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Mezzacappa C, Rossi R, Jaffe A, Taddei TH, Strazzabosco M. Community-Level Factors Associated with Hepatocellular Carcinoma Incidence and Mortality: An Observational Registry Study. Cancer Epidemiol Biomarkers Prev 2024; 33:270-278. [PMID: 38059831 PMCID: PMC10872555 DOI: 10.1158/1055-9965.epi-23-0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) incidence and outcomes vary across populations in the United States, but few studies evaluate local drivers of observed disparities. We measured HCC incidence at the community level and assessed community-level HCC risk factors with the goal of informing resource allocation to improve early case detection, which is associated with improved outcomes. METHODS Clinical and demographic data including census tract of residence for all adults diagnosed with HCC in the Connecticut Tumor Registry between 2008 and 2019 were combined with publicly available U.S. Census and Centers for Disease Control and Prevention (CDC) data at the ZIP Code tabulation area (ZCTA) level. The average annual incidence of HCC was calculated for each ZCTA and associations between community-level characteristics, HCC incidence, stage at diagnosis, and survival were evaluated. RESULTS Average annual HCC incidence during the study period was 8.9/100,000 adults and varied from 0 to 97.7 per 100,000 adults by ZCTA. At the community level, lower rates of high school graduation, higher rates of poverty, and rural community type were associated with higher HCC incidence. Persons with HCC living in the highest incidence ZCTAs were diagnosed at a younger age and were less likely to be alive at 1, 2, and 5 years after diagnosis. CONCLUSIONS Community-level socioeconomic factors are strongly associated with HCC incidence and survival in Connecticut. IMPACT This reproducible geo-localization approach using cancer registry, Census, and CDC data can be used to identify communities most likely to benefit from health system investments to reduce disparities in HCC.
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Affiliation(s)
- Catherine Mezzacappa
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
| | - Raiza Rossi
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
| | - Ariel Jaffe
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
| | - Tamar H Taddei
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
- VA Connecticut Healthcare System
| | - Mario Strazzabosco
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
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Gross M, Huber S, Arora S, Ze'evi T, Haider SP, Kucukkaya AS, Iseke S, Kuhn TN, Gebauer B, Michallek F, Dewey M, Vilgrain V, Sartoris R, Ronot M, Jaffe A, Strazzabosco M, Chapiro J, Onofrey JA. Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics. Eur Radiol 2024:10.1007/s00330-023-10495-5. [PMID: 38217704 DOI: 10.1007/s00330-023-10495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Tal Ze'evi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Tom Niklas Kuhn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Gebauer
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Michallek
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valérie Vilgrain
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Riccardo Sartoris
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Maxime Ronot
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - John A Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
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Zheng M, Hakim A, Konkwo C, Deaton AM, Ward LD, Silveira MG, Assis DN, Liapakis A, Jaffe A, Jiang ZG, Curry MP, Lai M, Cho MH, Dykas D, Bale A, Mistry PK, Vilarinho S. Advancing diagnosis and management of liver disease in adults through exome sequencing. EBioMedicine 2023; 95:104747. [PMID: 37566928 PMCID: PMC10433007 DOI: 10.1016/j.ebiom.2023.104747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Whole-exome sequencing (WES) is an effective tool for diagnosis in patients who remain undiagnosed despite a comprehensive clinical work-up. While WES is being used increasingly in pediatrics and oncology, it remains underutilized in non-oncological adult medicine, including in patients with liver disease, in part based on the faulty premise that adults are unlikely to harbor rare genetic variants with large effect size. Here, we aim to assess the burden of rare genetic variants underlying liver disease in adults at two major tertiary referral academic medical centers. METHODS WES analysis paired with comprehensive clinical evaluation was performed in fifty-two adult patients with liver disease of unknown etiology evaluated at two US tertiary academic health care centers. FINDINGS Exome analysis uncovered a definitive or presumed diagnosis in 33% of patients (17/52) providing insight into their disease pathogenesis, with most of these patients (12/17) not having a known family history of liver disease. Our data shows that over two-thirds of undiagnosed liver disease patients attaining a genetic diagnosis were being evaluated for cholestasis or hepatic steatosis of unknown etiology. INTERPRETATION This study reveals an underappreciated incidence and spectrum of genetic diseases presenting in adulthood and underscores the clinical value of incorporating exome sequencing in the evaluation and management of adults with liver disease of unknown etiology. FUNDING S.V. is supported by the NIH/NIDDK (K08 DK113109 and R01 DK131033-01A1) and the Doris Duke Charitable Foundation Grant #2019081. This work was supported in part by NIH-funded Yale Liver Center, P30 DK34989.
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Affiliation(s)
- Melanie Zheng
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Aaron Hakim
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chigoziri Konkwo
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Marina G Silveira
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - David N Assis
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - AnnMarie Liapakis
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Ariel Jaffe
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Z Gordon Jiang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael P Curry
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michelle Lai
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Dykas
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Allen Bale
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | - Pramod K Mistry
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Silvia Vilarinho
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
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4
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Aizenbud Y, Jaffe A, Wang M, Hu A, Amsel N, Nadler B, Chang JT, Kluger Y. Spectral top-down recovery of latent tree models. Inf inference 2023; 12:iaad032. [PMID: 37593361 PMCID: PMC10431953 DOI: 10.1093/imaiai/iaad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/24/2023] [Accepted: 06/24/2023] [Indexed: 08/19/2023]
Abstract
Modeling the distribution of high-dimensional data by a latent tree graphical model is a prevalent approach in multiple scientific domains. A common task is to infer the underlying tree structure, given only observations of its terminal nodes. Many algorithms for tree recovery are computationally intensive, which limits their applicability to trees of moderate size. For large trees, a common approach, termed divide-and-conquer, is to recover the tree structure in two steps. First, separately recover the structure of multiple, possibly random subsets of the terminal nodes. Second, merge the resulting subtrees to form a full tree. Here, we develop spectral top-down recovery (STDR), a deterministic divide-and-conquer approach to infer large latent tree models. Unlike previous methods, STDR partitions the terminal nodes in a non random way, based on the Fiedler vector of a suitable Laplacian matrix related to the observed nodes. We prove that under certain conditions, this partitioning is consistent with the tree structure. This, in turn, leads to a significantly simpler merging procedure of the small subtrees. We prove that STDR is statistically consistent and bound the number of samples required to accurately recover the tree with high probability. Using simulated data from several common tree models in phylogenetics, we demonstrate that STDR has a significant advantage in terms of runtime, with improved or similar accuracy.
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Affiliation(s)
- Yariv Aizenbud
- Program in Applied Mathematics, Yale University, New Haven, CT 06511, USA
| | - Ariel Jaffe
- Program in Applied Mathematics, Yale University, New Haven, CT 06511, USA
| | - Meng Wang
- Department of Pathology, Yale University, New Haven, CT 06511, USA
| | - Amber Hu
- Program in Applied Mathematics, Yale University, New Haven, CT 06511, USA
| | - Noah Amsel
- Program in Applied Mathematics, Yale University, New Haven, CT 06511, USA
| | - Boaz Nadler
- Department of Computer Science, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Joseph T Chang
- Department of Statistics, Yale University, New Haven, CT 06520, USA
| | - Yuval Kluger
- Program in Applied Mathematics, Yale University, New Haven, CT 06511, USA
- Department of Pathology, Yale University, New Haven, CT 06511, USA
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511, USA
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Plaz Torres MC, Jaffe A, Perry R, Marabotto E, Strazzabosco M, Giannini EG. Reply: Novel antidiabetic drugs and the risk for HCC. What else to expect from these "wonderful" drug classes? Hepatology 2023; 77:E184-E185. [PMID: 36724446 DOI: 10.1097/hep.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Maria C Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ariel Jaffe
- Department of Internal Medicine, Liver Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel Perry
- Department of Internal Medicine, Liver Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Mario Strazzabosco
- Department of Internal Medicine, Liver Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Cao Y, Mezzacappa C, Jaffe A, Strazzabosco M, Taddei TH. Adherence to Tumor Board Recommendations in the Treatment of Patients with Hepatocellular Carcinoma. J Multidiscip Healthc 2023; 16:1531-1540. [PMID: 37283950 PMCID: PMC10239642 DOI: 10.2147/jmdh.s407908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a heterogeneous disease that typically arises in the setting of chronic liver disease, making treatment selection complex. Multidisciplinary liver tumor boards (MDLTB) have been shown to improve outcomes in patients with HCC. However, in many cases, patients evaluated by MDLTBs ultimately do not receive the board's recommended treatment. Purpose This study aims to assess adherence to MDLTB recommendations for the treatment of HCC, the reasons for non-adherence, and the survival of Barcelona Clinic Liver Cancer (BCLC) Stage A patients treated with curative treatment compared to palliative locoregional therapy. Patients and Methods A single-site, retrospective cohort study was conducted of all patients with treatment-naïve HCC who were evaluated by an MDLTB at a tertiary care center in Connecticut between 2013 and 2016, of which 225 patients met inclusion criteria. Investigators conducted a chart review and recorded adherence to the MDLTB's recommendations, and in cases of discordance, evaluated and recorded the underlying cause; investigators assessed MDLTB recommendations' compliance with BCLC guidelines. Survival data was accrued through February 1st of 2022 and analyzed via Kaplan-Meier analysis and multivariate Cox regression. Results Treatment adherent to MDLTB recommendations occurred in 85.3% of patients (n=192). The majority of non-adherence occurred in the management of BCLC Stage A disease. In cases where adherence was possible but the recommendation was not followed, most discrepancies were whether to treat with curative or palliative intent (20/24), with almost all discrepancies occurring in patients (19/20) with BCLC Stage A disease. For patients with Stage A unifocal HCC, those who received curative therapy lived significantly longer than patients who received palliative locoregional therapy (5.55 years vs 4.26 years, p=0.037). Conclusion Most forms of non-adherence to MDLTB recommendations were unavoidable; however, treatment discordance in the management of patients with BCLC Stage A unifocal disease may present an opportunity for clinically significant quality improvement.
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Affiliation(s)
- Yueming Cao
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Catherine Mezzacappa
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USA
| | - Ariel Jaffe
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USA
| | - Tamar H Taddei
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine Digestive Disease Section, Yale School of Medicine, New Haven, CT, USA
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Kayali S, Pasta A, Plaz Torres MC, Jaffe A, Strazzabosco M, Marenco S, Giannini EG. Immune checkpoint inhibitors in malignancies after liver transplantation: A systematic review and pooled analysis. Liver Int 2023; 43:8-17. [PMID: 36102312 PMCID: PMC10087158 DOI: 10.1111/liv.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Treatment of de novo malignancies and recurrent hepatocellular carcinoma with immune checkpoint inhibitors (ICI) in liver transplant recipients (LT) is an attractive strategy that is infrequently pursued because of the lack of strong evidence regarding their safety and efficacy. In this systematic review with pooled analysis, we aimed to assess safety and efficacy of ICI therapy following LT. METHODS We performed a systematic search of case reports and series published until January 2022. We included 31 publications reporting a total of 52 patients treated with ICIs after LT and assessed in a pooled analysis the risk of graft rejection and the outcome of ICI therapy. RESULTS Acute graft rejection occurred in 15 patients (28.8%) and 7 patients (13.4% of the total cohort) died because of graft loss. Rejection was associated with shorter overall survival (OS) (17.2 months, confidence interval [CI] 12.1-22.2 vs. 3.5 months, CI 1.6-5.4, p < 0.001). Disease control rate was 44.2% (n = 23), and in these patients, OS was longer than in non-responders (26.4 months, CI 20.8-32.0 vs. 3.4 months, CI 2.1-4.7, p < 0.001). CONCLUSIONS Observational, off-label experience suggests that treatment with ICI for advanced malignancies in LT recipients might not be discarded a priori. This notwithstanding, ICI treatment in these patients is associated with a substantial risk of graft rejection and mortality. Prospective studies are needed to provide adequate safety and efficacy figures of ICI treatment in this fragile population.
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Affiliation(s)
- Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ariel Jaffe
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
| | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
| | - Simona Marenco
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Jaffe A, Taddei TH, Giannini EG, Ilagan-Ying YC, Colombo M, Strazzabosco M. Alternative HCC prognostic biomarkers and use of artificial intelligence in the management of HCC. Liver Int 2023; 43:258-259. [PMID: 36426717 DOI: 10.1111/liv.15482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ariel Jaffe
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
| | - Tamar H Taddei
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ysabel C Ilagan-Ying
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Smilow Cancer Hospital and Liver Cancer Program, New Haven, Connecticut, USA
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9
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Jaffe A, Taddei TH, Giannini EG, Ilagan-Ying YC, Colombo M, Strazzabosco M. Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook. Liver Int 2022; 42:2607-2619. [PMID: 36161463 PMCID: PMC10878125 DOI: 10.1111/liv.15432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 09/21/2022] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common complication in patients with chronic liver disease and leads to significant morbidity and mortality. Liver disease and liver cancer are preventable by mitigating and managing common risk factors, including chronic hepatitis B and C infection, alcohol use, diabetes, obesity and other components of the metabolic syndrome. The management of patients with HCC requires treatment of the malignancy and adequate control of the underlying liver disease, as preserving liver function is critical for successful cancer treatment and may have a relevant prognostic role independent of HCC management. Hepatologists are the ideal providers to guide the care of patients with HCC as they are trained to identify patients at risk, apply appropriate surveillance strategies, assess and improve residual liver function, evaluate candidacy for transplant, provide longitudinal care to optimize and preserve liver function during and after HCC treatment, survey for cancer recurrence and manage its risk factors, and prevent and treat decompensating events. We highlight the need for a team-based holistic approach to the patient with liver disease and HCC and identify necessary gaps in current care and knowledge.
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Affiliation(s)
- Ariel Jaffe
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Smilow Cancer Hospital and Liver Cancer Program, New Haven, CT, USA
| | - Tamar H. Taddei
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ysabel C. Ilagan-Ying
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Mario Strazzabosco
- Liver Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Smilow Cancer Hospital and Liver Cancer Program, New Haven, CT, USA
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Plaz Torres MC, Jaffe A, Perry R, Marabotto E, Strazzabosco M, Giannini EG. Diabetes medications and risk of HCC. Hepatology 2022; 76:1880-1897. [PMID: 35239194 PMCID: PMC9790535 DOI: 10.1002/hep.32439] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus is a recognized risk factor for HCC in patients with liver disease, independent from the etiology of their liver disease. Hence, prevention and treatment of type 2 diabetes mellitus and its underlying cause, insulin resistance, should be considered a treatment target for patients with liver disease. The drug armamentarium for diabetes is wide and consists of agents with insulin-sensitizing activity, agents that stimulate insulin secretion, insulin itself, and agents that reduce gastrointestinal and urinary glucose absorption. From an endocrinology perspective, the main goal of treatment is the achievement of euglycemia; however, in patients at risk of, or with known underlying liver disease, the choice of diabetic medication as it relates to potential hepatic carcinogenesis remains complex and should be carefully considered. In the last decade, increasing evidence has suggested that metformin may reduce the risk of HCC, whereas evidence for other classes of diabetic medications, particularly some of the newer agents including the sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, is fewer and often inconsistent. In this review, we aim to summarize the current evidence on the potential effects of the most widely used diabetic agents on liver cancer tumorigenesis.
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Affiliation(s)
- Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal MedicineIRCCS—Ospedale Policlinico San Martino, University of GenoaGenoaItaly
| | - Ariel Jaffe
- Liver CenterDepartment of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Rachel Perry
- Liver CenterDepartment of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
- Section of EndocrinologyDepartment of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
- Department of Cellular and Molecular PhysiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal MedicineIRCCS—Ospedale Policlinico San Martino, University of GenoaGenoaItaly
| | - Mario Strazzabosco
- Liver CenterDepartment of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal MedicineIRCCS—Ospedale Policlinico San Martino, University of GenoaGenoaItaly
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11
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De Michieli L, Knott J, Attia Z, Ola O, Akula A, Mehta R, Dworak M, Lobo R, Hodge D, Tak T, Cagin C, Friedman P, Gulati R, Jaffe A, Sandoval Y. Artificial intelligence-enabled electrocardiographic algorithm for the detection of left ventricular dysfunction in emergency department patients undergoing high-sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Artificial intelligence-augmented electrocardiogram (AI-ECG) algorithms have been developed from the standard 12-lead ECG and validated for the recognition of left ventricular systolic dysfunction (LVSD), defined as LV ejection fraction (LVEF)≤35%. Whether AI-ECG facilitates identification of LVSD and is associated with adverse outcomes in emergency department (ED) patients undergoing high-sensitivity cardiac troponin (hs-cTnT) testing is uncertain.
Purpose
To investigate the diagnostic and prognostic performance of AI-ECG in ED patients undergoing hs-cTnT measurement.
Methods
Observational US cohort study of ED patients undergoing hs-cTnT measurement. Cases with hs-cTnT increases >sex-specific 99th percentiles were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Post-discharge major adverse cardiac events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischemic attack, and new onset atrial fibrillation/flutter during 2-years follow-up. The AI-ECG network output, which is a continuous number between 0–1, that provides a probability of LVSD, was obtained for each patient from the first ECG during the index presentation. An AI-ECG threshold of ≥0.256 indicates a positive screen that correlates with a high probability of LVSD.
Results
Among 1977 patients, 1729 (87%) had a negative AI-ECG screen, while 248 (13%) had a positive AI-ECG screen. Patients with a positive AI-ECG screen were older and had more comorbidities. As compared to patients with hs-cTnT≤99th percentile in whom AI-ECG was positive in 5.8%, those with hs-cTnT>99th percentile had a positive AI-ECG in 22% of cases (p<0.0001). Based on adjudicated diagnoses, the frequency of a positive AI-ECG was 20% in myocardial injury, 38% in type 1 MI, and 20% in type 2 MI. At 2-years follow-up, as compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p<0.0001, adjusted HR 1.39, 95% CI 1.11–1.75) (Figure 1), mainly because of more deaths (43% vs. 30%, p=0.004) and HF hospitalizations (36% vs. 13%, p<0.0001). A positive AI-ECG was associated with a higher risk for MACE (60% vs. 41%, p<0.0001, adjusted HR 1.30, 95% CI 1.02–1.64) in those with hs-cTnT increases >99th percentile, but not in those without hs-cTnT increases. Among patients with an echocardiogram during index presentation or within 30-days (n=452), the diagnostic accuracy of AI-ECG for LVEF ≤35% was 81.4% (95% CI 77.5, 84.9) with a negative predictive value of 96.5% (95% CI 94.0, 98.2). A normal LVEF (>50%) was observed in 87% of those with a negative AI ECG, whereas in those with a positive AI-ECG LVEF was reduced (<50%) in 60%.
Conclusions
Among ED patients evaluated with hs-cTnT, a positive AI-ECG screen for LVSD identifies patients at high risk of MACE. These findings are largely because of more deaths and HF hospitalizations in those with hs-cTnT increases >sex-specific 99th percentiles.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Knott
- Mayo Clinic , Rochester , United States of America
| | - Z Attia
- Mayo Clinic , Rochester , United States of America
| | - O Ola
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - A Akula
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Mehta
- Mayo Clinic , Rochester , United States of America
| | - M Dworak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Lobo
- Mayo Clinic , Rochester , United States of America
| | - D Hodge
- Mayo Clinic , Jacksonville , United States of America
| | - T Tak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - C Cagin
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - P Friedman
- Mayo Clinic , Rochester , United States of America
| | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - A Jaffe
- Mayo Clinic , Rochester , United States of America
| | - Y Sandoval
- Mayo Clinic , Rochester , United States of America
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12
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Borde T, Nezami N, Laage Gaupp F, Savic LJ, Taddei T, Jaffe A, Strazzabosco M, Lin M, Duran R, Georgiades C, Hong K, Chapiro J. Optimization of the BCLC Staging System for Locoregional Therapy for Hepatocellular Carcinoma by Using Quantitative Tumor Burden Imaging Biomarkers at MRI. Radiology 2022; 304:228-237. [PMID: 35412368 PMCID: PMC9270683 DOI: 10.1148/radiol.212426] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Patients with intermediate- and advanced-stage hepatocellular carcinoma (HCC) represent a highly heterogeneous patient collective with substantial differences in overall survival. Purpose To evaluate enhancing tumor volume (ETV) and enhancing tumor burden (ETB) as new criteria within the Barcelona Clinic Liver Cancer (BCLC) staging system for optimized allocation of patients with intermediate- and advanced-stage HCC to undergo transarterial chemoembolization (TACE). Materials and Methods In this retrospective study, 682 patients with HCC who underwent conventional TACE or TACE with drug-eluting beads from January 2000 to December 2014 were evaluated. Quantitative three-dimensional analysis of contrast-enhanced MRI was performed to determine thresholds of ETV and ETB (ratio of ETV to normal liver volume). Patients with ETV below 65 cm3 or ETB below 4% were reassigned to BCLC Bn, whereas patients with ETV or ETB above the determined cutoffs were restratified or remained in BCLC Cn by means of stepwise verification of the median overall survival (mOS). Results This study included 494 patients (median age, 62 years [IQR, 56-71 years]; 401 men). Originally, 123 patients were classified as BCLC B with mOS of 24.3 months (95% CI: 21.4, 32.9) and 371 patients as BCLC C with mOS of 11.9 months (95% CI: 10.5, 14.8). The mOS of all included patients (including the BCLC B and C groups) was 15 months (95% CI: 12.3, 17.2). A total of 152 patients with BCLC C tumors were restratified into a new BCLC Bn class, in which the mOS was then 25.1 months (95% CI: 21.8, 29.7; P < .001). The mOS of the remaining patients (ie, BCLC Cn group) (n = 222; ETV ≥65 cm3 or ETB ≥4%) was 8.4 months (95% CI: 6.1, 11.2). Conclusion Substratification of patients with intermediate- and advanced-stage hepatocellular carcinoma according to three-dimensional quantitative tumor burden identified patients with a survival benefit from transarterial chemoembolization before therapy. © RSNA, 2022 Online supplemental material is available for this article.
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13
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Abstract
We study super-resolution multi-reference alignment, the problem of estimating a signal from many circularly shifted, down-sampled and noisy observations. We focus on the low SNR regime, and show that a signal in ℝ M is uniquely determined when the number L of samples per observation is of the order of the square root of the signal's length ( L = O ( M ) ). Phrased more informally, one can square the resolution. This result holds if the number of observations is proportional to 1/SNR3. In contrast, with fewer observations recovery is impossible even when the observations are not down-sampled (L = M). The analysis combines tools from statistical signal processing and invariant theory. We design an expectation-maximization algorithm and demonstrate that it can super-resolve the signal in challenging SNR regimes.
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Affiliation(s)
- Tamir Bendory
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Jaffe
- Applied Mathematics Program, Yale University, New Haven, CT, USA
| | - William Leeb
- School of Mathematics, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Nir Sharon
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Singer
- Department of Mathematics and Program in Applied and Computational Mathematics, Princeton University, Princeton, NJ, USA
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14
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Schulz K, Amy S, Kavsak P, Jaffe A, Ordóñez-Llanos J, Collinson P, Lindgren B, Ler R, Sexter A, Chapman A, Apple F. M173 Total imprecision of 8 high sensitivity cardiac troponin assays within sex-specific reference limits: Clinical implications. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Gross M, Spektor M, Jaffe A, Kucukkaya AS, Iseke S, Haider SP, Strazzabosco M, Chapiro J, Onofrey JA. Improved performance and consistency of deep learning 3D liver segmentation with heterogeneous cancer stages in magnetic resonance imaging. PLoS One 2021; 16:e0260630. [PMID: 34852007 PMCID: PMC8635384 DOI: 10.1371/journal.pone.0260630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Accurate liver segmentation is key for volumetry assessment to guide treatment decisions. Moreover, it is an important pre-processing step for cancer detection algorithms. Liver segmentation can be especially challenging in patients with cancer-related tissue changes and shape deformation. The aim of this study was to assess the ability of state-of-the-art deep learning 3D liver segmentation algorithms to generalize across all different Barcelona Clinic Liver Cancer (BCLC) liver cancer stages. METHODS This retrospective study, included patients from an institutional database that had arterial-phase T1-weighted magnetic resonance images with corresponding manual liver segmentations. The data was split into 70/15/15% for training/validation/testing each proportionally equal across BCLC stages. Two 3D convolutional neural networks were trained using identical U-net-derived architectures with equal sized training datasets: one spanning all BCLC stages ("All-Stage-Net": AS-Net), and one limited to early and intermediate BCLC stages ("Early-Intermediate-Stage-Net": EIS-Net). Segmentation accuracy was evaluated by the Dice Similarity Coefficient (DSC) on a dataset spanning all BCLC stages and a Wilcoxon signed-rank test was used for pairwise comparisons. RESULTS 219 subjects met the inclusion criteria (170 males, 49 females, 62.8±9.1 years) from all BCLC stages. Both networks were trained using 129 subjects: AS-Net training comprised 19, 74, 18, 8, and 10 BCLC 0, A, B, C, and D patients, respectively; EIS-Net training comprised 21, 86, and 22 BCLC 0, A, and B patients, respectively. DSCs (mean±SD) were 0.954±0.018 and 0.946±0.032 for AS-Net and EIS-Net (p<0.001), respectively. The AS-Net 0.956±0.014 significantly outperformed the EIS-Net 0.941±0.038 on advanced BCLC stages (p<0.001) and yielded similarly good segmentation performance on early and intermediate stages (AS-Net: 0.952±0.021; EIS-Net: 0.949±0.027; p = 0.107). CONCLUSION To ensure robust segmentation performance across cancer stages that is independent of liver shape deformation and tumor burden, it is critical to train deep learning models on heterogeneous imaging data spanning all BCLC stages.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Ahmet S. Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Stefan P. Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - John A. Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States of America
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16
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Jaffe A, Amsel N, Aizenbud Y, Nadler B, Chang JT, Kluger Y. Spectral neighbor joining for reconstruction of latent tree Models. SIAM J Math Data Sci 2021; 3:113-141. [PMID: 34124606 PMCID: PMC8194222 DOI: 10.1137/20m1365715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A common assumption in multiple scientific applications is that the distribution of observed data can be modeled by a latent tree graphical model. An important example is phylogenetics, where the tree models the evolutionary lineages of a set of observed organisms. Given a set of independent realizations of the random variables at the leaves of the tree, a key challenge is to infer the underlying tree topology. In this work we develop Spectral Neighbor Joining (SNJ), a novel method to recover the structure of latent tree graphical models. Given a matrix that contains a measure of similarity between all pairs of observed variables, SNJ computes a spectral measure of cohesion between groups of observed variables. We prove that SNJ is consistent, and derive a sufficient condition for correct tree recovery from an estimated similarity matrix. Combining this condition with a concentration of measure result on the similarity matrix, we bound the number of samples required to recover the tree with high probability. We illustrate via extensive simulations that in comparison to several other reconstruction methods, SNJ requires fewer samples to accurately recover trees with a large number of leaves or long edges.
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Affiliation(s)
- Ariel Jaffe
- Program in Applied Mathematics, Yale University, New Haven, CT 06511
| | - Noah Amsel
- Program in Applied Mathematics, Yale University, New Haven, CT 06511
| | - Yariv Aizenbud
- Program in Applied Mathematics, Yale University, New Haven, CT 06511
| | - Boaz Nadler
- Department of Computer Science, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Joseph T Chang
- Department of Statistics, Yale University, New Haven, CT 06520, USA
| | - Yuval Kluger
- Program in Applied Mathematics, Yale University, New Haven, CT 06511
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511
- Department of Pathology, Yale University New Haven, CT 06511
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17
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Jaffe A, Kluger Y, Lindenbaum O, Patsenker J, Peterfreund E, Steinerberger S. The Spectral Underpinning of word2vec. Front Appl Math Stat 2020; 6:593406. [PMID: 34504892 PMCID: PMC8425479 DOI: 10.3389/fams.2020.593406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Word2vec introduced by Mikolov et al. is a word embedding method that is widely used in natural language processing. Despite its success and frequent use, a strong theoretical justification is still lacking. The main contribution of our paper is to propose a rigorous analysis of the highly nonlinear functional of word2vec. Our results suggest that word2vec may be primarily driven by an underlying spectral method. This insight may open the door to obtaining provable guarantees for word2vec. We support these findings by numerical simulations. One fascinating open question is whether the nonlinear properties of word2vec that are not captured by the spectral method are beneficial and, if so, by what mechanism.
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Affiliation(s)
- Ariel Jaffe
- Program in Applied Mathematics, Yale University, New Haven, CT, United States
| | - Yuval Kluger
- Program in Applied Mathematics, Yale University, New Haven, CT, United States
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
- Interdepartmental Program in Computational Biology and Bioinformatics, New Haven, CT, United States
| | - Ofir Lindenbaum
- Program in Applied Mathematics, Yale University, New Haven, CT, United States
| | - Jonathan Patsenker
- Program in Applied Mathematics, Yale University, New Haven, CT, United States
| | - Erez Peterfreund
- School of Computer Science and Engineering, The Hebrew University, Jerusalem, Israel
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18
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Strachan R, Gilbert L, Homaira N, Oftadeh S, Snelling T, Jaffe A. Pneumococcal serotypes causing pneumonia in the 13 valent pneumococcal conjugate vaccine era in Australian children. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Cortesi PA, Conti S, Scalone L, Jaffe A, Ciaccio A, Okolicsanyi S, Rota M, Fabris L, Colledan M, Fagiuoli S, Belli LS, Cesana G, Strazzabosco M, Mantovani LG. Health related quality of life in chronic liver diseases. Liver Int 2020; 40:2630-2642. [PMID: 32851764 DOI: 10.1111/liv.14647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The impact of chronic liver diseases (CLDs) on health-related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision-making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. METHODS Using the EQ-5D-3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. RESULTS Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self-care and lower EQ-5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced stages of liver disease (DC or HCC), HRQoL decreased significantly with higher risk of reporting problems in the physical domains, and significant reductions in the VAS and utility index scores. CONCLUSIONS Different subtypes of CLD affected different QoL domains. This study therefore provides a real estimate of the impact of CLDs on patients' HRQoL, and represents a much needed tool to inform decision-making while assessing the effectiveness and cost-effectiveness of the care of these patients.
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Affiliation(s)
- Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luciana Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Ariel Jaffe
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Matteo Rota
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Department of Molecular and Traslational Medicine, University of Brescia, Brescia, Italy
| | - Luca Fabris
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Colledan
- Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca S Belli
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Mario Strazzabosco
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Sesto San Giovanni, Italy
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20
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Jaffe A, Schilsky ML, Deshpande R, Batra R. Liver Transplantation in the Time of COVID19: Barriers and Ethical considerations for Management and Next Steps. Hepatol Commun 2020; 4:1242-1256. [PMID: 32838103 PMCID: PMC7361607 DOI: 10.1002/hep4.1568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
The recent outbreak of the novel virus severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), which causes the corona virus disease of 2019 (COVID19), has spread globally and affects millions of people. This pandemic has taxed our health care system and disrupted normal operations, even life‐saving procedures, such as liver transplants. During these unprecedented times, providers and patients are imperiled and resources for diagnosis and care may be limited. Continuing to perform resource‐intense advanced procedures is challenging, as is caring for patients with end‐stage liver disease or patients with urgent needs for liver tumor control. Liver transplantation, in particular, requires critical resources, like blood products and critical care beds, which are fairly limited in the COVID19 pandemic. The potential of COVID19 infections in posttransplant recipients on immunosuppression and staff contacts further adds to the complexity. Therefore, transplant programs must reevaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end‐stage liver disease during the COVID19 pandemic.
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Affiliation(s)
- Ariel Jaffe
- Yale University School of Medicine New Haven United States
| | | | | | - Ramesh Batra
- Yale University School of Medicine New Haven United States
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21
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Linderman GC, Mishne G, Jaffe A, Kluger Y, Steinerberger S. Randomized near-neighbor graphs, giant components and applications in data science. J Appl Probab 2020; 57:458-476. [PMID: 32913373 PMCID: PMC7480951 DOI: 10.1017/jpr.2020.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
If we pick n random points uniformly in [0, 1] d and connect each point to its c d log n-nearest neighbors, where d ≥ 2 is the dimension and c d is a constant depending on the dimension, then it is well known that the graph is connected with high probability. We prove that it suffices to connect every point to c d,1 log log n points chosen randomly among its c d,2 log n-nearest neighbors to ensure a giant component of size n - o(n) with high probability. This construction yields a much sparser random graph with ~ n log log n instead of ~ n log n edges that has comparable connectivity properties. This result has nontrivial implications for problems in data science where an affinity matrix is constructed: instead of connecting each point to its k nearest neighbors, one can often pick k' ≪ k random points out of the k nearest neighbors and only connect to those without sacrificing quality of results. This approach can simplify and accelerate computation; we illustrate this with experimental results in spectral clustering of large-scale datasets.
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Affiliation(s)
- George C Linderman
- Postal address: Applied Mathematics, Yale University, New Haven, CT 06511
| | - Gal Mishne
- Postal address: Applied Mathematics, Yale University, New Haven, CT 06511
| | - Ariel Jaffe
- Postal address: Applied Mathematics, Yale University, New Haven, CT 06511
| | - Yuval Kluger
- Dept. of Pathology & Applied Mathematics, Yale University, New Haven, CT 06511
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22
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Abstract
Hepatic encephalopathy (HE) is one of the major clinical decompensations of cirrhosis, with a high impact on health care resource utilization and cost. For an effective and comprehensive management of HE, the clinicians need to understand the pathophysiologic mechanisms of HE. This review describes the multiorgan processes involved in HE and how several HE precipitants and treatment strategies act on ammonia production, excretion, and neurotoxicity, including the impact of diabetes and use of cannabinoids. The authors also discuss the current and future role of gut microbiome, systemic/central inflammation, and various neurotransmitters for the pathogenesis and treatment of HE.
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Affiliation(s)
- Ariel Jaffe
- Section of Digestive Diseases, Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520-8019, USA
| | - Joseph K Lim
- Section of Digestive Diseases, Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520-8019, USA; VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sofia Simona Jakab
- Section of Digestive Diseases, Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06520-8019, USA; VA Connecticut Healthcare System, West Haven, Connecticut, USA.
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Ghazikhanian S, McKay T, Irani Z, Cui J, Jaffe A, Pollak J, Smolinski-Zhao S. 03:36 PM Abstract No. 272 Safety and efficacy of small diameter incrementally expandable transjugular intrahepatic portosystemic shunt for management of refractory ascites and variceal bleeding. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Homaira N, Briggs N, Oei JL, Hilder L, Bajuk B, Snelling T, Jaffe A. High impact of influenza on hospitalisation rates in children with a range of chronic lung diseases: A population-based study. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Real eigenpairs of symmetric tensors play an important role in multiple applications. In this paper we propose and analyze a fast iterative Newton-based method to compute real eigenpairs of symmetric tensors. We derive sufficient conditions for a real eigenpair to be a stable fixed point for our method and prove that given a sufficiently close initial guess, the convergence rate is quadratic. Empirically, our method converges to a significantly larger number of eigenpairs compared with previously proposed iterative methods, and with enough random initializations typically finds all real eigenpairs. In particular, for a generic symmetric tensor, the sufficient conditions for local convergence of our Newton-based method hold simultaneously for all its real eigenpairs.
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Affiliation(s)
- Ariel Jaffe
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Roi Weiss
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Boaz Nadler
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot 76100, Israel
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Coffey M, Low I, Stelzer-Braid S, Rawlinson W, Thomas T, Jaffe A, Ooi C. EPS4.04 Characterising the intestinal virome in cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Coffey M, Zhong L, Jaffe A, Ooi C, Waters S. WS03.5 The human intestinal proteome in children with cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
An abundance of label-free microfluidic techniques for measuring cell intrinsic markers exists, yet these techniques are seldom combined because of integration complexity such as restricted physical space and incompatible modes of operation. We introduce a multiparameter intrinsic cytometry approach for the characterization of single cells that combines ≥2 label-free measurement techniques onto the same platform and uses cell tracking to associate the measured properties to cells. Our proof-of-concept implementation can measure up to five intrinsic properties including size, deformability, and polarizability at three frequencies. Each measurement module along with the integrated platform were validated and evaluated in the context of chemically induced changes in the actin cytoskeleton of cells. viSNE and machine learning classification were used to determine the orthogonality between and the contribution of the measured intrinsic markers for cell classification.
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Affiliation(s)
- N Apichitsopa
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 36-824, Cambridge, MA 02139, USA.
| | - A Jaffe
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 36-824, Cambridge, MA 02139, USA.
| | - J Voldman
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Room 36-824, Cambridge, MA 02139, USA.
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Tripto-Shkolnik L, Jaffe A, Liel Y. The impact of vitamin D status and parameters of calcium metabolism in patients with primary hyperparathyroidism. QJM 2018; 111:97-101. [PMID: 29462468 DOI: 10.1093/qjmed/hcx200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is ample evidence associating vitamin D deficiency in primary hyperparathyroidism (PHP) patients with more severe disease manifestations and increased risk of postoperative hypocalcemia. Yet, there is limited data regarding the safety of vitamin D repletion in these patients. AIM To assess the safety of vitamin D repletion in PHP patients in a real-world setting. DESIGN We included patients with asymptomatic PHP and few symptomatic patients who declined surgery, followed in our clinic, and treated on a routine basis with 2000 IU/day of vitamin D3. METHODS Serum calcium (sCa), PTH, 25-hydroxyvitamin D, and 24 h urinary calcium (uCa) and creatinine collections were compared between the lowest and the highest vitamin D time points. RESULTS There were 40 patients of a mean age was 63 ± 10 years. 25(OH)D at lowest and highest vitamin D time points was 15.5 ± 6.2 ng/ml and 33.2 ± 8, respectively (P < 0.001). Serum calcium was not affected by the changes in vitamin D levels. In none of the patients did sCa exceed 11.5 mg/dL. uCa was 220 ± 110 mg/24 h at the lowest vitamin D time point and 260 ± 140 at the highest vitamin D time point (P = 0.14). uCa exceeded 400 mg/24 h in two vs. five patients (P = 0.23) at the lowest and highest vitamin D time points, respectively. PTH was not significantly different between the different vitamin D time points. DISCUSSION/CONCLUSION Vitamin D repletion in PHP seems safe. Considering the documented adverse influence of vitamin D deficiency in PHP, particularly on skeletal manifestations and on the postoperative course, vitamin D repletion is warranted.
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Affiliation(s)
| | - A Jaffe
- Endocrine Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Y Liel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gibson PG, Reddel H, McDonald VM, Marks G, Jenkins C, Gillman A, Upham J, Sutherland M, Rimmer J, Thien F, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Robinson P, Wright C, Yozghatlian V, Burgess S, Sivakumaran P, Jaffe A, Bowden J, Wark PAB, Yan KY, Kritikos V, Peters M, Hew M, Aminazad A, Bint M, Guo M. Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry. Intern Med J 2017; 46:1054-62. [PMID: 27350385 DOI: 10.1111/imj.13166] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. AIMS To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants. METHODS A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma. RESULTS Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). CONCLUSION Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
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Affiliation(s)
- P G Gibson
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
| | - H Reddel
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Liverpool Hospital, Sydney, New South Wales, Australia
| | - V M McDonald
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Marks
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - C Jenkins
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - A Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - J Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Sutherland
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - J Rimmer
- St Vincent's Clinic, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - F Thien
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - G P Katsoulotos
- St George Specialist Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - M Cook
- Department of Immunology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - I Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - C Katelaris
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Bowler
- Department of Respiratory and Sleep Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - D Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia
| | - P Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - C Wright
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - V Yozghatlian
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - S Burgess
- QLD Children's Lung and Sleep Specialists, Brisbane, Queensland, Australia
| | - P Sivakumaran
- Department of Respiratory Medicine, Gold Coast District Hospital, Gold Coast, Queensland, Australia
| | - A Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - J Bowden
- Department of Respiratory, Allergy and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - P A B Wark
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - K Y Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - V Kritikos
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - M Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - A Aminazad
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - M Bint
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - M Guo
- Clinical Management, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
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Gualandro D, Puelacher C, Lurati-Buse G, Strunz C, Cardozo F, Yu P, Jaffe A, Twerenbold R, Hammerer-Lercher A, Melo E, Calderaro D, Duarte A, Luccia N, Caramelli B, Mueller C. P6224Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Garg M, Leach S, Needham B, Coffey M, Katz T, Strachan R, Widger J, Field P, Belessis Y, Chuang S, Day A, Jaffe A, Ooi C. WS21.1 Determining the age-related levels of fecal M2-pyruvate kinase in children with cystic fibrosis during the first decade of life. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Check J, Jaffe A. Dextroamphetamine sulfate provided quick relief of severe post-partum depression that was recalcitrant to standard antidepressants and psychotherapy. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3316.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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34
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Jaffe A, Brown RS. A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women. Gastroenterol Hepatol (N Y) 2017; 13:154-163. [PMID: 28539842 PMCID: PMC5439134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains high even with the proper use of active-passive immunoprophylaxis in newborns. Mothers with significant viremia are at a much higher risk of MTCT; therefore, treatments aimed at lowering HBV DNA levels during pregnancy may ultimately decrease global disease burden. The exact threshold for treatment remains controversial; however, most studies have accepted levels greater than 2 × 5 log10 IU/mL as significant viremia. We reviewed the most recent literature on antiviral efficacy, maternal and fetal safety, and viral resistance patterns when used for short-duration therapy in pregnancy. The literature review shows that antiviral therapy during pregnancy significantly reduces maternal HBV DNA levels with subsequent reductions in infant HBV infections. Tenofovir disoproxil fumarate (TDF) is associated with mild gastrointestinal distress and may cause decreased fetal bone growth (although long-term studies are needed to evaluate the clinical significance of this finding), and the impact of this drug is likely limited when use is restricted to the third trimester. Lamivudine and telbivudine remain inferior to TDF in regard to resistance profiles. Overall, TDF, lamivudine, and telbivudine in conjunction with standard immunoprophylaxis are recommended for use in pregnant women with significant HBV viremia (>2 × 5 log10 IU/mL) to prevent MTCT and appear reassuring in regard to their maternal and fetal safety profiles.
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Affiliation(s)
- Ariel Jaffe
- Dr Jaffe is an internal medicine resident in the Department of Medicine at Columbia University Medical Center in New York, New York. Dr Brown is the Gladys and Roland Harriman Professor of Medicine and clinical chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York
| | - Robert S Brown
- Dr Jaffe is an internal medicine resident in the Department of Medicine at Columbia University Medical Center in New York, New York. Dr Brown is the Gladys and Roland Harriman Professor of Medicine and clinical chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York
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Check JH, Jaffe A. Dextroamphetamine sulfate provided quick relief of severe post-partum depression that was recalcitrant to standard antidepressants and psychotherapy. CLIN EXP OBSTET GYN 2017; 44:272-274. [PMID: 29746037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine if dextroamphetamine sulfate could improve symptoms of post-partum depression. MATERIALS AND METHODS A woman with severe post-partum depression that was resistant to standard antidepressant therapy and psychotherapy was treated with dextroamphetamine sulfate extended release capsules 15 mg/day. RESULTS A quick and complete abrogation of the depression ensued along with improvement of migraine headaches, insomnia, and chronic fatigue. CONCLUSIONS Dextr6amphetamine sulfate should be considered as a treatment modality for post-partum depression.
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Hew M, Gillman A, Sutherland M, Wark P, Bowden J, Guo M, Reddel HK, Jenkins C, Marks GB, Thien F, Rimmer J, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Wright C, Bint M, Yozghatlian V, Burgess S, Sivakumaran P, Yan KY, Kritikos V, Peters M, Baraket M, Aminazad A, Robinson P, Jaffe A, Powell H, Upham JW, McDonald VM, Gibson PG. Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria. Clin Exp Allergy 2016; 46:1407-1415. [PMID: 27377155 DOI: 10.1111/cea.12774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR). OBJECTIVES To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. METHODS Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). RESULTS Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV1 ) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV1 . CONCLUSIONS AND CLINICAL RELEVANCE Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.
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Affiliation(s)
- M Hew
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia.
| | - A Gillman
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia
| | | | - P Wark
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J Bowden
- Flinders Medical Centre, Bedford Park, SA, Australia
| | - M Guo
- Woolcock Institute of Medical Research, Glebe, University of Sydney NSW, Australia
| | - H K Reddel
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C Jenkins
- Concord Hospital, Concord, NSW, Australia
| | - G B Marks
- Liverpool Hospital, Liverpool, NSW, Australia
| | - F Thien
- Box Hill Hospital, Box Hill, Vic., Australia
| | - J Rimmer
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | | | - M Cook
- Canberra Hospital, Woden, ACT, Australia
| | - I Yang
- The Prince Charles Hospital, Chermside, Qld, Australia
| | - C Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia
| | - S Bowler
- Mater Adult Hospital, South Brisbane, Qld, Australia
| | - D Langton
- Frankston Hospital, Frankston, Vic., Australia
| | - C Wright
- Nambour Hospital, Nambour, Qld, Australia
| | - M Bint
- Nambour Hospital, Nambour, Qld, Australia
| | | | - S Burgess
- QLD Children's Lung and Sleep Specialists, Woolloongabba, Qld, Australia
| | - P Sivakumaran
- Gold Coast District Hospital, Southport, Qld, Australia
| | - K Y Yan
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - V Kritikos
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - M Peters
- Concord Hospital, Concord, NSW, Australia
| | - M Baraket
- Liverpool Hospital, Liverpool, NSW, Australia
| | - A Aminazad
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - P Robinson
- Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A Jaffe
- School of Women's & Children's Health, UNSW Medicine, Randwick, NSW, Australia
| | - H Powell
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J W Upham
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - V M McDonald
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - P G Gibson
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
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Casamento K, Laverty A, Wilsher M, Twiss J, Gabbay E, Glaspole I, Jaffe A. Assessing the feasibility of a web-based registry for multiple orphan lung diseases: the Australasian Registry Network for Orphan Lung Disease (ARNOLD) experience. Orphanet J Rare Dis 2016; 11:42. [PMID: 27090393 PMCID: PMC4835874 DOI: 10.1186/s13023-016-0389-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background We investigated the feasibility of using an online registry to provide prevalence data for multiple orphan lung diseases in Australia and New Zealand. Methods A web-based registry, The Australasian Registry Network of Orphan Lung Diseases (ARNOLD) was developed based on the existing British Paediatric Orphan Lung Disease Registry. All adult and paediatric respiratory physicians who were members of the Thoracic Society of Australia and New Zealand in Australia and New Zealand were sent regular emails between July 2009 and June 2014 requesting information on patients they had seen with any of 30 rare lung diseases. Prevalence rates were calculated using population statistics. Results Emails were sent to 649 Australian respiratory physicians and 65 in New Zealand. 231 (32.4 %) physicians responded to emails a total of 1554 times (average 7.6 responses per physician). Prevalence rates of 30 rare lung diseases are reported. Conclusions A multi-disease rare lung disease registry was implemented in the Australian and New Zealand health care settings that provided prevalence data on orphan lung diseases in this region but was limited by under reporting.
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Affiliation(s)
- K Casamento
- Sydney Children's Hospitals Network, Sydney, Australia.
| | - A Laverty
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
| | - M Wilsher
- Auckland District Health Board, Auckland, New Zealand
| | - J Twiss
- Starship Children's Health, Grafton, Auckland, New Zealand
| | - E Gabbay
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - I Glaspole
- Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - A Jaffe
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Sydney, NSW, Australia
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Check JH, Jaffe A. Resolution of pelvic pain related to adenomyosis following treatment with dextroamphetamine sulfate. CLIN EXP OBSTET GYN 2015; 42:671-672. [PMID: 26524821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine if treatment with dextroamphetamine sulfate can reduce pelvic pain that was attributed to adenomyosis. MATERIALS AND METHODS Dextroamphetamine sulfate was given to a 32-year-old woman who suffered on a daily basis from severe chronic pelvic pain that was not relieved by laparoscopic removal of endometriosis by oral contraceptive and ibuprofen. The adenomyosis was diagnosed by magnetic resonance imaging. RESULTS Within three months the pain was completely gone and has remained absent for six months. CONCLUSIONS Dextroamphetamine sulfate relieved pain from adenomyosis similar to its effect on endometriosis.
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Ade PAR, Akiba Y, Anthony AE, Arnold K, Atlas M, Barron D, Boettger D, Borrill J, Chapman S, Chinone Y, Dobbs M, Elleflot T, Errard J, Fabbian G, Feng C, Flanigan D, Gilbert A, Grainger W, Halverson NW, Hasegawa M, Hattori K, Hazumi M, Holzapfel WL, Hori Y, Howard J, Hyland P, Inoue Y, Jaehnig GC, Jaffe A, Keating B, Kermish Z, Keskitalo R, Kisner T, Le Jeune M, Lee AT, Linder E, Leitch EM, Lungu M, Matsuda F, Matsumura T, Meng X, Miller NJ, Morii H, Moyerman S, Myers MJ, Navaroli M, Nishino H, Paar H, Peloton J, Quealy E, Rebeiz G, Reichardt CL, Richards PL, Ross C, Schanning I, Schenck DE, Sherwin B, Shimizu A, Shimmin C, Shimon M, Siritanasak P, Smecher G, Spieler H, Stebor N, Steinbach B, Stompor R, Suzuki A, Takakura S, Tomaru T, Wilson B, Yadav A, Zahn O. Measurement of the cosmic microwave background polarization lensing power spectrum with the POLARBEAR experiment. Phys Rev Lett 2014; 113:021301. [PMID: 25062161 DOI: 10.1103/physrevlett.113.021301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Indexed: 06/03/2023]
Abstract
Gravitational lensing due to the large-scale distribution of matter in the cosmos distorts the primordial cosmic microwave background (CMB) and thereby induces new, small-scale B-mode polarization. This signal carries detailed information about the distribution of all the gravitating matter between the observer and CMB last scattering surface. We report the first direct evidence for polarization lensing based on purely CMB information, from using the four-point correlations of even- and odd-parity E- and B-mode polarization mapped over ∼30 square degrees of the sky measured by the POLARBEAR experiment. These data were analyzed using a blind analysis framework and checked for spurious systematic contamination using null tests and simulations. Evidence for the signal of polarization lensing and lensing B modes is found at 4.2σ (stat+sys) significance. The amplitude of matter fluctuations is measured with a precision of 27%, and is found to be consistent with the Lambda cold dark matter cosmological model. This measurement demonstrates a new technique, capable of mapping all gravitating matter in the Universe, sensitive to the sum of neutrino masses, and essential for cleaning the lensing B-mode signal in searches for primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff CF10 3XQ, United Kingdom
| | - Y Akiba
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - A E Anthony
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, Colorado 80309, USA
| | - K Arnold
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - M Atlas
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - D Barron
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - D Boettger
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - J Borrill
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, Berkeley, California 94720, USA
| | - S Chapman
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Y Chinone
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - M Dobbs
- Physics Department, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - T Elleflot
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - J Errard
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, Berkeley, California 94720, USA
| | - G Fabbian
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France and International School for Advanced Studies (SISSA), Trieste 34014, Italy
| | - C Feng
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - D Flanigan
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA and Columbia University, New York, New York 10027, USA
| | - A Gilbert
- Physics Department, McGill University, Montreal, Quebec H3A 0G4, Canada
| | - W Grainger
- Rutherford Appleton Laboratory, STFC, Swindon SN2 1SZ, United Kingdom
| | - N W Halverson
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, Colorado 80309, USA and Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, Colorado 80309, USA and Department of Physics, University of Colorado, Boulder, Colorado 80309, USA
| | - M Hasegawa
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan and High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K Hattori
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - M Hazumi
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan and High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Kavli Institute for the Physics and Mathematics of the Universe (WPI), Todai Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - W L Holzapfel
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - Y Hori
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - J Howard
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA and Department of Physics, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - P Hyland
- Physics Department, Austin College, Sherman, Texas 75090, USA
| | - Y Inoue
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - G C Jaehnig
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, Colorado 80309, USA and Department of Physics, University of Colorado, Boulder, Colorado 80309, USA
| | - A Jaffe
- Department of Physics, Imperial College London, London SW7 2AZ, United Kingdom
| | - B Keating
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - Z Kermish
- Physics Department, Princeton University, Princeton, New Jersey 08544, USA
| | - R Keskitalo
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA
| | - T Kisner
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, Berkeley, California 94720, USA
| | - M Le Jeune
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - A T Lee
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA and Physics Division, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA
| | - E Linder
- Space Sciences Laboratory, University of California, Berkeley, Berkeley, California 94720, USA and Physics Division, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA
| | - E M Leitch
- Department of Astronomy and Astrophysics, University of Chicago, 5640 South Ellis Avenue, Chicago, Illinois 60637, USA and Kavli Institute for Cosmological Physics, University of Chicago, 5640 South Ellis Avenue, Chicago, Illinois 60637, USA
| | - M Lungu
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - F Matsuda
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - T Matsumura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - X Meng
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - N J Miller
- Observational Cosmology Laboratory, Code 665, NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - H Morii
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - S Moyerman
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - M J Myers
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - M Navaroli
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - H Nishino
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), Todai Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - H Paar
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - J Peloton
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - E Quealy
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA and Physics Department, Napa Valley College, Napa, California 94558, USA
| | - G Rebeiz
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - C L Reichardt
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - P L Richards
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - C Ross
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - I Schanning
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - D E Schenck
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, Colorado 80309, USA and Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, Colorado 80309, USA
| | - B Sherwin
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA and Miller Institute for Basic Research in Science, University of California, Berkeley, Berkeley, California 94720, USA
| | - A Shimizu
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - C Shimmin
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - M Shimon
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA and School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - P Siritanasak
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - G Smecher
- Three-Speed Logic, Inc., Vancouver, British Columbia V6A 2J8, Canada
| | - H Spieler
- Physics Division, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA
| | - N Stebor
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - B Steinbach
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - R Stompor
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - A Suzuki
- Department of Physics, University of California, Berkeley, Berkeley, California 94720, USA
| | - S Takakura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - T Tomaru
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - B Wilson
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - A Yadav
- Department of Physics, University of California, San Diego, La Jolla, California 92093-0424, USA
| | - O Zahn
- Physics Division, Lawrence Berkeley National Laboratory, Berkeley, California 92093-0424, USA
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Ade PAR, Akiba Y, Anthony AE, Arnold K, Atlas M, Barron D, Boettger D, Borrill J, Borys C, Chapman S, Chinone Y, Dobbs M, Elleflot T, Errard J, Fabbian G, Feng C, Flanigan D, Gilbert A, Grainger W, Halverson NW, Hasegawa M, Hattori K, Hazumi M, Holzapfel WL, Hori Y, Howard J, Hyland P, Inoue Y, Jaehnig GC, Jaffe A, Keating B, Kermish Z, Keskitalo R, Kisner T, Le Jeune M, Lee AT, Leitch EM, Linder E, Lungu M, Matsuda F, Matsumura T, Meng X, Miller NJ, Morii H, Moyerman S, Myers MJ, Navaroli M, Nishino H, Paar H, Peloton J, Poletti D, Quealy E, Rebeiz G, Reichardt CL, Richards PL, Ross C, Rotermund K, Schanning I, Schenck DE, Sherwin BD, Shimizu A, Shimmin C, Shimon M, Siritanasak P, Smecher G, Spieler H, Stebor N, Steinbach B, Stompor R, Suzuki A, Takakura S, Tikhomirov A, Tomaru T, Wilson B, Yadav A, Zahn O. Evidence for gravitational lensing of the cosmic microwave background polarization from cross-correlation with the cosmic infrared background. Phys Rev Lett 2014; 112:131302. [PMID: 24745402 DOI: 10.1103/physrevlett.112.131302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Indexed: 06/03/2023]
Abstract
We reconstruct the gravitational lensing convergence signal from cosmic microwave background (CMB) polarization data taken by the Polarbear experiment and cross-correlate it with cosmic infrared background maps from the Herschel satellite. From the cross spectra, we obtain evidence for gravitational lensing of the CMB polarization at a statistical significance of 4.0σ and indication of the presence of a lensing B-mode signal at a significance of 2.3σ. We demonstrate that our results are not biased by instrumental and astrophysical systematic errors by performing null tests, checks with simulated and real data, and analytical calculations. This measurement of polarization lensing, made via the robust cross-correlation channel, not only reinforces POLARBEAR auto-correlation measurements, but also represents one of the early steps towards establishing CMB polarization lensing as a powerful new probe of cosmology and astrophysics.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff CF10 3XQ, United Kingdom
| | - Y Akiba
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - A E Anthony
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, CO 80309, USA and Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, CO 80309, USA
| | - K Arnold
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - M Atlas
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - D Barron
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - D Boettger
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - J Borrill
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, CA 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, CA 94720, USA
| | - C Borys
- California Institute of Technology, Pasadena, California, USA
| | - S Chapman
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Y Chinone
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Department of Physics, University of California, Berkeley, CA 94720, USA
| | - M Dobbs
- Physics Department, McGill University, Montreal, QC H3A 0G4, Canada
| | - T Elleflot
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - J Errard
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, CA 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, CA 94720, USA
| | - G Fabbian
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France and International School for Advanced Studies (SISSA), Trieste 34014, Italy
| | - C Feng
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - D Flanigan
- Department of Physics, University of California, Berkeley, CA 94720, USA and Department of Physics, Columbia University, New York, NY 10027, USA
| | - A Gilbert
- Physics Department, McGill University, Montreal, QC H3A 0G4, Canada
| | - W Grainger
- Rutherford Appleton Laboratory, STFC, Swindon, SN2 1SZ, United Kingdom
| | - N W Halverson
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, CO 80309, USA and Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, CO 80309, USA and Department of Physics, University of Colorado, Boulder, CO 80309, USA
| | - M Hasegawa
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan and High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K Hattori
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - M Hazumi
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan and High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Kavli Institute for the Physics and Mathematics of the Universe (WPI), Todai Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - W L Holzapfel
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - Y Hori
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - J Howard
- Department of Physics, University of California, Berkeley, CA 94720, USA and Department of Physics, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - P Hyland
- Physics Department, Austin College, Sherman, TX 75090, USA
| | - Y Inoue
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - G C Jaehnig
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, CO 80309, USA and Department of Physics, University of Colorado, Boulder, CO 80309, USA
| | - A Jaffe
- Department of Physics, Imperial College London, London SW7 2AZ, United Kingdom
| | - B Keating
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - Z Kermish
- Physics Department, Princeton University, Princeton, NJ 08544, USA
| | - R Keskitalo
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, CA 92093-0424, USA
| | - T Kisner
- Computational Cosmology Center, Lawrence Berkeley National Laboratory, Berkeley, CA 92093-0424, USA and Space Sciences Laboratory, University of California, Berkeley, CA 94720, USA
| | - M Le Jeune
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - A T Lee
- Department of Physics, University of California, Berkeley, CA 94720, USA and Physics Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - E M Leitch
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL 60637, USA and Kavli Institute for Cosmological Physics, University of Chicago, Chicago, IL 60637, USA
| | - E Linder
- Space Sciences Laboratory, University of California, Berkeley, CA 94720, USA and Physics Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - M Lungu
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - F Matsuda
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - T Matsumura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - X Meng
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - N J Miller
- Observational Cosmology Laboratory, Code 665, NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - H Morii
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - S Moyerman
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - M J Myers
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - M Navaroli
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - H Nishino
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), Todai Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - H Paar
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - J Peloton
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - D Poletti
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - E Quealy
- Department of Physics, University of California, Berkeley, CA 94720, USA and Physics Department, Napa Valley College, Napa, CA 94558, USA
| | - G Rebeiz
- Department of Electrical and Computer Engineering, University of California, San Diego, CA 92093, USA
| | - C L Reichardt
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - P L Richards
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - C Ross
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - K Rotermund
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - I Schanning
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - D E Schenck
- Center for Astrophysics and Space Astronomy, University of Colorado, Boulder, CO 80309, USA and Department of Astrophysical and Planetary Sciences, University of Colorado, Boulder, CO 80309, USA
| | - B D Sherwin
- Department of Physics, University of California, Berkeley, CA 94720, USA and Miller Institute for Basic Research in Science, University of California, Berkeley, CA 94720, USA
| | - A Shimizu
- The Graduate University for Advanced Studies, Hayama, Miura District, Kanagawa 240-0115, Japan
| | - C Shimmin
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - M Shimon
- Department of Physics, University of California, San Diego, CA 92093-0424, USA and School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - P Siritanasak
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - G Smecher
- Three-Speed Logic, Inc., Vancouver, B.C., V6A 2J8, Canada
| | - H Spieler
- Physics Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - N Stebor
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - B Steinbach
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - R Stompor
- AstroParticule et Cosmologie, Univ Paris Diderot, CNRS/IN2P3, CEA/Irfu, Obs de Paris, Sorbonne Paris Cité, France
| | - A Suzuki
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - S Takakura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan and Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - A Tikhomirov
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - T Tomaru
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - B Wilson
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - A Yadav
- Department of Physics, University of California, San Diego, CA 92093-0424, USA
| | - O Zahn
- Physics Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
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Tovey ER, Stelzer-Braid S, Toelle B, Willenborg C, Reddel H, Garden F, Jaffe A, Strachan R, Oliver B, Belessis Y, Marks G, Rawlinson W. Asthma Symptoms and Rhinovirus In A Longitudinal Children's Cohort. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bordun K, Premecz S, da Silva M, White C, Muller A, Li Y, Villarraga H, Herrmann J, Sandhu N, Kohli M, Jaffe A, Pitz M, Thliveris J, Freed D, Singal P, Mulvagh S, Jassal D. The Utility of Cardiac Biomarkers, Tissue Velocity and Strain Rate Imaging for the Early Detection of Bevacizumab and Sunitinib Mediated Cardiotoxicity. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Doumit M, Belessis Y, Stelzer-Braid S, Rawlinson W, Jaffe A. WS19.3 The value of deep oropharyngeal suction specimens in identifying lower airway bacteria in young children with cystic fibrosis. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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45
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Thomas PS, Lowe AJ, Samarasinghe P, Lodge CJ, Huang Y, Abramson MJ, Dharmage SC, Jaffe A. Exhaled breath condensate in pediatric asthma: promising new advance or pouring cold water on a lot of hot air? a systematic review. Pediatr Pulmonol 2013; 48:419-42. [PMID: 23401497 DOI: 10.1002/ppul.22776] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/01/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Exhaled breath condensate (EBC) analysis is a simple non-invasive technique that allows repeated collection of breath samples with a minimum of inconvenience for the subject. These breath samples can potentially indicate lung disease activity and given the ease of collection, EBC is becoming a useful research tool in the study of respiratory diseases. It has the potential to be used in both population-based studies and in the context of pediatric asthma it may prove useful in diagnosis and monitoring. METHODS A systematic review was conducted to identify studies of EBC markers in childhood asthma. RESULTS Most of the studies were cross-sectional in design, and the results suggest that simple chemical entities such as hydrogen ions (as pH), hydrogen peroxide, and oxides of nitrogen are associated with pediatric allergic asthma and exacerbations. In addition, more complex molecules including leukotrienes, prostaglandins, and cytokines such as the interleukins IL-4 and IL-5 are also elevated in the breath of those with asthma. CONCLUSION EBC has the potential to aid diagnosis, and to evaluate the inflammatory status of asthmatic children. Future studies may be able to refine further how best to collect EBC samples, to interpret them, and the technique has the potential to allow repeated sampling which will allow studies of natural history, pathogenesis and response to treatment to be undertaken.
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Affiliation(s)
- P S Thomas
- Inflammation and Infection Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Ooi C, Lee J, Leach S, Katz T, Day A, Jaffe A. 226 Intestinal inflammation in CF: stool markers and correlation with pancreatic enzymes. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guerrero-Preston R, Soudry E, Acero J, Orera M, Moreno-López L, Macía-Colón G, Jaffe A, Berdasco M, Ili-Gangas C, Brebi-Mieville P, Fu Y, Engstrom C, Irizarry RA, Esteller M, Westra W, Koch W, Califano J, Sidransky D. NID2 and HOXA9 promoter hypermethylation as biomarkers for prevention and early detection in oral cavity squamous cell carcinoma tissues and saliva. Cancer Prev Res (Phila) 2011; 4:1061-72. [PMID: 21558411 DOI: 10.1158/1940-6207.capr-11-0006] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Differentially methylated oral squamous cell carcinoma (OSCC) biomarkers, identified in vitro and validated in well-characterized surgical specimens, have shown poor clinical correlation in cohorts with different risk profiles. To overcome this lack of relevance, we used the HumanMethylation27 BeadChip, publicly available methylation and expression array data, and quantitative methylation specific PCR to uncover differential methylation in OSCC clinical samples with heterogeneous risk profiles. A two stage design consisting of discovery and prevalence screens was used to identify differential promoter methylation and deregulated pathways in patients diagnosed with OSCC and head and neck squamous cell carcinoma. Promoter methylation of KIF1A (κ = 0.64), HOXA9 (κ = 0.60), NID2 (κ = 0.60), and EDNRB (κ = 0.60) had a moderate to substantial agreement with clinical diagnosis in the discovery screen. HOXA9 had 68% sensitivity, 100% specificity, and a 0.81 Area Under the Curve (AUC). NID2 had 71% sensitivity, 100% specificity, and a 0.79 AUC. In the prevalence screen, HOXA9 (κ = 0.82) and NID2 (κ = 0.80) had an almost perfect agreement with histologic diagnosis. HOXA9 had 85% sensitivity, 97% specificity, and a 0.95 AUC. NID2 had 87% sensitivity, 95% specificity, and a 0.91 AUC. A HOXA9 and NID2 gene panel had 94% sensitivity, 97% specificity, and a 0.97 AUC. In saliva, from OSCC cases and controls, HOXA9 had 75% sensitivity, 53% specificity, and a 0.75 AUC. NID2 had 87% sensitivity, 21% specificity, and a 0.73 AUC. This phase I Biomarker Development Trial identified a panel of differentially methylated genes in normal and OSCC clinical samples from patients with heterogeneous risk profiles. This panel may be useful for early detection and cancer prevention studies.
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Affiliation(s)
- R Guerrero-Preston
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, Maryland 21231, USA
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Affiliation(s)
- I. Buskens
- a Research for the Future , Cape Town , S. Africa
| | - A. Jaffe
- b Eshowe Hospital , Kwazulu Natal , S. Africa
| | - H. Mkhatshwa
- c Swaziland Institute of Health Sciences , Mbabane , Swaziland
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Williams J, Benden C, Jaffe A, Suri R, Wells J, Fewtrell M. Longitudinal changes in bone mass in children with cystic fibrosis: effect of size adjustment using bone mineral apparent density. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Williams J, Benden C, Jaffe A, Suri R, Wells J, Fewtrell M. Body composition and lung function in young children with cystic fibrosis. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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