Publications by authors named "James Nolan"

129 Publications

Outcomes of COVID-19 Positive Acute Coronary Syndrome Patients; a multisource Electronic Healthcare Records Study from England.

J Intern Med 2021 Jan 19. Epub 2021 Jan 19.

Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Stoke On Trent, United Kingdom of Great Britain and Northern Ireland.

Background: Patients with underlying cardiovascular disease and Coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality.

Objectives: This study was designed to characterise the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection.

Methods: This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March- 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality.

Results: A total of 12,958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19 positive and were more likely to present with non-ST elevation acute myocardial infarction. COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR) 3.27 95% confidence interval (CI) 2.41-4.42) and 30-day mortality (aOR 6.53 95%CI 5.1-8.36) compared to the non COVID-19 ACS group.

Conclusion: COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline recommended treatment and significant mortality hazard.
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http://dx.doi.org/10.1111/joim.13246DOI Listing
January 2021

Printable Nonenzymatic Glucose Biosensors Using Carbon Nanotube-PtNP Nanocomposites Modified with AuRu for Improved Selectivity.

ACS Biomater Sci Eng 2020 Sep 12;6(9):5315-5325. Epub 2020 Aug 12.

Weldon School of Biomedical Engineering, Birck Nanotechnology Center, Center for Implantable Devices, Purdue University, West Lafayette, Indiana 47907, United States.

Nonenzymatic glucose biosensors have the potential for a more reliable in vivo functionality due to the reduced risk of biorecognition element degradation. However, these novel sensing mechanisms often are nanoparticle-based and have nonlinear responses, which makes it difficult to gauge their potential utility against more conventional enzymatic biosensors. Moreover, these nonenzymatic biosensors often suffer from poor selectivity that needs to be better addressed before being used in vivo. To address these problems, here we present an amperometric nonenzymatic glucose biosensor fabricated using one-step electrodeposition of Au and Ru nanoparticles on the surface of a carbon-nanotube-based platinum-nanoparticle hybrid in conductive polymer. Using benchtop evaluations, we demonstrate that the bimetallic catalyst of Au-Ru nanoparticles can enable the nonenzymatic detection of glucose with a superior performance and stability. Furthermore, our biosensor shows good selectivity against other interferents, with a nonlinear dynamic range of 1-19 mM glucose. The Au-Ru catalyst has a conventional linear range of 1-10 mM, with a sensitivity of 0.2347 nA/(μM mm) ± 0.0198 ( = 3) and a limit of detection of 0.068 mM (signal-to-noise, / = 3). The biosensor also exhibits a good repeatability and stability at 37 °C over a 3 week incubation period. Finally, we use a modified Butler-Volmer nonlinear analytical model to evaluate the impact of geometrical and chemical design parameters on our nonenzymatic biosensor's performance, which may be used to help optimize the performance of this class of biosensors.
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http://dx.doi.org/10.1021/acsbiomaterials.0c00647DOI Listing
September 2020

"Freedom to Breathe": Youth Participatory Action Research (YPAR) to Investigate Air Pollution Inequities in Richmond, CA.

Int J Environ Res Public Health 2021 01 11;18(2). Epub 2021 Jan 11.

Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California at Berkeley, Berkeley, CA 94704, USA.

Air pollution is a major contributor to human morbidity and mortality, potentially exacerbated by COVID-19, and a threat to planetary health. Participatory research, with a structural violence framework, illuminates exposure inequities and refines mitigation strategies. Home to profitable oil and shipping industries, several census tracts in Richmond, CA are among the most heavily impacted by aggregate burdens statewide. Formally trained researchers from the Center for Environmental Research and Children's Health (CERCH) partnered with the RYSE youth justice center to conduct youth participatory action research on air quality justice. Staff engaged five youth researchers in: (1) collaborative research using a network of passive air monitors to quantify neighborhood disparities in nitrogen dioxide (NO) and sulfur dioxide (SO), noise pollution and community risk factors; (2) training in environmental health literacy and professional development; and (3) interpretation of findings, community outreach and advocacy. Inequities in ambient NO, but not SO, were observed. Census tracts with higher Black populations had the highest NO. Proximity to railroads and major roadways were associated with higher NO. Greenspace was associated with lower NO, suggesting investment may be conducive to improved air quality, among many additional benefits. Youth improved in measures of empowerment, and advanced community education via workshops, Photovoice, video, and "zines".
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http://dx.doi.org/10.3390/ijerph18020554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826540PMC
January 2021

Improving the Quality of Survey Data on College Campus Woman Abuse: The Contribution of a Supplementary Open-Ended Question.

Violence Against Women 2020 Dec 27:1077801220975496. Epub 2020 Dec 27.

West Virginia University, Morgantown, WV, USA.

Obtaining accurate survey data on the prevalence of woman abuse in institutions of higher education continues to be a major methodological challenge. Underreporting is difficult to overcome; yet, there may be effective ways of minimizing this problem. One is adding a supplementary open-ended question to a primarily quantitative questionnaire. Using data derived from the Campus Quality of Life Survey (CQLS), this article examines whether asking respondents to complete such a question increases the prevalence rates of four types of woman abuse and provides information on behaviors that are not included in widely used and validated measures of these harms.
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http://dx.doi.org/10.1177/1077801220975496DOI Listing
December 2020

Recurrent odontogenic keratocyst with orbital invasion.

Orbit 2020 Dec 27:1-6. Epub 2020 Dec 27.

South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide, Australia.

Odontogenic keratocysts (OKCs) are aggressive lesions that have been variously classified as neoplasms or cysts according to the World Health Organisation (WHO). They can be challenging to surgically remove and the cysts can exhibit locally aggressive behaviour if incompletely excised. We describe a case of recurrent OKC invading the orbit requiring multidisciplinary approach for extended surgical excision, and review the current literature regarding this condition.
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http://dx.doi.org/10.1080/01676830.2020.1862248DOI Listing
December 2020

A case of monoclonal gammopathy of renal significance presenting as atypical amyloidosis with IgA lambda paraproteinemia.

J Pathol Transl Med 2020 Nov 9;54(6):504-507. Epub 2020 Nov 9.

Department of Anatomical Pathology, SA Pathology, Adelaide, Australia.

Monoclonal gammopathy of renal significance is defined as any B cell or plasma cell clonal lymphoproliferation which neither causes tumor complications nor meets any current hematological criteria for specific therapy, with one or more kidney lesions related to the produced monoclonal immunoglobulin, such as amyloidosis. A 50-year-old male presented with heavy proteinuria and blood tests showing IgA and Lambda paraproteinemia. Light microscopy showed mesangial eosinophilic ground substance extending into the capillary loops, and positive staining within the glomeruli and vessel walls for amyloid P immunohistochemistry was also noted. Immunofluorescence showed positive staining for IgA and Lambda in the mesangia and capillary loops. Electron microscopy exhibited organized fibrils measuring 4-5 nm in diameter in the mesangia, glomerular basement membranes and vessel walls. We interpreted the overall findings as atypical renal amyloidosis with IgA and Lambda deposition on immunofluorescence. Further amyloid typing using laser microdissection-liquid chromatography and mass spectrometry will be useful.
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http://dx.doi.org/10.4132/jptm.2020.09.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674760PMC
November 2020

Biclonal lymphoproliferative disorders: another association with NOTCH1-mutated chronic lymphocytic leukaemias.

Ir J Med Sci 2020 Oct 17. Epub 2020 Oct 17.

Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland.

Introduction: Biclonal lymphoid disorders, when two distinct lymphoproliferative disorders (LPD) co-exist, are rare (incidence of 1.4%) and associated with a poor prognosis. NOTCH1 mutations occur in 10% of CLL at diagnosis, associated with a short disease-free interval and increased risk of Richter's transformation. We hypothesised that the incidence of NOTCH1 mutations in CLL with a second LPD may be increased, because the mutation occurs early in leukaemogenesis, permitting clonal divergence.

Methods: We identified 19 patients with biclonal LPD at diagnosis: 11 with CLL and a second LPD (group A) and 8 with a second distinct CLL (group B). NOTCH1 mutation analysis was performed and clinical outcome investigated.

Results: Ten of 19 (52%) were NOTCH1 mutated: 5 in group A (45%) and 5 in group B (62.5%) with a favourable clinical outcome observed among this cohort with 28.7 (range 1-99) months of follow-up.

Conclusion: In conclusion, we identified a significant (52%) incidence of NOTCH1 mutations in CLL in the context of biclonal LPD, associated with an indolent clinical course.
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http://dx.doi.org/10.1007/s11845-020-02386-1DOI Listing
October 2020

Radiation protection in the cardiac catheterisation lab: best practice.

Heart 2021 Jan 14;107(1):76-82. Epub 2020 Oct 14.

Department of Cardiology, Royal Stoke University Hospital and Keele University, Stoke-on-Trent, Staffordshire, UK

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http://dx.doi.org/10.1136/heartjnl-2019-316369DOI Listing
January 2021

Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery: An Analysis From the British Cardiovascular Intervention Society Database.

Circ Cardiovasc Interv 2020 09 2;13(9):e009049. Epub 2020 Sep 2.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom (A.S., M.R., E.F.F., J.N., K.R., A.A., M. Mohamed, M.A.M.).

Background: Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures.

Methods: We analyzed a large longitudinal PCI cohort (2007-2014, n=501 841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506 691).

Results: Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %, <0.001), at 30 days (15% versus 2%, <0.001), and at one-year (24% versus 5%, <0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65-2.44], <0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78-2.5], <0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59-2.03], <0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42-2.19], <0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated.

Conclusions: In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.120.009049DOI Listing
September 2020

The predictive value of CHADS-VASc score on in-hospital death and adverse periprocedural events among patients with the acute coronary syndrome and atrial fibrillation who undergo percutaneous coronary intervention: a 10-year National Inpatient Sample (NIS) analysis.

Cardiovasc Revasc Med 2020 Aug 7. Epub 2020 Aug 7.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America. Electronic address:

Background: The predictive value of CHADS-VASc score regarding the in-hospital death and periprocedural adverse events following percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) and concomitant atrial fibrillation (AF) is not established.

Methods: We retrospectively analyzed data of patients with the in-hospital and primary diagnosis of ACS, with concomitant AF, who underwent PCI during the 2004-2014 period from the US National Inpatient Sample database. A CHADS-VASc score was incorporated into multiple covariate-adjusted logistic regression analyses to determine its independent impact on designated outcomes.

Results: A total of 283,890 patients hospitalized with the primary diagnosis of ACS who underwent PCI and had an AF on record were included in the analysis. The average reported prevalence of AF in the whole cohort of ACS patients was 10.0% with a significant increasing trend during the observed 10-year period (p < .001). The average age of the cohort was 72.1 ± 11 years, 63.4% were male while the median CHADS-VASc score was 3 (IQR 2-4). Following adjustment for baseline covariates, incremental increase in CHADS-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18-1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17-1.20), bleeding (OR 1.17, 95% CI 1.16-1.18), stroke/transient ischemic attack (OR 1.17, 95% CI 1.15-1.19), and acute kidney injury (OR 1.05, 95% CI 1.04-1.06).

Conclusions: The CHADS-VASc score provides important prognostic information in ACS patients undergoing PCI. It is independently associated with in-hospital death and adverse periprocedural events following PCI in patients presenting with ACS and concomitant AF.
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http://dx.doi.org/10.1016/j.carrev.2020.08.003DOI Listing
August 2020

BK virus-associated nephropathy in a lung transplant patient: case report and literature review.

BMC Infect Dis 2020 Aug 14;20(1):600. Epub 2020 Aug 14.

Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.

Background: BK virus-associated nephropathy (BKVAN) is a relatively common cause of renal dysfunction in the first six months after renal transplantation. It arises from reactivation of the latent and usually harmless BK virus (BK virus) due to immunosuppression and other factors including some that are unique to renal transplantation such as allograft injury. BKVAN is much rarer in non-renal solid organ transplantation, where data regarding diagnosis and management are extremely limited.

Case Presentation: We report a case of a 58-year-old man found to have worsening renal dysfunction nine months after bilateral sequential lung transplantation for chronic obstructive pulmonary disease (COPD). He had required methylprednisolone for acute allograft rejection but achieved good graft function. Urine microscopy and culture and renal ultrasound were normal. BK virus PCR was positive at high levels in urine and blood. Renal biopsy subsequently confirmed BKVAN. The patient progressed to end-stage renal failure requiring haemodialysis despite reduction in immunosuppression, including switching mycophenolate for everolimus, and the administration of intravenous immunoglobulin (IVIG).

Conclusions: This very rare case highlights the challenges presented by BK virus in the non-renal solid organ transplant population. Diagnosis can be difficult, especially given the heterogeneity with which BKV disease has been reported to present in such patients, and the optimal approach to management is unknown. Balancing reduction in immunosuppression against prevention of allograft rejection is delicate. Improved therapeutic options are clearly required.
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http://dx.doi.org/10.1186/s12879-020-05292-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427921PMC
August 2020

Fabrication and evaluation of activated carbon-Pt microparticle based glutamate biosensor.

J Electroanal Chem (Lausanne) 2020 Jun 17;866. Epub 2020 Apr 17.

Weldon School of Biomedical Engineering, Birck Nanotechnology Center, Center for Implantable Device, Purdue University, West Lafayette, IN, USA.

As one of the most abundant neurotransmitters in the brain and the spinal cord, glutamate plays many important roles in the nervous system. Precise information about the level of glutamate in the extracellular space of living brain tissue may provide new insights on fundamental understanding of the role of glutamate in neurological disorders as well as neurophysiological phenomena. Electrochemical sensor has emerged as a promising solution that can satisfy the requirement for highly reliable and continuous monitoring method with good spatiotemporal resolution for characterization of extracellular glutamate concentration. Recently, we published a method to create a simple printable glutamate biosensor using platinum nanoparticles. In this work, we introduce an even simpler and lower cost conductive polymer composite using commercially available activated carbon with platinum microparticles to easily fabricate highly sensitive glutamate biosensor using direct ink writing method. The fabricated biosensors are functionality superior than previously reported with the sensitivity of 5.73 ± 0.078 nA μM mm, detection limit of 0.03 μM, response time less than or equal to 1 s, and a linear range from 1 μM up to 925 μM. In this study, we utilize astrocyte cell culture to demonstrate our biosensor's ability to monitor glutamate uptake process. We also demonstrate direct measurement of glutamate release from optogenetic stimulation in mouse primary visual cortex (V1) brain slices.
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http://dx.doi.org/10.1016/j.jelechem.2020.114136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266303PMC
June 2020

The impact of 2018 ASCO-CAP HER2 testing guidelines on breast cancer HER2 results. An audit of 2132 consecutive cases evaluated by immunohistochemistry and in situ hybridization.

Mod Pathol 2020 09 4;33(9):1783-1790. Epub 2020 May 4.

Directorate of Surgical Pathology, SA Pathology at the Royal Adelaide Hospital, Adelaide, S.A., Australia.

The 2018 iteration of the ASCO-CAP HER2 testing guidelines proposes significant changes with an emphasis on the integration of concurrent immunohistochemistry (IHC) and in situ hybridization (ISH). We wished to evaluate the impact of these changes on clinical practice. Between Jan 2012 to Feb 2017, 2132 consecutive invasive breast carcinomas were evaluated with IHC and ISH for HER2. The sample tested was the breast primary or axillary nodes in all but 57 (2.7%) distant metastases. For 1824 cases with both dual-probe ISH and IHC results, the ISH subgroup was 1: 299 (16.4%), 2: 19 (1.0%), 1.0%, 3: 6 (0.3%), 4: 48 (2.6%) and 5: 1452 (79.6%). Ultimately 21% of group 2 and 4 cases and 80% of group 4 cases were positive. The change in HER2 status between the 2018 vs 2013 was: amplified in 323 (15.2%) vs 15.5%; not amplified in 1804 (84.6%) vs 82.2%; equivocal in 0 vs 2.3% previously. In 22 of 2127 cases (1.03%) the 2013 and 2018 results were discordant, all in groups 2-4. The discrepant cases included 15 of 331 (4.5%) of 2013 amplified cancers, now negative (all in groups 2 or 3) and 7 of 1796 (0.4%) 2013 nonamplified cases, now positive (all in group 4). Because of routine testing with both IHC and ISH, we found 6 of 1147 (0.52%) IHC negative (0 or 1+) cases were amplified by ISH. Further, 19 of 289 (6.6%) of IHC 3+ cases were nonamplified by ISH, circumstances not covered by these guidelines. In summary at the population level, the 2018 ASCO-CAP guidelines have a 99% agreement with the 2013 results. A major advantage is the abolishment of the clinically problematic equivocal category. Routine performance of both IHC and ISH uncovers a small proportion of cancers whose HER2 status is not addressed by these guidelines.
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http://dx.doi.org/10.1038/s41379-020-0555-7DOI Listing
September 2020

Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy.

J Sex Med 2020 06 4;17(6):1203-1206. Epub 2020 Apr 4.

Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA.

Background: Climacturia affects up to 45% of men after radical prostatectomy (RP). Although urethral slings decrease the severity and frequency of stress incontinence after RP, their efficacy as a treatment for climacturia after RP has not been well studied.

Aim: The aim of this study was to assess patient-reported changes in climacturia symptoms after implantation of a urethral sling as a treatment for stress incontinence after RP.

Methods: After Institutional Review Board approval, a retrospective chart review identified males aged 18-80 years who received urethral slings for stress incontinence after RP at our institution from 2012 to 2017. These patients were mailed an 11-item questionnaire asking them about climacturia symptoms before and after implantation of a urethral sling. Written informed consent was obtained from patients participating in the mailed questionnaire.

Outcomes: Respondents were asked to report on climacturia frequency and severity, bother, partner bother, and incontinence before and after implantation of urethral slings.

Results: A total of 42 questionnaires were mailed; 17 were available for analysis. The median age (and interquartile range, IQR) of the sample at RP was 64 (59.5, 68.0). Almost all (94.1%) of the men were sexually active at the time of the study and 64.7% reported experiencing urinary leakage during sexual arousal. Most (58.8%) underwent the urethral sling procedure to treat general incontinence; 35.3% underwent the procedure to treat both general incontinence and incontinence during sexual activity and 1 (5.9%) underwent it for other reasons. A median of 28.1 months elapsed between RP and sling procedure (IQR: 18.36, 53.88; minimum: 8.00; maximum: 108.36). Statistically significant shifts toward improvement from presling to postsling were noted for frequency of leakage during sexual arousal or orgasm (P = .041) and for the degree to which leakage of urine during sexual arousal or orgasm was a "bother" (P = .027). While almost all (94%) of the men were incontinent before sling, this percentage dropped to 53% after sling (P = .031).

Clinical Implications: Urethral slings should be discussed as a treatment strategy for climacturia during clinical consultations with patients.

Strengths & Limitations: Strengths include consistent surgical technique. Limitations include retrospective design, lack of a nonsling comparison group, subjective nature of outcome measures, possible response bias, and variability in time interval between RP and sling procedure.

Conclusion: Use of urethral slings after RP is associated with improvements in climacturia symptoms, bother, and incontinence. Nolan J, Kershen R, Staff I, et al. Use of the Urethral Sling to Treat Symptoms of Climacturia in Men After Radical Prostatectomy. J Sex Med 2020;17:1203-1206.
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http://dx.doi.org/10.1016/j.jsxm.2020.03.001DOI Listing
June 2020

Transcatheter aortic valve implantation via surgical subclavian versus direct aortic access: A United Kingdom analysis.

Int J Cardiol 2020 06 21;308:67-72. Epub 2020 Mar 21.

Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Electronic address:

Background: Surgical subclavian (SC) and direct aortic (DA) access are established alternatives to the default transfemoral route for transcatheter aortic valve implantation (TAVI). We sought to find differences in survival and procedure-related outcomes after SC- versus DA-TAVI.

Methods: We performed an observational cohort analysis of cases prospectively uploaded to the UK TAVI registry. To ensure the most contemporaneous comparison, the analysis focused on SC and DA procedures performed from 2013 to 2015.

Results: Between January 2013 and July 2015, 82 (37%) SC and 142 (63%) DA cases were performed that had validated 1-year life status. Multivariable regression analysis showed procedure duration was longer for SC cases (SC 193.5 ± 65.8 vs. DA 138.4 ± 57.7 min; p < .01) but length of hospital stay was shorter (SC 8.6 ± 9.5 vs. DA 11.9 ± 10.8 days; p = .03). Acute kidney injury was observed less frequently after SC cases (odds ratio [OR] 0.35, 95% confidence interval [CI 0.12-0.96]; p = .042) but vascular access site-related complications were more common (OR 9.75 [3.07-30.93]; p < .01). Procedure-related bleeding (OR 0.54 [0.24-1.25]; p = .15) and in-hospital stroke rate (SC 3.7% vs. DA 2.1%; p = .67) were similar. There were no significant differences in in-hospital (SC 2.4% vs. DA 4.9%; p = .49), 30-day (SC 2.4% vs. DA 4.2%; p = .71) or 1-year (SC 14.5% vs. DA 21.9%; p = .344) mortality.

Conclusions: Surgical subclavian and direct aortic approaches can offer favourable outcomes in appropriate patients. Neither access modality conferred a survival advantage but there were significant differences in procedural metrics that might influence which approach is selected.
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http://dx.doi.org/10.1016/j.ijcard.2020.03.059DOI Listing
June 2020

An Unexpected Cause of Gastrointestinal Bleeding after Stem Cell Transplantation.

Gastroenterology 2020 Aug 20;159(2):443-445. Epub 2020 Mar 20.

Royal Adelaide Hospital, Department of Gastroenterology and Hepatology.

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http://dx.doi.org/10.1053/j.gastro.2020.03.035DOI Listing
August 2020

Association Between Hospital Cardiac Catheter Laboratory Status, Use of an Invasive Strategy, and Outcomes After NSTEMI.

Can J Cardiol 2020 06 16;36(6):868-877. Epub 2019 Oct 16.

Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke on Trent, United Kingdom; Department of Cardiology, University Hospital of North Midlands, Stoke on Trent, United Kingdom; Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.

Background: Increased use of invasive coronary strategies in patients admitted to hospitals with on-site cardiac catheter laboratory (CCL) facilities has been reported, but the utilisation of invasive coronary strategies according to types of CCL facilities at the first admitting hospital and clinical outcomes is unknown.

Methods: We included 452,216 patients admitted with a diagnosis of non-ST-segment-elevation myocardial infarction (NSTEMI) in England and Wales from 2007 to 2015. The admitting hospitals were categorized into no-laboratory, diagnostic, and PCI hospitals according to CCL facilities. Multilevel logistic regression models were used to study associations between CCL facilities and in-hospital outcomes.

Results: A total of 97,777 (21.6%) of the patients were admitted to no-laboratory hospitals, and 134,381 (29.7%) and 220,058 (48.7%) were admitted to diagnostic and PCI hospitals, respectively. Use of coronary angiography was significantly higher in PCI hospitals (77.3%) than in diagnostic (63.2%) and no-laboratory (61.4%) hospitals. The adjusted odds of in-hospital mortality were similar for diagnostic (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.83-1.04) and PCI hospitals (OR 1.09, 95% CI 0.96-1.24) compared with no-laboratory hospitals. However, in high-risk NSTEMI subgroup (defined as Global Registry of Acute Coronary Events score > 140), an admission to diagnostic hospitals was associated with significantly increased in-hospital mortality (OR 1.36, 95% CI 1.06-1.75) compared with no-laboratory and PCI hospitals.

Conclusions: This study highlights important differences in both the utilisation of invasive coronary strategies and subsequent management and outcomes of NSTEMI patients according to admitting hospital CCL facilities. High-risk NSTEMI patients admitted to diagnostic hospitals had greater in-hospital mortality, possibly because of reduced PCI use, which needs to be addressed.
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http://dx.doi.org/10.1016/j.cjca.2019.10.010DOI Listing
June 2020

Rates, predictors and the impact of cannabis misuse on in-hospital outcomes among patients undergoing percutaneous coronary intervention (from the National Inpatient Sample).

Int J Clin Pract 2020 May 31;74(5):e13477. Epub 2020 Jan 31.

Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.

Background: Whether cannabis use worsens outcomes in coronary heart disease is unknown and no previous study has evaluated the outcomes for patients who undergo percutaneous coronary intervention (PCI) according to cannabis use.

Methods: We analysed patients in the National Inpatient Sample between 2004 and 2014 who underwent PCI and evaluated rates, predictors and outcomes of patients according to cannabis misuse defined by cannabis abuse or dependence.

Results: A total of 7 306 012 patients were included and 32 765 cannabis misusers (0.4%). Cannabis misusers were younger (49.5 vs 64.6 years, P < .001) and were more likely to be male (82.7% vs 66.3%, P < .001). There was also a greater proportion of patients who were of black ethnicity in the cannabis misuse group (27.7% vs 7.9%, P < .001) and fewer elective admissions (7.8% vs 27.6%, P < .001). There was no difference in in-hospital mortality (OR 1.06 95% CI 0.80-1.40, P = .67), bleeding (OR 0.94 95% CI 0.77-1.15, P = .55) and stroke/transient ischaemic attack (OR 1.19 95% CI 0.98-1.45, P = .084) compared with non-cannabis misusers. Cannabis misusers had significantly lower odds of in-hospital vascular complications (OR 0.73 95% CI 0.58-0.90, P = .004).

Conclusions: Our results suggest that cannabis misusers are more likely to be male, of black ethnicity and from the lowest quartile of income, but there was no evidence that cannabis misuse is associated with worse periprocedural outcomes following PCI when controlling for key proxies of health status.
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http://dx.doi.org/10.1111/ijcp.13477DOI Listing
May 2020

Cost of coronary syndrome treated with percutaneous coronary intervention and 30-day unplanned readmission in the United States.

Catheter Cardiovasc Interv 2021 Jan 26;97(1):80-93. Epub 2019 Dec 26.

Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.

Objectives: This study aimed to examine the cost of coronary syndrome treated with percutaneous coronary intervention (PCI) and 30-day unplanned readmissions.

Background: There is limited understanding of the hospital cost of index PCI and 30-day unplanned readmissions.

Methods: Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were included. The primary outcome was total cost defined by cost of index PCI and first unplanned readmission within 30 days.

Results: This analysis included 2,294,244 patients who underwent PCI, and the mean cost was $23,541 ± $20,730 (~$10.8 billion/year). There was a modest increase in cost over the study years of 17.5%. Of the 9.4% with an unplanned readmission within 30 days, the mean total cost was $35,333 ± 24,230 versus $22,323 ± 19,941 for those not readmitted. The variables most strongly associated with the highest quartile of cost were heart failure (adjusted odds ratio (aOR) 25.60 [95% CI 21.59-30.35]), need for circulatory support (aOR 11.62 [10.13-13.32]), periprocedural coronary artery bypass graft (CABG, aOR 585.08 [357.85-956.58]), and readmission within 30 days (aOR 24.49 [22.40-26.77]). An acute kidney injury (AKI; 8.5%), major bleed (0.8%), vascular injury (0.8%), or need for periprodedural CABG (1.4%) had an average increased cost of $21,935; $30,898; $27,875; and $43,005, respectively, compared to PCI without adverse outcome.

Conclusions: The annual 30-day hospital cost of PCI is approximately $10.8 billion, and the costs associated with in-hospital adverse events, particularly the need for AKI and periprocedural CABG, were significant.
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http://dx.doi.org/10.1002/ccd.28660DOI Listing
January 2021

Simple Fabrication of Flexible Biosensor Arrays Using Direct Writing for Multianalyte Measurement from Human Astrocytes.

SLAS Technol 2020 02 26;25(1):33-46. Epub 2019 Nov 26.

Weldon School of Biomedical Engineering, Center for Implantable Devices, Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA.

Simultaneous measurements of glucose, lactate, and neurotransmitters (e.g., glutamate) in cell culture over hours and days can provide a more dynamic and longitudinal perspective on ways neural cells respond to various drugs and environmental cues. Compared with conventional microfabrication techniques, direct writing of conductive ink is cheaper, faster, and customizable, which allows rapid iteration for different applications. Using a simple direct writing technique, we printed biosensor arrays onto cell culture dishes, flexible laminate, and glass to enable multianalyte monitoring. The ink was a composite of PEDOT:PSS conductive polymer, silicone, activated carbon, and Pt microparticles. We applied 0.5% Nafion to the biosensors for selectivity and functionalized them with oxidase enzymes. We characterized biosensors in phosphate-buffered saline and in cell culture medium supplemented with fetal bovine serum. The biosensor arrays measured glucose, lactate, and glutamate simultaneously and continued to function after incubation in cell culture at 37 °C for up to 2 days. We cultured primary human astrocytes on top of the biosensor arrays and placed arrays into astrocyte cultures. The biosensors simultaneously measured glucose, glutamate, and lactate from astrocyte cultures. Direct writing can be integrated with microfluidic organ-on-a-chip platforms or as part of a smart culture dish system. Because we print extrudable and flexible components, sensing elements can be printed on any 3D or flexible substrate.
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http://dx.doi.org/10.1177/2472630319888442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263197PMC
February 2020

Outcomes Following Percutaneous Coronary Intervention in Saphenous Vein Grafts With and Without Embolic Protection Devices.

JACC Cardiovasc Interv 2019 11;12(22):2286-2295

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom. Electronic address:

Objectives: The aim of this study was to describe the early (inpatient and 30-day) and late (1-year) outcomes of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs), with and without the use of embolic protection devices (EPD), in a large, contemporary, unselected national cohort from the database of the British Cardiovascular Intervention Society.

Background: There are limited, and discrepant, data on the clinical benefits of the adjunctive use of EPDs during PCI to SVGs in the contemporary era.

Methods: A longitudinal cohort of patients (2007 to 2014, n = 20,642) who underwent PCI to SVGs in the British Cardiovascular Intervention Society database was formed. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 2 groups: no EPD (PCI to SVGs without EPDs, n = 17,730) and EPD (PCI to SVGs with EPDs, n = 2,912).

Results: Patients in the EPD group were older, had more comorbidities, and had a higher prevalence of moderate to severe left ventricular systolic dysfunction. Mortality was lower in the EPD group during hospital admission (0.70% vs. 1.29%; p = 0.008) and at 30 days (1.44% vs. 2.01%; p = 0.04) but similar at 1 year (6.22% vs. 6.01%; p = 0.67). Following multivariate analyses, no significant difference in mortality was observed during index admission (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.42 to 1.19; p = 0.19), at 30 days (OR: 0.87; 95% CI: 0.60 to 1.25; p = 0.45), and at 1 year (OR: 0.92; 95% CI: 0.77 to 1.11; p = 0.41), along with similar rates of in-hospital major adverse cardiovascular events (OR: 1.16; 95% CI: 0.83 to 1.62; p = 0.39) and stroke (OR: 0.68; 95% CI: 0.20 to 2.35; p = 0.54). In propensity score-matched analyses, lower inpatient mortality was observed in the EPD group (OR: 0.46; 95% CI: 0.13 to 0.80; p = 0.002), although the adjusted risk for the periprocedural no-reflow or slow-flow phenomenon was higher in patients in whom EPDs were used (OR: 2.16; 95% CI: 1.71 to 2.73; p < 0.001).

Conclusions: In this contemporary cohort, EPDs were used more commonly in higher risk patients but were associated with similar clinical outcomes in multivariate analyses. Lower inpatient mortality was observed in the EPD group in univariate and propensity score-matched analyses.
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http://dx.doi.org/10.1016/j.jcin.2019.08.037DOI Listing
November 2019

Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention: An International Consensus Paper.

JACC Cardiovasc Interv 2019 11;12(22):2235-2246

Quebec Heart and Lung Institute, Quebec City, Canada. Electronic address:

Transradial access (TRA) is increasingly used worldwide for percutaneous interventional procedures and associated with lower bleeding and vascular complications than transfemoral artery access. Radial artery occlusion (RAO) is the most frequent post-procedural complication of TRA, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery bypass graft. The authors review recent advances in the prevention of RAO following percutaneous TRA diagnostic or interventional procedures. Based on the available data, the authors provide easily applicable and effective recommendations to prevent periprocedural RAO and maximize the chances of access in case of repeat catheterization or coronary artery bypass grafting surgery.
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http://dx.doi.org/10.1016/j.jcin.2019.07.043DOI Listing
November 2019

The Human Gut Virome Is Highly Diverse, Stable, and Individual Specific.

Cell Host Microbe 2019 10;26(4):527-541.e5

APC Microbiome Ireland & School of Microbiology, University College Cork, Cork T12 YT20, Ireland. Electronic address:

The human gut contains a vast array of viruses, mostly bacteriophages. The majority remain uncharacterized, and their roles in shaping the gut microbiome and in impacting on human health remain poorly understood. We performed longitudinal metagenomic analysis of fecal viruses in healthy adults that reveal high temporal stability, individual specificity, and correlation with the bacterial microbiome. Using a database-independent approach that uses most of the sequencing data, we uncovered the existence of a stable, numerically predominant individual-specific persistent personal virome. Clustering of viral genomes and de novo taxonomic annotation identified several groups of crAss-like and Microviridae bacteriophages as the most stable colonizers of the human gut. CRISPR-based host prediction highlighted connections between these stable viral communities and highly predominant gut bacterial taxa such as Bacteroides, Prevotella, and Faecalibacterium. This study provides insights into the structure of the human gut virome and serves as an important baseline for hypothesis-driven research.
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http://dx.doi.org/10.1016/j.chom.2019.09.009DOI Listing
October 2019

Ex vivo electrochemical measurement of glutamate release during spinal cord injury.

MethodsX 2019 23;6:1894-1900. Epub 2019 Aug 23.

Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA.

Excessive glutamate release following traumatic spinal cord injury (SCI) has been associated with exacerbating the extent of SCI. However, the mechanism behind sustained high levels of extracellular glutamate is unclear. Spinal cord segments mounted in a sucrose double gap recording chamber are an established model for traumatic spinal cord injury. We have developed a method to record, with micro-scale printed glutamate biosensors, glutamate release from rat spinal cord segments following injury. This protocol would work equally well for similar glutamate biosensors.
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http://dx.doi.org/10.1016/j.mex.2019.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727010PMC
August 2019

Corrigendum to Facile fabrication of flexible glutamate biosensor using direct writing of platinum nanoparticle-based nanocomposite ink.

Biosens Bioelectron 2019 09 17;141:111429. Epub 2019 Jun 17.

Weldon School of Biomedical Engineering, Birck Nanotechnology Center, Center for Implantable Device, Purdue University, West Lafayette, IN, USA. Electronic address:

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http://dx.doi.org/10.1016/j.bios.2019.111429DOI Listing
September 2019

Complex regional pain syndrome: A rare but potentially disabling complication of transradial cardiac catheterization.

Catheter Cardiovasc Interv 2020 04 30;95(5):E140-E143. Epub 2019 May 30.

Department of Interventional Cardiology, Keele University and University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.

Background: Chronic Regional Pain Syndrome (CRPS) is a rare complication following transradial cardiac catheterization.

Aims: To discuss the clinical features, pathophysiology, diagnosis and management of CRPS.

Methods: Literature review performed.

Results: CRPS is seen rarely in the literature following upper limb arterial access for coronary procedures, which may be due to a low incidence of the syndrome as well as limited recognition and underreporting.

Discussion: The diagnosis and management of CRPS are discussed in detail.

Conclusion: If CRPS is a potential diagnosis then prompt early referral to a center with a specialist interest in CRPS is recommended. Prompt diagnosis and early commencement on the correct patient treatment pathway are essential, to avoid potentially life changing disability and the psychological consequences of living with intractable chronic undiagnosed pain.
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http://dx.doi.org/10.1002/ccd.28357DOI Listing
April 2020

Immunoglobulin G related disease: a single-centre experience from South Australia.

Intern Med J 2019 09;49(9):1099-1104

Immunology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Background: IgG related disease (IgG4RD) is a newly described multisystem fibro-inflammatory disorder. There is a paucity of literature describing the Australian experience of this rare condition.

Aims: To characterise the Royal Adelaide Hospital IgG4RD cohort with biopsy-proven disease.

Methods: A search of the Frome Road SA Pathology database was performed for all tissue biopsies containing the phrase 'IgG positive'. Case notes were reviewed for clinical details, laboratory and radiology results. Histological features according to the Boston Criteria were used. Patients with available case notes, highly suggestive or probable histology and clinical features to suggest IgG4RD were included.

Results: Twenty patients had definite or probable IgG4RD and suggestive clinical features; median age 59 (20-76), male : female 1.5:1. There was considerable delay in diagnosis (median diagnosis at 64 months). Organ involvement included: 11 exocrine gland, seven pancreatobiliary, seven nodal, seven soft tissue, five retro-orbital, three retroperitoneal fibrosis and two renal. Systemic symptoms at diagnosis were seen in eight patients. Seven (35%) had an elevated serum IgG (>1.35 g/L) at diagnosis. Only 12 (60%) required immunosuppressive treatment (corticosteroids); of these, four (20%) required a steroid-sparing agent and four (20%) required B-cell depleting therapy (rituximab). The median duration of follow up was 18 months.

Conclusions: This is the first characterised Australian cohort with generalised IgG4RD, a rare, relatively indolent and under-recognised multisystem disorder. Diagnosis is difficult given lack of awareness of this rare condition among physicians, its presentation as a great disease mimic, challenges with histopathological assessment and the absence of a suitable serum biomarker.
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http://dx.doi.org/10.1111/imj.14331DOI Listing
September 2019

Characteristics and outcome of acute heart failure patients according to the severity of peripheral oedema.

Int J Cardiol 2019 06 15;285:40-46. Epub 2019 Mar 15.

Department of Academic Cardiology, University of Hull, Kingston upon Hull, UK; Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, Scotland, UK; National Heart and Lung Institute, Imperial College, London, UK.

Background: Most trials of patients hospitalized for heart failure focus on breathlessness (alveolar pulmonary oedema) but worsening peripheral oedema is also an important presentation. We investigated the relationship between the severity of peripheral oedema on admission and outcome amongst patients with a primary discharge death or diagnosis of heart failure.

Objectives: We tested the hypothesis that severity of peripheral oedema is associated with length of hospital stay and mortality.

Methods: Patient variables reported to the National Heart Failure Audit for England & Wales between April 2008 and March 2013 were included in this analysis. Peripheral oedema was classified as 'none', 'mild', 'moderate' or 'severe'. Length of stay, mortality during the index admission and for up to three years after discharge are reported.

Results: Of 121,214 patients, peripheral oedema on admission was absent in 24%, mild in 24%, moderate in 33% and severe in 18%. Median length of stay was, respectively, 6, 7, 9 and 12 days (P- < 0.001), index admission mortality was 7%, 8%, 10% and 16% (P- < 0.001) and mortality at a median follow-up of 344 (IQR 94-766) days was 39%, 46%, 52% and 59%. In an adjusted multi-variable Cox model, the hazard ratio for death was 1.51 for severe (P- < 0.001, CI 1.50-1.53), 1.21 for moderate (P- < 0.001, CI 1.20-1.22) and 1.04 (P- < 0.001, CI 1.02-1.05) for mild peripheral oedema compared to patients without peripheral oedema at presentation.

Conclusion: Length of hospital stay and mortality during index admission and after discharge increased progressively with increasing severity of peripheral oedema at admission.
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http://dx.doi.org/10.1016/j.ijcard.2019.03.020DOI Listing
June 2019

Facile fabrication of flexible glutamate biosensor using direct writing of platinum nanoparticle-based nanocomposite ink.

Biosens Bioelectron 2019 Apr 31;131:257-266. Epub 2019 Jan 31.

Weldon School of Biomedical Engineering, Birck Nanotechnology Center, Center for Implantable Device, Purdue University, West Lafayette, IN, USA. Electronic address:

Glutamate excitotoxicity is a pathology in which excessive glutamate can cause neuronal damage and degeneration. It has also been linked to secondary injury mechanisms in traumatic spinal cord injury. Conventional bioanalytical techniques used to characterize glutamate levels in vivo, such as microdialysis, have low spatiotemporal resolution, which has impeded our understanding of this dynamic event. In this study, we present an amperometric biosensor fabricated using a simple direct ink writing technique for the purpose of in vivo glutamate monitoring. The biosensor is fabricated by immobilizing glutamate oxidase on nanocomposite electrodes made of platinum nanoparticles, multi-walled carbon nanotubes, and a conductive polymer on a flexible substrate. The sensor is designed to measure extracellular dynamics of glutamate and other potential biomarkers during a traumatic spinal cord injury event. Here we demonstrate good sensitivity and selectivity of these rapidly prototyped implantable biosensors that can be inserted into a spinal cord and measure extracellular glutamate concentration. We show that our biosensors exhibit good flexibility, linear range, repeatability, and stability that are suitable for future in vivo evaluation.
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http://dx.doi.org/10.1016/j.bios.2019.01.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261495PMC
April 2019