirado Alderete, J, Vallejo, E, Faraggi, M, Sereegotov, E, Ben Rais, N, Alaoui, N, Kyiphyu, T, Oo, S, Win, S, Zar, H, Ghimire, R, Neupane, M, Glaudemans, A, Slart, R, Verschure, D, Allen, B, Edmond, J, Mckenzie, C, Tie, S, Van Pelt, N, Worthington, K, Young, C, Soli, I, Kana, S, Onubogu, U, Sani, M, Braten, A, Jorgensen, A, Vassbotn, H, Al Dhuhli, H, Jawa, Z, Tag, N, Fatima, S, Imran, M, Younis, M, Saadullah, M, Malo, Y, Lenturut-Katal, D, Castillo, M, Ortellado, J, Akhter, A, Cader, F, Hussain, R, Khan, S, Mandal, T, Nasreen, F, An, Y, Cao, D, Gong, L, Hou, Y, Jia, C, Li, T, Li, C, Liu, H, Liu, W, Liu, J, Ng, M, Shi, H, Tang, C, Wang, X, Wang, Z, Wang, Y, Wu, J, Yi, Y, Yuan, L, Zhang, T, Zhang, L, Chavez, E, Cruz, C, Llontop, C, Morales, R, Abrihan, P, Bustos-Barroso, A, Duldulao-Ogbac, M, Eduarte, C, Obaldo, J, Quinon, A, San Juan, B, San Juan, C, Sauler-Gomez, M, Uy, M, Kostkiewicz, M, Kunikowska, J, Teresinska, A, Urbanik, T, Bettencourt, N, Fontes-Carvalho, R, Gavina, C, Goncalves, L, Macedo, F, Moreno, N, Sousa, C, Timoteo, A, Vidigal, M, Al Heidous, M, Ramanathan, S, Arnous, S, Aytani, S, Byrne, A, Gleeson, T, Kerins, D, O'Brien, J, Bang, J, Bom, H, Cheon, M, Cheon, G, Cho, S, Hong, C, Jeong, Y, Kang, W, Kang, Y, Kim, J, Oh, S, So, Y, Song, H, Won, K, Yoo, S, Mitevska, I, Vavlukis, M, Salobir, B, Stalc, M, Benedek, T, Pop, M, Stan, C, Dariy, O, Gagarina, N, Itskovich, I, Karalkin, A, Kokov, A, Marina, G, Migunova, E, Pospelov, V, Ryzhkova, D, Sayfullina, G, Sergienko, V, Shurupova, I, Vakhromeeva, M, Valiullina, N, Zavadovsky, K, Zhuravlev, K, Abazid, R, Al Garni, T, Alasnag, M, Aljizeeri, A, Amer, H, Amro, A, Hamdy, H, Smettei, O, Saranovic, D, Vlajkovic, M, Keng, F, See, J, Berecova, Z, Mistinova, J, Evbuomwan, O, Govender, N, Hack, J, Hadebe, B, Hlongwa, K, Kaplan, M, Lakhi, H, Milos, K, Modiselle, M, More, S, Muambadzi, N, Scholtz, L, Barreiro-Perez, M, Blanco, I, Broncano, J, Camarero, A, Casans-Tormo, I, De Haro, J, Flotats, A, Garcia, E, Mendiguchia, C, Jimenez-Heffernan, A, Leta, R, Diaz, J, Vega, L, Manovel-Sanchez, A, Monzonis, A, Patrut, B, Pubul, V, Perez, R, Zeidan, N, Nanayakkara, D, Suliman, A, Engblom, H, Murtadha, M, Ostenfeld, E, Simonsson, M, Alkadhi, H, Buechel, R, Burger, P, Grani, C, Kamani, C, Kawel-Bohm, N, Klaeser, B, Manka, R, Prior, J, Kaewchur, T, Khiewvan, B, Kositwattanarerk, A, Namwongprom, S, Thientunyakit, T, Sayman, H, Yuksel, M, Sebikali, M, Okello, E, Korol, P, Noverko, I, Satyr, M, Ahmad, T, Alfakih, K, Andrade, I, Buckingham, S, Bularga, A, Carpenter, J, Cole, G, Cusack, D, David, S, Davis, P, Fairbairn, T, Ghosh, A, Ramkumar, P, Hamilton, M, Haque, F, Hudson, B, Johnstone, A, Karthikeyan, V, Kay, M, Khan, M, Kitt, J, Low, C, Mcalindon, E, Mccreavy, D, Morrissey, B, Motwani, M, Na, D, Nicol, E, Patel, D, Rodrigues, J, Rofe, C, Schofield, R, Semple, T, Sheikh, A, Sinha, A, Subedi, D, Topping, W, Tweed, K, Underwood, S, Weir-Mccall, J, Zuhairy, H, Abbasi, T, Abohashem, S, Abramson, S, Al-Mallah, M, Kumar, M, Balmer-Swain, M, Berman, D, Bernheim, A, Bhatti, S, Biederman, R, Bieging, E, Bingham, S, Bloom, S, Blue, S, Borges, A, Branch, K, Bravo, P, Buddhe, S, Budoff, M, Bullock-Palmer, R, Cahill, M, Candela, C, Cao, J, Chatterjee, S, Chatzizisis, Y, Chaudhuri, N, Cheezum, M, Chelliah, A, Chen, T, Chen, M, Chen, L, Chokshi, A, Chung, J, Danciu, S, Desisto, W, Dilorenzo, M, Doukky, R, Duvall, W, Ferencik, M, Foster, C, Fuisz, A, Gannon, M, German, D, Gerson, M, Geske, J, Hage, F, Haider, A, Haider, S, Hamirani, Y, Hassen, K, Hendel, R, Henkel, J, Horgan, S, Hyun, M, Janardhanan, R, Jerome, S, Kalra, D, Kassop, D, Kinkhabwala, M, Kinzfogl, G, Koch, B, Koweek, L, Krepp, J, Kwon, Y, Layer, J, Lesser, J, Leung, S, Lisske, B, Magurany, K, Markowitz, J, Mccullough, B, Moalemi, A, Moffitt, C, Montanez, J, Moore, W, Morayati, S, Mossa-Basha, M, Mrsic, Z, Murthy, V, Nagpal, P, Nelson, K, Nijjar, P, O'Quinn, R, Passen, E, Patil, P, Pursnani, A, Quachang, N, Rabbat, M, Ranjan, P, Lozano, P, Schemmer, M, Seifried, R, Shah, N, Shah, A, Shanbhag, S, Sharma, G, Skotnicki, R, Sobczak, M, Soman, P, Sorrell, V, Srichai, M, Streeter, J, Strickland, L, Suliman, S, Tebyanian, N, Thomas, D, Thompson, R, Uretsky, S, Vallurupalli, S, Vandyck-Acquah, M, Verma, V, Weinstein, J, Wolinsky, D, Zareba, K, Zgaljardic, M, Beretta, M, Ferrando, R, Kapitan, M, Mut, F, Djuraev, O, Rozikhodjaeva, G, Vera, L, Duc, B, Nguyen, X, Hiep Nguyen, P, Einstein, Andrew J, Hirschfeld, Cole, Williams, Michelle C, Vitola, Joao V, Better, Nathan, Villines, Todd C, Cerci, Rodrigo, Shaw, Leslee J, Choi, Andrew D, Dorbala, Sharmila, Karthikeyan, Ganesan, Lu, Bin, Sinitsyn, Valentin, Ansheles, Alexey A, Kudo, Takashi, Bucciarelli-Ducci, Chiara, Nørgaard, Bjarne Linde, Maurovich-Horvat, Pál, Campisi, Roxana, Milan, Elisa, Louw, Lizette, Allam, Adel H, Bhatia, Mona, Sewanan, Lorenzo, Malkovskiy, Eli, Cohen, Yosef, Randazzo, Michael, Narula, Jagat, Morozova, Olga, Pascual, Thomas N B, Pynda, Yaroslav, Dondi, Maurizio, Paez, Diana, and Cuocolo, Alberto

Subjects
cardiac testing, Health Personnel, delivery of health care, coronavirus, COVID-19, global health, 610 Medicine & health, cardiovascular disease, health personnel, humans, pandemics, surveys and questionnaires, coronaviru, Surveys and Questionnaires, Humans, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Pandemics, COVID-19/epidemiology
Abstract

BACKGROUND: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.

Published
2022
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139. Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis: The EVOLVED Randomized Clinical Trial.

Author

Loganath K, Craig NJ, Everett RJ, Bing R, Tsampasian V, Molek P, Botezatu S, Aslam S, Lewis S, Graham C, White AC, MacGillivray T, Tuck CE, Rayson P, Cranley D, Irvine S, Armstrong R, Milne L, Chin CWL, Hillis GS, Fairbairn T, Greenwood JP, Steeds R, Leslie SJ, Lang CC, Bucciarelli-Ducci C, Joshi NV, Kunadian V, Vassiliou VS, Dungu JN, Hothi SS, Boon N, Prasad SK, Keenan NG, Dawson D, Treibel TA, Motwani M, Miller CA, Mills NL, Rajani R, Ripley DP, McCann GP, Prendergast B, Singh A, Newby DE, and Dweck MR

Subjects
Humans, Female, Male, Aged, Prospective Studies, Conservative Treatment, Asymptomatic Diseases, Aged, 80 and over, Myocardium pathology, Transcatheter Aortic Valve Replacement, Cause of Death, Intention to Treat Analysis, Aortic Valve pathology, Aortic Valve surgery, Heart Valve Prosthesis Implantation, Early Medical Intervention, Aortic Valve Stenosis, Fibrosis, Hospitalization
Abstract

Importance: Development of myocardial fibrosis in patients with aortic stenosis precedes left ventricular decompensation and is associated with an adverse long-term prognosis., Objective: To investigate whether early valve intervention reduced the incidence of all-cause death or unplanned aortic stenosis-related hospitalization in asymptomatic patients with severe aortic stenosis and myocardial fibrosis., Design, Setting, and Participants: This prospective, randomized, open-label, masked end point trial was conducted between August 2017 and October 2022 at 24 cardiac centers across the UK and Australia. Asymptomatic patients with severe aortic stenosis and myocardial fibrosis were included. The final date of follow-up was July 26, 2024., Intervention: Early valve intervention with transcatheter or surgical aortic valve replacement or guideline-directed conservative management., Main Outcomes and Measures: The primary outcome was a composite of all-cause death or unplanned aortic stenosis-related hospitalization in a time-to-first-event intention-to-treat analysis. There were 9 secondary outcomes, including the components of the primary outcome and symptom status at 12 months., Results: The trial enrolled 224 eligible patients (mean [SD] age, 73 [9] years; 63 women [28%]; mean [SD] aortic valve peak velocity of 4.3 [0.5] m/s) of the originally planned sample size of 356 patients. The primary end point occurred in 20 of 113 patients (18%) in the early intervention group and 25 of 111 patients (23%) in the guideline-directed conservative management group (hazard ratio, 0.79 [95% CI, 0.44-1.43]; P = .44; between-group difference, -4.82% [95% CI, -15.31% to 5.66%]). Of 9 prespecified secondary end points, 7 showed no significant difference. All-cause death occurred in 16 of 113 patients (14%) in the early intervention group and 14 of 111 (13%) in the guideline-directed group (hazard ratio, 1.22 [95% CI, 0.59-2.51]) and unplanned aortic stenosis hospitalization occurred in 7 of 113 patients (6%) and 19 of 111 patients (17%), respectively (hazard ratio, 0.37 [95% CI, 0.16-0.88]). Early intervention was associated with a lower 12-month rate of New York Heart Association class II-IV symptoms than guideline-directed conservative management (21 [19.7%] vs 39 [37.9%]; odds ratio, 0.37 [95% CI, 0.20-0.70])., Conclusions and Relevance: In asymptomatic patients with severe aortic stenosis and myocardial fibrosis, early aortic valve intervention had no demonstrable effect on all-cause death or unplanned aortic stenosis-related hospitalization. The trial had a wide 95% CI around the primary end point, with further research needed to confirm these findings., Trial Registration: ClinicalTrials.gov Identifier: NCT03094143.

Published
2025
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141. Quantifying and mitigating motor phenotypes induced by antisense oligonucleotides in the central nervous system.

Author

Moazami MP, Rembetsy-Brown JM, Sarli SL, McEachern HR, Wang F, Ohara M, Wagh A, Kelly K, Krishnamurthy PM, Weiss A, Marosfoi M, King RM, Motwani M, Gray-Edwards H, Fitzgerald KA, Brown RH, and Watts JK

Subjects
Animals, Mice, Central Nervous System drug effects, Central Nervous System metabolism, Male, Humans, Phosphorothioate Oligonucleotides pharmacology, Phosphorothioate Oligonucleotides chemistry, Motor Activity drug effects, Oligonucleotides, Antisense pharmacology, Oligonucleotides, Antisense administration & dosage, Phenotype
Abstract

Antisense oligonucleotides (ASOs) are emerging as a promising class of therapeutics for neurological diseases. When injected directly into cerebrospinal fluid, ASOs distribute broadly across brain regions and exert long-lasting therapeutic effects. However, many phosphorothioate (PS)-modified gapmer ASOs show transient motor phenotypes when injected into the cerebrospinal fluid, ranging from reduced motor activity to ataxia or acute seizure-like phenotypes. Using a behavioral scoring assay customized to reflect the timing and nature of these effects, we show that both sugar and phosphate modifications influence acute motor phenotypes. Among sugar analogs, DNA induces the strongest motor phenotypes while 2'-substituted RNA modifications improve the tolerability of PS ASOs. Reducing the PS content of gapmer ASOs, which contain a stretch of PS-DNA, improves their toxicity profile, but in some cases also reduces efficacy or duration of effect. We show that this acute toxicity is not mediated by major nucleic acid sensing immune pathways. Formulating ASOs with divalent ions before injection and avoiding phosphate-based buffers modestly improved tolerability through mechanisms at least partially distinct from reduced PS content. Overall, our work identifies and quantifies an understudied aspect of oligonucleotide toxicology in the CNS, explores its mechanism, and presents platform-level medicinal chemistry and formulation approaches that improve tolerability of this class of compounds., Competing Interests: Declaration of interests F.W., R.H.B., and J.K.W. are co-founders of Nucyrna Therapeutics. J.K.W. is advisory board member of EnPlusOne, PepGen, and Sixfold. R.H.B. is co-founder and Scientific Advisory Board member of ApicBio. The authors have filed patent applications on oligonucleotides and designs intended for use in the CNS., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2024
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142. Artificial Intelligence and Machine Learning for Cardiovascular Computed Tomography (CCT): A White Paper of the Society of Cardiovascular Computed Tomography (SCCT).

Author

Williams MC, Weir-McCall JR, Baldassarre LA, De Cecco CN, Choi AD, Dey D, Dweck MR, Isgum I, Kolossvary M, Leipsic J, Lin A, Lu MT, Motwani M, Nieman K, Shaw L, van Assen M, and Nicol E

Abstract

Competing Interests: Declaration of competing interest Conflict of interest information will be provided by Stacy De La O, CAE, Consultant, SCCT Guidelines sdelao@scct.org.

Published
2024
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144. Radiographic Association of Maxillary Sinus Volume in Patients with Deviated Nasal Septum: A Systematic Review and Meta-analysis.

Author

Dhole A, Ramteke A, and Motwani M

Abstract

The nasal septum, composed of bone and cartilage, maintains nasal alignment and airflow. Deviation, common but potentially problematic, can lead to symptoms like congestion and sinusitis. Maxillary sinus, a key paranasal sinus, influences airflow and drainage. Nasal septum deviation can alter maxillary sinus volume, affecting airflow dynamics and drainage. Cone beam computed tomography (CBCT) and CT imaging are essential for assessing these conditions accurately, providing detailed 3D images and aiding in diagnosis and treatment planning. The study aims to review the radiographic association of maxillary sinus volume in patients with deviated nasal septum. The present review has been registered with PROSPERO-An international prospective register of systematic review CRD42023467988. Eligibility criteria: Studies from 2013 to 2022, in English, on maxillary sinus volume in deviated nasal septum patients. Exclusions: Animal studies, case reports, non-English articles. The Meta-analysis found that consistent association between nasal septum deviation and reduced maxillary sinus volume and no publication bias. The radiographic association of maxillary sinus volume in patients with deviated nasal septum was found to be statistically meaningful., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Published
2024
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145. Pericardial fat volume is related to endothelial-mediated coronary blood flow in women with suspected coronary microvascular dysfunction. A report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study.

Author

Landes S, Aldiwani H, Thomson L, Wei J, Al-Badri A, Mehta PK, Pedram M, Motwani M, Cook-Weins G, Sopko G, Pepine CJ, Merz CNB, and Dey D

Abstract

Background: Coronary microvascular dysfunction is prevalent in women with signs and symptoms of ischemia but no obstructive coronary artery disease (CAD) and is associated with an adverse prognosis. Elevated pericardial fat volume predicts adverse cardiac events, but mechanistic pathways of the association are not well understood., Methods: 118 women enrolled in the NHLBI-sponsored Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction study with suspected coronary microvascular dysfunction but no obstructive CAD underwent adenosine stress 1.5 T cardiovascular magnetic resonance imaging (CMR) imaging and invasive coronary reactivity testing. Semi-quantitative myocardial perfusion reserve index (MPR) index was derived from perfusion images. Pericardial fat volume was measured by manually contouring the cardiac margins and adjacent adipose tissue on a single trans-axial HASTE slice at the level of the left main coronary artery origin and indexed to body surface-area. Simple standard deviation analysis obtained for continuous variables and frequency (percent) for categorical variables. The relationships between pericardial fat volume and coronary reactivity testing parameters were examined by correlation and multivariable regression analyses., Results: Women with suspected coronary microvascular dysfunction had a mean age of 55 ± 10 years, body mass index (BMI) of 28 ± 7 kg/m 2 , 44 % had a history of smoking, 63 % hypertension, 8 % diabetes, and 20 % dyslipidemia. CMR imaging-derived pericardial fat volume and coronary blood flow response to intracoronary acetylcholine (Δ CBF) were negatively correlated ( r  = -0.32, p  = 0.0013). After adjustment for age, number of risk factors, high-density lipoprotein (HDL), and cold pressor diameter response, pericardial fat volume remained a significant predictor of Δ coronary blood flow ( p  = 0.04). There was no association with other coronary reactivity testing measures or CMRI derived MPR index., Conclusions: Among women with suspected coronary microvascular dysfunction but no obstructive CAD, pericardial fat volume appears to be related in a hypothesized adverse direction to coronary microvascular endothelial function. These results support further work confirming and extending these results to investigate pericardial fat volume as mechanistic pathway and potential treatment target for coronary microvascular dysfunction-related adverse events.Trial registration: clinicaltrials.govNCT00832702., Competing Interests: Dr. Bairey Merz has received honorarium from Abbott Diagnostics and serves on the Board of Directors for iRhythm. All other authors declare no competing non-financial interests., (© 2024 The Author(s).)

Published
2024
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146. Comparative efficacy of pre-operative and post-operative administration of amoxicillin in third molar extraction surgery - A systematic review and meta-analysis.

Author

Karemore TV, Ashtankar KA, and Motwani M

Abstract

To compare the effectiveness of pre-operative and post-operative administration of amoxicillin in patients undergoing third molar extraction surgery. A systematic search was executed according to PRISMA guidelines for studies published till December 2021. Studies were included based on the pre-eligibility criteria. The risk of bias was assessed using the Cochrane risk of bias tool. The heterogeneity was evaluated, and a random effect model was used for meta-analysis. A total of five studies were included from an initial search of 96 studies. The included studies were randomized controlled trials and comparative studies assessing pre-operative and post-operative administration of antibiotics among patients undergoing third molar extraction surgery. For comparison between pre-operative and post-operative groups, interincisal distance, complications, pain, and swelling were systematically reviewed and meta-analysis was done for interincisal distance and complications. The mean change in interincisal distance ranged from 5.5 to 47.9 and from 4.56 to 46.1 in the pre-operative and post-operative amoxicillin groups, respectively. Complications reported were infections, alveolar osteitis, nausea, diarrhea, gastric pain, rash, and headache with a pooled incidence of 4.3-33% in the pre-operative amoxicillin group and 0-22.7% in the post-operative amoxicillin group. Quantitative synthesis of data carried out from meta-analysis shows a significant difference in the pre-operative and post-operative amoxicillin groups in improving the interincisal distance and incidence of complications post surgery. The qualitative synthesis of data derived from systematic review for pain provides favoring results for post-operative amoxicillin administration. In case of swelling, a non-conclusive result was obtained., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 National Journal of Maxillofacial Surgery.)

Published
2024
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147. 2022 Artificial intelligence primer for the nuclear cardiologist.

Author

Motwani M

Subjects
Humans, Artificial Intelligence, Forecasting, Cardiologists, Cardiology methods
Abstract

Driven by advances in computing power, the past decade has seen rapid developments in artificial intelligence (AI) which now offers potential enhancements to every aspect of nuclear cardiology workflow including acquisition, reconstruction, segmentation, direct image analysis, and interpretation; as well as facilitating clinical and imaging big-data integration for superior personalized risk stratification. To understand the relevance and potential of AI in their field, this review provides a primer for nuclear cardiologists in 2022. The aim is to explain terminology and provide a summary of key current implementations, challenges, and future aspirations of AI-based enhancements to nuclear cardiology., (© 2022. Crown.)

Published
2023
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148. Overall survival with sacituzumab govitecan in hormone receptor-positive and human epidermal growth factor receptor 2-negative metastatic breast cancer (TROPiCS-02): a randomised, open-label, multicentre, phase 3 trial.

Author

Rugo HS, Bardia A, Marmé F, Cortés J, Schmid P, Loirat D, Trédan O, Ciruelos E, Dalenc F, Gómez Pardo P, Jhaveri KL, Delaney R, Valdez T, Wang H, Motwani M, Yoon OK, Verret W, and Tolaney SM

Subjects
Humans, Female, Quality of Life, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms pathology
Abstract

Background: Sacituzumab govitecan demonstrated significant progression-free survival benefit over chemotherapy in the phase 3 TROPiCS-02 trial in patients with pretreated, endocrine-resistant hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+ and HER2-) metastatic breast cancer with limited treatment options. Here, we report the protocol-specified final analysis of overall survival and endpoints by trophoblast cell-surface antigen 2 (Trop-2) expression and other variables., Methods: In this randomised, open-label, multicentre, phase 3 trial, which took place in 91 centres across North America (the USA and Canada) and Europe (Belgium, France, Germany, Italy, the Netherlands, Spain, and the UK), patients were randomly assigned (1:1) to receive sacituzumab govitecan or chemotherapy (eribulin, vinorelbine, capecitabine, or gemcitabine). Patients had confirmed HR+ and HER2- locally recurrent inoperable or metastatic breast cancer and had received at least one previous endocrine therapy, a taxane, and a CDK4/6 inhibitor in any setting and two to four previous chemotherapy regimens for metastatic disease. The primary endpoint was progression-free survival (previously reported and not included in this analysis), and secondary endpoints included overall survival, objective response rate (ORR), and patient-reported outcomes. Overall survival was assessed using stratified log-rank tests and Cox regression. Trop-2 expression was assessed in tumour tissue by immunohistochemistry. In the statistical testing hierarchy, ORR and patient-reported outcomes were tested sequentially if overall survival was significant. This study is registered with ClinicalTrials.gov, NCT03901339., Findings: At the data cutoff date of July 1, 2022, 543 of 776 screened patients were randomly assigned between May 30, 2019, and April 5, 2021, with 272 patients in the sacituzumab govitecan group and 271 patients in the chemotherapy group. With a 12·5-month (IQR 6·4-18·8) median follow-up, 390 deaths occurred among 543 patients. Overall survival was significantly improved with sacituzumab govitecan versus chemotherapy (median 14·4 months [95% CI 13·0-15·7] vs 11·2 months [10·1-12·7]; hazard ratio [HR] 0·79, 95% CI 0·65-0·96; p=0·020); survival benefit was consistent across Trop-2 expression-level subgroups. ORR was significantly improved with sacituzumab govitecan compared with chemotherapy (57 [21%] patients vs 38 [14%]; odds ratio 1·63 [95% CI 1·03-2·56]; p=0·035), as was time to deterioration of global health status and quality of life (median 4·3 months vs 3·0 months; HR 0·75 [0·61-0·92]; p=0·0059) and fatigue (median 2·2 months vs 1·4 months; HR 0·73 [0·60-0·89]; p=0·0021). The safety profile of sacituzumab govitecan was consistent with previous studies (including the TROPiCS-02 primary analysis and the ASCENT trial). One fatal adverse event (septic shock caused by neutropenic colitis) was determined to be related to sacituzumab govitecan treatment., Interpretation: Sacituzumab govitecan demonstrated statistically significant and clinically meaningful benefit over chemotherapy, with a 3·2-month median overall survival improvement and a manageable safety profile. These data support sacituzumab govitecan as a new treatment option for patients with pretreated, endocrine-resistant HR+ and HER2- metastatic breast cancer., Funding: Gilead Sciences., Competing Interests: Declaration of interests HSR reports honoraria from Puma Biotechnology, Mylan, and Samsung Bioepis, and institutional research funding from Macrogenics, OBI Pharma, Pfizer, Novartis, Lilly, Genentech, Merck, Odonate Therapeutics, Daiichi Sankyo, Seattle Genetics, Sermonix Pharmaceuticals, AstraZeneca, Gilead Sciences, and Ayala Pharmaceuticals. AB reports institutional research funding from Genentech, Novartis, Pfizer, Merck, Sanofi, Radius Health and Menarini, Immunomedics and Gilead Sciences, Daiichi Sankyo, and AstraZeneca, and Eli Lilly, and consulting fees from Pfizer, Novartis, Genentech, Merck, Radius Health and Menarini, Immunomedics and Gilead Sciences, Sanofi, Daiichi Sankyo, AstraZeneca, Phillips, Eli Lilly, and Foundation Medicine. FM reports institutional research funding from Roche, Novartis, AstraZeneca, GSK and Tesaro, MED, Clovis, Vaccibody, Gilead Sciences, and Eisai; consulting fees from AstraZeneca, GSK and Tesaro, Pfizer, Eisai, Gilead Sciences, Vaccibody, and GenomicHealth; honoraria from AstraZeneca, Clovis, GSK and Tesaro, Eli Lilly, Novartis, Pfizer, Roche, Myriad Genetics, PharmaMar, Eisai, MSD, Immunomedics and Gilead Sciences, Pierre-Fabre, Agendia, Genomic Health, and Seattle Genetics; support for meeting attendance and travel from Pfizer, Roche, and AstraZeneca; and participation on a data safety monitoring board or advisory board for Palleos and Amgen. JC reports institutional research funding from Roche, Ariad Pharmaceuticals, AstraZeneca, Baxalta, Servier Affaires, Bayer Healthcare, Eisai, F Hoffman-La Roche, Guardant Health, Merck Sharp & Dohme, Pfizer, Piqur Therapeutics, Puma Biotechnology, and Queen Mary University of London; consulting fees from Roche, Celgene, Cellestia, AstraZeneca, Seattle Genetics, Daiichi Sankyo, Erytech, Athenex, Polyphor, Lilly, Merck, Sharp & Dohme, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Ellipses, Hibercell, BioInvent, GEMoaB, Gilead Sciences, Menarini, Zymeworks, Reveal Genomics, and Expres2ion Biotechnologies; honoraria from Roche, Novartis, Celgene, Eisai, Pfizer, Samsung Bioepis, Lilly, Merck, Sharp & Dohme, and Daiichi Sankyo; travel and accommodations from Roche, Novartis, Eisai, Pfizer, Daiichi Sankyo, AstraZeneca, and Gilead Sciences; stock ownership from MedSIR and Nektar Pharmaceuticals; and several patents. PS reports institutional research funding from Astellas, AstraZeneca, Genentech, Novartis, Oncogenex, Roche, and Medivation; consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Merck, Novartis, Pfizer, Puma, Roche, Eisai, and Celgene; and spouse's employment at Roche. DL reports honoraria from AstraZeneca, Novartis, MSD, Lilly, Amgen, Eisai, and Gilead Sciences; consulting fees from Roche, AstraZeneca, Pfizer, Novartis, MSD, Immunomedics, Pharma4D, Daiichi Sankyo, Lilly, Amgen, and Eisai; and travel and accommodations from Roche, AstraZeneca, Pfizer, Novartis, MSD, Gilead Sciences, and Amgen. OT reports institutional research funding from Bristol Myers Squibb and MSD; honoraria from Roche, Pfizer, Novartis-Sandoz, Lilly, MSD, AstraZeneca, Pierre Fabre, Seagen, Daiichi Sankyo, Gilead Sciences, Eisai, and Stemline; travel and accommodations from Roche, Pfizer, Novartis-Sandoz, Lilly, MSD, AstraZeneca, Seagen, Daiichi Sankyo, and Gilead Sciences; and participation on a data safety monitoring board or advisory board for Roche, Pfizer, Novartis-Sandoz, Lilly, MSD, AstraZeneca, Seagen, and Daiichi Sankyo. EC reports consulting fees from Novartis, Lilly, Pfizer, Roche, AstraZeneca, and Daiichi Sankyo; speaker's bureau from Lilly, Pfizer, AstraZeneca, and Daiichi Sankyo; and travel and accommodations from Pfizer and Roche. KLJ reports consulting fees from Novartis, Pfizer, Bristol Myers Squibb, Jounce Therapeutics, Taiho Oncology, Genentech, Synthon, AbbVie, Eisai, AstraZeneca, Blueprint Medicine, Daiichi Sankyo, Sun Pharma Advanced Research Company, Gilead Sciences, Seattle Genetics, and Lilly Pharmaceuticals and Loxo Oncology; and institutional research funding from Novartis, Clovis Oncology, Genentech, AstraZeneca, ADC Therapeutics, Novita Pharmaceuticals, Debio Pharmaceuticals, Pfizer, Lilly Pharmaceuticals and Loxo Oncology, Zymeworks, Immunomedics and Gilead Sciences, Puma Biotechnology, and Merck Pharmaceuticals. RD, TV, HW, MM, and OKY report employment by and stock ownership in Gilead Sciences. WV reports previous employment by and stock ownership in Genentech and employment by Gilead Sciences. SMT reports institutional research funding from Gilead Sciences, AstraZeneca, Eli Lilly, Merck, Nektar, Novartis, Pfizer, Genentech and Roche, Exelixis, Bristol Myers Squibb, Eisai, Nanostring, Cyclacel, Sanofi, Odonate, and Seagen; consulting fees from AstraZeneca, Eli Lilly, Merck, Nektar, Novartis, Pfizer, Genentech and Roche, Gilead Sciences, Bristol Myers Squibb, Eisai, Nanostring, Sanofi, Odonate, Seagen, Daiichi Sankyo, Athenex, CytomX, Blueprint Medicines, Zentalis, Zymeworks, Ellipses Pharma, 4D Pharma, OncoSec, Infinity Therapeutics, BeyondSpring Pharma, OncXerna, Reveal Genomics, ARC Therapeutics, Kyowa Kirin Pharma, G1 Therapeutics, Silverback Therapeutics, Certara, Mersana Therapeutics, and OncoPep; and honoraria from Chugai, Genentech and Roche, Eisai, Gilead Sciences, AstraZeneca, and Bristol Myers Squibb. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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149. Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial.

Author

Kuronuma K, van Diemen PA, Han D, Lin A, Grodecki K, Kwiecinski J, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, and Knaapen P

Subjects
Humans, Prospective Studies, Tomography, X-Ray Computed, Positron-Emission Tomography, Coronary Angiography methods, Computed Tomography Angiography methods, Adipose Tissue diagnostic imaging, Coronary Vessels diagnostic imaging, Predictive Value of Tests, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
Abstract

Background: Positron emission tomography (PET) is the clinical gold standard for quantifying myocardial blood flow (MBF). Pericoronary adipose tissue (PCAT) attenuation may detect vascular inflammation indirectly. We examined the relationship between MBF by PET and plaque burden and PCAT on coronary CT angiography (CCTA)., Methods: This post hoc analysis of the PACIFIC trial included 208 patients with suspected coronary artery disease (CAD) who underwent [ 15 O]H 2 O PET and CCTA. Low-attenuation plaque (LAP, < 30HU), non-calcified plaque (NCP), and PCAT attenuation were measured by CCTA., Results: In 582 vessels, 211 (36.3%) had impaired per-vessel hyperemic MBF (≤ 2.30 mL/min/g). In multivariable analysis, LAP burden was independently and consistently associated with impaired hyperemic MBF (P = 0.016); over NCP burden (P = 0.997). Addition of LAP burden improved predictive performance for impaired hyperemic MBF from a model with CAD severity and calcified plaque burden (P < 0.001). There was no correlation between PCAT attenuation and hyperemic MBF (r = - 0.11), and PCAT attenuation was not associated with impaired hyperemic MBF in univariable or multivariable analysis of all vessels (P > 0.1)., Conclusion: In patients with stable CAD, LAP burden was independently associated with impaired hyperemic MBF and a stronger predictor of impaired hyperemic MBF than NCP burden. There was no association between PCAT attenuation and hyperemic MBF., (© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.)

Published
2023
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