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2.
Mol Cancer Ther ; 22(5): 630-645, 2023 05 04.
Article in English | MEDLINE | ID: mdl-36912782

ABSTRACT

Antitumor immunity can be hampered by immunosuppressive mechanisms in the tumor microenvironment, including recruitment of arginase (ARG) expressing myeloid cells that deplete l-arginine essential for optimal T-cell and natural killer cell function. Hence, ARG inhibition can reverse immunosuppression enhancing antitumor immunity. We describe AZD0011, a novel peptidic boronic acid prodrug to deliver an orally available, highly potent, ARG inhibitor payload (AZD0011-PL). We demonstrate that AZD0011-PL is unable to permeate cells, suggesting that this compound will only inhibit extracellular ARG. In vivo, AZD0011 monotherapy leads to arginine increases, immune cell activation, and tumor growth inhibition in various syngeneic models. Antitumor responses increase when AZD0011 is combined with anti-PD-L1 treatment, correlating with increases in multiple tumor immune cell populations. We demonstrate a novel triple combination of AZD0011, anti-PD-L1, and anti-NKG2A, and combination benefits with type I IFN inducers, including polyI:C and radiotherapy. Our preclinical data demonstrate AZD0011's ability to reverse tumor immunosuppression and enhance immune stimulation and antitumor responses with diverse combination partners providing potential strategies to increase immuno-oncology therapies clinically.


Subject(s)
Arginase , T-Lymphocytes , Humans , Cell Line, Tumor , Immunosuppression Therapy , Immune Tolerance , Tumor Microenvironment
3.
Sci Adv ; 8(46): eabq3925, 2022 Nov 18.
Article in English | MEDLINE | ID: mdl-36383648

ABSTRACT

Direct links between carbonaceous chondrites and their parent bodies in the solar system are rare. The Winchcombe meteorite is the most accurately recorded carbonaceous chondrite fall. Its pre-atmospheric orbit and cosmic-ray exposure age confirm that it arrived on Earth shortly after ejection from a primitive asteroid. Recovered only hours after falling, the composition of the Winchcombe meteorite is largely unmodified by the terrestrial environment. It contains abundant hydrated silicates formed during fluid-rock reactions, and carbon- and nitrogen-bearing organic matter including soluble protein amino acids. The near-pristine hydrogen isotopic composition of the Winchcombe meteorite is comparable to the terrestrial hydrosphere, providing further evidence that volatile-rich carbonaceous asteroids played an important role in the origin of Earth's water.

4.
Sci Rep ; 12(1): 17951, 2022 10 26.
Article in English | MEDLINE | ID: mdl-36289432

ABSTRACT

The Atacama Desert is the driest and oldest desert on Earth. Despite the abundance evidence for long-term landscape stability, there are subtle signs of localised fluvial erosion and deposition since the onset of hyperaridity in the rock record. In the dry core of the Atacama Desert, pluvial episodes allowed antecedent drainage to incise into uplifting fault scarps, which in turn generated sinuous to meandering channels. Incision of ancient alluvial fan surfaces occurred during intermittent fluvial periods, albeit without signs of surface erosion. Fluvial incision during predominantly hyperarid climate periods is evident from these channels in unconsolidated alluvium. The absence of dense vegetation to provide bank stability and strength led us to investigate the potential role of regionally ubiquitous CaSO4-rich surface cover. This has enabled the preservation of Miocene surfaces and we hypothesize that it provided the required bank stability by adding strength to the upper decimetre to meter of incised alluvium to allow high sinuosity of stream channels to form during pluvial episodes in the Quaternary.


Subject(s)
Desert Climate , Soil , Soil Microbiology , Rivers
5.
Nat Commun ; 13(1): 5405, 2022 09 15.
Article in English | MEDLINE | ID: mdl-36109491

ABSTRACT

Feedbacks between climatic and geological processes are highly controversial and testing them is a key challenge in Earth sciences. The Great Escarpment of the Arabian Red Sea margin has several features that make it a useful natural laboratory for studying the effect of surface processes on deep Earth. These include strong orographic rainfall, convex channel profiles versus concave swath profiles on the west side of the divide, morphological disequilibrium in fluvial channels, and systematic morphological changes from north to south that relate to depth changes of the central Red Sea. Here we show that these features are well interpreted with a cycle that initiated with the onset of spreading in the Red Sea and involves feedbacks between orographic precipitation, tectonic deformation, mid-ocean spreading and coastal magmatism. It appears that the feedback is enhanced by the moist easterly trade winds that initiated largely contemporaneously with sea floor spreading in the Red Sea.


Subject(s)
Wind , Feedback , Indian Ocean
6.
ACS Med Chem Lett ; 13(8): 1295-1301, 2022 Aug 11.
Article in English | MEDLINE | ID: mdl-35978693

ABSTRACT

The DNA-PK complex is activated by double-strand DNA breaks and regulates the non-homologous end-joining repair pathway; thus, targeting DNA-PK by inhibiting the DNA-PK catalytic subunit (DNA-PKcs) is potentially a useful therapeutic approach for oncology. A previously reported series of neutral DNA-PKcs inhibitors were modified to incorporate a basic group, with the rationale that increasing the volume of distribution while maintaining good metabolic stability should increase the half-life. However, adding a basic group introduced hERG activity, and basic compounds with modest hERG activity (IC50 = 10-15 µM) prolonged QTc (time from the start of the Q wave to the end of the T wave, corrected by heart rate) in an anaesthetized guinea pig cardiovascular model. Further optimization was necessary, including modulation of pK a, to identify compound 18, which combines low hERG activity (IC50 = 75 µM) with excellent kinome selectivity and favorable pharmacokinetic properties.

7.
Sci Total Environ ; 824: 153835, 2022 Jun 10.
Article in English | MEDLINE | ID: mdl-35176379

ABSTRACT

Geological storage of carbon dioxide (CO2) is an integral component of cost-effective greenhouse gas emissions reduction scenarios. However, a robust monitoring regime is necessary for public and regulatory assurance that any leakage from a storage site can be detected. Here, we present the results from a controlled CO2 release experiment undertaken at the K-COSEM test site (South Korea) with the aim of demonstrating the effectiveness of the inherent tracer fingerprints (noble gases, δ13C) in monitoring CO2 leakage. Following injection of 396 kg CO2(g) into a shallow aquifer, gas release was monitored for 2 months in gas/water phases in and above the injection zone. The injection event resulted in negative concentration changes of the dissolved gases, attributed to the stripping action of the depleted CO2. Measured fingerprints from inherent noble gases successfully identified solubility-trapping of the injected CO2 within the shallow aquifer. The δ13C within the shallow aquifer could not resolve the level of gas trapping, due to the interaction with heterogeneous carbonate sources in the shallow aquifer. The time-series monitoring of δ13CDIC and dissolved gases detected the stripping action of injected CO2(g), which can provide an early warning of CO2 arrival. This study highlights that inherent noble gases can effectively trace the upwardly migrating and fate of CO2 within a shallow aquifer.


Subject(s)
Carbon Dioxide , Groundwater , Delayed-Action Preparations , Gases , Noble Gases
9.
J Med Chem ; 64(18): 13704-13718, 2021 09 23.
Article in English | MEDLINE | ID: mdl-34491761

ABSTRACT

The epidermal growth factor receptor (EGFR) harboring activating mutations is a clinically validated target in non-small-cell lung cancer, and a number of inhibitors of the EGFR tyrosine kinase domain, including osimertinib, have been approved for clinical use. Resistance to these therapies has emerged due to a variety of molecular events including the C797S mutation which renders third-generation C797-targeting covalent EGFR inhibitors considerably less potent against the target due to the loss of the key covalent-bond-forming residue. We describe the medicinal chemistry optimization of a biochemically potent but modestly cell-active, reversible EGFR inhibitor starting point with sub-optimal physicochemical properties. These studies culminated in the identification of compound 12 that showed improved cell potency, oral exposure, and in vivo activity in clinically relevant EGFR-mutant-driven disease models, including an Exon19 deletion/T790M/C797S triple-mutant mouse xenograft model.


Subject(s)
Antineoplastic Agents/therapeutic use , ErbB Receptors/antagonists & inhibitors , Neoplasms/drug therapy , Organophosphorus Compounds/therapeutic use , Protein Kinase Inhibitors/therapeutic use , Pyrimidines/therapeutic use , Animals , Antineoplastic Agents/chemical synthesis , Antineoplastic Agents/metabolism , Cell Line, Tumor , Drug Resistance, Neoplasm/drug effects , ErbB Receptors/genetics , ErbB Receptors/metabolism , Female , Humans , Mice, Nude , Mice, SCID , Mutation , Organophosphorus Compounds/chemical synthesis , Organophosphorus Compounds/metabolism , Protein Kinase Inhibitors/chemical synthesis , Protein Kinase Inhibitors/metabolism , Pyrimidines/chemical synthesis , Pyrimidines/metabolism , Rats , Xenograft Model Antitumor Assays
10.
Inorg Chem ; 60(11): 8293-8303, 2021 Jun 07.
Article in English | MEDLINE | ID: mdl-33988988

ABSTRACT

We report the synthesis of aromatic germanimines [(HMDS)2Ge═NAr] (Ar = Ph, Mes, Dipp; Mes = 2,4,6-Me3C6H2, Dipp = 2,6-iPr2C6H3) and an investigation into their associated reactivity. [(HMDS)2Ge═NPh] decomposes above -30 °C, while [(HMDS)2Ge═NDipp] engages in an intramolecular reaction at 60 °C. [(HMDS)2Ge═NMes] was shown to rearrange via a 1,3-silyl migration to give [(HMDS){(SiMe3)(Mes)N}Ge(NSiMe3)] in a 1:7 equilibrium mixture at room temperature. These latter germanimines react with unsaturated polar substrates such as CO2, ketones, and arylisocyanate via a [2 + 2] cycloaddition pathway.

11.
J Cardiovasc Electrophysiol ; 32(4): 941-948, 2021 04.
Article in English | MEDLINE | ID: mdl-33527562

ABSTRACT

Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Heart Failure, Systolic , Pulmonary Veins , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Humans , Pulmonary Veins/surgery , Recurrence , Treatment Outcome
12.
Clin Cancer Res ; 27(1): 189-201, 2021 01 01.
Article in English | MEDLINE | ID: mdl-33028591

ABSTRACT

PURPOSE: Osimertinib is a potent and selective EGFR tyrosine kinase inhibitor (EGFR-TKI) of both sensitizing and T790M resistance mutations. To treat metastatic brain disease, blood-brain barrier (BBB) permeability is considered desirable for increasing clinical efficacy. EXPERIMENTAL DESIGN: We examined the level of brain penetration for 16 irreversible and reversible EGFR-TKIs using multiple in vitro and in vivo BBB preclinical models. RESULTS: In vitro osimertinib was the weakest substrate for human BBB efflux transporters (efflux ratio 3.2). In vivo rat free brain to free plasma ratios (Kpuu) show osimertinib has the most BBB penetrance (0.21), compared with the other TKIs (Kpuu ≤ 0.12). PET imaging in Cynomolgus macaques demonstrated osimertinib was the only TKI among those tested to achieve significant brain penetrance (C max %ID 1.5, brain/blood Kp 2.6). Desorption electrospray ionization mass spectroscopy images of brains from mouse PC9 macrometastases models showed osimertinib readily distributes across both healthy brain and tumor tissue. Comparison of osimertinib with the poorly BBB penetrant afatinib in a mouse PC9 model of subclinical brain metastases showed only osimertinib has a significant effect on rate of brain tumor growth. CONCLUSIONS: These preclinical studies indicate that osimertinib can achieve significant exposure in the brain compared with the other EGFR-TKIs tested and supports the ongoing clinical evaluation of osimertinib for the treatment of EGFR-mutant brain metastasis. This work also demonstrates the link between low in vitro transporter efflux ratios and increased brain penetrance in vivo supporting the use of in vitro transporter assays as an early screen in drug discovery.


Subject(s)
Acrylamides/pharmacokinetics , Aniline Compounds/pharmacokinetics , Blood-Brain Barrier/metabolism , Brain Neoplasms/drug therapy , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/pharmacokinetics , Acrylamides/administration & dosage , Aniline Compounds/administration & dosage , Animals , Brain Neoplasms/secondary , Dogs , ErbB Receptors/antagonists & inhibitors , Humans , Lung Neoplasms/pathology , Macaca fascicularis , Madin Darby Canine Kidney Cells , Male , Mice , Permeability , Protein Kinase Inhibitors/administration & dosage , Rats , Tissue Distribution , Xenograft Model Antitumor Assays
13.
J Med Chem ; 63(7): 3461-3471, 2020 04 09.
Article in English | MEDLINE | ID: mdl-31851518

ABSTRACT

DNA-PK is a key component within the DNA damage response, as it is responsible for recognizing and repairing double-strand DNA breaks (DSBs) via non-homologous end joining. Historically it has been challenging to identify inhibitors of the DNA-PK catalytic subunit (DNA-PKcs) with good selectivity versus the structurally related PI3 (lipid) and PI3K-related protein kinases. We screened our corporate collection for DNA-PKcs inhibitors with good PI3 kinase selectivity, identifying compound 1. Optimization focused on further improving selectivity while improving physical and pharmacokinetic properties, notably co-optimization of permeability and metabolic stability, to identify compound 16 (AZD7648). Compound 16 had no significant off-target activity in the protein kinome and only weak activity versus PI3Kα/γ lipid kinases. Monotherapy activity in murine xenograft models was observed, and regressions were observed when combined with inducers of DSBs (doxorubicin or irradiation) or PARP inhibition (olaparib). These data support progression into clinical studies (NCT03907969).


Subject(s)
DNA-Activated Protein Kinase/antagonists & inhibitors , Protein Kinase Inhibitors/therapeutic use , Purines/therapeutic use , Pyrans/therapeutic use , Triazoles/therapeutic use , Animals , Antineoplastic Agents/chemical synthesis , Antineoplastic Agents/pharmacokinetics , Antineoplastic Agents/therapeutic use , Cell Line, Tumor , Class Ib Phosphatidylinositol 3-Kinase/metabolism , Dogs , Drug Discovery , Humans , Mice , Molecular Structure , Neoplasms/drug therapy , Protein Kinase Inhibitors/chemical synthesis , Protein Kinase Inhibitors/pharmacokinetics , Purines/chemical synthesis , Purines/pharmacokinetics , Pyrans/chemical synthesis , Pyrans/pharmacokinetics , Rats , Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/antagonists & inhibitors , Structure-Activity Relationship , Triazoles/chemical synthesis , Triazoles/pharmacokinetics , Xenograft Model Antitumor Assays
14.
J Clin Invest ; 130(1): 258-271, 2020 01 02.
Article in English | MEDLINE | ID: mdl-31581151

ABSTRACT

Potentiating radiotherapy and chemotherapy by inhibiting DNA damage repair is proposed as a therapeutic strategy to improve outcomes for patients with solid tumors. However, this approach risks enhancing normal tissue toxicity as much as tumor toxicity, thereby limiting its translational impact. Using NU5455, a newly identified highly selective oral inhibitor of DNA-dependent protein kinase catalytic subunit (DNA-PKcs) activity, we found that it was indeed possible to preferentially augment the effect of targeted radiotherapy on human orthotopic lung tumors without influencing acute DNA damage or a late radiation-induced toxicity (fibrosis) to normal mouse lung. Furthermore, while NU5455 administration increased both the efficacy and the toxicity of a parenterally administered topoisomerase inhibitor, it enhanced the activity of doxorubicin released locally in liver tumor xenografts without inducing any adverse effect. This strategy is particularly relevant to hepatocellular cancer, which is treated clinically with localized drug-eluting beads and for which DNA-PKcs activity is reported to confer resistance to treatment. We conclude that transient pharmacological inhibition of DNA-PKcs activity is effective and tolerable when combined with localized DNA-damaging therapies and thus has promising clinical potential.


Subject(s)
Carcinoma, Hepatocellular , DNA-Activated Protein Kinase/antagonists & inhibitors , Liver Neoplasms, Experimental , Neoplasm Proteins/antagonists & inhibitors , Protein Kinase Inhibitors , Animals , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/enzymology , Carcinoma, Hepatocellular/pathology , DNA-Activated Protein Kinase/metabolism , Doxorubicin/pharmacology , Humans , Liver Neoplasms, Experimental/drug therapy , Liver Neoplasms, Experimental/enzymology , Liver Neoplasms, Experimental/pathology , MCF-7 Cells , Mice , Neoplasm Proteins/metabolism , Protein Kinase Inhibitors/chemistry , Protein Kinase Inhibitors/pharmacology , Xenograft Model Antitumor Assays
15.
Nat Commun ; 10(1): 5065, 2019 11 07.
Article in English | MEDLINE | ID: mdl-31699977

ABSTRACT

DNA-dependent protein kinase (DNA-PK) is a critical player in the DNA damage response (DDR) and instrumental in the non-homologous end-joining pathway (NHEJ) used to detect and repair DNA double-strand breaks (DSBs). We demonstrate that the potent and highly selective DNA-PK inhibitor, AZD7648, is an efficient sensitizer of radiation- and doxorubicin-induced DNA damage, with combinations in xenograft and patient-derived xenograft (PDX) models inducing sustained regressions. Using ATM-deficient cells, we demonstrate that AZD7648, in combination with the PARP inhibitor olaparib, increases genomic instability, resulting in cell growth inhibition and apoptosis. AZD7648 enhanced olaparib efficacy across a range of doses and schedules in xenograft and PDX models, enabling sustained tumour regression and providing a clear rationale for its clinical investigation. Through its differentiated mechanism of action as an NHEJ inhibitor, AZD7648 complements the current armamentarium of DDR-targeted agents and has potential in combination with these agents to achieve deeper responses to current therapies.


Subject(s)
Apoptosis/drug effects , Cell Proliferation/drug effects , DNA-Activated Protein Kinase/antagonists & inhibitors , Drug Synergism , Protein Kinase Inhibitors/pharmacology , Purines/pharmacology , Pyrans/pharmacology , Radiation Tolerance/drug effects , Triazoles/pharmacology , A549 Cells , Animals , Antibiotics, Antineoplastic/pharmacology , Carcinoma, Non-Small-Cell Lung , Cell Line, Tumor , Doxorubicin/analogs & derivatives , Doxorubicin/pharmacology , Genomic Instability/drug effects , Humans , Lung Neoplasms , Mice , Phthalazines/pharmacology , Piperazines/pharmacology , Poly(ADP-ribose) Polymerase Inhibitors/pharmacology , Polyethylene Glycols/pharmacology , Radiotherapy , Xenograft Model Antitumor Assays
16.
J Med Chem ; 62(14): 6540-6560, 2019 07 25.
Article in English | MEDLINE | ID: mdl-31199640

ABSTRACT

Tumors have evolved a variety of methods to reprogram conventional metabolic pathways to favor their own nutritional needs, including glutaminolysis, the first step of which is the hydrolysis of glutamine to glutamate by the amidohydrolase glutaminase 1 (GLS1). A GLS1 inhibitor could potentially target certain cancers by blocking the tumor cell's ability to produce glutamine-derived nutrients. Starting from the known GLS1 inhibitor bis-2-(5-phenylacetamido-1,2,4-thiadiazol-2-yl)ethyl sulfide, we describe the medicinal chemistry evolution of a series from lipophilic inhibitors with suboptimal physicochemical and pharmacokinetic properties to cell potent examples with reduced molecular weight and lipophilicity, leading to compounds with greatly improved oral exposure that demonstrate in vivo target engagement accompanied by activity in relevant disease models.


Subject(s)
Antineoplastic Agents/pharmacology , Glutaminase/antagonists & inhibitors , Neoplasms/drug therapy , Pyridazines/pharmacology , Thiadiazoles/pharmacology , Animals , Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacokinetics , Antineoplastic Agents/therapeutic use , Biological Availability , Cell Line, Tumor , Drug Discovery , Glutaminase/metabolism , Humans , Male , Mice, SCID , Molecular Docking Simulation , Neoplasms/metabolism , Neoplasms/pathology , Pyridazines/chemistry , Pyridazines/pharmacokinetics , Pyridazines/therapeutic use , Thiadiazoles/chemistry , Thiadiazoles/pharmacokinetics , Thiadiazoles/therapeutic use
17.
Opt Express ; 27(4): 5641-5654, 2019 Feb 18.
Article in English | MEDLINE | ID: mdl-30876162

ABSTRACT

We report the development and characterisation of highly miniaturised fibre-optic sensors for simultaneous pressure and temperature measurement, and a compact interrogation system with a high sampling rate. The sensors, which have a maximum diameter of 250 µm, are based on multiple low-finesse optical cavities formed from polydimethylsiloxane (PDMS), positioned at the distal ends of optical fibres, and interrogated using phase-resolved low-coherence interferometry. At acquisition rates of 250 Hz, temperature and pressure changes of 0.0021 °C and 0.22 mmHg are detectable. An in vivo experiment demonstrated that the sensors had sufficient speed and sensitivity for monitoring dynamic physiological pressure waveforms. These sensors are ideally suited to various applications in minimally invasive surgery, where diminutive lateral dimensions, high sensitivity and low manufacturing complexities are particularly valuable.


Subject(s)
Fiber Optic Technology/instrumentation , Interferometry/methods , Pressure , Temperature , Equipment Design , Optical Fibers , Transducers
18.
An Acad Bras Cienc ; 91(1): e20170397, 2019 Mar 21.
Article in English | MEDLINE | ID: mdl-30916146

ABSTRACT

We have developed the first laboratory for (U-Th-Sm)/He thermochronology measurements in South America. Helium is measured using a high-sensitivity magnetic sector mass spectrometer (GVI-Helix-SFT) and a double focusing single collector inductively coupled plasma mass spectrometer (Thermo Scientific ELEMENT2) is used for U, Th and Sm determinations. Repeated analyses of fragments of Durango fluorapatite crystals yields an average age of 31.6 ± 1.6 Ma (2σ) (n=62). This overlaps the long-term average of Durango fluorapatite measured in laboratories worldwide. The analysis of multiple single apatite crystals of a Precambrian basement sample from Serra do Mar, southeastern Brazil, yields an average He age (60.5 ± 8.7 Ma; n=8) that overlaps that measured in the SUERC laboratory (59.6 ± 3 Ma; n=3). This confirms that the UNESP laboratory is capable of routinely measuring the (U-Th-Sm)/He ages of single apatite crystals.


Subject(s)
Apatites/chemistry , Geologic Sediments/chemistry , Helium/analysis , Temperature , Thorium/analysis , Uranium/analysis , Brazil , Environmental Monitoring , Mass Spectrometry , Radiation Monitoring , Radiometric Dating/methods , Signal Processing, Computer-Assisted
19.
J Interv Card Electrophysiol ; 56(2): 199-203, 2019 Nov.
Article in English | MEDLINE | ID: mdl-29858762

ABSTRACT

PURPOSE: Audit has played a key role in monitoring and improving clinical practice. However, audit often fails to drive change as summative institutional data alone may be insufficient to do so. We hypothesised that the practice of attributed audit, wherein each individual's procedural performance is presented will have a greater impact on clinical practice. This hypothesis was tested in an observational study evaluating improvement in fluoroscopy times for AF ablation. METHODS: Retrospective analyses of fluoroscopy times in AF ablations at the Barts Heart Centre (BHC) from 2012-2017. Fluoroscopy times were compared pre- and post- the introduction of attributed audit in 2012 at St Bartholomew's Hospital (SBH). In order to test the hypothesis, this concept was introduced to a second group of experienced operators from the Heart Hospital (HH) as part of a merger of the two institutions in 2015 and change in fluoroscopy times recorded. RESULTS: A significant drop in fluoroscopy times (33.3 ± 9.14 to 8.95 ± 2.50, p < 0.0001) from 2012-2014 was noted after the introduction of attributed audit. At the time of merger, a significant difference in fluoroscopy times between operators from the two centres was seen in 2015. Each operator's procedural performance was shared openly at the audit meeting. Subsequent audits showed a steady decrease in fluoroscopy times for each operator with the fluoroscopy time (min, mean±SD) decreasing from 13.29 ± 7.3 in 2015 to 8.84 ± 4.8 (p < 0.0001) in 2017 across the entire group. CONCLUSIONS: Systematic improvement in fluoroscopy times for AF ablation procedures was noted byevaluating individual operators' performance. Attributing data to physicians in attributed audit can promptsignificant improvement and hence should be adopted in clinical practice.


Subject(s)
Atrial Fibrillation/surgery , Electrophysiologic Techniques, Cardiac/standards , Medical Audit , Catheter Ablation , Cross-Sectional Studies , Female , Fluoroscopy , Humans , London , Male , Operative Time , Quality Improvement , Radiography, Interventional , Retrospective Studies
20.
Int J Cardiol ; 278: 114-119, 2019 Mar 01.
Article in English | MEDLINE | ID: mdl-30391065

ABSTRACT

BACKGROUND: Low voltage zones (LVZs) are associated with conduction velocity (CV) slowing. Rate-dependent CV slowing may play a role in reentry mechanisms. METHODS: Patients undergoing catheter ablation for AT were enrolled. Aim was to assess the relationship between rate-dependent CV slowing and sites of localized reentrant atrial tachycardias (AT). On a bipolar voltage map regions were defined as non-LVZs [≥0.5 mV], LVZs [0.2-0.5 mV] and very-LVZs [<0.2 mV]. Unipolar electrograms were recorded with a 64-pole basket catheter during uninterrupted atrial pacing at four pacing intervals (PIs) during sinus rhythm. CVs were measured between pole pairs along the wavefront path. Sites of rate-dependent CV slowing were defined as exhibiting a reduction in CV between PI = 600 ms and 250 ms of ≥20% more than the mean CV reduction seen between these PIs for that voltage zone. Rate-dependent CV slowing sites were correlated to sites of localized reentrant ATs as confirmed with conventional mapping, entrainment and response to ablation. RESULTS: Eighteen patients were included (63 ±â€¯10 years). Mean CV at 600 ms was 1.53 ±â€¯0.19 m/s in non-LVZs, 1.14 ±â€¯0.15 m/s in LVZs, and 0.73 ±â€¯0.13 m/s in very-LVZs respectively (p < 0.001). Rate-dependent CV slowing sites were predominantly in LVZs [0.2-0.5 mV] (74.4 ±â€¯10.3%; p < 0.001). Localized reentrant ATs were mapped to these sites in 81.8% of cases (sensitivity 81.8%, 95% CI 48.2-97.9% and specificity 83.9%, 95% CI 81.8-86.0%). Macro-reentrant or focal ATs were not mapped to sites of rate-dependent CV slowing. CONCLUSIONS: Rate-dependent CV slowing sites are predominantly confined to LVZs [0.2-0.5 mV] and the resultant CV heterogeneity may promote reentry mechanisms. These may represent a novel adjunctive target for AT ablation.


Subject(s)
Atrial Fibrillation/physiopathology , Catheter Ablation/methods , Heart Atria/physiopathology , Heart Conduction System/physiopathology , Heart Rate/physiology , Aged , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Catheter Ablation/trends , Female , Heart Atria/diagnostic imaging , Heart Conduction System/diagnostic imaging , Heart Conduction System/surgery , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies
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