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Chung D, Song TJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Park MS, Kim JT, Hwang YH, Kim YJ, Chung JW, Bang OY, Kim GM, Seo WK, Choi JC. Stroke-Specific Predictors of Major Bleeding in Anticoagulated Patients With Stroke and Atrial Fibrillation: A Nationwide Multicenter Registry-Based Study. J Clin Neurol 2023; 19:429-437. [PMID: 37455504 PMCID: PMC10471546 DOI: 10.3988/jcn.2022.0289] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) scores have been validated in estimating the risks of ischemic stroke and major bleeding, respectively, in patients with atrial fibrillation (AF). This study investigated stroke-specific predictors of major bleeding in patients with stroke and AF who were taking oral anticoagulants (OACs). METHODS Subjects were selected from patients enrolled in the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) nationwide multicenter registry between 2013 and 2015. Patients were excluded if they were not taking OACs, had no brain imaging data, or had intracranial bleeding directly related to the index stroke. Major bleeding was defined according to International Society of Thrombosis and Haemostasis criteria. Cox regression analyses were performed to assess the associations between clinical variables and major bleeding and Kaplan-Meier estimates were performed to analyze event-free survival. RESULTS Of a total of 3,213 patients, 1,414 subjects (mean age of 72.6 years, 52.5% males) were enrolled in this study. Major bleeding was reported in 34 patients during the median follow-up period of 1.73 years. Multivariable analysis demonstrated that initial National Institutes of Health Stroke Scale scores (hazard ratio [HR] 1.07, p=0.006), hypertension (HR 3.18, p=0.030), persistent AF type (HR 2.51, p=0.016), and initial hemoglobin level (HR 0.74, p=0.001) were independently associated with major bleeding risk. Except for hypertension, these associations remained significant after adjusting for the HAS-BLED score. Intracranial atherosclerosis presented a trend of association without statistical significance (HR 2.21, p=0.050). CONCLUSIONS This study found that major bleeding risk was independently associated with stroke-specific factors in anticoagulated patients with stroke and AF. This has the clinical implication that baseline characteristics of patients with stroke and AF should be considered in secondary prevention, which would bring the net clinical benefit of balancing recurrent stroke prevention with minimal bleeding complications.
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Affiliation(s)
- Darda Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea.
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Chung D, Hong S, Lee J, Chung J, Bang OY, Kim G, Seo W, Park S. Topographical Association Between Left Ventricular Strain and Brain Lesions in Patients With Acute Ischemic Stroke and Normal Cardiac Function. J Am Heart Assoc 2023; 12:e029604. [PMID: 37522166 PMCID: PMC10492978 DOI: 10.1161/jaha.123.029604] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Background Although it is well known that the disordered brain provokes cardiac autonomic dysfunction, the detailed location of brain lesions related to cardiac function warrants further investigation. We aimed to elucidate the brain lesions topographically associated with left ventricular (LV) systolic function measured by myocardial strain in patients with acute ischemic stroke without preexisting primary cardiac dysfunction by using support vector regression lesion-symptom mapping. Methods and Results Subjects were those with LV ejection fraction of 50% or more among patients with acute ischemic stroke registered in the Samsung Medical Center stroke registry between 2016 and 2017. To evaluate LV systolic performance and contractility, we measured LV ejection fraction and LV global and regional longitudinal strain using 2-dimensional speckle-tracking echocardiography. The association between stroke lesion location and cardiac strain was assessed using support vector regression lesion-symptom mapping. Of a total of 776 patients, 286 subjects (mean age of 67.0 years, 65.4% men) were finally enrolled in this study. The mean global longitudinal strain was -17.0±3.4%, and the mean LV ejection fraction was 64.7±5.7%. The support vector regression lesion-symptom mapping analysis revealed that the right insula and peri-insular regions and left parietal cortex were associated with impaired LV global longitudinal strain in patients with acute ischemic stroke. In addition, impaired regional longitudinal strain showed topographical associations with these regions. Conclusions This study suggests that brain lesions in the right insula and peri-insular regions and left parietal cortex are topographically associated with impaired LV strain in patients with acute ischemic stroke without preexisting cardiac dysfunction.
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Affiliation(s)
- Darda Chung
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Suk‐Woo Hong
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Program in Brain Science, College of Natural SciencesSeoul National UniversitySeoulRepublic of Korea
| | - Jieun Lee
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jong‐Won Chung
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Gyeong‐Moon Kim
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Woo‐Keun Seo
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulRepublic of Korea
| | - Sung‐Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Lee H, Kwon D, Park S, Park SR, Chung D, Ha J. Temporal association between the age-specific incidence of Guillain-Barré syndrome and SARS-CoV-2 vaccination in Republic of Korea: a nationwide time-series correlation study. Osong Public Health Res Perspect 2023; 14:224-231. [PMID: 37415440 PMCID: PMC10522829 DOI: 10.24171/j.phrp.2023.0050] [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: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The incidence of Guillain-Barré syndrome (GBS) changed significantly during the coronavirus disease 2019 (COVID-19) pandemic. Emerging reports suggest that viral vector-based vaccines may be associated with an elevated risk of GBS. METHODS In this nationwide time-series correlation study, we examined the age-specific incidence of GBS from January 2011 to August 2022, as well as data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations and infections from February 2021 to August 2022. We compared the forecasted estimates of age-specific GBS incidence, using the pre-SARS-CoV-2 period as a benchmark, with the actual incidence observed during the post-vaccination period of the pandemic. Furthermore, we assessed the temporal association between GBS, SARS-CoV-2 vaccinations, and COVID-19 for different age groups. RESULTS In the age group of 60 and older, the rate ratio was significantly elevated during June-August and November 2021. A significant, strong positive association was observed between viral vector-based vaccines and GBS incidence trends in this age group (r=0.52, p=0.022). For the 30 to 59 years age group, the rate ratio was notably high in September 2021. A statistically significant, strong positive association was found between mRNA-based vaccines and GBS incidence in this age group (r=0.61, p=0.006). CONCLUSION Viral vector-based SARS-CoV-2 vaccines were found to be temporally associated with an increased risk of GBS, particularly in older adults. To minimize age-specific and biological mechanism-specific adverse events, future vaccination campaigns should adopt a more personalized approach, such as recommending homologous mRNA-based SARS-CoV-2 vaccines for older adults to reduce the heightened risk of GBS.
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Affiliation(s)
- Hyunju Lee
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Donghyok Kwon
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seoncheol Park
- Department of Mathematics, Hanyang University, Seoul, Republic of Korea
- Research Institute for Natural Sciences, Hanyang University, Seoul, Republic of Korea
| | - Seung Ri Park
- Gyeonggi Infectious Disease Control Center, Gyeonggi Provincial Government, Suwon, Republic of Korea
| | - Darda Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongmok Ha
- Gyeonggi Infectious Disease Control Center, Gyeonggi Provincial Government, Suwon, Republic of Korea
- Department of Neurology, Yeoncheon Public Medical Center, Yeoncheon, Republic of Korea
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Hong SW, Song HN, Choi JU, Cho HH, Baek IY, Lee JE, Kim YC, Chung D, Chung JW, Bang OY, Kim GM, Park HJ, Liebeskind DS, Seo WK. Automated in-depth cerebral arterial labelling using cerebrovascular vasculature reframing and deep neural networks. Sci Rep 2023; 13:3255. [PMID: 36828857 PMCID: PMC9957982 DOI: 10.1038/s41598-023-30234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Identifying the cerebral arterial branches is essential for undertaking a computational approach to cerebrovascular imaging. However, the complexity and inter-individual differences involved in this process have not been thoroughly studied. We used machine learning to examine the anatomical profile of the cerebral arterial tree. The method is less sensitive to inter-subject and cohort-wise anatomical variations and exhibits robust performance with an unprecedented in-depth vessel range. We applied machine learning algorithms to disease-free healthy control subjects (n = 42), patients with stroke with intracranial atherosclerosis (ICAS) (n = 46), and patients with stroke mixed with the existing controls (n = 69). We trained and tested 70% and 30% of each study cohort, respectively, incorporating spatial coordinates and geometric vessel feature vectors. Cerebral arterial images were analyzed based on the 'segmentation-stacking' method using magnetic resonance angiography. We precisely classified the cerebral arteries across the exhaustive scope of vessel components using advanced geometric characterization, redefinition of vessel unit conception, and post-processing algorithms. We verified that the neural network ensemble, with multiple joint models as the combined predictor, classified all vessel component types independent of inter-subject variations in cerebral arterial anatomy. The validity of the categorization performance of the model was tested, considering the control, ICAS, and control-blended stroke cohorts, using the area under the receiver operating characteristic (ROC) curve and precision-recall curve. The classification accuracy rarely fell outside each image's 90-99% scope, independent of cohort-dependent cerebrovascular structural variations. The classification ensemble was calibrated with high overall area rates under the ROC curve of 0.99-1.00 [0.97-1.00] in the test set across various study cohorts. Identifying an all-inclusive range of vessel components across controls, ICAS, and stroke patients, the accuracy rates of the prediction were: internal carotid arteries, 91-100%; middle cerebral arteries, 82-98%; anterior cerebral arteries, 88-100%; posterior cerebral arteries, 87-100%; and collections of superior, anterior inferior, and posterior inferior cerebellar arteries, 90-99% in the chunk-level classification. Using a voting algorithm on the queued classified vessel factors and anatomically post-processing the automatically classified results intensified quantitative prediction performance. We employed stochastic clustering and deep neural network ensembles. Ma-chine intelligence-assisted prediction of vessel structure allowed us to personalize quantitative predictions of various types of cerebral arterial structures, contributing to precise and efficient decisions regarding the cerebrovascular disease.
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Affiliation(s)
- Suk-Woo Hong
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
- Program in Brain Science, College of Natural Sciences, Seoul National University, Seoul, 08826, Korea
| | - Ha-Na Song
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Jong-Un Choi
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Hwan-Ho Cho
- Department of Medical Artificial Intelligence, Konyang University, Daejeon, Korea
| | - In-Young Baek
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Ji-Eun Lee
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Yoon-Chul Kim
- Division of Digital Healthcare, Yonsei University Mirae Campus, Wonju, 26493, Korea
| | - Darda Chung
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Jong-Won Chung
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Oh-Young Bang
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Gyeong-Moon Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Hyun-Jin Park
- Department of Electronic Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Korea
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, UCLA, Los Angeles, CA, USA
| | - Woo-Keun Seo
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Irwon-dong, Gangnam-gu, Seoul, 06351, Korea.
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Chung D, Lee J, Yoo S, Choo M, Cho M, Son H, Jeong H. Effect of EphA2 silencing on inhibiting the progression of non-metastatic renal cell carcinoma in an orthotopic mouse model of renal cell carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02455-7] [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: 11/11/2022] Open
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Chung D, Lee J, Yoo S, Choo M, Cho M, Son H, Jeong H. Role of neutrophil-to-lymphocytes ratio in predicting non-complete response at 3 months evaluation after BCG induction in non-muscle invasive bladder cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02587-3] [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: 11/11/2022] Open
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Zenilman A, Fan W, Hernan R, Wynn J, Abramov A, Farkouh-Karoleski C, Aspelund G, Krishnan US, Khlevner J, Azarow K, Crombleholme T, Cusick R, Chung D, Danko ME, Potoka D, Lim FY, McCulley DJ, Mychaliska GB, Schindel D, Soffer S, Wagner AJ, Warner BW, Chung WK, Duron VP. Being small for gestational age is not an independent risk factor for mortality in neonates with congenital diaphragmatic hernia: a multicenter study. J Perinatol 2022; 42:1183-1188. [PMID: 35449444 DOI: 10.1038/s41372-022-01326-4] [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] [Received: 11/30/2020] [Revised: 11/21/2021] [Accepted: 01/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) accounts for 8% of all major congenital anomalies. Neonates who are small for gestational age (SGA) generally have a poorer prognosis. We sought to identify risk factors and variables associated with outcomes in neonates with CDH who are SGA in comparison to neonates who are appropriate for gestational age (AGA). METHODS We used the multicenter Diaphragmatic Hernia Research & Exploration Advancing Molecular Science (DHREAMS) study to include neonates enrolled from 2005 to 2019. Chi-squared or Fisher's exact tests were used to compare categorical variables and t tests or Wilcoxon rank sum for continuous variables. Cox model analyzed time to event outcomes and logistic regression analyzed binary outcomes. RESULTS 589 neonates were examined. Ninety were SGA (15.3%). SGA patients were more likely to be female (p = 0.003), have a left sided CDH (p = 0.05), have additional congenital anomalies and be diagnosed with a genetic syndrome (p < 0.001). On initial single-variable analysis, SGA correlated with higher frequency of death prior to discharge (p < 0.001) and supplemental oxygen requirement at 28 days (p = 0.005). Twice as many SGA patients died before repair (12.2% vs 6.4%, p = 0.04). Using unadjusted Cox model, the risk of death prior to discharge among SGA patients was 1.57 times the risk for AGA patients (p = 0.029). There was no correlation between SGA and need for ECMO, pulmonary hypertensive medication at discharge or oxygen at discharge. After adjusting for confounding variables, SGA no longer correlated with mortality prior to discharge or incidence of unrepaired defects but remained significant for oxygen requirement at 28 days (p = 0.03). CONCLUSION Infants with CDH who are SGA have worse survival and poorer lung function than AGA infants. However, the outcome of SGA neonates is impacted by other factors including gestational age, genetic syndromes, and particularly congenital anomalies that contribute heavily to their poorer prognosis.
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Affiliation(s)
- A Zenilman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - W Fan
- Department of Biostatistics, Columbia University Irving Medical Center, New York, NY, USA
| | - R Hernan
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - J Wynn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - A Abramov
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - C Farkouh-Karoleski
- Department of Neonatology, Columbia University Irving Medical Center, New York, NY, USA
| | - G Aspelund
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - U S Krishnan
- Department of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - J Khlevner
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center, New York, NY, USA
| | - K Azarow
- Pediatric Surgery Division, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - T Crombleholme
- Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - R Cusick
- Division of Pediatric Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA
| | - D Chung
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - M E Danko
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - D Potoka
- Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - F Y Lim
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - D J McCulley
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - G B Mychaliska
- Section of Pediatric Surgery, Fetal Diagnosis and Treatment Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - D Schindel
- Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - S Soffer
- Department of Pediatric Surgery, Northwell Health, New York, NY, USA
| | - A J Wagner
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B W Warner
- Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - W K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - V P Duron
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Chung D, Burger H, Kaiser L, Osswald B, Baersch V, Naegele H, Knaut M, Reichenspurner H, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome and risk prediction in patients with implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction: a GALLERY subgroup analysis. Europace 2022. [DOI: 10.1093/europace/euac053.520] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD).
Objectives
Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE.
Methods
We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.
Results
A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p<0.001), less likely to be female (20.8 vs. 27.1%; p<0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p<0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p>0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p<0.001), followed by device-related infection (45.6 vs. 73.0%; p<0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p<0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p<0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p<0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p<0.001).
Conclusions
Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - H Burger
- Kerckhoff Clinic, Cardiac Surgery, Bad Nauheim, Germany
| | - L Kaiser
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - B Osswald
- Johanniter Hospital Duisburg Rheinhausen, Division of Electrophysiological Surgery, Duisburg, Germany
| | - V Baersch
- St. Marien-Hospital Siegen, Cardiology, Siegen, Germany
| | - H Naegele
- Albertinen Hospital, Cardiology, Hamburg, Germany
| | - M Knaut
- Dresden University Heart Center, Cardiology, Dresden, Germany
| | - H Reichenspurner
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - S Pecha
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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Chung D, Hochadel M, Senges J, Kleemann T, Eckhardt L, Brachmann J, Steinbeck G, Larbig R, Butter C, Schulz E, Willems S, Hakmi S. Implantable cardioverter-defibrillator therapy in the very young - Patient characteristics procedural outcome and one-year follow-up - A subgroup analysis of the german DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.456] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are well-established and essential therapeutic pillars for patients with heart failure and survivors of sudden cardiac death. The number of young patients receiving ICD or CRT-D has been increasing in the last decades. Understanding the key differences between the typically older ICD population and younger patients is paramount to optimized patient care.
Methods
The DEVICE registry prospectively enrolled patients undergoing ICD/CRT implantation or revision from 50 German centers between 2007–2014. Data on patient characteristics, procedural outcome, adverse events and mortality during the initial stay and follow-up was collected. All patients under the age of 45 years were identified and included into a comparative analysis with the remaining population.
Results
A total number of 4181 patients were enrolled into the registry, of which 236 patients (5.6%) were under the age of 45 years. Median age was 38.0 [31.0; 42.0] vs. 69.0 [60.0; 75.0] years, p<0.001), compared to older patients. Young patients were more likely to receive an ICD (91.5 vs. 69.4%, p<0.001), than CRT device and were less likely to suffer from non-cardiac comorbidities (20.3 vs. 67.4%, p<0.001). Coronary artery disease was less common in young patients (15.7 vs. 63.6%, p<0.001), whereas hypertrophic cardiomyopathy (11.0 vs. 2.5%, p<0.001) and primary cardiac electrical diseases (14.0 vs. 1.6%, p< 0.001) were encountered more often. Mean left-ventricular ejection fractions were 42.4±18.5 vs. 31.5±11.8%, respectively (p<0.001) with less young patients in NYHA functional class III/IV (19.5 vs. 45.3%, p<0.001). Primary symptom at presentation was chronic heart failure for older patients (19.5 vs. 34.8%, p<0.001) and survived sudden cardiac death (30.9 vs. 15.6%, p<0.001) for young patients. Thus, ICD for secondary prevention was more common in young patients (53.8 vs. 43.2%, p<0.001). There were no detectable differences in postoperative complications (3.0 vs. 4.1%, p=0.500) or in-hospital mortality (0.0 vs. 0.3%, p=1.000). Median follow-up time was 514 [398; 669] vs. 458 [391; 563] days (p=0.006). Device-associated complications requiring revision were more common in young patients (16.3 vs. 8.2%, p<0.001) and all-cause 1-year-mortality after implantation was lower (3.1 vs. 7.3%, p=0.029; HR 0.42, 95%CI: 0.19-0.94). Even though there was no difference in rates of rehospitalization between groups (32.1 vs. 32.4%, p=0.93), young patients were re-admitted more often for "cardiac" reasons (82.7 vs. 58.9%, p<0.001).
Conclusion
Rates for procedural complications and in-hospital mortality were very low and without differences between both age groups. However younger patients experienced a higher rate of postoperative complications requiring revision and had higher readmission rates for cardiac reasons, potentially due to a more active lifestyle.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - M Hochadel
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - J Senges
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - L Eckhardt
- Muenster University Hospital, Cardiac Electrophysiology, Muenster, Germany
| | - J Brachmann
- Cardiac Center of Coburg, RegioMed Medical School, Coburg, Germany
| | | | - R Larbig
- Kliniken Maria Hilf Moenchengladbach, Cardiology, Moenchengladbach, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - E Schulz
- General Hospital of Celle, Cardiology, Celle, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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10
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Fuqua JL, Rouchka EC, Waigel S, Sokoloski K, Chung D, Zacharias W, Zhang M, Chariker J, Talley D, Santisteban I, Varsani A, Moyer S, Holm RH, Yeager RA, Smith T, Bhatnagar A. A rapid assessment of wastewater for genomic surveillance of SARS-CoV-2 variants at sewershed scale in Louisville, KY. medRxiv 2021:2021.03.18.21253604. [PMID: 33791725 PMCID: PMC8010757 DOI: 10.1101/2021.03.18.21253604] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this communication, we report on the genomic surveillance of SARS-CoV-2 using wastewater samples in Jefferson County, KY. In February 2021, we analyzed seven wastewater samples for SARS-CoV-2 genomic surveillance. Variants observed in smaller catchment areas, such as neighborhood manhole locations, were not necessarily consistent when compared to associated variant results in downstream treatment plants, suggesting catchment size or population could impact the ability to detect diversity.
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Affiliation(s)
- J L Fuqua
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - E C Rouchka
- Department of Computer Science and Engineering, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
- KY-INBRE Bioinformatics Core, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
| | - S Waigel
- Department of Medicine, University of Louisville, 530 S. Hancock Jackson St., Louisville, KY 40402, United States
| | - K Sokoloski
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Department of Microbiology and Immunology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - D Chung
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Department of Microbiology and Immunology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - W Zacharias
- Department of Medicine, University of Louisville, 530 S. Hancock Jackson St., Louisville, KY 40402, United States
| | - M Zhang
- Department of Neuroscience Training, University of Louisville, 505 S. Hancock St, Louisville, KY 40202
| | - J Chariker
- Department of Computer Science and Engineering, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
- KY-INBRE Bioinformatics Core, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
| | - D Talley
- Louisville/Jefferson County Metropolitan Sewer District, Morris Forman Water Quality Treatment Center, 4522 Algonquin Parkway, Louisville KY 40211, United States
| | - I Santisteban
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - A Varsani
- The Biodesign Center of Fundamental and Applied Microbiomics, School of Life Sciences, Center for Evolution and Medicine, Arizona State University, Tempe, AZ 85287, United States
| | - S Moyer
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
- Department of Public Health and Wellness, Louisville Metro Government, 400 E. Grays St., Louisville, KY 40202, United States
| | - R H Holm
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - R A Yeager
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
| | - T Smith
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
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11
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Woo MH, Lee KO, Chung D, Choi JW, Kim SH, Oh SH. Triglyceride/HDL-Cholesterol Ratio as an Index of Intracranial Atherosclerosis in Nonstroke Individuals. Front Neurol 2021; 11:504219. [PMID: 33536991 PMCID: PMC7848285 DOI: 10.3389/fneur.2020.504219] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/07/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Triglyceride (TG)/high-density lipoprotein cholesterol ratio (THR) is a marker of dyslipidemia, and high THR is associated with an increase in cardiovascular events. In the present study, whether THR was associated with various markers of cerebral vascular pathologies, atherosclerosis of major cerebral arteries, including large artery atherosclerosis (LAA) and cerebral small vessel disease (SVD), in neurologically healthy individuals was investigated. Methods: Vascular risk factors, brain magnetic resonance imaging (MRI) scans, and MR angiograms of 851 study subjects were evaluated. Findings of extracranial atherosclerosis (ECAS) and intracranial atherosclerosis (ICAS) were considered indices of LAA based on brain MR angiograms. The presence of silent lacunar infarct (SLI) and white matter hyperintensities (WMHs) were evaluated as indices of SVD based on brain MRIs. Results: Subjects with ICAS (odds ratio, 1.83; 95% confidence interval, 1.06-3.16; P = 0.03) were significantly more likely to have high THR tertile (THR > 2.06) than low THR tertile (THR < 1.37) after adjusting for cardiovascular risk factors. THR was higher in subjects with multiple ICAS lesions than in those with single ECAS or without ICAS lesions. Associations among THR tertiles in ECAS, SLI, and WMHs were not significant. Conclusion: In the present study, a positive association between high THR and the development of ICAS was observed in neurologically healthy participants.
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Affiliation(s)
- Min-Hee Woo
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Darda Chung
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sang-Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
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12
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Chung D, Lee KO, Choi JW, Kim NK, Kim OJ, Kim SH, Oh SH, Kim WC. Blood Neutrophil/Lymphocyte Ratio Is Associated With Cerebral Large-Artery Atherosclerosis but Not With Cerebral Small-Vessel Disease. Front Neurol 2020; 11:1022. [PMID: 33013672 PMCID: PMC7509145 DOI: 10.3389/fneur.2020.01022] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Objective: The blood neutrophil/lymphocyte ratio (NLR) is a marker of peripheral inflammation, with a high NLR associated with an increased risk of cardiovascular events and poor prognosis in ischemic stroke. However, few data are available on the differential impact of the blood NLR on different silent cerebral vascular pathologies, including cerebral large-artery atherosclerosis (LAA) and cerebral small-vessel disease (CSVD), in neurologically healthy individuals. Methods: We evaluated cardiovascular risk factors, brain magnetic resonance imaging (MRI), and MR angiography of 950 individuals without any neurological diseases. The study participants were divided into three groups according to NLR tertile (low, middle, and high). The presences of extracranial (EC) and intracranial (IC) atherosclerosis were considered to indicate LAA on brain MR angiography. The presences of silent lacunar infarction (SLI) and cerebral white matter hyperintensities (WMHs) were analyzed as indices of CSVD on brain MRI. Results: In univariate analysis, the high NLR tertile group showed a high prevalence of old age, hyperlipidemia, and renal dysfunction and higher fasting glucose. Multivariable logistic regression analysis revealed that indices of LAA (EC atherosclerosis [odds ratio: 1.88; 95% confidence interval: 1.14–3.09; p = 0.01] and IC atherosclerosis [odds ratio: 1.87; 95% confidence interval: 1.15–3.06; p = 0.01]) were more prevalent in the highest NLR tertile group than in the lowest NLR tertile group after adjustment for cardiovascular risk factors. However, no significant differences were found in the prevalence of CSVD indices (SLI and WMHs) among the three NLR tertile groups. Conclusions: A high NLR is associated with the development of cerebral LAA but not CSVD.
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Affiliation(s)
- Darda Chung
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Nam Keun Kim
- Institute for Clinical Research, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sang-Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Won Chan Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
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13
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Chung D, Pecha S, Burger H, Moeller V, Madej T, Osswald B, Ghaffari N, Baersch V, Naegele H, Gosau N, Knaut M, Butter C, Willems S, Hakmi S. 1255Comprehensive analysis of pacemaker patients with and without abandoned leads undergoing transvenous lead extraction: A GALLERY subgroup analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.261] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
OnBehalf
GALLERY investigators
Background
The number of cardiac implantable electronic device (CIED)-associated complications such as infection, lead dysfunction or thrombotic events is continuously rising and thus making transvenous lead extraction (TLE) an ever more needed procedure in clinical practice today. Patients with abandoned leads represent a special cohort with a potentially higher susceptibility to CIED-related infections and vascular complications. Moreover, according to literature abandoned leads seem to be associated with more procedural complications and mortality during TLE.
Aim
The aim of this study was to provide an insight on safety, procedural outcome and risk prediction on pacemaker patients with abandoned leads undergoing TLE from the largest national laser-sheath registry to date.
Methods + Results:
We conducted a retrospective analysis of the GALLERY database, which collected 2533 patients undergoing TLE in Germany between 2013 and 2017. Out of 903 pacemaker patients, who underwent TLE, 226 patients (25.0%) with abandoned leads were identified. Those patients had a higher number of leads per patient (3.2 ± 0.8 vs. 1.9 ± 0.3; ns) and longer lead dwell-times (168.0 ± 89.7 vs. 123.0 ± 69.2 months; p < 0.0001) compared to pacemaker patients without abandoned leads. There were no differences in age (71.5 vs. 72.3 years; ns), body mass index (26.5 ± 4.5 vs. 26.78 ± 4.8 kg/m2; ns) or gender distribution (69.0 vs. 66.5% male; ns). Leading indication for TLE was device infection with no difference between groups (79.7 vs 77.8 %; ns). There were no differences in terms of pacemaker dependency, length of hospitalization or comorbidities. Patients with abandoned leads had longer procedure times (112.0 ± 69.0 vs. 86.4 ± 53.0 minutes; p < 0.0001) and a higher incidence of procedural complications (6.6 vs. 3.1%; p = 0.03), but there were no differences in neither procedural and clinical success rates (96.5 vs. 97.3%; ns), nor all-cause mortality (1.33 vs. 2.66%; ns). Multivariate logistic regression revealed abandoned leads (OR 2.1, CI 1.0-4.4, p = 0.04) and female gender (OR 2.4, CI 1.2-4.9, p = 0.02) as independent predictors for procedural complications. Systemic infection (OR 5.4, CI 2.0-14.8, p = 0.001) and chronic kidney disease (OR 4.0, CI 1.5-10.7, p = 0.007) were strong predictors for all-cause mortality in patients with indwelling pacemaker. Patient age > 75 years (OR 3.9, CI 2.7-5.6, p < 0.0001) and a lead dwell-time > 10 years (OR 1.6, CI 1.1-2.2, p = 0.01) were identified as risk factors for an infectious cause for TLE.
Conclusion
Abandoned leads are frequently encountered in pacemaker patients undergoing TLE and pose an important risk factor for procedural complications. Systemic CIED-related infections are the strongest driver of mortality in this patient cohort and urgently call for further improvements in early diagnosis and prevention.
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Affiliation(s)
- D Chung
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Pecha
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - H Burger
- Kerckhoff Clinic, Cardiac Surgery, Bad Nauheim, Germany
| | - V Moeller
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - T Madej
- Heart Center - University Hospital Dresden, Cardiac Surgery, Dresden, Germany
| | - B Osswald
- Heart Center Duisburg, Cardiac Surgery, Duisburg, Germany
| | - N Ghaffari
- Helios Heart Surgery Clinic Karlsruhe, Karlsruhe, Germany
| | - V Baersch
- St. Marien-Hospital Siegen, Cardiology, Siegen, Germany
| | - H Naegele
- Albertinen Hospital, Cardiology, Hamburg, Germany
| | - N Gosau
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Knaut
- Heart Center - University Hospital Dresden, Cardiac Surgery, Dresden, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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14
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Hollimon L, Moore J, Richards S, Robbins R, Grandner M, Chung A, Chung D, Jean-Louis G, Seixas A. 1212 A Systematic Assessment Of Engagement, Functionality, Aesthetics, Information, And Recommendation Features In Sleep Mobile Applications. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1206] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Initial download and use of sleep tracking is very high, but prolonged use is very low. Poor prolonged use may be attributable to several factors such as engagement, functionality, aesthetics, information, and recommendation. We appraised these five factors in 16 consumer- and research/medical- grade digital sleep devices.
Methods
Three reviewers independently assessed 16 consumer- and medical-grade sleep digital devices using the Mobile Application Rating Scale (MARS) App quality ratings, which measures engagement (engagement, entertainment, interest, customization, interactivity, target group), functionality (functionality, performance, ease of use, navigation, gestural design), aesthetics (layout, graphics, visual appeal), information (Accuracy. Goals, Quality of information, Quantity of information, Visual information, Credibility, and Evidence base) and recommended on a Likert scale, with 1- Inadequate to 5 Excellent. Each subcategory is rated on a 1-5 Likert scale which is summed for each category: engagement (30), functionality (25), aesthetics (15), information (35) and recommended (yes or no).
Results
Devices that had the highest engagement score were Fitbit (27), Apple Watch (27), Garmin (27), and Dreem 2 headband (25.5). Apple Watch (30) had highest score; while Fitbit (13), Apple Watch (13), Garmin (13), Samsung Gear (13) had highest aesthetic score. While for information, ActiGraph (35), SOMNOwatch plus (35), CleveMed SleepView Monitor (35), CleveMed Sapphire PSG (35), SOMNOscreen plus (35), Nox T3 Sleep Monitor (35) and Nox A1 PSG System (35) had the highest ratings. The Dreem 2 headband has the potential induce prolong use among users with and without sleep disorders, based on high scores on engagement (25.5), Functionality (20.5), and Information (26.5).
Conclusion
Consumer- and research-grade digital devices that measure sleep have varying levels of engagement, functionality, aesthetics, information and recommendations to facilitate prolong use. Consumer grade devices had higher engagement, functionality and aesthetics scores, while research grade devices had higher information and recommendation scores. If consumer- and research-grade devices are to have prolonged use, standardization is needed across the five MARS components.
Support
K01HL135452, R01MD007716, R01HL142066, and K07AG052685
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Affiliation(s)
- L Hollimon
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - S Richards
- NYU Grossman School of Medicine, New York, NY
| | | | | | - A Chung
- NYU Grossman School of Medicine, New York, NY
| | - D Chung
- NYU Grossman School of Medicine, New York, NY
| | | | - A Seixas
- NYU Grossman School of Medicine, New York, NY
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15
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Moore J, Williams N, Chung D, Parra Y, Jean-Louis G, Seixas A. 1113 Physical Activity Moderates The Sleep-emotional Distress Relationship, But Less So Among Blacks Vs. Whites. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1108] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Emotional distress (ED) is associated with poor sleep. Research shows that minority populations experience greater vulnerabilities to both ED and poor sleep. Interventions such as relaxation training and behavioral therapy address this relationship but are not always successful. Research shows that physical activity (PA) is negatively associated with ED and positively associated with sleep duration. However, it is unclear whether PA attenuates the relationship between ED and sleep, and if this relationship differs by race/ethnicity.
Methods
We analyzed data from the 2005-2015 National Health Interview Survey (NHIS), a nationally representative dataset of 416,152 participants. ED, hours of PA per day, and average sleep duration were collected. Regression models with covariates (age, sex, employment status, BMI) were used to analyze the moderation effect of PA within sleep and ED. Regression models were stratified by race/ethnicity.
Results
261,686 participants (45,926 blacks, 17.55%, and 215,760 whites, 82.45%) responded with the required variables for analysis. 63% of participants reported at least some physical activity. The results of the regression showed that a significant amount of variance in ED stemmed from sleep duration; F (7, 121088) = 1,619.72, p < 0.001. PA was found to have a significant main effect, t(121,088) = 9.01, p= <0.001. There was a significant moderation effect of PA, t(121088) =7.26, p < 0.001. Stratification showed that the moderation effect of PA was not significant among blacks t(121,088) = -1.45, p=0.149 and significant among whites b = -.08, t(101,754) = -7.82, p < 0.001.
Conclusion
The present study found support for moderation of PA in the sleep-ED relationship. However, it found that blacks do not experience the same benefits of PA in this relationship as whites. Further research should be performed to understand the connection of PA to sleep duration and ED.
Support
This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685
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Affiliation(s)
- J Moore
- NYU Grossman School of Medicine, New York, NY
| | - N Williams
- NYU Grossman School of Medicine, New York, NY
| | - D Chung
- NYU Grossman School of Medicine, New York, NY
| | - Y Parra
- NYU Grossman School of Medicine, New York, NY
| | | | - A Seixas
- NYU Grossman School of Medicine, New York, NY
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Lee KO, Lee CY, Lee KY, Oh SH, Heo JH, Na SJ, Chung D, Woo MH, Choi JW, Hong JY. Abstract WP133: The Clinical Impact of Neutrophil/Lymphocyte Ratio in Patient With Cerebral Aneurysm. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp133] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Increased neutrophils, and stress-induced low lymphocyte levels both indicate changes in the immune system. Blood neutrophil/lymphocyte ratio (NLR) is shown to be a simple, reliable and inexpensive inflammatory indicator that can provide important information on many conditions. Recently, NLR has been proposed as a useful biomarker to predict cardiovascular risk. However, little is known about the role of NLR in patients with intracranial aneurysm (IA).
Hypothesis:
The purpose of present study was to investigate whether NLR values differ in patients with IA.
Methods:
The study group consisted of patients with IA who had been admitted to the neurology department from January 2008 to December 2016. A total of 406 patients including 198 patients with unruptured IA, 208 patient with ruptured IA were enrolled in this study. The control group consisted of 420 age, sex-matched healthy adults who had not harbor IA by CTA, MRA, DSA. The baseline NLR was calculated as the ratio of neutrophil count to lymphocyte count. WBC count>12.000 cells per μL or <4.000 cells per μL and high body temperature>38 ° are excluded from the study.
Results:
The Mean NLR was significantly higher among persons with cerebral aneurysm compared with controls (P < 0.001). The level of NLR in ruptured IA group were found higher compared to unruptured IA and control group (6.1 ± 4.3 vs 2.7 ± 1.5 vs 1.8 ± 1.1, P < 0.001). Other comorbid conditions were balanced between these three groups.
Conclusions:
We demonstrated that the NLR is an independent predictor of IA patients. In addition, higher NLR is associated with ruptured IA. Unlike many other inflammatory markers and bioassays, NLR are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with cerebral aneurysm. The clinical implications of NLR on IA remain to be established by future investigations. A long term prospective study is needed to clarify this matter.
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Affiliation(s)
- Kee Ook Lee
- CHA Bundang Med Cntr, Seongnam-si, Gyunggi-do, Korea, Republic of
| | - Cheol-Young Lee
- Konyang Univ College of Medicine, Daejeon, Korea, Republic of
| | - Kyung-Yul Lee
- Yonsei Univ College of Medicine, Seoul, Korea, Republic of
| | - Seung-Hun Oh
- CHA Bundang Med Cntr, Seongnam-si, Gyunggi-do, Korea, Republic of
| | - Ji Hoe Heo
- Yonsei Univ College of Medicine, Seoul, Korea, Republic of
| | - Sang-Jun Na
- Konyang Univ College of Medicine, Daejeon, Korea, Republic of
| | - Darda Chung
- CHA Bundang Med Cntr, Seongnam-si, Gyunggi-do, Korea, Republic of
| | - Min-Hee Woo
- CHA Bundang Med Cntr, Seongnam-si, Gyunggi-do, Korea, Republic of
| | - Jung-Won Choi
- CHA Bundang Med Cntr, Seongnam-si, Gyunggi-do, Korea, Republic of
| | - Jun Yeong Hong
- Konyang Univ College of Medicine, Daejeon, Korea, Republic of
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Hall H, Tocock A, Ricketts W, Robson J, Round T, Gorolay S, Chung D, Janes S, Møller H, Peake M, Navani N. Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30233-6] [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: 11/26/2022]
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Lee KO, Woo MH, Chung D, Choi JW, Kim NK, Kim OJ, Oh SH. Differential Impact of Plasma Homocysteine Levels on the Periventricular and Subcortical White Matter Hyperintensities on the Brain. Front Neurol 2019; 10:1174. [PMID: 31787924 PMCID: PMC6856638 DOI: 10.3389/fneur.2019.01174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background: The clinical significance of cerebral white matter hyperintensities (WMH) on brain magnetic resonance imaging (MRI) has recently increased, and recognized now as a risk factor for future stroke and dementia. High levels of plasma homocysteine (Hcyt) are associated with cerebral WMH. Recent studies suggest a different anatomy and physiology in the arteriolar system may be supplied to the periventricular and deep subcortical white matter. We hypothesize that plasma Hcyt levels have differing impacts on periventricular WMH (PVWMH) than on deep subcortical WMH (DSWMH). Methods: We evaluated plasma Hcyt levels from 937 neurologically healthy participants. The severity of PVWMH and DSWMH was evaluated by the use of a manual grading scale. Moderate to severe PVWMH and DSWMH levels were defined when the Fazekas score was two or three, respectively. Predominant PVWMH (pred-PVWMH) and predominant DSWMH (pred-DSWMH) were defined as having a difference of Fazekas score between PVWMH and DSWMH of two or more. Other confounding variables including age, sex, vascular risk factors, and estimated glomerular filtration rate (eGFR) were also analyzed. Results: Logistic regression revealed that, after adjusting for the confounding variables, PVWMH was associated with old age, hypertension, diabetes mellitus, low eGFR, and high plasma Hcyt levels. DSWMH was associated with old age, hypertension, and hypercholesterolemia but not with plasma Hcyt levels. Plasma Hcyt levels were associated with pred-PVWMH but not with pred-DSWMH. Conclusions: High plasma Hcyt levels are strongly associated with the development of PVWMH but not DSWMH. Our results suggest the possibility that different pathogeneses exist for PVWMH and DSWMH and that dysregulated Hcyt metabolism associated with the development of PVWMH.
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Affiliation(s)
- Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Min-Hee Woo
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Darda Chung
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Nam-Keun Kim
- Institute for Clinical Research, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
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Chung D, Yoon W. P14.51 Brain mapping for mentalizing in GBM patient. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.286] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma is a disease with very poor outcome. Most patients underwent maximal safe resection, especially focusing in the preservation of motor and language function. However, many caregivers were suffered from the blockage of emotion communication with patients. So the definition of maximal safe resection must include the preservation of cognition and mentalizing of patients. Here we present the experience of brain mapping in awake surgery to preserve mentalizing.
MATERIAL AND METHODS
A 61-year-old male patient with headache was transferred to our hospital because of brain tumor on CT scan checked in another hospital. On the initial MRI, multi-septate cystic tumor was shown on left medial prefrontal area. The patient was recommended the surgical resection, but patient discharged with the denial of the operation. Ten days later, patient visited our hospital again with slowness of response by the enlargement of tumor size. The tumor extensively involved left cingulum and corpus callosum at anterior part. On diffusion tensor image, tumor located at mediosuperior part of inferior fronto-occipital fasciculus (IFOF). The patient showed deficit of visual and verbal memory, generative naming ability, and phonemic generative naming ability on preoperative neuropsychological test (SNSB-II). Pyramid and palm tree test (PPTT) and ‘Reading the Mind in the Eyes’ test (RMET) were also performed to evaluate the semantic association function and mentalizing preoperatively.
RESULTS
The patient underwent awake surgery with asleep-awake-asleep technique. The tumor was resected until identification of incorrect response to PPTT or RMET on subcortical stimulation (Ojeman stimulator, 1.5mA, 60Hz, biphasic). The histopathologic diagnosis was glioblastoma. Small part of tumor was remained on cingulum, but patient was discharged without change of mentalizing.
CONCLUSION
Although the patients with glioblastomas show poor outcome, we think that it is important to consider the cognition and mentalizing of patients for emotion communication with caregivers. With awake surgery, mentalizing can be preserved in selective patients.
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Affiliation(s)
- D Chung
- Incheon St. Mary’s Hospital, Incheon, Korea, Republic of
| | - W Yoon
- Incheon St. Mary’s Hospital, Incheon, Korea, Republic of
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Swaraj S, Wang M, Chung D, Curtis J, Firth J, Ramanuj PP, Sara G, Large M. Meta-analysis of natural, unnatural and cause-specific mortality rates following discharge from in-patient psychiatric facilities. Acta Psychiatr Scand 2019; 140:244-264. [PMID: 31325315 DOI: 10.1111/acps.13073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND People discharged from in-patient psychiatric facilities have highly elevated rates of suicide, and there is increasing concern about natural mortality among the seriously mentally ill. METHOD A meta-analysis of English-language, peer-reviewed longitudinal studies of mortality among patients discharged from in-patient psychiatric facilities was conducted using papers published in MEDLINE, PsycINFO or EMBASE (from 1 January 1960 to 1 April 2018) located using the terms ((suicid*).ti AND (hospital OR discharg* OR inpatient OR in-patient OR admit*)).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* OR hospital* OR inpatient* OR in-patient* OR discharg*).ab. Pooled mortality rates for aggregated natural and unnatural causes, and the specific causes of suicide, accident, homicide, vascular, neoplastic, respiratory, gastrointestinal, infectious and metabolic death were calculated using a random-effects meta-analytic model. Between-study heterogeneity was investigated using subgroup analysis and metaregression. RESULTS The pooled natural death rate of 1128 per 100 000 person-years exceeded the pooled unnatural deaths of 479 per 100 000 person-year among studies with varying periods of follow-up. Natural deaths significantly exceeded unnatural deaths among studies with a mean follow-up of longer than 2 years, and vascular deaths exceeded suicide deaths among studies with mean period of follow-up of 5 years or longer. CONCLUSION Suicide may be the largest single cause of death in the short term after discharge from in-patient psychiatric facilities but vascular disease is the major cause of mortality in the medium- and long-term.
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Affiliation(s)
- S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - J Curtis
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - J Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | | | - G Sara
- Northern Clinical School, Sydney Medical School, The University of Sydney, North Sydney, NSW, Australia.,InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Sydney, NSW, Australia
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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Wang M, Swaraj S, Chung D, Stanton C, Kapur N, Large M. Meta-analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours. Acta Psychiatr Scand 2019; 139:472-483. [PMID: 30864183 DOI: 10.1111/acps.13023] [Citation(s) in RCA: 15] [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] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To quantify the suicide rate among people discharged from non-psychiatric settings after presentations with suicidal thoughts or behaviours. METHOD Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. RESULTS A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). CONCLUSIONS People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades.
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Affiliation(s)
- M Wang
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - S Swaraj
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - D Chung
- Faculty of Medicine, University of NSW, Kensington, Sydney, NSW, Australia
| | - C Stanton
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
| | - N Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester and Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, UK
| | - M Large
- School of Psychiatry, University of NSW, Kensington, Sydney, NSW, Australia
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Commodore A, Mukherjee N, Chung D, Svendsen E, Vena J, Pearce J, Roberts J, Arshad SH, Karmaus W. Erratum: Frequency of heavy vehicle traffic and association with DNA methylation at age 18 years in a subset of the Isle of Wight birth cohort. Environ Epigenet 2019; 5:dvz003. [PMID: 30911411 PMCID: PMC6427087 DOI: 10.1093/eep/dvz003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
[This corrects the article DOI: 10.1093/eep/dvy028.][This corrects the article DOI: 10.1093/eep/dvy028.].
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Commodore A, Mukherjee N, Chung D, Svendsen E, Vena J, Pearce J, Roberts J, Arshad SH, Karmaus W. Frequency of heavy vehicle traffic and association with DNA methylation at age 18 years in a subset of the Isle of Wight birth cohort. Environ Epigenet 2018; 4:dvy028. [PMID: 30697444 PMCID: PMC6343046 DOI: 10.1093/eep/dvy028] [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: 05/23/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 05/08/2023]
Abstract
Assessment of changes in DNA methylation (DNA-m) has the potential to identify adverse environmental exposures. To examine DNA-m among a subset of participants (n = 369) in the Isle of Wight birth cohort who reported variable near resident traffic frequencies. We used self-reported frequencies of heavy vehicles passing by the homes of study subjects as a proxy measure for TRAP, which were: never, seldom, 10 per day, 1-9 per hour and >10 per hour. Methylation of cytosine-phosphate-guanine (CpG) dinucleotide sequences in the DNA was assessed from blood samples collected at age 18 years (n = 369) in the F1 generation. We conducted an epigenome wide association study to examine CpGs related to the frequency of heavy vehicles passing by subjects' homes, and employed multiple linear regression models to assess potential associations. We repeated some of these analysis in the F2 generation (n = 140). Thirty-five CpG sites were associated with heavy vehicular traffic. After adjusting for confounders, we found 23 CpGs that were more methylated, and 11 CpGs that were less methylated with increasing heavy vehicular traffic frequency among all subjects. In the F2 generation, 2 of 31 CpGs were associated with traffic frequencies and the direction of the effect was the same as in the F1 subset while differential methylation of 7 of 31 CpG sites correlated with gene expression. Our findings reveal differences in DNA-m in participants who reported higher heavy vehicular traffic frequencies when compared to participants who reported lower frequencies.
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Affiliation(s)
- A Commodore
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - N Mukherjee
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN 38152, USA
| | - D Chung
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - E Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - J Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - J Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - J Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - S H Arshad
- Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - W Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN 38152, USA
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Kalinowskisi J, Seixas A, Chung A, Chery K, Richards S, Chung D, Jean-Louis G. 0582 High Rate of OSA among Blacks Using Home-Based WatchPAT Recordings. Sleep 2018. [DOI: 10.1093/sleep/zsy061.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Seixas
- New York University School of Medicine, New York, NY
| | - A Chung
- New York University School of Medicine, New York, NY
| | - K Chery
- New York University School of Medicine, New York, NY
| | - S Richards
- New York University School of Medicine, New York, NY
| | - D Chung
- New York University School of Medicine, New York, NY
| | - G Jean-Louis
- New York University School of Medicine, New York, NY
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25
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Prada T, Shimano A, Chung D, Karcher D, Minto B. Mechanical analysis of transversal iliac fracture stabilization using dynamic compression plate or screws and PMM in polyurethane bone model. ARQ BRAS MED VET ZOO 2017. [DOI: 10.1590/1678-4162-8434] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Pelvic fractures correspond to 20 to 30 % of the fractures observed in dogs. Complete fractures, especially with bone axis deviation should be surgically treated. The mechanical study of surgical techniques is of utmost importance to assess the best way of treating these injuries. This study compared, biomechanically, the use of a dynamic compression plate (DCP) and screws (group 1) or screws and polymethylmethacrylate (PMMA) (group 2) to stabilize an iliac fracture using a static test. Sixteen canine synthetic hemi-pelvises (test specimens) with a transverse iliac osteotomy were used. After fixation with implants, a load was applied to the acetabulum until failure. Group 1 maximal compressive load was 133.9±18.60 N, displacement at yield 21.10±3.59mm and stiffness 125.22±12.25N/mm. Group 2 maximal compressive load was 183.50±27.38N, displacement at yield 16.66±5.42mm and stiffness 215.68±33.34N/mm. The stabilization with polymethylmethacrylate was stronger than dynamic compression plate since it resisted a greater load in all test specimens.
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Nelson C, O'Brien K, Mendizabal A, Gersten I, Uhl L, Chung D, Shah N, Avigan D, Pasquini M. Development and management of a multi-center, center-specific cellular therapy manufacturing approach: The experience of the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Protocol #1401. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.201] [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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Richards S, Seixas A, Chung D, Nunes J, Grandner M, Zizi F, Tan N, Jean-Louis G. 1150 SLEEP IMPACTS QUALITY OF LIFE AND NEUROCOGNITIVE CHARACTERISTICS OF BLACK AND HISPANIC STROKE SURVIVORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1149] [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: 11/13/2022] Open
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Chung D, Seixas A, Richards SL, Casimir G, Auguste E, Vallon J, Hutchinson J, Zizi F, Jean-Louis G. 1055 THE IMPACT OF SHORT SLEEP DURATION ON INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) AMONG STROKE SURVIVORS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1054] [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: 11/13/2022] Open
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Chan L, MacDonald M, Chung D, Hutchins N, Ooi A. Analysis of the coherent and turbulent stresses of a numerically simulated rough wall pipe. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/822/1/012011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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30
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Cho S, Chang MH, Yun SH, Kang HG, Chung H, Song KM, Koo D, Chung D, Jeong D, Lee MK, Lim JY, Kim DJ. R&D Activities on the Tritium Storage and Delivery System in Korea. Fusion Science and Technology 2017. [DOI: 10.13182/fst11-a12602] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. Cho
- National Fusion Research Institute, 52 Eoeun-dong, Yuseong-gu, Daejeon, 305-333, Korea
| | - M. H. Chang
- National Fusion Research Institute, 52 Eoeun-dong, Yuseong-gu, Daejeon, 305-333, Korea
| | - S. H. Yun
- National Fusion Research Institute, 52 Eoeun-dong, Yuseong-gu, Daejeon, 305-333, Korea
| | - H.-G. Kang
- National Fusion Research Institute, 52 Eoeun-dong, Yuseong-gu, Daejeon, 305-333, Korea
| | - H. Chung
- Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yuseong, Daejeon, 305-353, Korea
| | - K. M. Song
- KEPCO Research Institute, 103-16 Munji-Dong, Yuseong-gu, Daejeon, 305-380, Korea
| | - D. Koo
- Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yuseong, Daejeon, 305-353, Korea
| | - D. Chung
- Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yuseong, Daejeon, 305-353, Korea
| | - D. Jeong
- Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yuseong, Daejeon, 305-353, Korea
| | - M. K. Lee
- National Fusion Research Institute, 52 Eoeun-dong, Yuseong-gu, Daejeon, 305-333, Korea
| | - J. Y. Lim
- Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 305-340, Korea
| | - D. J. Kim
- KOCEN Consulting and Services, Inc, 5442-1 Sangdaewon-dong, Seongnam-si, Gyeonggi 462-729, Korea
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Parvizi N, Chung D, Little MW, Gleeson FV, Anderson EM. Does perfusion CT play a role in the evaluation of percutaneous microwave-ablated lung tumours? Clin Radiol 2016; 71:1137-42. [PMID: 27554616 DOI: 10.1016/j.crad.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/16/2016] [Accepted: 07/01/2016] [Indexed: 11/21/2022]
Abstract
AIM To assess the clinical utility of perfusion computed tomography (pCT) parameters in microwave ablation (MWA) of lung tumours. MATERIALS AND METHODS Patients were included who had primary or metastatic lung tumours and underwent pCT studies immediately pre- and post-MWA. Perfusion maps of the tumours were constructed using CT perfusion software (GE, Milwaukee, WI, USA). Regions of interest were drawn on sequential axial sections to extract the pCT parameters, blood volume (BV), average blood flow (BF), and mean transit time (MTT) from the entire tumour volume. Direct visualisation of perfusion maps were performed by two experienced readers blinded to outcome. Data were analysed using the Mann-Whitney test. RESULTS Thirty-one patients with 34 lung tumours had follow-up data at 12 months. The median tumour diameter was 19 mm (10-52 mm). Seven patients developed local tumour progression (LTP) at 12 months. There was no statistical difference between patients with LTP and complete treatment based on quantitative pCT parameters. Using radiologist visualisation of perfusion maps, there was moderate agreement between the two readers (kappa coefficient 0.53) with a combined 96% sensitivity, 62% specificity, 91% positive predictive value, and 80% negative predictive value. CONCLUSION Quantitative pCT parameters do not help differentiate between LTP and complete treatment, but subjective analysis of perfusion maps may be a useful assessment tool for identifying treatment adequacy potentially enabling identification of areas requiring further treatment at the time of the procedure.
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Affiliation(s)
- N Parvizi
- Department of Clinical Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington OX3 7LE, UK
| | - D Chung
- Department of Clinical Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington OX3 7LE, UK
| | - M W Little
- Department of Clinical Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington OX3 7LE, UK
| | - F V Gleeson
- Department of Clinical Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington OX3 7LE, UK
| | - E M Anderson
- Department of Clinical Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington OX3 7LE, UK.
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Ruparel M, Ejaz A, Chauhan N, Ridge M, Chung D, Succony L, Banka R, Thakrar R, Kumar N, Sage E, Forster M, Janes S, Newsom-Davis T, Ahmad T, Navani N. 23 Characteristics of lung cancer patients diagnosed following emergency admission. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30040-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: 10/22/2022]
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Chung D. Gene therapy clinical trials for childhood blindness and its applications for ocular, auditory and renal ciliopathies. Cilia 2015. [PMCID: PMC4518623 DOI: 10.1186/2046-2530-4-s1-o10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chung D, Ferro Luzzi E, Bettoli Musy L, Narring F. [Contraception and abortion: an update in 2015]. Rev Med Suisse 2015; 11:1744-1749. [PMID: 26591787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Family doctors can play an important role in preventing unplanned pregnancies. This article addresses the different contraceptives methods available in Switzerland, which are classified in 2 groups and recommends using the GATHER approach (Greet, Ask, Tell, Help, Explain, Return) to promote compliance. LARC (long acting reversible contraceptives) can be recommended to any woman who needs a reliable birth control method. These contraceptives require minimum effort for high efficiency. Further explanation regarding the use of an emergency contraception must be provided when short action contraceptives are chosen. Switzerland's abortion rate is one of the lowest in the world. Medical abortion tends to be more and more prominent. Under certain circumstances, it can be self-administered at home.
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Chung J, Cho D, Chung D, Chung M. Serum Cystatin C Levels are Positively Associated with Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1555774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - D. Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - D. Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - M. Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Chung D, Kim S. Laparoendoscopic Single-Site Radical Trachelectomy Using Conventional Laparoscopic Instruments: A Case Report. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.032] [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: 11/30/2022]
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Yoon WS, Chung D. Helical Tomotherapy for Skull Base Tumors: A Preliminary Report. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384186] [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: 10/20/2022]
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Zamarin D, Giralt S, Landau H, Lendvai N, Lesokhin A, Chung D, Koehne G, Chimento D, Devlin SM, Riedel E, Bhutani M, Babu D, Hassoun H. Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients' monitoring after transplantation. Bone Marrow Transplant 2012; 48:419-24. [PMID: 22890289 DOI: 10.1038/bmt.2012.151] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Auto-SCT (ASCT) is widely used in first-line treatment of multiple myeloma (MM). However, most patients eventually relapse or have progression of disease (R/POD). Although precise knowledge of R/POD patterns would be important to generate evidence-based surveillance recommendations after ASCT, such data is limited in the literature, especially after introduction of the free light chain assay (FLCA). This retrospective study examined the patterns of R/POD after first-line ASCT in 273 patients, using established criteria. At the time of R/POD, only 2% of patients had no associated serological evidence of R/POD. A total of 85% had asymptomatic R/POD, first detected by serological testing, whereas 15% had symptomatic R/POD with aggressive disease, early R/POD and short survival, with poor cytogenetics and younger age identified as risk factors. Although occult skeletal lesions were found in 40% of asymptomatic patients tested following serological R/POD, yearly skeletal surveys and urine testing were poor at heralding R/POD. We found a consistent association between paraprotein types at diagnosis and R/POD, allowing informed recommendations for appropriate serological monitoring and propose a new needed criterion using FLCA for patients relapsing by FLC only. Our findings provide important evidence-based recommendations that strengthen current monitoring guidelines after first-line ASCT in MM.
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Affiliation(s)
- D Zamarin
- Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Yuki K, Eva M, Richer E, Chung D, Paquet M, Canonne-Hergaux F, Vaulont S, Vidal S, Malo D. Suppression of hepcidin expression and iron overload mediate Salmonella susceptibility in ankyrin 1 ENU-induced mutant. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.386] [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: 10/28/2022] Open
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Kim Y, Chung D, Lee M, Yim G, Kim S, Kim S, Nam E, Kim J. IgA immune response in saliva induced by AS04-adjuvant HPV-16/18 vaccine. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.270] [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: 11/26/2022]
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Yim G, Nam E, Kim S, Kim Y, Kim S, Kim J, Chung D, Park J. Outcome of repeat loop electrosurgical excision procedure or hysterectomy of cervical intraepithelial neoplasia of cervix: Is repeat procedure necessary in margin positive cases? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.134] [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: 10/28/2022]
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Lee Y, Chung D, Xiao K, Small T, Papadopoulos E, Jakubowski A, Papanicolaou G. Adenovirus Viremia in Patients with Clinical Symptoms After T-Cell Depleted HSCT: Rates of Adenovirus Disease and Outcomes. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.034] [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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Uberoi R, Chung D. Endovascular solutions for the management of visceral aneurysms. J Cardiovasc Surg (Torino) 2011; 52:323-331. [PMID: 21577187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Visceral artery aneurysms is a rare but important condition associated with significant mortality when rupture occurs. Technological advance has increased the role endovascular therapy plays in their management, particularly in patients whom surgery is considered to pose significant risk. Maintenance of end organ perfusion is vital when selecting the optimal endovascular treatment to exclude the aneurysm. This review will discuss the precautions required in different vascular territory outlining the endovascular treatments available. The evidence supporting the endovascular treatments and associated risks will also be discussed.
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Affiliation(s)
- R Uberoi
- John Radcliffe Hospital, Headington, Oxford, UK.
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Chan JKK, Choa RM, Chung D, Sleat G, Warwick R, Smith GD. High resolution ultrasonography of the hand and wrist: three-year experience at a District General Hospital Trust. ACTA ACUST UNITED AC 2011; 15:177-83. [PMID: 21089192 DOI: 10.1142/s0218810410004813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 07/12/2010] [Accepted: 07/20/2010] [Indexed: 02/06/2023]
Abstract
A retrospective analysis of 227 patients undergoing ultrasonography (US) of the hand/wrist over a three-year period in a district general hospital trust was performed. The usefulness in each case was assessed by two independent reviewers using a qualitative rating system, as (A) Useful: determines management, (B) Useful: contributory, (C) Not useful: not misleading, or (D) Not useful: misleading/potentially harmful. US was useful in 74.8% of cases but misleading/potentially harmful in 13.1%. Misleading rates exceeding 10% in sub-categories including tendinopathy, carpal tunnel syndrome, foreign body and lumps, where US findings may influence the decision to operate or not, are particularly worrying. There were a number of cases where US led to unnecessary operations or suggested operating on the wrong structures, and also cases where US findings wrongly suggested that surgery was unnecessary. Various recommendations aimed to improve the usefulness of US in the Hand and Wrist, including mandatory/formal musculoskeletal US training, are made.
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Affiliation(s)
- J K K Chan
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire NHS Trust, Aylesbury, HP21 8AL, UK.
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Park J, Godbold J, Chung D, Sampson H, Wang J. Comparison of Cetirizine to Diphenhydramine in the Treatment of Acute Food Allergic Reactions. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.941] [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: 10/18/2022]
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Fourati Ben Mustapha S, Khrouf M, Kacem Ben Rejeb K, Elloumi Chaabene H, Merdassi G, Wahbi D, Ben Meftah M, Zhioua F, Zhioua A, Azzarello A, Host T, Mikkelsen AL, Theofanakis CP, Dinopoulou V, Mavrogianni D, Partsinevelos GA, Drakakis P, Stefanidis K, Bletsa A, Loutradis D, Rienzi L, Cobo A, Paffoni A, Scarduelli C, Capalbo A, Garrido N, Remohi J, Ragni G, Ubaldi FM, Herrer R, Quera M, GIL E, Serna J, Grondahl ML, Bogstad J, Agerholm IE, Lemmen JG, Bentin-Ley U, Lundstrom P, Kesmodel US, Raaschou-Jensen M, Ladelund S, Guzman L, Ortega C, Albuz FK, Gilchrist RB, Devroey P, Smitz J, De Vos M, Bielanska M, Leveille MC, Borghi E, Magli MC, Figueroa MJ, Mascaretti G, Ferraretti AP, Gianaroli L, Szlit E, Leocata Nieto F, Maggiotto G, Arenas G, Tarducci Bonfiglio N, Ahumada A, Asch R, Sciorio R, Dayoub N, Thong J, Pickering S, Ten J, Carracedo MA, Guerrero J, Rodriguez-Arnedo A, Llacer J, Bernabeu R, Tatone C, Heizenrieder T, Di Emidio G, Treffon P, Seidel T, Eichenlaub-Ritter U, Cortezzi SS, Cabral EC, Ferreira CR, Trevisan MG, Figueira RCS, Braga DPAF, Eberlin MN, Iaconelli Jr. A, Borges Jr. E, Zabala A, Pessino T, Blanco L, Rey Valzacchi G, Leocata F, Ahumada A, Vanden Meerschaut F, Heindryckx B, Qian C, Deforce D, Leybaert L, De Sutter P, De las Heras M, De Pablo JL, Navarro B, Agirregoikoa JA, Barrenetxea G, Cruz M, Perez-Cano I, Gadea B, Herrero J, Martinez M, Roldan M, Munoz M, Pellicer A, Meseguer M, Munoz M, Cruz M, Roldan M, Gadea B, Galindo N, Martinez M, Pellicer A, Meseguer M, Perez-Cano I, Scarselli F, Alviggi E, Colasante A, Minasi MG, Rubino P, Lobascio M, Ferrero S, Litwicka K, Varricchio MT, Giannini P, Piscitelli P, Franco G, Zavaglia D, Nagy ZP, Greco E, Urner F, Wirthner D, Murisier F, Mock P, Germond M, Amorocho Llanos B, Calderon G, Lopez D, Fernandez L, Nicolas M, Landeras J, Finn-Sell SL, Leandri R, Fleming TP, Macklon NS, Cheong YC, Eckert JJ, Lee JH, Jung YJ, Hwang HK, Kang A, An SJ, Jung JY, Kwon HC, Lee SJ, Palini S, Zolla L, De Stefani S, Scala V, D'Alessandro A, Polli V, Rocchi P, Tiezzi A, Pelosi E, Dusi L, Bulletti C, Fadini R, Lain M, Mignini Renzini M, Brambillasca F, Coticchio G, Merola M, Guglielmo MC, Dal Canto M, Figueira R, Setti AS, Braga DPAF, Iaconelli Jr. A, Borges Jr. E, Worrilow KC, Uzochukwu CD, Eid S, Le Gac S, Esteves TC, van Rossem F, van den Berg A, Boiani M, Kasapi E, Panagiotidis Y, Goudakou M, Papatheodorou A, Pasadaki T, Prapas N, Prapas Y, Panagiotidis Y, Kasapi E, Goudakou M, Papatheodorou A, Pasadaki T, Vanderzwalmen P, Prapas N, Prapas Y, Norasing S, Atchajaroensatit P, Tawiwong W, Thepmanee O, Saenlao S, Aojanepong J, Hunsajarupan P, Sajjachareonpong K, Punyatanasakchai P, Maneepalviratn S, Jetsawangsri U, Herrero J, Cruz M, Tejera A, Rubio I, Romero JL, Meseguer M, Nordhoff V, Schlatt S, Schuring AN, Kiesel L, Kliesch S, Azambuja R, Okada L, Lazzari V, Dorfman L, Michelon J, Badalotti M, Badalotti F, Petracco A, Schwarzer C, Esteves TC, Nordhoff V, Schlatt S, Boiani M, Versieren K, Heindryckx B, De Croo I, Lierman S, De Vos W, Van den Abbeel E, Gerris J, De Sutter P, Milacic I, Borogovac D, Veljkovic M, Arsic B, Jovic Bojovic D, Lekic D, Pavlovic D, Garalejic E, Guglielmo MC, Coticchio G, Albertini DF, Dal Canto M, Brambillasca F, Mignini Renzini M, De Ponti E, Fadini R, Sanges F, Talevi R, Capalbo A, Papini L, Mollo V, Ubaldi FM, Rienzi LF, Gualtieri R, Albuz FK, Guzman L, Orteg C, Gilchrist RB, Devroey P, De Vos M, Smitz J, Choi J, Lee H, Ku S, Kim S, Choi Y, Kim J, Moon S, Demilly E, Assou S, Moussaddykine S, Dechaud H, Hamamah S, Takisawa T, Doshida M, Hattori H, Nakamura Y, Kyoya T, Shibuya Y, Nakajo Y, Tasaka A, Toya M, Kyono K, Novo S, Penon O, Gomez R, Barrios L, Duch M, Santalo J, Esteve J, Nogues C, Plaza JA, Perez-Garcia L, Ibanez E, Chavez S, Loewke K, Behr B, Reijo Pera R, Huang S, Wang H, Soong Y, Chang C, Okimura T, Kuwayama M, Mori C, Morita M, Uchiyama K, Aono F, Kato K, Takehara Y, Kato O, Minasi M, Casciani V, Scarselli F, Rubino P, Colasante A, Arizzi L, Litwicka K, Ferrero S, Mencacci C, Piscitelli C, Giannini P, Cucinelli F, Tocci A, Nagy ZP, Greco E, Wydooghe E, Vandaele L, Dewulf J, Van den Abbeel E, De Sutter P, Van Soom A, Moon JH, Son WY, Mahfoudh A, Henderson S, Jin SG, Shalom-Paz E, Dahan M, Holzer H, Mahmoud K, Triki-Hmam C, Terras K, Zhioua F, Hfaiedh T, Ben Aribia MH, Otsubo H, Egashira A, Tanaka K, Matsuguma T, Murakami M, Murakami K, Otsuka M, Yoshioka N, Araki Y, Kuramoto T, Smit JG, Sterrenburg MD, Eijkemans MJC, Al-Inany HG, Youssef MAFM, Broekmans FJM, Willoughby K, DiPaolo L, Deys L, Lagunov A, Amin S, Faghih M, Hughes E, Karnis M, Ashkar F, King WA, Neal MS, Antonova I, Veleva L, Petkova L, Shterev A, Nogales C, Martinez E, Ariza M, Cernuda D, Gaytan M, Linan A, Guillen A, Bronet F, Cottin V, Fabian D, Allemann F, Koller A, Spira JC, Agudo D, Martinez-Burgos M, Arnanz A, Basile N, Rodriguez A, Bronet F, Cho YS, Filioli Uranio M, Ambruosi B, Paternoster MS, Totaro P, Sardanelli AM, Dell'Aquila ME, Zollner U, Hofmann T, Zollner KP, Kovacic B, Roglic P, Vlaisavljevic V, Sole M, Santalo J, Boada M, Coroleu B, Veiga A, Martiny G, Molinari M, Revelli A, Chimote NM, Chimote M, Mehta B, Chimote NN, Sheikh N, Nath N, Mukherjee A, Rakic K, Reljic M, Kovacic B, Vlaisavljevic V, Ingerslev HJ, Kirkegaard K, Hindkjaer J, Grondahl ML, Kesmodel US, Agerholm I, Kitasaka H, Fukunaga N, Nagai R, Yoshimura T, Tamura F, Kitamura K, Hasegawa N, Nakayama K, Katou M, Itoi F, Asano E, Deguchi N, Ooyama K, Hashiba Y, Asada Y, Michaeli M, Rotfarb N, Karchovsky E, Ruzov O, Atamny R, Slush K, Fainaru O, Ellenbogen A, Chekuri S, Chaisrisawatsuk T, Chen P, Pangestu M, Jansen S, Catt S, Molinari E, Racca C, Revelli A, Ryu C, Kang S, Lee J, Chung D, Roh S, Chi H, Yokota Y, Yokota M, Yokota H, Sato S, Nakagawa M, Komatsubara M, Makita M, Araki Y, Yoshimura T, Asada Y, Fukunaga N, Nagai R, Kitasaka H, Itoi F, Tamura F, Kitamura K, Hasegawa N, Katou M, Nakayama K, Asano E, Deguchi N, Oyama K, Hashiba Y, Naruse K, Kilani S, Chapman MG, Kwik M, Chapman M, Guven S, Odaci E, Yildirim O, Kart C, Unsal MA, Yulug E, Isachenko E, Maettner R, Strehler E, Isachenko V, Hancke K, Kreienberg R, Sterzik K, Coticchio G, Guglielmo MC, Dal Canto M, Albertini DF, Brambillasca F, Mignini Renzini M, Fadini R, Zheng XY, Wang LN, Liu P, Qiao J, Inoue F, Dashtizad M, Wahid H, Rosnina Y, Daliri M, Hajarian H, Akbarpour M, Abbas Mazni O, Knez K, Tomaevic T, Vrtacnik Bokal E, Zorn B, Virant Klun I, Koster M, Liebenthron J, Nicolov A, van der Ven K, van der Ven H, Montag M, Fayazi M, Salehnia M, Beigi Boroujeni M, Khansarinejad B, Deignan K, Emerson G, Mocanu E, Wang JJ, Andonov M, Linara E, Ahuja KK, Nachef S, Figueira RCS, Braga DPAF, Setti AS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Pasqualotto E, Borges Jr. E, Pasqualotto FF, Chang CC, Bernal DP, Elliott TA, Shapiro DB, Toledo AA, Nagy ZP, Economou K, Davies S, Argyrou M, Doriza S, Sisi P, Moschopoulou M, Karagianni A, Mendorou C, Polidoropoulos N, Papanicopoulos C, Stefanis P, Karamalegos C, Cazlaris H, Koutsilieris M, Mastrominas M, Gotts S, Doshi A, Harper J, Serhal P, Borini A, Guzeloglu-Kayisli O, Bianchi V, Seli E, Bianchi V, Lappi M, Bonu MA, Borini A, Mizuta S, Hashimoto H, Kuroda Y, Matsumoto Y, Mizusawa Y, Ogata S, Yamada S, Kokeguchi S, Noda Y, Shiotani M, Stojkovic M, Ilic M, Markovic N, Stojkovic P, Feng G, Zhang B, Zhou H, Zhou L, Gan X, Qin X, Shu J, Wu F, Molina Botella I, Lazaro Ibanez E, Debon Aucejo A, Pertusa J, Fernandez Colom PJ, Pellicer A, Li C, Zhang Y, Cui Y, Zhao H, Liu J, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Silva LFI, Ricci J, Cavagna M, Pontes A, Vagnini LD, Baruffi RLR, Franco Jr. JG, Massaro FC, Petersen CG, Vagnini LD, Mauri AL, Silva LFI, Felipe V, Cavagna M, Pontes A, Baruffi RLR, Oliveira JBA, Franco Jr. JG, Vilela M, Tiveron M, Lombardi C, Viglierchio MI, Marconi G, Rawe V, Wale PL, Gardner DK, Nakagawa K, Sugiyama R, Nishi Y, Kuribayashi Y, Jyuen H, Yamashiro E, Shirai A, Sugiyama R, Inoue M, Salehnia M, Hovatta O, Tohonen V, Inzunza J, Parmegiani L, Cognigni GE, Bernardi S, Ciampaglia W, Infante FE, Tabarelli de Fatis C, Pocognoli P, Arnone A, Maccarini AM, Troilo E, Filicori M, Radwan P, Polac I, Borowiecka M, Bijak M, Radwan M. POSTER VIEWING SESSION - EMBRYOLOGY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chang H, Glaspy J, Gornbein J, Kass F, Allison M, Chung D. Clinical Advantages of Neoadjuvant Docetaxel (T) and Carboplatin (C) ± Trastuzumab (H) in Locally Advanced Breast Cancer (LABC). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1100] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant systemic treatment has become a standard choice for locally advanced breast cancer with many proposed benefits in achieving clear margins, preserving breasts, reducing relapse and improving survival. Recently, we completed a neoadjuvant trial studying the effects of 4 cycles of docetaxel (75 mg/m2) and carboplatin (AUC=6) with or without trastuzumab (4mg/kg loading dose and 2 mg/kg weekly dose) on LABC. In this report, we assessed whether clinical complete response (cCR) or pathologic complete response (pCR) correlated better with having breast conservation surgery, fewer relapses and improved survival outcomes.Materials and Methods: Seventy-one of the 74 consented patients with T2-T4 non-metastatic breast cancer completed the preoperative treatment and had evaluable data on tumor response, surgical treatment and clinical outcome. We used the Kaplan Meier method to estimate survival probabilities and log rank test to compare relapse-free and survival curves.Results: Clinical outcomes from a preplanned 2-year analysis of a phase II neoadjuvant are reported. Of the 19 patients with pCR, 16 occurred in patients with cCR (n=32) and 3 were in the group of non-cCR (n=39). Although cCR overestimated tumor response, 84.2% pCR occurred in the cCR group and only 15.8% in the non-cCR group. The relapse-free survival at 2 and 3 years for pCR vs. non-pCR were 93.8% and 83.3% vs. 78.4% (p=0.122) and 58%, respectively; and for cCR vs. non-cCR were 80.9% and 65% vs. 83.9% and 64.3% (p=0.999). The pCR was also more predictive than cCR for overall survival. Of the 30 HER2 positive breast cancer, 15 received trastuzumab throughout the neoadjuvant and adjuvant phases for a total of 52 weeks. The remaining 15 patients received identical chemotherapy but trastuzumab was started after the surgery and continued for 52 weeks. While distinctively different pCR between the two treatment groups was expected, the better survival rate observed in the group receiving neoadjuvant TCH was not expected. Our study showed that pCR was strongly associated with a more frequent use of lumpectomy than the non-pCR group 63.2% vs. 36.5% (p=0.045).Conclusion: The effects of preoperative systemic treatment on LABC can be assessed both clinically and pathologically. Our data suggests that pathologic complete response was a better predictor for having breast conservation surgery and relapse-free survival rates. Our data also suggests that patients with HER2 positive breast cancer may benefit from receiving preoperative trastuzumab and chemotherapy.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1100.
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Affiliation(s)
- H. Chang
- 1Revlon/UCLA Breast Center, University of California Los Angeles, CA,
| | - J. Glaspy
- 2Jonsson Comprehensive Cancer Center, University of California Los Angeles, CA,
| | | | - F. Kass
- 4Cancer Center of Santa Barbara, CA,
| | - M. Allison
- 5Comprehensive Cancer Center of Nevada, NV,
| | - D. Chung
- 1Revlon/UCLA Breast Center, University of California Los Angeles, CA,
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Jahng AW, Chung D, Pham B, Reicher S, Yee B, Abramyan L, Venegas R, French S, Eysselein VE. Staining for intracytoplasmic lumina and CAM5.2 increases the detection rate for bile duct cancers. Endoscopy 2009; 41:965-70. [PMID: 19866394 DOI: 10.1055/s-0029-1215227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic biopsies have a low sensitivity for diagnosing malignant bile duct strictures. Tumor markers detected by mucin staining and immunohistochemistry may help to determine the malignancy of a biopsy specimen where histologic evaluation alone is nondiagnostic. PATIENTS AND METHODS 61 patients who underwent forceps biopsies were retrospectively identified, yielding 49 and 40 biopsy specimens for strictures finally diagnosed as benign and malignant, respectively. Biopsy specimens were histologically evaluated and stained for p53, Ki-67, carcinoembryonic antigen (CEA), CA19-9, CAM5.2, and presence of intracytoplasmic lumina (ICL). Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (PLR and NLR) were calculated to evaluate the performance of each test. RESULTS Histology alone provided sensitivity and specificity of 53 % and 100 %. Addition of ICL or CAM5.2 increased sensitivity to 73 % or 60 %, respectively, and provided excellent specificity, PPV, and PLR (ICL, 98 %, 97 %, and 36; CAM5.2, 100 %, 100 %, and infinite). Both stains in combination increased the sensitivity to 75 %. Staining for Ki-67, p53, CEA, and CA19-9 increased the sensitivity to detect malignancy (range 60 % to 83 %), but significantly reduced the specificity, PPV and PLR (ranges 73 % to 90 %, 72 % to 86 %, and 3 to 7, respectively). Markers in all combinations performed poorly as a negative test (NPV 69 % to 87 %, and NLR 0.19 to 0.55). CONCLUSIONS Staining for tumor markers ICL and CAM5.2 can improve the diagnostic value of endoscopic biopsies, and may change the course of management for patients with indeterminate histological findings.
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Affiliation(s)
- A W Jahng
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California 90509, USA
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Amigues I, Cohen N, Chung D, Seo SK, Plescia C, Jakubowski A, Barker J, Papanicolaou GA. Hepatic safety of voriconazole after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2009; 16:46-52. [PMID: 20053331 DOI: 10.1016/j.bbmt.2009.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/24/2009] [Indexed: 11/27/2022]
Abstract
Voriconazole is increasingly used in allogeneic hematopoietic stem cell transplantation (HSCT) for prophylaxis and treatment of fungal infections. Hepatic dysfunction is common in patients undergoing HSCT and may have an impact on the clinical decision to institute voriconazole. We conducted a retrospective review of all adult and pediatric HSCT recipients who received >2 consecutive doses of voriconazole between January 2005 and February 2008. Clinical hepatotoxicity was defined as the subjective attribution of liver enzyme elevation (even a mild one) to hepatotoxicity because of voriconazole by the treating physician and leading to discontinuation of voriconazole. Biochemical hepatotoxicity was defined as an elevation in one or more liver enzymes to >3 times the upper limit of normal or >3 times the baseline value if abnormal at baseline. Liver enzymes assessed included aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin. Simple and multiple logistic regressions were used to define the risks for hepatic dysfunction. The Wilcoxon signed-rank test was used to assess the differences in liver function test values before, during, and after the use of voriconazole. Sixty-eight of 200 patients (34%) developed hepatotoxicity while on voriconazole. The median duration of voriconazole therapy was 72 days (range, 1-804 days). Biochemical hepatotoxicity occurred in 51 patients (75%); clinical hepatotoxicity, in 17 patients (25%). Thirty-five (51%) of the patients with hepatotoxicity required discontinuation of therapy. In simple logistic regression, acute graft-versus-host disease (GVHD) was a risk factor for hepatotoxicity, and receipt of a T-cell depleted allograft was protective. In multiple logistic regression, acute GVHD (P = .002) remained significant. There were no cases of liver failure or death attributed to voriconazole. In this cohort of patients undergoing allogeneic HSCT, the rate of hepatotoxicity while on voriconazole was 34%. In general, the hepatic dysfunction was mild and reversible. Voriconazole therapy with monitoring appears to be reasonably safe for use in HSCT recipients at high risk for invasive fungal infections.
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Affiliation(s)
- I Amigues
- Department of Medicine, Service of Infectious Disease, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA
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Chang HR, Prati R, Gornbein JA, Chung D, Glaspy JA. Survival in patients with locally advanced breast cancer after neoadjuvant docetaxel (T), carboplatin (C), and trastuzumab (H). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11573] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11573 Background: Neoadjuvant chemotherapy (NAC) has been widely used in patients with LABC. Although survival rates after neoadjuvant and adjuvant therapy are similar, NAC was shown to increase lumpectomy surgery and allow in vivo evaluation of treatment response. It is thought that pathologic complete response (pCR) after NAC by itself or together with other factors could predict overall survival (OS) and/or relapse free survival (RFS). Methods: Seventy-one of the 74 enrolled patients (mean tumor size=7.7cm) were analyzed. All patients received 4 cycles of T (75mg/m2) and C (AUC=6) before and after surgery. HER2+ patients were randomized to receive either TCH or TC preoperatively; both received 1 year of H. Tumor size and nodal status were estimated clinically at baseline and pathologically after surgery. Bi & multivariate analyses were performed on pCR, clinical and pathologic characteristics to predict OS and RFS. Hazard ratios (HR) are reported. Results: The median follow up was 2.0 years with 8 deaths and 9 recurrences. Nineteen (26.8%) had pCR. Kaplan-Meier RFS was 82.0% & 54.2% and OS was 88.9% vs 70.6% at 3 years follow up for pCR & non-pCR respectively. In the bivariate analysis, pCR (HR=0.32, p=0.114), lower tumor stage (p=0.097) and negative LN (p=0.0695) trended a favorable RFS. Lower tumor stage (p=0.032), negative LN (p=0.029) and lumpectomy surgery (p=0.023) were associated with better OS. In multivariate analysis, inflammatory breast cancer (p=0.041) and triple negative breast cancer-TNBC (p=0.044) predicted poor OS. Conclusions: With few deaths/recurrences we were unable to conclusively identify predictors for OS or RFS. Inflammatory and TNBC remain poor prognosticators for OS and RFS. pCR was a suggestive predictor (HR<1) but not statistically significant probably due to low sample size and high number of pCR cases that were TNBC. [Table: see text]
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Affiliation(s)
- H. R. Chang
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA, Los Angeles, CA
| | - R. Prati
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA, Los Angeles, CA
| | - J. A. Gornbein
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA, Los Angeles, CA
| | - D. Chung
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA, Los Angeles, CA
| | - J. A. Glaspy
- David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA, Los Angeles, CA
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