Publications by authors named "Vishal Shah"

121 Publications

Antibiotic resistance in mucosal bacteria from high Arctic migratory salmonids.

Environ Microbiol Rep 2021 Jun 9. Epub 2021 Jun 9.

College of the Sciences and Mathematics, West Chester University, West Chester, Pennsylvania, USA.

Two related salmonids, Arctic char (Salvelinus alpinus) and lake whitefish (Coregonus clupeaformis) sampled from the high Arctic region of Nunavut, Canada are anadromous fish, migrating annually from the same ice-covered freshwater waterbodies to spend summers in the marine waters of the Arctic Ocean. Microbiota associated with the skin-associated mucus undergo community change coincident with migration, and irrespective of this turnover, antibiotic resistance was detected in mixed bacterial cultures initiated with mucus samples. Although as expected most bacteria were unculturable, however, 5/7 isolates showed susceptibility to a panel of five common antibiotics. The fish were sampled under severe conditions and at remote locations far from human habitation. Regardless, two isolates, 'Carnobacterium maltaromaticum sm-2' and 'Arthrobacter citreus sm', showed multi-resistance to two or more antibiotics including ampicillin and streptomycin indicating multiple resistance genes. It is unknown if these fish bacteria have 'natural' resistance phenotypes or if resistance has been acquired. As result of these observations, we urge long-term monitoring of drug-resistant bacteria in the region and caution the assumption of a lack of drug-resistant organisms even in such extreme environments.
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http://dx.doi.org/10.1111/1758-2229.12975DOI Listing
June 2021

Evaluation of healthcare personnel exposures to patients with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) associated with personal protective equipment.

Infect Control Hosp Epidemiol 2021 May 12:1-5. Epub 2021 May 12.

Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota.

Objective: Personal protective equipment (PPE) is a critical aspect of preventing the transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in healthcare settings. We aimed to identify factors related to lapses in PPE use that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP).

Design: Retrospective cohort study.

Setting: Tertiary-care medical center in Minnesota.

Participants: In total, 345 HCP who sustained a significant occupational exposure to a patient with coronavirus disease 2019 (COVID-19) from May 13, 2020, through November 30, 2020, were evaluated.

Results: Overall, 8 HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day postexposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR) during the postexposure quarantine (relative risk [RR], 10.25; 95% confidence interval [CI], 1.28-82.39; P = .009). Overall, the most common reason for a significant exposure was the use of a surgical face mask instead of a respirator during an aerosol-generating procedure (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the postexposure quarantine (RR, 0.99; 95% CI, 0.96-1; P = 1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19.

Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient-to-HCP transmission of SARS-CoV-2.
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http://dx.doi.org/10.1017/ice.2021.219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144829PMC
May 2021

Theoretical advantages of a triaxial optically pumped magnetometer magnetoencephalography system.

Neuroimage 2021 Apr 7;236:118025. Epub 2021 Apr 7.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom.

The optically pumped magnetometer (OPM) is a viable means to detect magnetic fields generated by human brain activity. Compared to conventional detectors (superconducting quantum interference devices) OPMs are small, lightweight, flexible, and operate without cryogenics. This has led to a step change in instrumentation for magnetoencephalography (MEG), enabling a "wearable" scanner platform, adaptable to fit any head size, able to acquire data whilst subjects move, and offering improved data quality. Although many studies have shown the efficacy of 'OPM-MEG', one relatively untapped advantage relates to improved array design. Specifically, OPMs enable the simultaneous measurement of magnetic field components along multiple axes (distinct from a single radial orientation, as used in most conventional MEG systems). This enables characterisation of the magnetic field vector at all sensors, affording extra information which has the potential to improve source reconstruction. Here, we conduct a theoretical analysis of the critical parameters that should be optimised for effective source reconstruction. We show that these parameters can be optimised by judicious array design incorporating triaxial MEG measurements. Using simulations, we demonstrate how a triaxial array offers a dramatic improvement on our ability to differentiate real brain activity from sources of magnetic interference (external to the brain). Further, a triaxial system is shown to offer a marked improvement in the elimination of artefact caused by head movement. Theoretical results are supplemented by an experimental recording demonstrating improved interference reduction. These findings offer new insights into how future OPM-MEG arrays can be designed with improved performance.
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http://dx.doi.org/10.1016/j.neuroimage.2021.118025DOI Listing
April 2021

Methylmercury Production and Degradation under Light and Dark Conditions in the Water Column of the Hells Canyon Reservoirs, USA.

Environ Toxicol Chem 2021 Mar 17. Epub 2021 Mar 17.

College of the Sciences and Mathematics, West Chester University, West Chester, Pennsylvania, USA.

Methylmercury (MeHg) is a highly toxic form of mercury that can bioaccumulate in fish tissue. Methylmercury is produced by anaerobic bacteria, many of which are also capable of MeHg degradation. In addition, demethylation in surface waters can occur via abiotic sunlight-mediated processes. The goal of the present study was to understand the relative importance of microbial Hg methylation/demethylation and abiotic photodemethylation that govern the mass of MeHg within an aquatic system. The study location was the Hells Canyon complex of 3 reservoirs on the Idaho-Oregon border, USA, that has fish consumption advisories as a result of elevated MeHg concentrations. Our study utilized stable isotope addition experiments to trace MeHg formation and degradation within the water column of the reservoirs to understand the relative importance of these processes on the mass of MeHg using the Water Quality Analysis Simulation Program. The results showed that rates of MeHg production and degradation within the water column were relatively low (<0.07 d ) but sufficient to account for most of the MeHg observed with the system. Most MeHg production within the water column appeared to occur in the spring when much of the water column was in the processes of becoming anoxic. In the surface waters, rates of photodemethylation were relatively large (up to -0.25 d ) but quickly decreased at depths >0.5 m below the surface. These results can be used to identify the relative importance of MeHg processes that can help guide reservoir management decisions. Environ Toxicol Chem 2021;00:1-11. © 2021 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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http://dx.doi.org/10.1002/etc.5041DOI Listing
March 2021

Measuring functional connectivity with wearable MEG.

Neuroimage 2021 04 29;230:117815. Epub 2021 Jan 29.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.

Optically-pumped magnetometers (OPMs) offer the potential for a step change in magnetoencephalography (MEG) enabling wearable systems that provide improved data quality, accommodate any subject group, allow data capture during movement and potentially reduce cost. However, OPM-MEG is a nascent technology and, to realise its potential, it must be shown to facilitate key neuroscientific measurements, such as the characterisation of brain networks. Networks, and the connectivities that underlie them, have become a core area of neuroscientific investigation, and their importance is underscored by many demonstrations of their disruption in brain disorders. Consequently, a demonstration of network measurements using OPM-MEG would be a significant step forward. Here, we aimed to show that a wearable 50-channel OPM-MEG system enables characterisation of the electrophysiological connectome. To this end, we measured connectivity in the resting state and during a visuo-motor task, using both OPM-MEG and a state-of-the-art 275-channel cryogenic MEG device. Our results show that resting-state connectome matrices from OPM and cryogenic systems exhibit a high degree of similarity, with correlation values >70%. In addition, in task data, similar differences in connectivity between individuals (scanned multiple times) were observed in cryogenic and OPM-MEG data, again demonstrating the fidelity of the OPM-MEG device. This is the first demonstration of network connectivity measured using OPM-MEG, and results add weight to the argument that OPMs will ultimately supersede cryogenic sensors for MEG measurement.
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http://dx.doi.org/10.1016/j.neuroimage.2021.117815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216250PMC
April 2021

Letter to the Editor: Microbiota in the Respiratory System-A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2.

Authors:
Vishal Shah

Microbiol Insights 2021 19;14:1178636120988604. Epub 2021 Jan 19.

College of the Sciences and Mathematics, West Chester University, PA, USA.

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.
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http://dx.doi.org/10.1177/1178636120988604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818001PMC
January 2021

Assessment of pain, anxiety and depression, and quality of life after minimally invasive aortic surgery.

J Card Surg 2021 Mar 13;36(3):886-893. Epub 2021 Jan 13.

Department of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Background: Minimally invasive cardiac surgery may reduce surgical trauma, diminish postoperative pain and improve quality of life (QOL). The aim of this study is to assess pain, hospital anxiety and depression scale (HADS), and QOL in patients undergoing minimally invasive aortic surgery.

Methods: This is a prospective, single-center cohort study of 24 consecutive patients undergoing upper ministernotomy aortic valve, aortic root, and concomitant aortic valve and ascending aorta replacement. Visual analog scale (VAS) pain scores and HADS and Short-Form-36 (SF-36) questionnaires were evaluated at preoperative baseline, during hospitalization, and at 1 and 3 months postoperatively.

Results: At discharge, the average VAS pain score was significantly lower than postoperative Day 1 (2.7 ± 0.4 vs. 6.5 ± 0.4; p ≤ .001). By 1 month, the pain scores were not significantly different from baseline (1.7 ± 0.4 vs. 1.0 ± 0.4; p = 1.000), and by 3 months, pain scores returned to baseline (1.0 ± 0.4; p = 1.000). HADS scores show that compared with preoperative baseline, average anxiety scores decreased by 1 month (3.1 ± 0.7 vs. 4.3 ± 0.6; p = 1.000) and decreased significantly by 3 months (1.8 ± 0.7 vs. 4.3 ± 0.6; p = .012). Additionally, depression scores were unchanged at 1 month (3.0 ± 0.4 vs. 3.1. ± 0.4; p = 1.000) and decreased by 3 months (1.3 ± 0.5 vs. 3.0 ± 0.4; p = .060). SF-36 scores revealed no changes in scores in 7 of 8 domains at 1 month and a significant increase in "physical functioning," "energy," and "general health" domains compared to preoperative baseline at 3 months.

Conclusions: Following minimally invasive aortic surgery, VAS pain scores, HADS and scores in 7 of 8 SF-36 domains returned to preoperative baseline or improved compared to preoperative baseline at 1 month. At 3 months, scores in 3 of 8 SF-36 domains significantly improved compared to preoperative baseline. Larger studies are necessary for further investigation.
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http://dx.doi.org/10.1111/jocs.15320DOI Listing
March 2021

Transcatheter and ministernotomy aortic valve replacement after bioprosthetic valve failure.

J Card Surg 2021 Feb 6;36(2):493-500. Epub 2020 Dec 6.

Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Background: Transcatheter valve-in-valve implantation (TViV) and minimally invasive reoperative aortic valve replacement (MIrAVR) have rapidly increased as alternatives to conventional reoperative surgical AVR. This study reports a single-center experience of patients undergoing TViV and MIrAVR after bioprosthetic valve failure.

Methods: In this retrospective review between March 2009 and October 2018, 68 patients without reoperative full sternotomies, concomitant procedures, active endocarditis, and prior homografts or coronary artery bypass grafting underwent isolated AVR for degenerated aortic bioprostheses. Society of Thoracic Surgeons (STS) risk scores and age are reported as median (interquartile range [IQR]) and length of stay is reported as mean (standard deviation [SD]) due to their characteristics of the distribution.

Results: Forty-one (60.3%) patients underwent TViV, and 27 (39.7%) patients underwent MIrAVR. Median [IQR] STS risk scores were 5.7 [4.0-7.8] and 2.0 [1.5-3.4] for TViV and MIrAVR, respectively (p ≤ .001). The median [IQR] age for TViV patients was higher (78 [71-84] vs. 66 [53-72] years, p ≤ 0.001). More permanent pacemakers were implanted (22.2% vs. 9.8%) following MIrAVR. The MIrAVR group had a higher rate of atrial fibrillation (18.5% vs. 9.8%, p = .466). Average (SD) length of stay was less in TViV (5.3 days, SD: 3.4 vs. 8.6 days, SD: 7.4, p = .001). Survival at 1 year was not significantly different for TViV and MIrAVR (94.9% [95% confidence interval [CI]: 81.0%, 98.7%] and 86.9% [95% CI: 64.0%, 95.7%], respectively [p = .969]).

Conclusions: Despite being at higher-risk, patients undergoing TViV had reduced rates of permanent pacemaker implantations and atrial fibrillation, and a shorter hospital stay as compared to MIrAVR. Survival at 1-year was similar between the two groups.
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http://dx.doi.org/10.1111/jocs.15225DOI Listing
February 2021

Mouth magnetoencephalography: A unique perspective on the human hippocampus.

Neuroimage 2021 01 12;225:117443. Epub 2020 Oct 12.

Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, UK.

Traditional magnetoencephalographic (MEG) brain imaging scanners consist of a rigid sensor array surrounding the head; this means that they are maximally sensitive to superficial brain structures. New technology based on optical pumping means that we can now consider more flexible and creative sensor placement. Here we explored the magnetic fields generated by a model of the human hippocampus not only across scalp but also at the roof of the mouth. We found that simulated hippocampal sources gave rise to dipolar field patterns with one scalp surface field extremum at the temporal lobe and a corresponding maximum or minimum at the roof of the mouth. We then constructed a fitted dental mould to accommodate an Optically Pumped Magnetometer (OPM). We collected data using a previously validated hippocampal-dependant task to test the empirical utility of a mouth-based sensor, with an accompanying array of left and right temporal lobe OPMs. We found that the mouth sensor showed the greatest task-related theta power change. We found that this sensor had a mild effect on the reconstructed power in the hippocampus (~10% change) but that coherence images between the mouth sensor and reconstructed source images showed a global maximum in the right hippocampus. We conclude that augmenting a scalp-based MEG array with sensors in the mouth shows unique promise for both basic scientists and clinicians interested in interrogating the hippocampus.
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http://dx.doi.org/10.1016/j.neuroimage.2020.117443DOI Listing
January 2021

Attitudes to cataract surgery during the COVID-19 pandemic: a patient survey.

Eye (Lond) 2020 12 24;34(12):2161-2162. Epub 2020 Jul 24.

Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, United Kingdom.

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http://dx.doi.org/10.1038/s41433-020-1112-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379754PMC
December 2020

Total Aortic Arch Replacement: An Evolving Process.

Semin Thorac Cardiovasc Surg 2020 5;32(4):696-697. Epub 2020 Jul 5.

Abington-Jefferson Health, Abington, Pennsylvania. Electronic address:

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http://dx.doi.org/10.1053/j.semtcvs.2020.06.014DOI Listing
February 2021

Multi-channel whole-head OPM-MEG: Helmet design and a comparison with a conventional system.

Neuroimage 2020 10 29;219:116995. Epub 2020 May 29.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.

Magnetoencephalography (MEG) is a powerful technique for functional neuroimaging, offering a non-invasive window on brain electrophysiology. MEG systems have traditionally been based on cryogenic sensors which detect the small extracranial magnetic fields generated by synchronised current in neuronal assemblies, however, such systems have fundamental limitations. In recent years, non-cryogenic quantum-enabled sensors, called optically-pumped magnetometers (OPMs), in combination with novel techniques for accurate background magnetic field control, have promised to lift those restrictions offering an adaptable, motion-robust MEG system, with improved data quality, at reduced cost. However, OPM-MEG remains a nascent technology, and whilst viable systems exist, most employ small numbers of sensors sited above targeted brain regions. Here, building on previous work, we construct a wearable OPM-MEG system with 'whole-head' coverage based upon commercially available OPMs, and test its capabilities to measure alpha, beta and gamma oscillations. We design two methods for OPM mounting; a flexible (EEG-like) cap and rigid (additively-manufactured) helmet. Whilst both designs allow for high quality data to be collected, we argue that the rigid helmet offers a more robust option with significant advantages for reconstruction of field data into 3D images of changes in neuronal current. Using repeat measurements in two participants, we show signal detection for our device to be highly robust. Moreover, via application of source-space modelling, we show that, despite having 5 times fewer sensors, our system exhibits comparable performance to an established cryogenic MEG device. While significant challenges still remain, these developments provide further evidence that OPM-MEG is likely to facilitate a step change for functional neuroimaging.
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http://dx.doi.org/10.1016/j.neuroimage.2020.116995DOI Listing
October 2020

Cell-based therapy to reduce mortality from COVID-19: Systematic review and meta-analysis of human studies on acute respiratory distress syndrome.

Stem Cells Transl Med 2020 09 29;9(9):1007-1022. Epub 2020 May 29.

Department of Pathology and Laboratory Medicine, Department of Health Policy and Management, Rollins School of Public Health, Emory University, The Marcus Foundation, Atlanta, Georgia, USA.

Severe cases of COVID-19 infection, often leading to death, have been associated with variants of acute respiratory distress syndrome (ARDS). Cell therapy with mesenchymal stromal cells (MSCs) is a potential treatment for COVID-19 ARDS based on preclinical and clinical studies supporting the concept that MSCs modulate the inflammatory and remodeling processes and restore alveolo-capillary barriers. The authors performed a systematic literature review and random-effects meta-analysis to determine the potential value of MSC therapy for treating COVID-19-infected patients with ARDS. Publications in all languages from 1990 to March 31, 2020 were reviewed, yielding 2691 studies, of which nine were included. MSCs were intravenously or intratracheally administered in 117 participants, who were followed for 14 days to 5 years. All MSCs were allogeneic from bone marrow, umbilical cord, menstrual blood, adipose tissue, or unreported sources. Combined mortality showed a favorable trend but did not reach statistical significance. No related serious adverse events were reported and mild adverse events resolved spontaneously. A trend was found of improved radiographic findings, pulmonary function (lung compliance, tidal volumes, PaO /FiO ratio, alveolo-capillary injury), and inflammatory biomarker levels. No comparisons were made between MSCs of different sources.
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http://dx.doi.org/10.1002/sctm.20-0146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300743PMC
September 2020

Relationship between Substance Use and Socioeconomic Variables in Pennsylvania Adolescents: 2009-2017.

Subst Use Misuse 2020 27;55(11):1856-1866. Epub 2020 May 27.

Henderson High School, West Chester, Pennsylvania, USA.

The goal of the current study is to analyze the substance use trends in Generation Z youth (in both middle and high school environments) and to determine if any correlation exists between substance use behaviors and demographic variables. Analysis is based on substance use data collected through the Pennsylvania Youth Survey (PAYS) from 2009 to 2017 and the 2016 US census data. Our results suggest that substance use in Gen Z adolescents is mainly linked to alcohol, marijuana, cigarettes, smokeless tobacco, vaping, and narcotic prescription drugs. Alcohol is the most prevalent high-risk substance used by 12th grade students with 69.8% of students having consumed alcohol over their lifetime. Vaping is the next highly used substance with 28.9% of students in 12th grade having vaped 30 day prior to the survey. There is a significant correlation among adolescents between smoking cigarettes and using smokeless tobacco. A student using either alcohol, cigarettes or smokeless tobacco is highly likely to use the other two substances as well. Adolescents from counties with a high Caucasian population were at high risk for cigarette and smokeless tobacco use, while the opposite held true for counties with a high number of foreign-born persons or higher Asian or Hispanic populations. Higher median household incomes and higher adult education levels in a county were both protective factors against smokeless tobacco use. Results of the study suggest that students start experimenting with high-risk substance use in early grades and to combat the prevalence, we suggest the importance of educating adolescents of the dangers of drug use in early grades.
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http://dx.doi.org/10.1080/10826084.2020.1771594DOI Listing
May 2020

Diversity of navel microbiome in young adults.

J Med Microbiol 2020 May 5;69(5):721-727. Epub 2020 May 5.

College of the Sciences and Mathematics, West Chester University, West Chester, PA, USA.

Human skin microbial communities represent a tremendous source of genetic diversity that evolves as a function of human age. Microbiota differs between regions of oily and moist skin, and appears to stabilize with age. We have a minimal understanding of the time frame required for the stabilization of skin microbiota, and the role played by gender. In the current study, we examined the microbiota present in the navel region of college-attending young adults in the age group of 18-25 years and investigated if diversity is associated with gender (male and female). The study involved 16 female and six male subjects. Isolated DNA samples from navel swabs were processed using the Nextera XT library preparation kit and sequenced using the MiSeq platform. Data were analysed using QIIME and statistical analysis performed in R. Microbiota of navel skin is dominated by and and includes opportunistic pathogens like and . Also present as the major component of the flora were the organisms normally associated with the gastrointestinal tract such as , , and organisms from the and families. Comparison of alpha and beta diversity of the microbiota in the male and female navel regions suggests that the flora is not statistically different (>0.05). However, pairwise comparison suggests that the abundance of 12 specific genera varied with gender, including higher abundance of and in females. Our findings indicate that the navel skin microbiota of young adults has a core microbiota of and . We also noted the presence of a significant number of opportunistic pathogens. A minor gender difference in the abundance of individual organisms was also observed.
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http://dx.doi.org/10.1099/jmm.0.001192DOI Listing
May 2020

Total Arch Replacement with Hypothermic Circulatory Arrest, Antegrade Cerebral Perfusion and the Y-graft.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):683-691. Epub 2020 Apr 30.

Lankenau Heart Institute, Department of Cardiothoracic Surgery, Wynnewood, Pennsylvania.

This study examines postoperative morbidity and mortality and long-term survival after total arch replacement (TAR) using deep to moderate hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and the Y-graft. Seventy-five patients underwent TAR with the Y graft. Deep to moderate HCA was initiated at 18-22°C. ACP was either initiated immediately (early ACP) or after the distal anastomosis was performed (late ACP). The arch vessels were then serially anastomosed to the individual limbs of the Y-graft. The median age was 66 years (range = 32-82). Etiology of aneurysmal dilatation included 20 (27%) patients with medial degenerations, 25 (33%) with chronic dissections, 14 (19%) with acute dissections, 9 (12%) with atherosclerosis and 2 (3%) with Marfan syndrome. In-hospital mortality was 5%. Neurologic complications occurred in 8 (11%) patients; 2 (3%) had strokes and 6 (8%) had transient neurologic deficits. Patients undergoing TAR with moderate hypothermia had a significantly higher incidence of new-onset renal insufficiency (3 [23%] vs [0%], P < 0.001) and TND (3 (23%) vs 3 (5%), P = 0.028) than the profound and deep hypothermia cohort. Excluding the 1 patient who died intraoperatively, 89% (95%CI: 79-94%) were alive at 1 year, 78% at 5 years (95%CI: 66-86%), and 73% at 10 years (95%CI: 59-82%). The combination of deep to moderate HCA, ACP, and the Y-graft is a safe and reproducible technique. Further inquiry is needed to assess if early ACP provides superior clinical outcomes.
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http://dx.doi.org/10.1053/j.semtcvs.2020.03.001DOI Listing
March 2021

Repair of Extent III Thoracoabdominal Aneurysm in the Presence of Aortoiliac Occlusion.

Methodist Debakey Cardiovasc J 2020 Jan-Mar;16(1):57-60

LANKENAU MEDICAL CENTER, WYNNEWOOD, PENNSYLVANIA.

Concomitant thoracoabdominal aneurysm and aortoiliac occlusion are extremely rare and present a unique surgical challenge. We report the successful reconstruction of a 9.2-cm extent III thoracoabdominal aneurysm and aortoiliac occlusion in a 54-year-old male. The surgery was performed using a trifurcated graft and total cardiopulmonary bypass. The combination of cerebrospinal fluid drainage, cold renovisceral perfusion, and reattachment of large segmental arteries resulted in a successful outcome in this rare presentation.
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http://dx.doi.org/10.14797/mdcj-16-1-57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137630PMC
July 2020

Number, frequency and time interval of examinations under anesthesia in bilateral retinoblastoma.

Graefes Arch Clin Exp Ophthalmol 2020 Apr 3;258(4):879-886. Epub 2020 Jan 3.

Retinoblastoma Service, Royal London Hospital, London, UK.

Purpose: Current practice in retinoblastoma (Rb) has transformed this malignancy into a curable disease. More attention should therefore be given to quality of life considerations, including measures related to examinations under anesthesia (EUAs). We aimed to investigate EUA measures in bilateral Rb patients and compare the findings to EUAs in unilateral Rb.

Methods: A retrospective analysis of bilateral Rb patients that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up.

Results: A total of 62 Rb patients, 15 (24.2%) of which had International Intraocular Retinoblastoma Classification (IIRC) group A/B/no Rb at presentation, 26 (41.9%) C/D, and 21 (33.9%) were E in at least one eye. The mean number of EUAs was 35.8 ± 21.5, mean time from first to last EUA was 50.6 ± 19.9 months, and mean EUA frequency was 0.715 ± 0.293 EUAs/month. IIRC group was found not to correlate with any of the EUA measures. Age at presentation inversely correlated with time interval from first to last EUA and to EUA frequency (p ≤ 0.029). Rb family history correlated with the latter measure (p = 0.005) and intraophthalmic artery chemotherapy and brachytherapy correlated with all EUA measures (p ≤ 0.029). Mean follow-up time was 80.1 ± 24.3 months. When compared with a previously reported cohort of unilateral Rb, the present group underwent 3× more EUAs (p < 0.001) over nearly double the time (p < 0.001).

Conclusions: Families should be counselled on anticipated EUA burden associated with bilateral Rb. In this respect, age at presentation and family history were found to have a predictive role, whereas IIRC group did not.
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http://dx.doi.org/10.1007/s00417-019-04589-4DOI Listing
April 2020

Author Correction: A tool for functional brain imaging with lifespan compliance.

Nat Commun 2019 Dec 4;10(1):5628. Epub 2019 Dec 4.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41467-019-13752-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893010PMC
December 2019

Hybrid Aortic Arch Repair Using a Ministernotomy.

Vasc Endovascular Surg 2020 Feb 10;54(2):162-164. Epub 2019 Nov 10.

Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.

Hybrid thoracic endovascular aortic repair with surgical arch debranching is an accepted method for total arch reconstruction. Although off-pump arch debranching is increasingly used as a prophylactic adjunct to endovascular arch repair extending into landing zone 0, this technique is seldom performed with a ministernotomy due to a steep learning curve among surgeons. Herein, we report our standard technique for off-pump hybrid total aortic arch repair using a ministernotomy.
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http://dx.doi.org/10.1177/1538574419887600DOI Listing
February 2020

A tool for functional brain imaging with lifespan compliance.

Nat Commun 2019 11 5;10(1):4785. Epub 2019 Nov 5.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.

The human brain undergoes significant functional and structural changes in the first decades of life, as the foundations for human cognition are laid down. However, non-invasive imaging techniques to investigate brain function throughout neurodevelopment are limited due to growth in head-size with age and substantial head movement in young participants. Experimental designs to probe brain function are also limited by the unnatural environment typical brain imaging systems impose. However, developments in quantum technology allowed fabrication of a new generation of wearable magnetoencephalography (MEG) technology with the potential to revolutionise electrophysiological measures of brain activity. Here we demonstrate a lifespan-compliant MEG system, showing recordings of high fidelity data in toddlers, young children, teenagers and adults. We show how this system can support new types of experimental paradigm involving naturalistic learning. This work reveals a new approach to functional imaging, providing a robust platform for investigation of neurodevelopment in health and disease.
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http://dx.doi.org/10.1038/s41467-019-12486-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831615PMC
November 2019

Balanced, bi-planar magnetic field and field gradient coils for field compensation in wearable magnetoencephalography.

Sci Rep 2019 10 2;9(1):14196. Epub 2019 Oct 2.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD, UK.

To allow wearable magnetoencephalography (MEG) recordings to be made on unconstrained subjects the spatially inhomogeneous remnant magnetic field inside the magnetically shielded room (MSR) must be nulled. Previously, a large bi-planar coil system which produces uniform fields and field gradients was used for this purpose. Its construction presented a significant challenge, six distinct coils were wound on two 1.6 × 1.6 m planes. Here, we exploit shared coil symmetries to produce coils simultaneously optimised to generate homogenous fields and gradients. We show nulling performance comparable to that of a six-coil system is achieved with this three-coil system, decreasing the strongest field component B by a factor of 53, and the strongest gradient dB/dz by a factor of 7. To allow the coils to be used in environments with temporally-varying magnetic interference a dynamic nulling system was developed with a shielding factor of 40 dB at 0.01 Hz. Reducing the number of coils required and incorporating dynamic nulling should allow for greater take-up of this technology. Interactions of the coils with the high-permeability walls of the MSR were investigated using a method of images approach. Simulations show a degrading of field uniformity which was broadly consistent with measured values. These effects should be incorporated into future designs.
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http://dx.doi.org/10.1038/s41598-019-50697-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775070PMC
October 2019

Hand posture as localizing sign in adult focal epileptic seizures.

Ann Neurol 2019 11;86(5):793-800

Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.

Objective: The aim of this study was to identify specific ictal hand postures (HPs) as localizing signs of the epileptogenic zone (EZ) in patients with frontal or temporal lobe epilepsy.

Methods: In this study, we retrospectively analyzed ictal semiology of 489 temporal lobe or frontal lobe seizures recorded over a 6-year period at the Seizure Disorder Center at University of California, Los Angeles in the USA (45 patients) or at the C. Munari Epilepsy Surgery Center at Niguarda Hospital in Milan, Italy (34 patients). Our criterion for EZ localization was at least 2 years of seizure freedom after surgery. We analyzed presence and latency of ictal HP. We then examined whether specific initial HPs are predictive for EZ localization.

Results: We found that ictal HPs were present in 72.5% of patients with frontal and 54.5% of patients with temporal lobe seizures. We divided HPs into 6 classes depending on the reciprocal position of the fingers ("fist," "cup," "politician's fist," "pincer," "extended hand," "pointing"). We found a striking correlation between EZ localization and ictal HP. In particular, fist and pointing HPs are strongly predictive of frontal lobe EZ; cup, politician's fist, and pincer are strongly predictive of temporal lobe EZ.

Interpretation: Our study offers simple ictal signs that appear to clarify differential diagnosis of temporal versus frontal lobe EZ localization. These results are meant to be used as a novel complementary tool during presurgical evaluation for epilepsy. At the same time, they give us important insight into the neurophysiology of hand movements. ANN NEUROL 2019;86:793-800.
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http://dx.doi.org/10.1002/ana.25589DOI Listing
November 2019

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement.

Innovations (Phila) 2019 Nov/Dec;14(6):519-530. Epub 2019 Sep 9.

Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.

Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.
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http://dx.doi.org/10.1177/1556984519874806DOI Listing
April 2020

Wearable neuroimaging: Combining and contrasting magnetoencephalography and electroencephalography.

Neuroimage 2019 11 14;201:116099. Epub 2019 Aug 14.

Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.

One of the most severe limitations of functional neuroimaging techniques, such as magnetoencephalography (MEG), is that participants must maintain a fixed head position during data acquisition. This imposes restrictions on the characteristics of the experimental cohorts that can be scanned and the experimental questions that can be addressed. For these reasons, the use of 'wearable' neuroimaging, in which participants can move freely during scanning, is attractive. The most successful example of wearable neuroimaging is electroencephalography (EEG), which employs lightweight and flexible instrumentation that makes it useable in almost any experimental setting. However, EEG has major technical limitations compared to MEG, and therefore the development of wearable MEG, or hybrid MEG/EEG systems, is a compelling prospect. In this paper, we combine and compare EEG and MEG measurements, the latter made using a new generation of optically-pumped magnetometers (OPMs). We show that these new second generation commercial OPMs, can be mounted on the scalp in an 'EEG-like' cap, enabling the acquisition of high fidelity electrophysiological measurements. We show that these sensors can be used in conjunction with conventional EEG electrodes, offering the potential for the development of hybrid MEG/EEG systems. We compare concurrently measured signals, showing that, whilst both modalities offer high quality data in stationary subjects, OPM-MEG measurements are less sensitive to artefacts produced when subjects move. Finally, we show using simulations that OPM-MEG offers a fundamentally better spatial specificity than EEG. The demonstrated technology holds the potential to revolutionise the utility of functional brain imaging, exploiting the flexibility of wearable systems to facilitate hitherto impractical experimental paradigms.
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http://dx.doi.org/10.1016/j.neuroimage.2019.116099DOI Listing
November 2019

Monoclonal antibody utilization characteristics in patients with multiple myeloma.

Anticancer Drugs 2019 09;30(8):859-865

Division of Hematology-Oncology, Mayo Clinic.

This study analyzed 91 multiple myeloma patients who received two monoclonal antibodies, Daratumumab and Elotuzumab, over a year and report the adverse event profile, infusion practices and utilization of these drugs in the real world. All current reported data on monoclonal antibodies is from clinical trials, without any real-world experience. Patients from Mayo Clinic Florida or Arizona diagnosed with relapsed or refractory multiple myeloma who were treated with Daratumumab or Elotuzumab alone or in combination between 1 January 2016 and 31 December 2016 were included in the analysis. Daratumumab-treated patients (n = 78) were more heavily pre-treated than that in published clinical trials, whereas the elotuzumab patient (n = 13) profile was similar to that published before. Infusion time was on average 2 hours less than the prescribing guidelines and premedication use varied noticeably after the initial monoclonal antibody infusion, with an overall decrease over time. We noted higher than reported haematologic adverse events, especially neutropenia and fewer non-haematologic adverse events. 91.7% infusion-related reactions were observed during the first monoclonal antibody infusion, with a subsequent decrease. All infusion-related reactions were grade 2 or less, and none of the patients discontinued treatment due to infusion-related reactions. Baseline allergy profile or laboratory tests were not associated with the likelihood of developing monoclonal antibody-related infusion-related reactions. The real-world safety profile of monoclonal antibodies showed varying adverse event patterns than those reported in previous clinical trials. The infusion-related reaction patterns were similar to previous reports. Despite changes in premedication regimens safety was maintained in succeeding infusions. Such treatment utilization data is vital to broaden our knowledge of approved therapeutic agents and maximize their benefits for patients.
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http://dx.doi.org/10.1097/CAD.0000000000000810DOI Listing
September 2019

Low-Cost Fetal Magnetocardiography: A Comparison of Superconducting Quantum Interference Device and Optically Pumped Magnetometers.

J Am Heart Assoc 2019 08 9;8(16):e013436. Epub 2019 Aug 9.

Department of Medical Physics University of Wisconsin Madison WI.

Background Fetal magnetocardiography (fMCG) is a highly effective technique for evaluation of fetuses with life-threatening arrhythmia, but its dissemination has been constrained by the high cost and complexity of Superconducting Quantum Interference Device (SQUID) instrumentation. Optically pumped magnetometers (OPMs) are a promising new technology that can replace SQUIDs for many applications. This study compares the performance of an fMCG system, utilizing OPMs operating in a person-sized magnetic shield, to that of a conventional fMCG system, utilizing SQUID magnetometers operating in a magnetically shielded room. Methods and Results fMCG recordings were made in 24 subjects using the SQUID system with the mother lying supine in a magnetically shielded room and the OPM system with the mother lying prone in a person-sized, cylindrical shield. Signal-to-noise ratios of the OPM and SQUID recordings were not statistically different and were adequate for diagnostic purposes with both technologies. Although the environmental noise was higher using the small open-ended shield, this was offset by the higher signal amplitude achieved with prone positioning, which reduced the distance between the fetus and sensors and improved patient comfort. In several subjects, fMCG provided a differential diagnosis that was more precise and/or definitive than was possible with echocardiography alone. Conclusions The OPM-based system was portable, improved patient comfort, and performed as well as the SQUID-based system at a small fraction of the cost. Electrophysiological assessment of fetal rhythm is now practical and will have a major impact on management of fetuses with long QT syndrome and other life-threatening arrhythmias.
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http://dx.doi.org/10.1161/JAHA.119.013436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759914PMC
August 2019

Minimally invasive bicuspid aortic valve repair with external ring annuloplasty.

Ann Cardiothorac Surg 2019 May;8(3):441-443

Department of Cardiothoracic Surgery, Lankenau Medical Center, Wynnewood, PA, USA.

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http://dx.doi.org/10.21037/acs.2019.05.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562084PMC
May 2019