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Rockson SG, Zhou X, Zhao L, Hosseini DK, Jiang X, Sweatt AJ, Kim D, Tian W, Snyder MP, Nicolls MR. Exploring disease interrelationships in patients with lymphatic disorders: A single center retrospective experience. Clin Transl Med 2022; 12:e760. [PMID: 35452183 PMCID: PMC9028099 DOI: 10.1002/ctm2.760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The lymphatic contribution to the circulation is of paramount importance in regulating fluid homeostasis, immune cell trafficking/activation and lipid metabolism. In comparison to the blood vasculature, the impact of the lymphatics has been underappreciated, both in health and disease, likely due to a less well-delineated anatomy and function. Emerging data suggest that lymphatic dysfunction can be pivotal in the initiation and development of a variety of diseases across broad organ systems. Understanding the clinical associations between lymphatic dysfunction and non-lymphatic morbidity provides valuable evidence for future investigations and may foster the discovery of novel biomarkers and therapies. METHODS We retrospectively analysed the electronic medical records of 724 patients referred to the Stanford Center for Lymphatic and Venous Disorders. Patients with an established lymphatic diagnosis were assigned to groups of secondary lymphoedema, lipoedema or primary lymphovascular disease. Individuals found to have no lymphatic disorder were served as the non-lymphatic controls. The prevalence of comorbid conditions was enumerated. Pairwise co-occurrence pattern analyses, validated by Jaccard similarity tests, was utilised to investigate disease-disease interrelationships. RESULTS Comorbidity analyses underscored the expected relationship between the presence of secondary lymphoedema and those diseases that damage the lymphatics. Cardiovascular conditions were common in all lymphatic subgroups. Additionally, statistically significant alteration of disease-disease interrelationships was noted in all three lymphatic categories when compared to the control population. CONCLUSIONS The presence or absence of a lymphatic disease significantly influences disease interrelationships in the study cohorts. As a physiologic substrate, the lymphatic circulation may be an underappreciated participant in disease pathogenesis. These relationships warrant further, prospective scrutiny and study.
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Affiliation(s)
- Stanley G Rockson
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Xin Zhou
- Department of Genetics, Stanford University, School of Medicine, Stanford, California, USA
| | - Lan Zhao
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Davood K Hosseini
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Xinguo Jiang
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Andrew J Sweatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Dongeon Kim
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Wen Tian
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University, School of Medicine, Stanford, California, USA
| | - Mark R Nicolls
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
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Cofta-Woerpel L, Lam C, Reitzel LR, Wilson W, Karam-Hage M, Beneventi D, Cofer J, Baker E, Wetter DW, Cinciripini PM, Blalock J. A tele-mentoring tobacco cessation case consultation and education model for healthcare providers in community mental health centers. COGENT MEDICINE 2018; 5. [PMID: 30364535 PMCID: PMC6197484 DOI: 10.1080/2331205x.2018.1430652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Smoking prevalence among individuals with mental and behavioral health needs is considerably higher compared to the general population, but evidence-based smoking cessation therapies are underutilized in mental and behavioral healthcare settings, despite the fact that these treatments are both safe and effective. The goal of this paper is to present the background, design and pilot of Project TEACH (Tobacco Education and Cessation in the Health System) developed to improve clinical practice by offering specialized training in the provision of smoking cessation interventions to care providers in community mental health centers in Texas. This is achieved through engaging the expertise of clinicians at the MD Anderson Cancer Center’s Tobacco Treatment Program and disseminating this expertise to care providers by means of a novel tele-mentoring approach called Project ECHO (Extension for Community Healthcare Outcomes). Evaluation of our pilot ECHO training project demonstrated that the training was very well received and resulted in self-reported enhancement of the providers’ professional practice. This is the first project to extend the collaborative ECHO model to train healthcare providers in smoking cessation. This approach has potential to reduce smoking rates among smokers with mental and behavioral health needs, and consequently contribute to the prevention of cancer and other chronic diseases in this vulnerable population.
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Affiliation(s)
| | - Cho Lam
- Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lorraine R Reitzel
- HEALTH Research Institute and Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | | | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, USA
| | - Diane Beneventi
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, USA
| | - Jennifer Cofer
- Cancer Prevention and Control Platform, Moon Shots Program, MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen Baker
- Cancer Prevention and Control Platform, Moon Shots Program, MD Anderson Cancer Center, Houston, TX, USA
| | - David W Wetter
- Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, USA
| | - Janice Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, USA
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Minicã CC, Mbarek H, Pool R, Dolan CV, Boomsma DI, Vink JM. Pathways to smoking behaviours: biological insights from the Tobacco and Genetics Consortium meta-analysis. Mol Psychiatry 2017; 22:82-88. [PMID: 27021816 PMCID: PMC5777181 DOI: 10.1038/mp.2016.20] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 01/19/2023]
Abstract
By running gene and pathway analyses for several smoking behaviours in the Tobacco and Genetics Consortium (TAG) sample of 74 053 individuals, 21 genes and several chains of biological pathways were implicated. Analyses were carried out using the HYbrid Set-based Test (HYST) as implemented in the Knowledge-based mining system for Genome-wide Genetic studies software. Fifteen genes are novel and were not detected with the single nucleotide polymorphism-based approach in the original TAG analysis. For quantity smoked, 14 genes passed the false discovery rate of 0.05 (corrected for multiple testing), with the top association signal located at the IREB2 gene (P=1.57E-37). Three genomic loci were significantly associated with ever smoked. The top signal is located at the noncoding antisense RNA transcript BDNF-AS (P=6.25E-07) on 11p14. The SLC25A21 gene (P=2.09E-08) yielded the top association signal in the analysis of smoking cessation. The 19q13 noncoding RNA locus exceeded the genome-wide significance in the analysis of age at initiation (P=1.33E-06). Pathways belonging to the Neuronal system pathways, harbouring the nicotinic acetylcholine receptor genes expressing the α (CHRNA 1-9), β (CHRNB 1-4), γ, δ and ɛ subunits, yielded the smallest P-values in the pathway analysis of the quantity smoked (lowest P=4.90E-42). Additionally, pathways belonging to 'a subway map of cancer pathways' regulating the cell cycle, mitotic DNA replication, axon growth and synaptic plasticity were found significantly enriched for genetic variants in ever smokers relative to never smokers (lowest P=1.61E-07). In addition, these pathways were also significantly associated with the quantity smoked (lowest P=4.28E-17). Our results shed light on one of the world's leading causes of preventable death and open a path to potential therapeutic targets. These results are informative in decoding the biological bases of other disease traits, such as depression and cancers, with which smoking shares genetic vulnerabilities.
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Affiliation(s)
- Camelia C. Minicã
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hamdi Mbarek
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - René Pool
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Conor V. Dolan
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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