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Srivastava PK, Klomhaus AM, Rafique A, Desai PS, Daniels LB, Yancy CW, Yang EH, Fonarow GC, Parikh RV. Guideline-directed medical therapy prescribing patterns and in-hospital outcomes among heart failure patients during COVID-19. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100440. [PMID: 39220717 PMCID: PMC11363726 DOI: 10.1016/j.ahjo.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
Study objective The association of prior to admission guideline-directed medical therapy (GDMT) use in patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF, ejection fraction ≤40 %) and Coronavirus Disease 2019 (COVID-19) with in-hospital outcomes has not been well studied. Design/setting/participants/interventions/outcome measures Using the American Heart Association's Get With The Guidelines Heart Failure Registry, we identified HFrEF patients presenting with acute decompensated heart failure (ADHF) and compared rates of GDMT prescription between those presenting prior to and during the pandemic. In a subgroup of patients with a concomitant COVID-19 diagnosis, we evaluated the association of prior to admission GDMT use with in-hospital mortality and severe COVID-19. Results 23,899 patients were admitted with HFrEF during the pandemic (2/16/20-3/24/21) and 26,459 patients were admitted in the year prior (2/16/19-2/15/20). In this overall cohort, prior to admission ACEI/ARB/ARNI (45.6 % vs 48.1 %, p < 0.0001) and BB (56.9 % vs 62.4 %, p < 0.0001) use was lower among admitted HFrEF patients during the pandemic when compared to the year prior. Rates of ACEI/ARB/ARNI, MRA, and triple therapy (ACE/ARB/ARNI + BB + MRA) prescription at discharge were higher during the pandemic compared to the year prior. Among a subgroup of those with HFrEF and COVID-19 (n = 333), prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19. Conclusion We found no association between prior to admission GDMT use and in-hospital mortality or severe COVID-19 among HFrEF patients admitted with ADHF and COVID-19. GDMT prescription at discharge for HFrEF patients overall has remained either similar or improved during the pandemic.
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Affiliation(s)
- Pratyaksh K. Srivastava
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
| | - Alexandra M. Klomhaus
- Department of Medicine, Statistics Core, UCLA, Los Angeles, CA, United States of America
| | - Asim Rafique
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
| | - Pooja S. Desai
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Lori B. Daniels
- Division of Cardiovascular Medicine, UC San Diego, La Jolla, CA, United States of America
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University School of Medicine, Chicago, IL, United States of America
| | - Eric H. Yang
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
| | - Gregg C. Fonarow
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
| | - Rushi V. Parikh
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States of America
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Beon C, Wang L, Manchanda V, Mallya P, Hong H, Picotte H, Thomas K, Hall JL, Zhao J, Feng X. Empowering Research With the American Heart Association Get With The Guidelines Registries Through Integration of a Database and Research Tools. Circ Cardiovasc Qual Outcomes 2024; 17:e010967. [PMID: 39171403 DOI: 10.1161/circoutcomes.124.010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND The American Heart Association's Get With The Guidelines (GWTG) has emerged as a vital resource in advancing the standards and practices of inpatient care across stroke, heart failure, coronary artery disease, atrial fibrillation, and resuscitation focus areas. The GWTG registry data have also created new opportunities for secondary use of real-world clinical data in biomedical research. Our goal was to implement a scalable database with an integrated user interface (UI) to improve GWTG data management and accessibility. METHODS The curation of registry data begins by going through a data processing and quality control pipeline programmed in Python. This pipeline includes data cleaning and record exclusion, variable derivation and unit harmonization, limited data set preparation, and documentation generation of the registry data. The database was built using PostgreSQL, and integrations between the database and the UI were built using the Django Web Framework in Python. Smaller subsets of data were created using SQLite database files for distribution purposes. Use cases of these tools are provided in the article. RESULTS We implemented an automated data curation pipeline, centralized database, and UI application for the American Heart Association GWTG registry data. The database and the UI are accessible through a Precision Medicine Platform workspace. As of March 2024, the database contains over 13.2 million cleaned GWTG patient records. The SQLite subsets benefit researchers by optimizing data extraction and manipulation using Structured Query Language. The UI improves accessibility for nontechnical researchers by presenting data in a user-friendly tabular format with intuitive filtering options. CONCLUSIONS With the implementation of the GWTG database and UI application, we addressed data management and accessibility concerns despite its growing scale. We have launched tools to provide streamlined access and accessibility of GWTG registry data to all researchers, regardless of familiarity or experience in coding.
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Affiliation(s)
- Chandler Beon
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Lanjing Wang
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Vihaan Manchanda
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Pratheek Mallya
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Haoyun Hong
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Holly Picotte
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Kathie Thomas
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
| | - Jennifer L Hall
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
- Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.)
| | - Juan Zhao
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (J.Z.)
| | - Xue Feng
- Data Science and Evaluation, American Heart Association, Dallas, TX (C.B., L.W., V.M., P.M., H.H., H.P., K.T., J.L.H., J.Z., X.F.)
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Dhand A, Reeves M, Mu Y, Rosner B, Rothfeld-Wehrwein ZR, Nieves A, Dhongade V, Jarman M, Bergmark R, Semco RS, Ader J, Marshall BDL, Goedel WC, Fonarow GC, Smith EE, Saver JL, Schwamm L, Sheth KN. Mapping the Ecological Terrain of Stroke Prehospital Delay: A Nationwide Registry Study. Stroke 2024; 55:1507-1516. [PMID: 38787926 PMCID: PMC11299104 DOI: 10.1161/strokeaha.123.045521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/12/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Delays in hospital presentation limit access to acute stroke treatments. While prior research has focused on patient-level factors, broader ecological and social determinants have not been well studied. We aimed to create a geospatial map of prehospital delay and examine the role of community-level social vulnerability. METHODS We studied patients with ischemic stroke who arrived by emergency medical services in 2015 to 2017 from the American Heart Association Get With The Guidelines-Stroke registry. The primary outcome was time to hospital arrival after stroke (in minutes), beginning at last known well in most cases. Using Geographic Information System mapping, we displayed the geography of delay. We then used Cox proportional hazard models to study the relationship between community-level factors and arrival time (adjusted hazard ratios [aHR] <1.0 indicate delay). The primary exposure was the social vulnerability index (SVI), a metric of social vulnerability for every ZIP Code Tabulation Area ranging from 0.0 to 1.0. RESULTS Of 750 336 patients, 149 145 met inclusion criteria. The mean age was 73 years, and 51% were female. The median time to hospital arrival was 140 minutes (Q1: 60 minutes, Q3: 458 minutes). The geospatial map revealed that many zones of delay overlapped with socially vulnerable areas (https://harvard-cga.maps.arcgis.com/apps/webappviewer/index.html?id=08f6e885c71b457f83cefc71013bcaa7). Cox models (aHR, 95% CI) confirmed that higher SVI, including quartiles 3 (aHR, 0.96 [95% CI, 0.93-0.98]) and 4 (aHR, 0.93 [95% CI, 0.91-0.95]), was associated with delay. Patients from SVI quartile 4 neighborhoods arrived 15.6 minutes [15-16.2] slower than patients from SVI quartile 1. Specific SVI themes associated with delay were a community's socioeconomic status (aHR, 0.80 [95% CI, 0.74-0.85]) and housing type and transportation (aHR, 0.89 [95% CI, 0.84-0.94]). CONCLUSIONS This map of acute stroke presentation times shows areas with a high incidence of delay. Increased social vulnerability characterizes these areas. Such places should be systematically targeted to improve population-level stroke presentation times.
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Affiliation(s)
- Amar Dhand
- Harvard Medical School
- Department of Neurology, Brigham & Women’s Hospital
- Network Science Institute, Northeastern University
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, Michigan State University
| | - Yi Mu
- Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health
| | - Bernard Rosner
- Department of Biostatistics, Channing Laboratory, Harvard T.H. Chan School of Public Health
| | | | - Amber Nieves
- Dartmouth Institute for Health Policy and Clinical Practice
| | - Vrushali Dhongade
- Harvard Medical School
- Department of Neurology, Brigham & Women’s Hospital
| | - Molly Jarman
- Harvard Medical School
- Department of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital
| | - Regan Bergmark
- Harvard Medical School
- Center for Surgery and Public Health, Brigham and Women’s Hospital
- Department of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital
| | - Robert S. Semco
- Harvard Medical School
- Center for Surgery and Public Health, Brigham and Women’s Hospital
| | - Jeremy Ader
- Department of Neurology, Columbia University Irving Medical Center
| | | | - William C. Goedel
- Department of Epidemiology, Brown University School of Public Health
| | | | - Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary
| | | | - Lee Schwamm
- Harvard Medical School
- Department of Neurology, Massachusetts General Hospital
| | - Kevin N. Sheth
- Department of Neurology & Neurosurgery, Yale School of Medicine
- Yale Center for Brain & Mind Health
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Elkind MSV, Arnett DK, Benjamin IJ, Eckel RH, Grant AO, Houser SR, Jacobs AK, Jones DW, Robertson RM, Sacco RL, Smith SC, Weisfeldt ML, Wu JC, Jessup M. The American Heart Association at 100: A Century of Scientific Progress and the Future of Cardiovascular Science: A Presidential Advisory From the American Heart Association. Circulation 2024; 149:e964-e985. [PMID: 38344851 DOI: 10.1161/cir.0000000000001213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
In 1924, the founders of the American Heart Association (AHA) envisioned an international society focused on the heart and aimed at facilitating research, disseminating information, increasing public awareness, and developing public health policy related to heart disease. This presidential advisory provides a comprehensive review of the past century of cardiovascular and stroke science, with a focus on the AHA's contributions, as well as informed speculation about the future of cardiovascular science into the next century of the organization's history. The AHA is a leader in fundamental, translational, clinical, and population science, and it promotes the concept of the "learning health system," in which a continuous cycle of evidence-based practice leads to practice-based evidence, permitting an iterative refinement in clinical evidence and care. This advisory presents the AHA's journey over the past century from instituting professional membership to establishing extraordinary research funding programs; translating evidence to practice through clinical practice guidelines; affecting systems of care through quality programs, certification, and implementation; leading important advocacy efforts at the federal, state and local levels; and building global coalitions around cardiovascular and stroke science and public health. Recognizing an exciting potential future for science and medicine, the advisory offers a vision for even greater impact for the AHA's second century in its continued mission to be a relentless force for longer, healthier lives.
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Mallya P, Stevens LM, Zhao J, Hong C, Henao R, Economou-Zavlanos N, Wojdyla DM, Schibler T, Manchanda V, Pencina MJ, Hall JL. Facilitating Harmonization of Variables in Framingham, MESA, ARIC, and REGARDS Studies Through a Metadata Repository. Circ Cardiovasc Qual Outcomes 2023; 16:e009938. [PMID: 37850400 PMCID: PMC10841164 DOI: 10.1161/circoutcomes.123.009938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND High-quality research in cardiovascular prevention, as in other fields, requires inclusion of a broad range of data sets from different sources. Integrating and harmonizing different data sources are essential to increase generalizability, sample size, and representation of understudied populations-strengthening the evidence for the scientific questions being addressed. METHODS Here, we describe an effort to build an open-access repository and interactive online portal for researchers to access the metadata and code harmonizing data from 4 well-known cohort studies-the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, FHS (Framingham Heart Study), MESA (Multi-Ethnic Study of Atherosclerosis), and ARIC (Atherosclerosis Risk in Communities) study. We introduce a methodology and a framework used for preprocessing and harmonizing variables from multiple studies. RESULTS We provide a real-case study and step-by-step guidance to demonstrate the practical utility of our repository and interactive web page. In addition to our successful development of such an open-access repository and interactive web page, this exercise in harmonizing data from multiple cohort studies has revealed several key themes. These themes include the importance of careful preprocessing and harmonization of variables, the value of creating an open-access repository to facilitate collaboration and reproducibility, and the potential for using harmonized data to address important scientific questions and disparities in cardiovascular disease research. CONCLUSIONS By integrating and harmonizing these large-scale cohort studies, such a repository may improve the statistical power and representation of understudied cohorts, enabling development and validation of risk prediction models, identification and investigation of risk factors, and creating a platform for racial disparities research. REGISTRATION URL: https://precision.heart.org/duke-ninds.
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Affiliation(s)
- Pratheek Mallya
- American Heart Association, Dallas, TX (P.M., J.Z., V.M., J.L.H.)
| | - Laura M Stevens
- University of Colorado Anschutz Medical School, Aurora (L.M.S.)
| | - Juan Zhao
- American Heart Association, Dallas, TX (P.M., J.Z., V.M., J.L.H.)
| | - Chuan Hong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (C.H., R.H., M.P.)
- Duke Clinical Research Institute, Durham, NC (C.H., R.H., D.W., T.S.)
| | - Ricardo Henao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (C.H., R.H., M.P.)
- Duke Clinical Research Institute, Durham, NC (C.H., R.H., D.W., T.S.)
| | | | - Daniel M Wojdyla
- Duke Clinical Research Institute, Durham, NC (C.H., R.H., D.W., T.S.)
| | - Tony Schibler
- Duke Clinical Research Institute, Durham, NC (C.H., R.H., D.W., T.S.)
| | - Vihaan Manchanda
- American Heart Association, Dallas, TX (P.M., J.Z., V.M., J.L.H.)
| | - Michael J Pencina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (C.H., R.H., M.P.)
| | - Jennifer L Hall
- American Heart Association, Dallas, TX (P.M., J.Z., V.M., J.L.H.)
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Srivastava PK, Klomhaus AM, Tehrani DM, Fonarow GC, Ziaeian B, Desai PS, Rafique A, de Lemos J, Parikh RV, Yang EH. Impact of Age and Variant Time Period on Clinical Presentation and Outcomes of Hospitalized Coronavirus Disease 2019 Patients. Mayo Clin Proc Innov Qual Outcomes 2023; 7:411-429. [PMID: 37731677 PMCID: PMC10507578 DOI: 10.1016/j.mayocpiqo.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Objective To evaluate the impact of age and COVID-19 variant time period on morbidity and mortality among those hospitalized with COVID-19. Patients and Methods Patients from the American Heart Association's Get With The Guidelines COVID-19 cardiovascular disease registry (January 20, 2020-February 14, 2022) were divided into groups based on whether they presented during periods of wild type/alpha, delta, or omicron predominance. They were further subdivided by age (young: 18-40 years; older: more than 40 years), and characteristics and outcomes were compared. Results The cohort consisted of 45,421 hospitalized COVID-19 patients (wild type/alpha period: 41,426, delta period: 3349, and omicron period: 646). Among young patients (18-40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.6; 95% CI, 1.3-2.1), major adverse cardiovascular events (MACE) (OR, 1.8; 95% CI, 1.3-2.5), and in-hospital mortality (OR, 2.2; 95% CI, 1.5-3.3) when compared with presentation during wild type/alpha. Among older patients (more than 40 years), presentation during delta was associated with increased odds of severe COVID-19 (OR, 1.2; 95% CI, 1.1-1.3), MACE (OR, 1.5; 95% CI, 1.4-1.7), and in-hospital mortality (OR, 1.4; 95% CI, 1.3-1.6) when compared with wild type/alpha. Among older patients (more than 40 years), presentation during omicron associated with decreased odds of severe COVID-19 (OR, 0.7; 95% CI, 0.5-0.9) and in-hospital mortality (OR, 0.6; 95% CI, 0.5-0.9) when compared with wild type/alpha. Conclusion Among hospitalized adults with COVID-19, presentation during a time of delta predominance was associated with increased odds of severe COVID-19, MACE, and in-hospital mortality compared with presentation during wild type/alpha. Among older patients (aged more than 40 years), presentation during omicron was associated with decreased odds of severe COVID-19 and in-hospital mortality compared with wild type/alpha.
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Affiliation(s)
- Pratyaksh K. Srivastava
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - David M. Tehrani
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiology, West Los Angeles Medical Center, Los Angeles, CA
| | - Pooja S. Desai
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Asim Rafique
- Division of Cardiology, Santa Monica UCLA Medical Center, Los Angeles, CA
| | - James de Lemos
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX
| | - Rushi V. Parikh
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Eric H. Yang
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA
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7
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Miller AE, Daiwile AP, Cadet JL. Sex-Dependent Alterations in the mRNA Expression of Enzymes Involved in Dopamine Synthesis and Breakdown After Methamphetamine Self-Administration. Neurotox Res 2022; 40:1464-1478. [PMID: 35834057 DOI: 10.1007/s12640-022-00545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
Sex differences have been reported in methamphetamine (METH) use disorder in humans and in animal models of METH exposure. Specifically, animals that self-administer METH show sex-related dissimilarities in dopamine (DA) metabolism. To better understand the molecular bases for the differences in DA metabolism, we measured the levels of mRNAs of enzymes that catalyze DA synthesis and breakdown in the prefrontal cortex (PFC), nucleus accumbens (NAc), dorsal striatum (dSTR), and hippocampus (HIP) of rats that had self-administered METH. There were significant sex differences in control rats, with males having higher basal levels of Th in the PFC and dSTR, Ddc in the NAc, and MaoB in the HIP. In contrast, female controls showed higher basal levels of Comt in the HIP. Male and female METH SA rats also showed some distinct responses to the drug. Specifically, female METH rats exhibited increased expression of Ddc and MaoB, whereas male METH animals showed higher levels of Comt mRNA in the PFC compared to their respective controls. In the NAc, male METH rats displayed decreased Th and Ddc mRNA levels. Together, our results identified sex-dependent and region-specific changes in the mRNA expression of several enzymes involved in DA synthesis and breakdown in response to METH SA, with the majority of differences being observed in the mesocorticolimbic dopaminergic system. These findings are of significant translational importance providing further support for the inclusion of sex as an important variable when planning and evaluating therapeutic interventions against METH use disorder in human clinical studies.
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Affiliation(s)
- Aaron E Miller
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD, 21224, USA
| | - Atul P Daiwile
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD, 21224, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, NIDA Intramural Research Program, Baltimore, MD, 21224, USA.
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Nallamothu BK. Of Papers, PDFs, and Platforms. Circ Cardiovasc Qual Outcomes 2021; 14:e008466. [PMID: 34517726 DOI: 10.1161/circoutcomes.121.008466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brahmajee K Nallamothu
- Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor
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