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Miller C, Neidhart A, Hess K, Ali AMS, Benavidez A, Spilde M, Peterson E, Brearley A, Wang X, Dhanapala BD, Cerrato JM, Gonzalez-Estrella J, El Hayek E. Uranium accumulation in environmentally relevant microplastics and agricultural soil at acidic and circumneutral pH. Sci Total Environ 2024; 926:171834. [PMID: 38521258 DOI: 10.1016/j.scitotenv.2024.171834] [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: 01/12/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
The co-occurrence of microplastics (MPs) with potentially toxic metals in the environment stresses the need to address their physicochemical interactions and the potential ecological and human health implications. Here, we investigated the reaction of aqueous U with agricultural soil and high-density polyethylene (HDPE) through the integration of batch experiments, microscopy, and spectroscopy. The aqueous initial concentration of U (100 μM) decreased between 98.6 and 99.2 % at pH 5 and between 86.2 and 98.9 % at pH 7.5 following the first half hour of reaction with 10 g of soil. In similar experimental conditions but with added HDPE, aqueous U decreased between 98.6 and 99.7 % at pH 5 and between 76.1 and 95.2 % at pH 7.5, suggesting that HDPE modified the accumulation of U in soil as a function of pH. Uranium-bearing precipitates on the cracked surface of HDPE were identified by SEM/EDS after two weeks of agitation in water at both pH 5 and 7.5. Accumulation of U on the near-surface region of reacted HDPE was confirmed by XPS. Our findings suggest that the precipitation of U was facilitated by the weathering of the surface of HDPE. These results provide insights about surface-mediated reactions of aqueous metals with MPs, contributing relevant information about the mobility of metals and MPs at co-contaminated agricultural sites.
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Affiliation(s)
- Casey Miller
- Gerald May Department of Civil, Construction & Environmental Engineering, MSC01 1070, University of New Mexico, Albuquerque, NM 87131, USA; Department of Pharmaceutical Sciences, MSC09 5360, University of New Mexico, College of Pharmacy, Albuquerque, NM 87131, USA
| | - Andrew Neidhart
- Department of Pharmaceutical Sciences, MSC09 5360, University of New Mexico, College of Pharmacy, Albuquerque, NM 87131, USA; Department of Chemistry and Chemical Biology, MSC03 2060, University of New Mexico, Albuquerque, NM 87131, USA
| | - Kendra Hess
- School of Civil and Environmental Engineering, EN0059, Oklahoma State University, Stillwater, OK 740784, USA
| | - Abdul-Mehdi S Ali
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, NM 87131, USA
| | - Angelica Benavidez
- Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, NM, USA
| | - Michael Spilde
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, NM 87131, USA
| | - Eric Peterson
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, NM 87131, USA
| | - Adrian Brearley
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, NM 87131, USA
| | - Xuewen Wang
- School of Civil and Environmental Engineering, EN0059, Oklahoma State University, Stillwater, OK 740784, USA
| | - B Dulani Dhanapala
- College of Engineering, Architecture, and Technology, Oklahoma State University, Stillwater, OK 740784, USA
| | - José M Cerrato
- Gerald May Department of Civil, Construction & Environmental Engineering, MSC01 1070, University of New Mexico, Albuquerque, NM 87131, USA
| | - Jorge Gonzalez-Estrella
- School of Civil and Environmental Engineering, EN0059, Oklahoma State University, Stillwater, OK 740784, USA
| | - Eliane El Hayek
- Department of Pharmaceutical Sciences, MSC09 5360, University of New Mexico, College of Pharmacy, Albuquerque, NM 87131, USA.
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2
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Saha A, Li S, de Lemos JA, Pandey A, Bhatt DL, Fonarow GC, Nallamothu BK, Wang TY, Navar AM, Peterson E, Matsouaka RA, Bavry AA, Das SR, Grodin JL, Khera R, Drazner MH, Kumbhani DJ. Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction. Am J Cardiol 2024:S0002-9149(24)00237-6. [PMID: 38583700 DOI: 10.1016/j.amjcard.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
Cardiogenic shock after acute myocardial infarction (AMI-CS) carries significant mortality despite advances in revascularization and mechanical circulatory support. We sought to identify the process-based and structural characteristics of centers with lower mortality in AMI-CS. We analyzed 16,337 AMI-CS cases across 440 centers enrolled in the Chest Pain-MI Registry, a retrospective cohort database between January 1, 2015 and December 31, 2018. Centers were stratified across tertiles of risk-adjusted in-hospital mortality rate (RAMR) for comparison. Risk-adjusted multivariable logistic regression was also performed to identify hospital-level characteristics associated with decreased mortality. The median participant age was 66.0 (interquartile range 57.0 to 75.0) years, and 33.0% (n = 5,390) were women. The median RAMR was 33.4% (interquartile range 26.0% to 40.0%) and ranged from 26.9% to 50.2% across tertiles. Even after risk adjustment, lower-RAMR centers saw patients with fewer co-morbidities. Lower-RAMR centers performed more revascularization (92.8% vs 90.6% vs 85.9%, p <0.001) and demonstrated better adherence to associated process measures. Left ventricular assist device capability (odds ratio [OR] 0.78 [0.67 to 0.92], p = 0.002), more frequent revascularization (OR 0.93 [0.88 to 0.98], p = 0.006), and higher AMI-CS volume (OR 0.95 [0.91 to 0.99], p = 0.009) were associated with lower in-hospital mortality. However, several such characteristics were not more frequently observed at low-RAMR centers, despite potentially reflecting greater institutional experience or resources. This may reflect the heterogeneity of AMI-CS even after risk adjustment. In conclusion, low-RAMR centers do not necessarily exhibit factors associated with decreased mortality in AMI-CS, which may reflect the challenges in performing outcomes research in this complex population.
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Affiliation(s)
- Amit Saha
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shuang Li
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James A de Lemos
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deepak L Bhatt
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregg C Fonarow
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric Peterson
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anthony A Bavry
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sandeep R Das
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin L Grodin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rohan Khera
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Biostatistics, Section of Health Informatics, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Dharam J Kumbhani
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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3
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Marin LP, Presley JH, Noori K, McKinstry D, Dawson B, Sexton K, Peterson E, Harrington SE, Gardner JM, Nagalo BM, Montzavi-Karbassi B, Post SR, Nicholas RW, Kelly T. Partnership in Cancer Research (PCAR) Program Increases Medical Student Knowledge and Confidence to Perform Cancer Research. J Cancer Educ 2024; 39:111-117. [PMID: 37957501 PMCID: PMC10995089 DOI: 10.1007/s13187-023-02383-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
Arkansas has a high cancer burden, and a pressing need exists for more medical students to pursue oncology as a career. The Partnership in Cancer Research (PCAR) program provides a summer research experience at the University of Arkansas for Medical Sciences for 12 medical students who have completed their first year of medical training. A majority of participants spend time pursuing cancer research in basic science, clinical, or community-based research. Students report on their research progress in an interactive "Live from the Lab!" series and assemble a final poster presentation describing their findings. Other activities include participation in a moderated, cancer-patient support group online, lecture series on cancer topics, medical simulations, palliative care clinic visit, "Death Over Dinner" event, and an entrepreneurship competition. Students completed surveys over PCAR's first 2 years in operation to evaluate all aspects of the program. Surveys reveal that students enthusiastically embraced the program in its entirety. This was especially true of the medical simulations which received the highest evaluations. Most significantly, surveys revealed that the program increased cancer knowledge and participant confidence to perform cancer research.
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Affiliation(s)
- Luis P Marin
- University of Arkansas for Medical Sciences Northwest Regional Campus, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Jessica H Presley
- University of Arkansas for Medical Sciences Northwest Regional Campus, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Katerina Noori
- University of Arkansas for Medical Sciences Northwest Regional Campus, 1125 N College Ave, Fayetteville, AR, 72703, USA
| | - Diane McKinstry
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Brandi Dawson
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Kevin Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Eric Peterson
- Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Sarah Elizabeth Harrington
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Jerad M Gardner
- Departments of Laboratory Medicine and Dermatology, Geisinger Medical Center, Danville, PA, USA
| | - Bolni Marius Nagalo
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 845, Little Rock, AR, 72205, USA
| | - Behjatolah Montzavi-Karbassi
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 845, Little Rock, AR, 72205, USA
| | - Steven R Post
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 845, Little Rock, AR, 72205, USA
| | - Richard W Nicholas
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Thomas Kelly
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 845, Little Rock, AR, 72205, USA.
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4
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Li Z, Zhang X, Ding L, Jing J, Gu HQ, Jiang Y, Meng X, Du C, Wang C, Wang M, Xu M, Zhang Y, Hu M, Li H, Gong X, Dong K, Zhao X, Wang Y, Liu L, Xian Y, Peterson E, Fonarow GC, Schwamm LH, Wang Y. Rationale and design of the GOLDEN BRIDGE II: a cluster-randomised multifaceted intervention trial of an artificial intelligence-based cerebrovascular disease clinical decision support system to improve stroke outcomes and care quality in China. Stroke Vasc Neurol 2024:svn-2023-002411. [PMID: 37699726 DOI: 10.1136/svn-2023-002411] [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: 02/20/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease. AIMS To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality. DESIGN The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study. A total of 80 hospitals in China were randomly assigned to the AI-CDSS intervention group or the control group. For eligible participants with acute ischaemic stroke in the AI-CDSS intervention group, cerebrovascular disease AI-CDSS will provide AI-assisted imaging analysis, auxiliary stroke aetiology and pathogenesis analysis, and guideline-based treatment recommendations. In the control group, patients will receive the usual care. The primary outcome is the occurrence of new vascular events (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction or vascular death) at 3 months after stroke onset. The sample size was estimated to be 21 689 with a 26% relative reduction in the incidence of new composite vascular events at 3 months by using multiple quality-improving interventions provided by AI-CDSS. All analyses will be performed according to the intention-to-treat principle and accounted for clustering using generalised estimating equations. CONCLUSIONS Once the effectiveness is verified, the cerebrovascular disease AI-CDSS could improve stroke care and outcomes in China. TRIAL REGISTRATION NUMBER NCT04524624.
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Affiliation(s)
- Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinmiao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lingling Ding
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunying Du
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Meng Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Man Xu
- Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yanxu Zhang
- Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Meera Hu
- Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Kehui Dong
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ying Xian
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eric Peterson
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregg C Fonarow
- Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Clinical Center for Precision Medicine in Stroke, Capital Medical Universit, Beijing, China
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Terry LG, Peterson E, Summers RS. Organic matter biofiltration performance modeling: Influence of influent water quality, operating conditions, and biomass. Water Res 2024; 249:121006. [PMID: 38141435 DOI: 10.1016/j.watres.2023.121006] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Abstract
The impact of source water dissolved organic matter (DOM) origin, empty bed contact time (EBCT), temperature, and pretreatment methods on biofiltration performance was evaluated and predictive models based on experimental data were developed. Three DOM source water types, terrestrial, microbial, and treated wastewater (WW) effluent, were utilized. A model was developed to predict biofilter performance for dissolved organic carbon (DOC) removal based on the influent biodegradable DOC (BDOC) fraction, a single active biomass measurement from the top of the filter and the filter EBCT. A biomass distribution model was developed to predict total active biomass throughout the filter based on a single biomass measurement from the top of the filter. The measured BDOC fractions were 21 % for the nonWW impacted source waters, 36 % for the WW effluents and 62 % for the ozonated WW effluents. At an EBCT of 15 min, biofilters removed between 7 and 21 % of the DOC (19 to 50 % for BDOC) depending on the DOM type and use of ozonation. When the EBCT decreased to 5 min DOC removal decreased by 40 % and when increased to 30 min removal increased by 42 %. When the temperature decreased from 22 °C to 6 °C DOC removal was 33 % lower and when increased to 28 °C removal was 42 % higher. ATP values were found to be a function of temperature and DOM origin, as the average ATP values from the WW effluent biofilters were almost double that of the non-WW impacted sources and pre-ozonation of the WW effluent yielded values three times higher. The model was applied to the results of 27 different biofilter runs at three EBCTs yielding one distinct rate constant for the non-WW impacted source waters and one rate constant for the WW effluents. The model was successfully applied to the results of 19 filter runs from the literature and to those from a pilot plant over 6 months of operation.
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Affiliation(s)
- Leigh G Terry
- Department of Civil, Construction, and Environmental Engineering, University of Alabama, Box 870205, Tuscaloosa, AL 35487, USA
| | - Eric Peterson
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado at Boulder, UCB 428, Boulder, CO 80309, USA
| | - R Scott Summers
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado at Boulder, UCB 428, Boulder, CO 80309, USA.
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Meza I, Hua H, Gagnon K, Mulchandani A, Gonzalez-Estrella J, Burns PC, Ali AMS, Spilde M, Peterson E, Lichtner P, Cerrato JM. Removal of Aqueous Uranyl and Arsenate Mixtures after Reaction with Limestone, PO 43-, and Ca 2. Environ Sci Technol 2023; 57:20881-20892. [PMID: 38019567 PMCID: PMC10739782 DOI: 10.1021/acs.est.3c03809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The co-occurrence of uranyl and arsenate in contaminated water caused by natural processes and mining is a concern for impacted communities, including in Native American lands in the U.S. Southwest. We investigated the simultaneous removal of aqueous uranyl and arsenate after the reaction with limestone and precipitated hydroxyapatite (HAp, Ca10(PO4)6(OH)2). In benchtop experiments with an initial pH of 3.0 and initial concentrations of 1 mM U and As, uranyl and arsenate coprecipitated in the presence of 1 g L-1 limestone. However, related experiments initiated under circumneutral pH conditions showed that uranyl and arsenate remained soluble. Upon addition of 1 mM PO43- and 3 mM Ca2+ in solution (initial concentration of 0.05 mM U and As) resulted in the rapid removal of over 97% of U via Ca-U-P precipitation. In experiments with 2 mM PO43- and 10 mM Ca2+ at pH rising from 7.0 to 11.0, aqueous concentrations of As decreased (between 30 and 98%) circa pH 9. HAp precipitation in solids was confirmed by powder X-ray diffraction and scanning electron microscopy/energy dispersive X-ray. Electron microprobe analysis indicated U was coprecipitated with Ca and P, while As was mainly immobilized through HAp adsorption. The results indicate that natural materials, such as HAp and limestone, can effectively remove uranyl and arsenate mixtures.
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Affiliation(s)
- Isabel Meza
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131, United States
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Han Hua
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131, United States
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Kaelin Gagnon
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131, United States
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Anjali Mulchandani
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131, United States
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Jorge Gonzalez-Estrella
- School of Civil and Environmental Engineering, College of Engineering, Architecture, and Technology, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - Peter C Burns
- Department of Civil and Environmental Engineering and Earth Sciences and Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Abdul-Mehdi S Ali
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Michael Spilde
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Eric Peterson
- Department of Earth and Planetary Sciences, MSC03 2040, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Peter Lichtner
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - José M Cerrato
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, Albuquerque, New Mexico 87131, United States
- Center for Water and the Environment, University of New Mexico, Albuquerque, New Mexico 87131, United States
- UNM Metals Exposure and Toxicity Assessment on Tribal Lands in the Southwest (UNM METALS) Superfund Research Program Center, Albuquerque,New Mexico 87131, United States
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7
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Reiter PD, Bianchini ML, Dietrich S, Soles SA, Bacher RS, Finical KL, Peterson E, Neubrand T. Postintubation Sedation Practices Within Multiple Emergency Departments Across a Large Pediatric Health Care Organization. Pediatr Emerg Care 2023; 39:863-868. [PMID: 36943935 DOI: 10.1097/pec.0000000000002921] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Children requiring rapid or standard sequence intubation are at risk of experiencing paralysis without adequate sedation when the duration of neuromuscular blockade exceeds the duration of sedation provided by the induction agent. The objective of this study was to evaluate the rate of appropriately timed postintubation sedation (PIS; defined as the administration of PIS before the clinical effects of the induction agent have dissipated) in patients requiring intubation across multiple emergency department/urgent care sites within a large pediatric health care organization. METHODS This retrospective cohort study included patients admitted to 1 of 6 affiliated pediatric emergency department or urgent care sites who were intubated with an induction agent and neuromuscular blocker between January 2016 and December 2021. Patients were excluded if they were intubated in the setting of status epilepticus or cardiac arrest. Stepwise logistic regression identified factors associated with appropriately timed PIS. RESULTS A total of 283 patients met the inclusion criteria (mean age, 8 ± 7.6 years; 56% male). Two hundred thirty-eight patients (83%) received some form of PIS (105 [37%] received appropriately timed PIS and 133 [47%] received delayed PIS), and 45 patients (16%) received no PIS. The median time to receive PIS following administration of the induction agent was 21 minutes (interquartile range, 11-40 minutes). Patients induced with fentanyl were the least likely to receive PIS, whereas patients induced with etomidate were the most likely. However, because of the short duration of etomidate, most patients induced with etomidate failed to receive PIS in a timely manner. CONCLUSIONS Delayed PIS is common and may result in periods of ongoing paralysis without adequate sedation. Emergency department providers and pharmacists must recognize the brevity of some induction agents and provide more timely PIS.
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8
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Luther E, McCarthy D, Hect J, Burks J, Lu VM, Govindarajan V, Ramsay IA, King H, Silva MA, Abdelsalam A, Yavagal D, Peterson E, Starke RM, Morcos J. Transradial Access Failures During Neuroangiography for Patients With Moyamoya. Neurosurgery 2023; 93:366-372. [PMID: 36847520 PMCID: PMC10586839 DOI: 10.1227/neu.0000000000002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. OBJECTIVE To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. METHODS A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. RESULTS Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. CONCLUSION Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jasmine Hect
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M. Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ian A. Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hunter King
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A. Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric Peterson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jacques Morcos
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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9
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Porter S, Liu CH, Pham H, DeLaRiva A, Peterson E, House S, Watt J, Kyriakidou EA, Datye AK. Formation of Pt-Pd 'Janus' Biphasic Particles During High-Temperature Aging of Diesel Oxidation Catalysts. Microsc Microanal 2023; 29:1599-1601. [PMID: 37613891 DOI: 10.1093/micmic/ozad067.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Stephen Porter
- Department of Chemical and Biological Engineering and Center for Microengineered Materials, University of New Mexico, Albuquerque, NM, United States
| | - Chih Han Liu
- University at Buffalo, Department of Chemical and Biological Engineering, The State University of New York, Buffalo, NY, United States
| | - Hien Pham
- Department of Chemical and Biological Engineering and Center for Microengineered Materials, University of New Mexico, Albuquerque, NM, United States
| | - Andrew DeLaRiva
- Department of Chemical and Biological Engineering and Center for Microengineered Materials, University of New Mexico, Albuquerque, NM, United States
| | - Eric Peterson
- Department of Chemical and Biological Engineering and Center for Microengineered Materials, University of New Mexico, Albuquerque, NM, United States
| | - Stephen House
- Center for Integrated Nanotechnologies, Sandia National Laboratories, Albuquerque, NM, United States
| | - John Watt
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Eleni A Kyriakidou
- University at Buffalo, Department of Chemical and Biological Engineering, The State University of New York, Buffalo, NY, United States
| | - Abhaya K Datye
- Department of Chemical and Biological Engineering and Center for Microengineered Materials, University of New Mexico, Albuquerque, NM, United States
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10
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Jaeger AS, Crooks CM, Weiler AM, Bliss MI, Rybarczyk S, Richardson A, Einwalter M, Peterson E, Capuano S, Barkhymer A, Becker JT, Greene JT, Freedman TS, Langlois RA, Friedrich TC, Aliota MT. Primary infection with Zika virus provides one-way heterologous protection against Spondweni virus infection in rhesus macaques. Sci Adv 2023; 9:eadg3444. [PMID: 37390207 PMCID: PMC10313173 DOI: 10.1126/sciadv.adg3444] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/30/2023] [Indexed: 07/02/2023]
Abstract
Spondweni virus (SPONV) is the closest known relative of Zika virus (ZIKV). SPONV pathogenesis resembles that of ZIKV in pregnant mice, and both viruses are transmitted by Aedes aegypti mosquitoes. We aimed to develop a translational model to further understand SPONV transmission and pathogenesis. We found that cynomolgus macaques (Macaca fascicularis) inoculated with ZIKV or SPONV were susceptible to ZIKV but resistant to SPONV infection. In contrast, rhesus macaques (Macaca mulatta) supported productive infection with both ZIKV and SPONV and developed robust neutralizing antibody responses. Crossover serial challenge in rhesus macaques revealed that SPONV immunity did not protect against ZIKV infection, whereas ZIKV immunity was fully protective against SPONV infection. These findings establish a viable model for future investigation into SPONV pathogenesis and suggest that the risk of SPONV emergence is low in areas with high ZIKV seroprevalence due to one-way cross-protection between ZIKV and SPONV.
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Affiliation(s)
- Anna S. Jaeger
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Saint Paul, Minnesota, USA
| | - Chelsea M. Crooks
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mason I. Bliss
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sierra Rybarczyk
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alex Richardson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Morgan Einwalter
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Eric Peterson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alison Barkhymer
- Department of Microbiology and Immunology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Jordan T. Becker
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Joseph T. Greene
- Department of Pharmacology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Tanya S. Freedman
- Department of Pharmacology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
- Center for Immunology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Ryan A. Langlois
- Department of Microbiology and Immunology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Saint Paul, Minnesota, USA
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11
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Hackett A, Luther E, Huang E, Walker A, Brim WR, Maddy K, Burks J, Lu VM, Silva MA, Peterson E. Transradial Flow-Diverting Stent Placement Through an Arteria Lusoria: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e438. [PMID: 36723287 DOI: 10.1227/ons.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/28/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ashia Hackett
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Cantu-Martinez O, Martinez Manzano JM, Peterson E, Tito S, Prendergast A, Jarrett SA, Chiang B, Wattoo A, Benzaquen S, Lo KB, Amanullah A. Clinical characteristics and treatment of patients with central pulmonary embolism and right heart thrombus. Echocardiography 2023. [PMID: 37212381 DOI: 10.1111/echo.15592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Right heart thrombus (RHT), also known as clot in transit, is an uncommon finding in pulmonary embolism (PE) that is associated with increased inpatient mortality. To date, there is no consensus on the management of RHT. Therefore, we aim to describe the clinical features, treatments, and outcomes of patients with simultaneous RHT and PE. METHODS This is a retrospective, cross-sectional, and single-center study of hospitalized patients with central PE who had RHT visualized on transthoracic echocardiography (TTE) from January 2012 to May 2022. We use descriptive statistics to describe their clinical features, treatments, and outcomes, including mechanical ventilation, major bleeding, inpatient mortality, length of hospital stay, and recurrent PE on follow-up. RESULTS Of 433 patients with central PE who underwent TTE, nine patients (2%) had RHT. The median age was 63 years (range 29-87), most were African American (6/9), and females (5/9). All patients had evidence of RV dysfunction and received therapeutic anticoagulation. Eight patients received RHT-directed interventions, including systemic thrombolysis (2/9), catheter-directed suction embolectomy (4/9), and surgical embolectomy (2/9). Regarding outcomes, 4/9 patients were hemodynamically unstable, 8/9 were hypoxemic, and 2/9 were mechanically ventilated. The median length of hospital stay was six days (range 1-16). One patient died during hospital admission, and two patients had recurrent PE. CONCLUSION We described the different therapeutic approaches and outcomes of patients with RHT treated in our institution. Our study adds valuable information to the literature, as there is no consensus on the treatment of RHT. HIGHLIGHTS Right heart thrombus (RHT) was a rare finding in central pulmonary embolism. Most patients with RHT had evidence of RV dysfunction and pulmonary hypertension. Most patients received RHT-directed therapies in addition to therapeutic anticoagulation.
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Affiliation(s)
- Omar Cantu-Martinez
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jose Manuel Martinez Manzano
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eric Peterson
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Albert Einstein Medical Center Philadelphia, Philadelphia, USA
| | - Sahana Tito
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander Prendergast
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Simone A Jarrett
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brenda Chiang
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ammaar Wattoo
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sadia Benzaquen
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Pulmonary and Critical Care Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, USA
| | - Kevin Bryan Lo
- Department of Medicine, Albert Einstein Medical Center Philadelphia 5501 Old York Road, Philadelphia, Pennsylvania, USA
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aman Amanullah
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Albert Einstein Medical Center Philadelphia, Philadelphia, USA
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13
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Badalassi V, Sircar A, Solberg JM, Bae JW, Borowiec K, Huang P, Smolentsev S, Peterson E. FERMI: Fusion Energy Reactor Models Integrator. Fusion Science and Technology 2023. [DOI: 10.1080/15361055.2022.2151818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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14
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Moore SM, Welsh MC, Peterson E. Childhood maltreatment predicts physical health in college students. J Am Coll Health 2023; 71:942-951. [PMID: 34152945 DOI: 10.1080/07448481.2021.1909047] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective: Childhood maltreatment (CM) is associated with physical health problems throughout the lifespan, yet more research is needed regarding the trajectory of health problems (e.g., onset of health risk indicators) in young adults. The current study examined whether college students self-reporting higher levels of CM exhibited poorer physical health outcomes. Method: Young adults in college (N = 100) completed a physical health assessment (heart rate, body mass index (BMI), blood pressure, blood sugar, waist circumference), self-reported measures of health (symptoms of illness), and CM during spring semester 2018. Results: CM scores predicted higher heart rate and increased symptoms of illness. Females with maltreatment history presented higher levels of obesity and more metabolic syndrome conditions than their peers. Conclusions: Findings support the importance of examining the trajectory of CM to chronic disease, as health risk indicators are present in young adults.
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Affiliation(s)
- Susannah M Moore
- School of Psychological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Marilyn C Welsh
- School of Psychological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Eric Peterson
- School of Psychological Sciences, University of Northern Colorado, Greeley, Colorado, USA
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15
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Lo KB, Essa H, Wattoo A, Gulab A, Akhtar H, Sudani HA, Angelim L, Helfman B, Peterson E, Brousas S, Whybrow-Huppatz I, Yazdanyar A, Sankaranarayanan R, Rangaswami J. Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review. Curr Probl Cardiol 2023; 48:101047. [PMID: 34785259 DOI: 10.1016/j.cpcardiol.2021.101047] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
Patients with advanced chronic kidney disease (CKD) have largely been excluded from randomized control trials (RCTs) in heart failure (HF). This creates a paucity of high quality evidence for guideline directed medical therapy (GDMT), particularly in patients with heart failure with reduced ejection fraction (HFrEF) and CKD. This is a systematic review looking at the patterns and rates of inclusion of CKD in RCTs among patients with HFrEF. The search included RCTs from January 2010 to December 2020. A heat map was constructed to reflect the stages of CKD stages. The percentage of studies that included advanced CKD (stages IV-V) was recorded and log transformed, and then fitted into a time regression model. A P value of <0.05 was considered statistically significant. Out of the 3052 screened, 706 studies were included in the analysis. Only 61% of the RCTs reported at least some information on kidney function. There was a trend of increase in percentage of studies that included CKD stages IV-V from years 2010 to 2020. This was confirmed with a statistically significant linear trend P = 0.02 while the percentage of studies that included dialysis and kidney transplant recipients remained consistently low. There is a paucity of high-quality evidence for GDMT in the HFrEF population with CKD, particularly in those with advanced non-dialytic CKD, those on maintenance dialysis and kidney transplant recipients. There is a pressing need for wider inclusion of patients with advanced CKD in RCTs of GDMT in HFrEF.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
| | - Ammaar Wattoo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Asma Gulab
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Hamza Akhtar
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Hussein Al Sudani
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Lucas Angelim
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Beth Helfman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Eric Peterson
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Sophia Brousas
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Ali Yazdanyar
- Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Medicine, Lincoln Medical Center, New York, NY
| | - Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
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16
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Kyaw NTT, Kipperman N, Alroy KA, Baumgartner J, Crawley A, Peterson E, Ross A, Fowler RC, Ruiz VE, Leelawong M, Hughes S, Juste-Tranquille M, Lovingood K, Joe CD, Chase M, Shinall A, Ackelsberg J, Bergeron-Parent C, Badenhop B, Slavinski S, Reddy V, Lee EH. Notes from the Field: Clinical and Epidemiologic Characteristics of Mpox Cases from the Initial Phase of the Outbreak - New York City, May 19-July 15, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1631-1633. [PMID: 36580429 PMCID: PMC9812443 DOI: 10.15585/mmwr.mm715152a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Thornton A, Peterson E, Thomas A, Regouski M, Liu Y, White K, Davies C, Polejaeva I, Rutigliano H. 86 The role of extracellular vesicles in immunomodulation during bovine pregnancy. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab86] [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: 12/12/2022] Open
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18
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Shavadia JS, Wilson J, Edmonston D, Platt A, Ephraim P, Hall R, Goldstein BA, Boulware LE, Peterson E, Pendergast J, Scialla JJ. Corrigendum to "Statins and atherosclerotic cardiovascular outcomes in patients on incident dialysis and with atherosclerotic heart disease" [Am Heart J (2021) 231:36-44]. Am Heart J 2022; 253:99-100. [PMID: 35934528 DOI: 10.1016/j.ahj.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jay S Shavadia
- Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke Clinical Research Institute, Durham, NC.
| | - Jonathan Wilson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Daniel Edmonston
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Alyssa Platt
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Patti Ephraim
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Durham, NC; Baltimore, MD
| | - Rasheeda Hall
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Benjamin A Goldstein
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - L Ebony Boulware
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Eric Peterson
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jane Pendergast
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Julia J Scialla
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
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19
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Pelayo J, Lo KB, Sultan S, Quintero E, Peterson E, Salacupa G, Zanoria MA, Guarin G, Helfman B, Sanon J, Mathew R, Yazdanyar A, Navarro V, Pressman G, Rangaswami J. Invasive hemodynamic parameters in patients with hepatorenal syndrome. IJC Heart & Vasculature 2022; 42:101094. [PMID: 36032268 PMCID: PMC9399284 DOI: 10.1016/j.ijcha.2022.101094] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/28/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
Background Hepatorenal syndrome (HRS), a form of kidney dysfunction frequent in cirrhotic patients, is characterized by low filling pressures and impaired kidney perfusion due to peripheral vasodilation and reduced effective circulatory volume. Cardiorenal syndrome (CRS), driven by renal venous hypertension and elevated filling pressures, is a separate cause of kidney dysfunction in cirrhotic patients. The two entities, however, have similar clinical phenotypes. To date, limited invasive hemodynamic data are available to help distinguish the primary forces behind worsened kidney function in cirrhotic patients. Objective Our aim was to analyze invasive hemodynamic profiles and kidney outcomes in patients with cirrhosis who met criteria for HRS. Methods We conducted a single center retrospective study among cirrhotic patients with worsening kidney function admitted for liver transplant evaluation between 2010 and 2020. All met accepted criteria for HRS and underwent concurrent right heart catheterization (RHC). Results 127 subjects were included. 79 had right atrial pressure >10 mmHg, 79 had wedge pressure >15 mmHg, and 68 had both. All patients with elevated wedge pressure were switched from volume loading to diuretics resulting in significant reductions between admission and post diuresis creatinine values (2.0 [IQR 1.5–2.8] vs 1.5 [IQR 1.2–2.2]; p = 0.003). Conclusion 62% of patients diagnosed with HRS by clinical criteria have elevated filling pressures. Improvement of renal function after diuresis suggests the presence of CRS physiology in these patients. Invasive hemodynamic data profiling can lead to meaningful change in management of cirrhotic patients with worsened kidney function, guiding appropriate therapies based on filling pressures.
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Affiliation(s)
- Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
- Corresponding author at: 5501 Old York Road, Philadelphia, PA 19141, United States.
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Sahar Sultan
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Eduardo Quintero
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Grace Salacupa
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | | | - Geneva Guarin
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Beth Helfman
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Julien Sanon
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital-Cedar Crest, Allentown, PA, United States
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Roy Mathew
- Division of Nephrology, VA Health Care System, Loma Linda University, CA, United States
| | - Ali Yazdanyar
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital-Cedar Crest, Allentown, PA, United States
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Victor Navarro
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
- Division of Liver Disease and Transplantation, Einstein Medical Center, Philadelphia, PA, United States
| | - Gregg Pressman
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA, United States
| | - Janani Rangaswami
- Department of Medicine, George Washington University, Washington, DC, United States
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Huang Y, Negrete J, Wagener J, Fralick C, Rodriguez A, Peterson E, Wosotowsky A. Graph neural networks and cross-protocol analysis for detecting malicious IP addresses. COMPLEX INTELL SYST 2022; 9:1-13. [PMID: 36120119 PMCID: PMC9471032 DOI: 10.1007/s40747-022-00838-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
Abstract
An internet protocol (IP) address is the foundation of the Internet, allowing connectivity between people, servers, Internet of Things, and services across the globe. Knowing what is connecting to what and where connections are initiated is crucial to accurately assess a company's or individual's security posture. IP reputation assessment can be quite complex because of the numerous services that may be hosted on that IP address. For example, an IP might be serving millions of websites from millions of different companies like web hosting companies often do, or it could be a large email system sending and receiving emails for millions of independent entities. The heterogeneous nature of an IP address typically makes it challenging to interpret the security risk. To make matters worse, adversaries understand this complexity and leverage the ambiguous nature of the IP reputation to exploit further unsuspecting Internet users or devices connected to the Internet. In addition, traditional techniques like dirty-listing cannot react quickly enough to changes in the security climate, nor can they scale large enough to detect new exploits that may be created and disappear in minutes. In this paper, we introduce the use of cross-protocol analysis and graph neural networks (GNNs) in semi-supervised learning to address the speed and scalability of assessing IP reputation. In the cross-protocol supervised approach, we combine features from the web, email, and domain name system (DNS) protocols to identify ones which are the most useful in discriminating suspicious and benign IPs. In our second experiment, we leverage the most discriminant features and incorporate them into the graph as nodes' features. We use GNNs to pass messages from node to node, propagating the signal to the neighbors while also gaining the benefit of having the originating nodes being influenced by neighboring nodes. Thanks to the relational graph structure we can use only a small portion of labeled data and train the algorithm in a semi-supervised approach. Our dataset represents real-world data that is sparse and only contain a small percentage of IPs with verified clean or suspicious labels but are connected. The experimental results demonstrate that the system can achieve 85.28 % accuracy in detecting malicious IP addresses at scale with only 5 % of labeled data.
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21
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Swiatek K, Peterson E, Gupta L, Timoney P. Pediatric cavernous sinus and superior ophthalmic vein thrombophlebitis complicated by peri-venous orbital abscesses. Am J Ophthalmol Case Rep 2022; 27:101640. [PMID: 35813589 PMCID: PMC9263864 DOI: 10.1016/j.ajoc.2022.101640] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This case report documents a 13-year-old male with bilateral cavernous sinus thrombosis and left superior ophthalmic vein thrombosis secondary to sphenoid sinusitis who subsequently developed peri-venous orbital abscesses. Observations Although the patient initially improved clinically with intravenous antibiotic therapy and therapeutic anticoagulation, his symptoms returned and repeat imaging demonstrated two well-circumscribed, rim-enhancing lesions in the left orbit concerning for abscesses. Surgical intervention revealed that these purulent collections were contiguous with the superior and inferior ophthalmic veins with the superior collection also containing hemorrhagic material. Despite aggressive management, the abscess in the inferolateral orbit recurred, requiring repeat surgical intervention. The patient was ultimately discharged on parenteral antibiotics and anticoagulation, and on outpatient follow-up, there was no evidence of recurrence. Conclusions and Importance This case report describes a pediatric patient with bilateral cavernous sinus thrombosis who developed the rare complication of multiple peri-venous orbital abscesses despite appropriate treatment with antibiotics. The patient's complex clinical course highlights the importance of prompt repeat imaging and possible surgical intervention upon clinical changes, especially in patients with infections from the Streptococcus milleri group.
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Affiliation(s)
- Kayla Swiatek
- University of Kentucky, College of Medicine 800 Rose Street, MN 150, Lexington, KY, 40506, USA
| | - Eric Peterson
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
| | - Lalita Gupta
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
| | - Peter Timoney
- University of Kentucky, Department of Ophthalmology, 110 Conn Terrace, Lexington, KY, 40508, USA
- Corresponding author. University of Kentucky Advanced Eye Care, 110 Conn Terrace, Lexington, KY, 40508, USA.
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22
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Pellikka PA, Strom JB, Pajares-Hurtado GM, Keane MG, Khazan B, Qamruddin S, Tutor A, Gul F, Peterson E, Thamman R, Watson S, Mandale D, Scott CG, Naqvi T, Woodward GM, Hawkes W. Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19. Front Cardiovasc Med 2022; 9:937068. [PMID: 35935624 PMCID: PMC9353267 DOI: 10.3389/fcvm.2022.937068] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background As automated echocardiographic analysis is increasingly utilized, continued evaluation within hospital settings is important to further understand its potential value. The importance of cardiac involvement in patients hospitalized with COVID-19 provides an opportunity to evaluate the feasibility and clinical relevance of automated analysis applied to limited echocardiograms. Methods In this multisite US cohort, the feasibility of automated AI analysis was evaluated on 558 limited echocardiograms in patients hospitalized with COVID-19. Reliability of automated assessment of left ventricular (LV) volumes, ejection fraction (EF), and LV longitudinal strain (LS) was assessed against clinically obtained measures and echocardiographic findings. Automated measures were evaluated against patient outcomes using ROC analysis, survival modeling, and logistic regression for the outcomes of 30-day mortality and in-hospital sequelae. Results Feasibility of automated analysis for both LVEF and LS was 87.5% (488/558 patients). AI analysis was performed with biplane method in 300 (61.5%) and single plane apical 4- or 2-chamber analysis in 136 (27.9%) and 52 (10.7%) studies, respectively. Clinical LVEF was assessed using visual estimation in 192 (39.3%), biplane in 163 (33.4%), and single plane or linear methods in 104 (21.2%) of the 488 studies; 29 (5.9%) studies did not have clinically reported LVEF. LV LS was clinically reported in 80 (16.4%). Consistency between automated and clinical values demonstrated Pearson's R, root mean square error (RMSE) and intraclass correlation coefficient (ICC) of 0.61, 11.3% and 0.72, respectively, for LVEF; 0.73, 3.9% and 0.74, respectively for LS; 0.76, 24.4ml and 0.87, respectively, for end-diastolic volume; and 0.82, 12.8 ml, and 0.91, respectively, for end-systolic volume. Abnormal automated measures of LVEF and LS were associated with LV wall motion abnormalities, left atrial enlargement, and right ventricular dysfunction. Automated analysis was associated with outcomes, including survival. Conclusion Automated analysis was highly feasible on limited echocardiograms using abbreviated protocols, consistent with equivalent clinically obtained metrics, and associated with echocardiographic abnormalities and patient outcomes.
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Affiliation(s)
- Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Patricia A. Pellikka
| | - Jordan B. Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Gabriel M. Pajares-Hurtado
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Martin G. Keane
- Temple Heart and Vascular Center, Philadelphia, PA, United States
| | - Benjamin Khazan
- Temple Heart and Vascular Center, Philadelphia, PA, United States
| | | | - Austin Tutor
- Ochsner Health System, New Orleans, LA, United States
| | - Fahad Gul
- Einstein Medical Center, Philadelphia, PA, United States
| | - Eric Peterson
- Einstein Medical Center, Philadelphia, PA, United States
| | - Ritu Thamman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shivani Watson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Deepa Mandale
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Christopher G. Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Tasneem Naqvi
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, United States
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23
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Peterson E, Gupta A, Wang Y, Gillard K, Israel M, Navar AM, Kolkailah A. Lipid-Lowering Therapy for Primary Prevention of Cardiovascular Disease: A Nationwide Analysis of 440,721 Patients. J Clin Lipidol 2022. [DOI: 10.1016/j.jacl.2022.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Al Sudani H, Lo KB, Essa H, Wattoo A, Gulab A, Akhtar H, Angelim L, Helfman B, Peterson E, Brousas S, Whybrow-Huppatz I, Yazdanyar A, Soman S, Sankaranarayanan R, Rangaswami J. Differences in ejection fraction as inclusion criterion in randomized controlled trials among patients with heart failure with reduced ejection fraction: a systematic review. Expert Rev Cardiovasc Ther 2022; 20:481-484. [PMID: 35654018 DOI: 10.1080/14779072.2022.2085687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Heart failure (HF) with reduced ejection fraction (HFrEF) has been defined by varying ejection fraction (EF) criteria in clinical trials, leading to differences in quantifying treatment effects. AREAS COVERED The definitions of HFrEF in randomized controlled trials from 2010 until 2020 were collected. The EF ranges were clustered into very low (<30%), low (30-39%) and mildly reduced (40-49%) stratified by intervention. Time series regression analysis was performed.A total of 3052 articles were screened and 706 were included. Interventions included were pharmacologic (37%), device therapy (10%) and 53% a combination of programs, procedural, and laboratory testing. By EF cutoffs, 41% of the studies utilized <40% while 26% used <35%. About 31% did not have a clearly defined EF. Between 2010-2020, studies with HFrEF ranges 30-39% have significantly decreased (p value<0.001 for trend) but those which included very low EF (<30%) and mildly reduced EF (40-49%) have remained the same. Expert opinion:EF definitions across clinical trials in HFrEF varied widely. Defining the specific target HF population phenotype when designing trials or in patient treatment is important as various beneficial effects of different heart failure treatment modalities can be modified or even attenuated across the spectrum of EF.
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Affiliation(s)
- Hussein Al Sudani
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Ammaar Wattoo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Asma Gulab
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hamza Akhtar
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Lucas Angelim
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Beth Helfman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Sophia Brousas
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | - Sandeep Soman
- Department of Nephrology, Henry Ford Hospital, Detroit, MI 48202 USA
| | - Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Janani Rangaswami
- George Washington University School of Medicine, Washington, DC, USA
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25
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McGraw MK, Osborn L, Berg M, Byrum S, Berquist M, Peterson E. Methamphetamine‐Induced Proteomic Changes Within the Neuroinflammatory TLR4 Pathway Persist After Long‐Term Self‐Administration in Rats. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Madison K. McGraw
- Department of Pharmacology and ToxicologyUniversity of Arkansas for Medical SciencesLittle RockAR
| | - Laura Osborn
- University of Arkansas for Medical SciencesLittle RockAR
| | - Madison Berg
- University of Arkansas for Medical SciencesLittle RockAR
| | | | | | - Eric Peterson
- University of Arkansas for Medical SciencesLittle RockAR
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26
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Peterson E, Maust RL, Jasti R, Kertesz M, Tovar JD. Splitting the Ring: Impact of Ortho and Meta Pi Conjugation Pathways through Disjointed [8]Cycloparaphenylene Electronic Materials. J Am Chem Soc 2022; 144:4611-4622. [PMID: 35245032 DOI: 10.1021/jacs.2c00419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this report, we describe the synthesis and electronic properties of small-molecule and polymeric [8]cycloparaphenylenes ([8]CPPs) with disjointed pi-conjugated substituents. Arylene-ethynylene linkers were installed on opposite sides of the [8]CPP nanohoop as separated by three phenyl units on either side such that the monomer systems have syn (C2 symmetry) and anti (C1 symmetry) conformers with a small energy gap (0.1-0.6 kcal/mol). This disjoined substitution pattern necessarily forces delocalization through and around the CPP radial structure. We demonstrate new electronic states from this radial/linear mixing in both the small molecules and the pi extended polymers. Quantum chemical calculations reveal that these electronic processes arise from multiple operative radial/linear conjugation pathways, as the disjoint pattern results in both ortho and meta connections to the CPP ring. These results affirm the unique nature of hybrid radial and linear pi electron delocalization operative in these new conjugation pathways.
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Affiliation(s)
- Eric Peterson
- Department of Chemistry, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218, United States
| | - Ruth L Maust
- Department of Chemistry and Biochemistry, Materials Science Institute, and Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, Oregon 97403, United States
| | - Ramesh Jasti
- Department of Chemistry and Biochemistry, Materials Science Institute, and Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, Oregon 97403, United States
| | - Miklos Kertesz
- Chemistry Department and Institute of Soft Matter, Georgetown University, 37th and O Streets, NW, Washington, D.C. 20057, United States
| | - John D Tovar
- Department of Chemistry, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218, United States.,Department of Materials Science and Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218, United States
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27
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Luther EM, Huang E, King H, Peterson E. Iatrogenic radial arteriovenous fistula closure via intraluminal compression in a patient with fibromuscular dysplasia. BMJ Case Rep 2022; 15:e248085. [PMID: 35241449 PMCID: PMC8895944 DOI: 10.1136/bcr-2021-248085] [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] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is an arteriopathy of medium-sized vessels causing pathological arterial wall fragility. However, only minimal data exist on evaluating the risk of transradial access (TRA) in these patients. We describe the case of a woman in her 70s who underwent left middle meningeal artery embolisation for an acute-on-chronic subdural haematoma via right TRA. Radial angiography demonstrated significant FMD throughout the entire right upper extremity. To prevent radial spasm, a 23 cm sheath was placed without difficulty. However, follow-up angiography demonstrated the presence of a new radial arteriovenous fistula (AVF) just distal to the brachial bifurcation. Since no forearm haematoma or limb ischaemia developed, the procedure was continued transradially. After embolisation, the guide catheter was removed and follow-up angiography demonstrated resolution of the fistula. This case illustrates that, in the absence of concerning clinical signs, compression from the guide catheter alone may facilitate thrombosis of an acutely identified iatrogenic radial AVF.
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Affiliation(s)
- Evan M Luther
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Eric Huang
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Hunter King
- Neurological Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Eric Peterson
- Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
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28
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Hawkes W, Keane MG, Khazan B, QAMRUDDIN SALIMA, Tutor A, Thamman R, Naqvi TZ, Mandale D, Strom JB, Hurtado GP, Peterson E, Gul FI, Watson S, Tilkes K, Davidson H, Scott C, Piotrowska H, Hansen WH, Woodward G, Pellikka PA. FULLY AUTOMATED ANALYSIS OF CARDIAC POINT OF CARE ULTRASOUND: FEASIBILITY AND CLINICAL RELEVANCE IN COVID-19 PATIENTS. J Am Coll Cardiol 2022. [PMCID: PMC8972461 DOI: 10.1016/s0735-1097(22)02998-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Peterson E, Kovacik R, Lo KB, Brito D, Antonio E, Quintero E, Barrett L, Pressman GS. Global longitudinal strain to identify low-risk patients with suspected ACS. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Albert Einstein Society
Background
Determining which chest pain presentations should be treated and considered an acute coronary syndrome/myocardial infarction (ACS/MI) versus those with non-cardiac chest pain (NCCP) can be difficult. Initial evaluation of suspected ACS requires assessment of presenting symptoms, risk factors, ECG, and cardiac biomarkers. Bedside echocardiography can assist in rapid assessment of suspected ACS through measurement of echocardiographic wall motion score index and left ventricular ejection fraction, though the sensitivity of these measurements has been called into question. Global longitudinal strain (GLS) has been associated with significant CAD and has been found to be more reproducible than LVEF. However, its utility in rapid ED evaluation of chest pain remains under-explored.
Purpose
Assess the utility of speckle-tracking strain in addition to clinical and demographic factors in identification of low-risk patients among those presenting to the ED with suspected ACS.
Methods
This was a retrospective single center study of 434 hospitalized patients aged 18 years or older in whom ACS (excluding STEMI) was suspected by ED assessment, from 9/1/2015 – 12/31/2019. Echocardiography within 24 hours of admission was analyzed, with left ventricular global longitudinal strain (LVGLS) obtained via AutoSTRAIN software (TOMTEC Imaging Systems GmbH). Patients were identified as having NCCP (n = 158, 36%), myocardial injury (n = 110, 25%), or MI (n = 166, 38%; subdivided into NSTEMI [n = 74, 44.6%] and type II MI [n = 92, 55.4%]) according to the 4th universal definition of MI. Mean strain values were compared between study groups using Independent T tests. Logistic regression and ROC analysis was done to determine the value of LVGLS in the prediction of ACS.
Results
Non-white subjects were over-represented in the NCCP group (92% vs 8%), versus the myocardial injury and MI groups (65% vs 35%, p < 0.001), and on average the NCCP group was younger (56.5 ± 14.5 vs 64.8 ± 15, p < 0.001). LVGLS was significantly higher for NCCP versus the MI group (17.7 ± 2.8 vs 14.9 ± 3.9, p < 0.001). ROC analysis (c-statistic = 0.72) identified an optimal cutoff at ≤15.6, with sensitivity of 56% and specificity of 82%. Logistic regression analysis, including demographic and clinical variables, identified age, LVGLS, LV end-diastolic volume and serum creatinine as significant independent predictors for NCCP vs ACS. The addition of these factors in the predictive analysis resulted in slightly improved model performance (c-statistic = 0.78).
Conclusions
LVGLS among patients with suspected ACS is significantly different between NCCP and MI; however, low sensitivity for MI makes it inadequate as a single test to discriminate between the two. Combining LVGLS with other clinical/laboratory factors may have potential utility and will be explored in future work. Abstract Figure. Distribution Plot for LVGLS Abstract Figure. ROC Curve for LVGLS
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Affiliation(s)
- E Peterson
- Einstein Medical Center Philadelphia, Department Of Internal Medicine, Philadelphia, United States of America
| | - R Kovacik
- Philadelphia College Of Osteopathic Medicine, Philadelphia, United States of America
| | - KB Lo
- Einstein Medical Center Philadelphia, Department Of Internal Medicine, Philadelphia, United States of America
| | - D Brito
- West Virginia University Hospital, Heart and Vascular Institute, Morgantown, United States of America
| | - E Antonio
- Einstein Medical Center Philadelphia, Department Of Internal Medicine, Philadelphia, United States of America
| | - E Quintero
- Einstein Medical Center Philadelphia, Department Of Internal Medicine, Philadelphia, United States of America
| | - L Barrett
- Einstein Medical Center Philadelphia, Department Of Internal Medicine, Philadelphia, United States of America
| | - GS Pressman
- Einstein Medical Center Philadelphia, Institute for Heart and Vascular Health, Philadelphia, United States of America
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30
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Challa AS, Luther E, Burks J, Saini V, Abecassis J, Silva M, Jamshidi A, Yavagal D, Peterson E, Starke RM. Radial Long Sheath Angioplasty for Proximal Severe Flow Limiting Radial Artery Spasm Utilizing the Dotter Technique. World Neurosurg 2022; 160:16-21. [PMID: 35032711 DOI: 10.1016/j.wneu.2022.01.025] [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: 10/26/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although studies continue to demonstrate the advantages of transradial access (TRA) for neurointerventions, radial artery spasm (RAS) remains a frequent cause of TRA failure. Dotter initially described a technique to dilate areas of peripheral vascular stenosis by advancing sequentially larger catheters across the lesion over a wire. We present our institutional experience performing a modified Dotter technique utilizing long radial sheaths to dilate areas of proximal flow limiting RAS. OBJECTIVE To review the use of the Dotter technique for alleviating RAS in patients undergoing TRA for neurointerventions. METHODS A retrospective review of all patients undergoing TRA for neurointerventions at our institution from 2018-2020 was performed to identify patients with proximal flow limiting RAS. In identified patients, a modified Dotter technique was employed to dilate the stenosis. Demographic and periprocedural data were assessed to identify any adverse outcomes. RESULTS Four patients with severe proximal flow limiting RAS were identified. In each case, a hydrophilic long radial sheath and vascular dilator were sequentially advanced through the stenosis. In all cases, repeat angiography demonstrated improvement of the spasm and final radial angiograms demonstrated persistent improvement in caliber and regularity of the vessel. Each procedure was also completed via TRA with no periprocedural complications. CONCLUSIONS Our modified Dotter technique is effective in bypassing areas of severe proximal flow limiting RAS thus obviating the need for access site conversion. Additional studies are warranted to understand the implication of the angioplasty-like effects seen within the radial artery following removal of the long radial sheaths.
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Affiliation(s)
- A S Challa
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - E Luther
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
| | - J Burks
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - V Saini
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - J Abecassis
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - M Silva
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - A Jamshidi
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - D Yavagal
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - E Peterson
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - R M Starke
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
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31
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Segar MW, Khan MS, Patel KV, Vaduganathan M, Kannan V, Willett D, Peterson E, Tang WHW, Butler J, Everett BM, Fonarow GC, Wang TJ, McGuire DK, Pandey A. Incorporation of natriuretic peptides with clinical risk scores to predict heart failure among individuals with dysglycaemia. Eur J Heart Fail 2022; 24:169-180. [PMID: 34730265 PMCID: PMC10535364 DOI: 10.1002/ejhf.2375] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycaemia and in combination with natriuretic peptides (NPs). METHODS AND RESULTS Adults with diabetes/pre-diabetes free of HF at baseline from four cohort studies (ARIC, CHS, FHS, and MESA) were included. The machine learning- [WATCH-DM(ml)] and integer-based [WATCH-DM(i)] scores were used to estimate the 5-year risk of incident HF. Discrimination was assessed by Harrell's concordance index (C-index) and calibration by the Greenwood-Nam-D'Agostino (GND) statistic. Improvement in model performance with the addition of NP levels was assessed by C-index and continuous net reclassification improvement (NRI). Of the 8938 participants included, 3554 (39.8%) had diabetes and 432 (4.8%) developed HF within 5 years. The WATCH-DM(ml) and WATCH-DM(i) scores demonstrated high discrimination for predicting HF risk among individuals with dysglycaemia (C-indices = 0.80 and 0.71, respectively), with no evidence of miscalibration (GND P ≥0.10). The C-index of elevated NP levels alone for predicting incident HF among individuals with dysglycaemia was significantly higher among participants with low/intermediate (<13) vs. high (≥13) WATCH-DM(i) scores [0.71 (95% confidence interval 0.68-0.74) vs. 0.64 (95% confidence interval 0.61-0.66)]. When NP levels were combined with the WATCH-DM(i) score, HF risk discrimination improvement and NRI varied across the spectrum of risk with greater improvement observed at low/intermediate risk [WATCH-DM(i) <13] vs. high risk [WATCH-DM(i) ≥13] (C-index = 0.73 vs. 0.71; NRI = 0.45 vs. 0.17). CONCLUSION The WATCH-DM risk score can accurately predict incident HF risk in community-based individuals with dysglycaemia. The addition of NP levels is associated with greater improvement in the HF risk prediction performance among individuals with low/intermediate risk than those with high risk.
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Affiliation(s)
- Matthew W Segar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Vaishnavi Kannan
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Duwayne Willett
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric Peterson
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Javed Butler
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Brendan M Everett
- Brigham and Women's Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA, USA
| | - Thomas J Wang
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Xu H, Granger B, Peterson E, Dupre M. Telehealth and 30-Day Readmissions Among Heart Failure Patients During the COVID-19 Pandemic. Innov Aging 2021. [PMCID: PMC8970218 DOI: 10.1093/geroni/igab046.1801] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
This study examined whether outpatient follow-up within 14 days of discharge via telehealth visits are as effective as in-person visits for reducing 30-day readmission in heart failure (HF) patients. Using electronic health records from a large health system, we included HF patients (n=1,722) who were hospitalized during the period of March 15-July 15, 2020. Overall, 28.1% of patients received an early outpatient follow-up visit. Patients who received telehealth visits (n=119) were more likely to be older and live in areas with higher median household incomes than those with in-person visits (n=365). Thirty-day readmission rates were 20.5% during the COVID-19 period. Multivariate models showed that patients who received a telehealth (OR=0.36, 95%CI [0.23-0.56]) or an in-person (OR=0.42, 95%CI [0.31-0.57]) visit were less likely to be readmitted within 30 days compared with patients without an early outpatient follow-up. Telehealth visits were just as effective as in-person visits at reducing 30-day readmissions.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Medicine, Duke University, North Carolina, United States
| | - Bradi Granger
- Duke university School of Nursing, Durham, North Carolina, United States
| | - Eric Peterson
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Matthew Dupre
- Duke University School of Medicine, Durham, North Carolina, United States
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Pelayo J, Lo KB, Peterson E, DeFaria C, Nehvi A, Torres R, Maqsood MH, Farooq M, Mathew RO, Rangaswami J. Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers and outcomes in patients with acute decompensated heart failure: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:1037-1043. [PMID: 34751630 DOI: 10.1080/14779072.2021.2004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin-receptor blocker (ARB) are cornerstones in the treatment of heart failure with reduced ejection (HFrEF). However, there are limited data on their risk-benefit profile in patients with acute heart failure requiring hospitalizations. METHODS We did a meta-analysis pooling data from all studies examining the use of ACEi/ARB in patients hospitalized for heart failure compared to patients without ACEi/ARB use. We calculated pooled hazard ratios (HR) and their 95% confidence intervals (CI) using a random-effects model. RESULTS Twenty-five studies were included in the meta-analysis. Continued use of ACEi/ARBs in hospitalized patients with HFrEF was associated with lower 1-year mortality risk (pooled HR 0.68 [0.60-0.77] p < 0.001) and with lower 1-6-year mortality risk in those with heart failure preserved ejection fraction (HFpEF) (pooled HR 0.86 [0.78-0.94] p = 0.002). There were significant reductions in 1-year HF readmissions among hospitalized HFrEF patients (pooled HR 0.83 [0.73-0.95] p = 0.005). CONCLUSION Maintaining or initiating patients with HFrEF hospitalized for acute decompensated heart failure (ADHF) on ACEi/ARB is associated with a reduce risk of mortality and 1-year admissions, but the effect size is lower among those with HFpEF with more heterogeneous outcomes.
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Affiliation(s)
- Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Carly DeFaria
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Atif Nehvi
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ricardo Torres
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Minaam Farooq
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Roy O Mathew
- Division of Nephrology, Columbia Va Health Care System, Columbia, SC, USA
| | - Janani Rangaswami
- Department of Nephrology, George Washington University, Washington, DC, USA
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Starr L, Reardon K, Rabovsky P, Peterson E. Redefining the Urban Preserve: Community Concerns Reframe the Ecological Imperative in a New Coastal Park. ECOL RESTOR 2021. [DOI: 10.3368/er.39.4.288] [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: 11/03/2022]
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35
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Yin L, Svigos K, Gutierrez D, Peterson E, Lo Sicco K, Shapiro J. Low-dose oral minoxidil increases hair density and thickness in androgenetic alopecia: a retrospective analysis of 60 patients. J Eur Acad Dermatol Venereol 2021; 36:e200-e202. [PMID: 34637178 DOI: 10.1111/jdv.17731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- L Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - K Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - D Gutierrez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - E Peterson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - K Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - J Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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Leffler CT, Schwartz SG, Peterson E, Couser NL, Salman AR. The First Cataract Surgeons in the British Isles. Am J Ophthalmol 2021; 230:75-122. [PMID: 33744237 DOI: 10.1016/j.ajo.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the entry of cataract surgery into the British Isles. METHODS Handbills, books, and other historical sources were reviewed to determine when cataract surgery was first performed in the region. RESULTS Roman artifacts suggest that couching was performed in the British Isles in antiquity. Seemingly miraculous cures of blindness during the early Middle Ages might be consistent with couching. However, there is no strong evidence of medieval cataract surgery in the region. Cataract couching probably arrived in England by the 1560s, in Scotland by 1595, in Ireland by 1684, and in Anglo-America by 1751. Before the 18th century, cataract surgery was taught within families, apprenticeships, and mountebank troupes. Beginning in the 17th century, congenital cataract surgery permitted surgeons to tout their skills and to explore visual perception. However, in some cases, such as the couching of the 13-year-old Daniel Dolins by surgeon William Cheselden in 1727, whether the cataracts were truly congenital, and whether vision improved in any way, remain in doubt. Beginning in the 1720s, cataract surgery began to be performed by traditional surgeons in hospitals. However, for most of the century, the highest-volume cataract surgeons continued to be itinerant oculists, including those who performed cataract extraction in the latter half of the century. CONCLUSIONS Cataract surgery might have been performed in Roman Britain. Specific evidence of cataract surgery emerges in the region in the Elizabethan era. Cataract extraction was performed in the British Isles by 1753, but couching remained popular throughout the 18th century. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Bhattad PB, Joseph DL, Peterson E. IgG4-Related Disease Manifesting as Hypocomplementemic Tubulointerstitial Nephritis: A Rare Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620952213. [PMID: 32830581 PMCID: PMC7448130 DOI: 10.1177/2324709620952213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/29/2022] Open
Abstract
Immunoglobulin G4–related disease (IgG4-RD) is a chronic fibrosing inflammatory systemic disorder that has been recognized relatively recently in the medical literature. Little is known about the exact disease pathogenesis and epidemiology. IgG4-RD may be asymptomatic or may have minimal symptoms or involve multiple organs with overt symptoms. The different phenotypes of IgG4-RD can lead to delayed or incorrect diagnosis. We report the case of a 66-year-old male with coal worker’s pneumoconiosis who presented with progressive kidney disease and was diagnosed with tubulointerstitial nephritis due to IgG4-RD. The patient was noted to have progressive kidney disease, skin involvement, worsening interstitial lung disease, complete vision loss in the left eye, and retroperitoneal fibrosis. Serologic workup revealed elevated inflammatory markers, IgG4 and IgG1 levels, and hypocomplementemia. A tissue biopsy helped us establish a definitive diagnosis of IgG4-RD and initiate treatment with glucocorticoids to prevent further progression of kidney disease and other end-organ damage.
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Affiliation(s)
| | - David L Joseph
- James H. Quillen Veterans Affairs Medical Center, Johnson City, TN, USA
| | - Eric Peterson
- James H. Quillen Veterans Affairs Medical Center, Johnson City, TN, USA
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38
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Pelayo J, Shahzad A, Peterson E, Pressman G. Platypnea-orthodeoxia syndrome in patent foramen ovale and fenestrated atrial septal aneurysm with normal right atrial pressure: what is the culprit? BMJ Case Rep 2021; 14:14/7/e243589. [PMID: 34210690 DOI: 10.1136/bcr-2021-243589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 76-year-old Korean woman presented with intermittent episodes of exertional hypoxia at the rehabilitation facility after a recent admission for ischaemic stroke. Clinical and diagnostic investigation confirmed the presence of platypnea-orthodeoxia syndrome (POS). Transoesophageal echocardiogram revealed a patent foramen ovale and hyperdynamic interatrial septum with right-to-left intracardiac shunt. Further diagnostic workup did not reveal right atrial hypertension, cirrhosis, pulmonary hypertension or any other extracardiac causes of right-to-left shunt. Positional preferential blood flow from inferior vena cava to the left atrium due to counterclockwise displacement of interatrial septum with age and posture was postulated to explain the atrial right-to-left shunt and the resultant POS. Closure was performed using a cribriform amplatzer occluder which improved her symptoms.
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Affiliation(s)
- Jerald Pelayo
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Anum Shahzad
- Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Eric Peterson
- Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Gregg Pressman
- Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
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Crooks CM, Weiler AM, Rybarczyk SL, Bliss MI, Jaeger AS, Murphy ME, Simmons HA, Mejia A, Fritsch MK, Hayes JM, Eickhoff JC, Mitzey AM, Razo E, Braun KM, Brown EA, Yamamoto K, Shepherd PM, Possell A, Weaver K, Antony KM, Morgan TK, Newman CM, Dudley DM, Schultz-Darken N, Peterson E, Katzelnick LC, Balmaseda A, Harris E, O’Connor DH, Mohr EL, Golos TG, Friedrich TC, Aliota MT. Previous exposure to dengue virus is associated with increased Zika virus burden at the maternal-fetal interface in rhesus macaques. PLoS Negl Trop Dis 2021; 15:e0009641. [PMID: 34329306 PMCID: PMC8357128 DOI: 10.1371/journal.pntd.0009641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/11/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
Concerns have arisen that pre-existing immunity to dengue virus (DENV) could enhance Zika virus (ZIKV) disease, due to the homology between ZIKV and DENV and the observation of antibody-dependent enhancement (ADE) among DENV serotypes. To date, no study has examined the impact of pre-existing DENV immunity on ZIKV pathogenesis during pregnancy in a translational non-human primate model. Here we show that macaques with a prior DENV-2 exposure had a higher burden of ZIKV vRNA in maternal-fetal interface tissues as compared to DENV-naive macaques. However, pre-existing DENV immunity had no detectable impact on ZIKV replication kinetics in maternal plasma, and all pregnancies progressed to term without adverse outcomes or gross fetal abnormalities detectable at delivery. Understanding the risks of ADE to pregnant women worldwide is critical as vaccines against DENV and ZIKV are developed and licensed and as DENV and ZIKV continue to circulate.
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Affiliation(s)
- Chelsea M. Crooks
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Sierra L. Rybarczyk
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Mason I. Bliss
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Anna S. Jaeger
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, United States of America
| | - Megan E. Murphy
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michael K. Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jennifer M. Hayes
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jens C. Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ann M. Mitzey
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Elaina Razo
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Katarina M. Braun
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Elizabeth A. Brown
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Keisuke Yamamoto
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Phoenix M. Shepherd
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Amber Possell
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kara Weaver
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kathleen M. Antony
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Terry K. Morgan
- Department of Pathology, Oregon Health and Science University, Portland, Oregon, United States of America
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Christina M. Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Dawn M. Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nancy Schultz-Darken
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Eric Peterson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Leah C. Katzelnick
- Division of Infectious Diseases and Vaccinology, University of California Berkeley, Berkeley, California, United States of America
| | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, University of California Berkeley, Berkeley, California, United States of America
| | - David H. O’Connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Emma L. Mohr
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thaddeus G. Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, United States of America
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40
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Adotama P, Callender V, Kolla A, Young C, Jones P, Svigos K, Yin L, Ugonabo N, Gutierrez D, Peterson E, Lo Sicco K, Shapiro J. Comparing the clinical differences in white and black women with frontal fibrosing alopecia. Br J Dermatol 2021; 185:1074-1076. [PMID: 34184243 DOI: 10.1111/bjd.20605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 01/06/2023]
Affiliation(s)
- P Adotama
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - V Callender
- The Callender Center for Clinical Research, Glenn Dale, MD, USA
| | - A Kolla
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - C Young
- The Callender Center for Clinical Research, Glenn Dale, MD, USA
| | - P Jones
- The Callender Center for Clinical Research, Glenn Dale, MD, USA
| | - K Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - L Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - N Ugonabo
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - D Gutierrez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - E Peterson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - K Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - J Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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41
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Schiller ZA, Rudolph MJ, Toomey JR, Ejemel M, LaRochelle A, Davis SA, Lambert HS, Kern A, Tardo AC, Souders CA, Peterson E, Cannon RD, Ganesa C, Fazio F, Mantis NJ, Cavacini LA, Sullivan-Bolyai J, Hu LT, Embers ME, Klempner MS, Wang Y. Blocking Borrelia burgdorferi transmission from infected ticks to nonhuman primates with a human monoclonal antibody. J Clin Invest 2021; 131:144843. [PMID: 33914704 PMCID: PMC8159683 DOI: 10.1172/jci144843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/22/2021] [Indexed: 01/21/2023] Open
Abstract
Disrupting transmission of Borrelia burgdorferi sensu lato complex (B. burgdorferi) from infected ticks to humans is one strategy to prevent the significant morbidity from Lyme disease. We have previously shown that an anti-OspA human mAb, 2217, prevents transmission of B. burgdorferi from infected ticks in animal models. Maintenance of a protective plasma concentration of a human mAb for tick season presents a significant challenge for a preexposure prophylaxis strategy. Here, we describe the optimization of mAb 2217 by amino acid substitutions (2217LS: M428L and N434S) in the Fc domain. The LS mutation led to a 2-fold increase in half-life in cynomolgus monkeys. In a rhesus macaque model, 2217LS protected animals from tick transmission of spirochetes at a dose of 3 mg/kg. Crystallographic analysis of Fab in complex with OspA revealed that 2217 bound an epitope that was highly conserved among the B. burgdorferi, B. garinii, and B. afzelii species. Unlike most vaccines that may require boosters to achieve protection, our work supports the development of 2217LS as an effective preexposure prophylaxis in Lyme-endemic regions, with a single dose at the beginning of tick season offering immediate protection that remains for the duration of exposure risk.
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MESH Headings
- Amino Acid Substitution
- Animals
- Antibodies, Bacterial/genetics
- Antibodies, Bacterial/immunology
- Antibodies, Bacterial/pharmacology
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antigens, Surface/genetics
- Antigens, Surface/immunology
- Bacterial Outer Membrane Proteins/genetics
- Bacterial Outer Membrane Proteins/immunology
- Bacterial Vaccines/genetics
- Bacterial Vaccines/immunology
- Borrelia burgdorferi/genetics
- Borrelia burgdorferi/immunology
- Disease Models, Animal
- Humans
- Lipoproteins/genetics
- Lipoproteins/immunology
- Lyme Disease/drug therapy
- Lyme Disease/genetics
- Lyme Disease/immunology
- Lyme Disease/transmission
- Macaca fascicularis
- Macaca mulatta
- Male
- Mice
- Mice, Transgenic
- Mutation, Missense
- Ticks/immunology
- Ticks/microbiology
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Affiliation(s)
- Zachary A. Schiller
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | | | - Jacqueline R. Toomey
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Monir Ejemel
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | | | - Simon A. Davis
- New York Structural Biology Center, New York, New York, USA
| | - Havard S. Lambert
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, USA
| | - Aurélie Kern
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Amanda C. Tardo
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, USA
| | - Colby A. Souders
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Eric Peterson
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Rebecca D. Cannon
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Chandrashekar Ganesa
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Frank Fazio
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Nicholas J. Mantis
- Division of Infectious Disease, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Lisa A. Cavacini
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - John Sullivan-Bolyai
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Linden T. Hu
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Monica E. Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, USA
| | - Mark S. Klempner
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
| | - Yang Wang
- MassBiologics of the University of Massachusetts Medical School, Boston, Massachusetts, USA
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42
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Bolden C, Tilley C, Hay C, Peterson E. Antibody Gene Therapy Mitigates the immunosuppressive effects of 3,4‐Methylenedioxymethamphetamine (MDMA) in the periphery of Male BALB/c Mice. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.05265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chris Bolden
- University of Texas Health Science Center at HoustonHoustonTX
| | - Cameron Tilley
- University of Arkansas for Medical SciencesLittle RockAR
| | - Charles Hay
- University of Arkansas for Medical SciencesLittle RockAR
| | - Eric Peterson
- University of Arkansas for Medical SciencesLittle RockAR
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Barnes DH, Lo KB, Bhargav R, Gul F, DeJoy R, Peterson E, Salacup G, Pelayo J, Albano J, Azmaiparashvili Z, Rangaswami J, Carpio AM, Patarroyo-Aponte G. Predictors of venous thromboembolism in patients with COVID-19 in an underserved urban population: A single tertiary center experience. Clin Respir J 2021; 15:885-891. [PMID: 33864721 PMCID: PMC8250753 DOI: 10.1111/crj.13377] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/02/2021] [Indexed: 11/04/2022]
Abstract
Introduction Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID‐19 due to SARS‐CoV‐2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID‐19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID‐19 patients associated with increased VTE risk. Methods This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID‐19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t‐tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves. Results Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D‐dimer levels on admission (P = 0.045) and peak D‐dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D‐dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D‐dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE. Conclusion Peak D‐dimer level may be the most reliable clinical marker in COVID‐19 patients for predicting VTE and future prospective studies should attempt to further validate this.
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Affiliation(s)
- Drew H Barnes
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ruchika Bhargav
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Fahad Gul
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Robert DeJoy
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Grace Salacup
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jeri Albano
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gabriel Patarroyo-Aponte
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA
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Yadlapati S, Lo KB, DeJoy R, Gul F, Peterson E, Bhargav R, Salacup GF, Pelayo J, Azmaiparashvilli Z, Patarroyo-Aponte G. Prevailing patterns of liver enzymes in patients with COVID-19 infection and association with clinical outcomes. Ann Gastroenterol 2021; 34:224-228. [PMID: 33654363 PMCID: PMC7903583 DOI: 10.20524/aog.2021.0573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is now a critical threat to global public health. Although the majority of patients present with respiratory illness, several studies have described multiorgan involvement. This study evaluated the prevailing patterns of liver enzymes in COVID-19 patients on admission and their association with clinical outcomes. Methods This was a single-center retrospective analysis of all inpatients with COVID-19. Demographic and clinical factors, and liver enzyme tests, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT), were noted on admission. The association of liver enzyme elevation with outcomes such as inpatient death, need for intubation, and vasopressor use was determined using the chi-square test and multivariate regression analysis. Results Among 200 patients, AST and ALT elevation was seen in 55% and 20%, respectively. Alkaline phosphatase elevation was seen in 28%. AST elevation was associated with inpatient death (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05; P=0.035), need for vasopressors (OR 1.034, 95%CI 1.015-1.055; P=0.001), and intubation (OR 1.03, 95%CI 1.01-1.05; P=0.002). An AST/ALT ratio of 2 or more was seen in 34% of patients and was associated with need for intubation (OR 2.678, 95%CI 1.202-5.963; P=0.016), and need for vasopressors (OR 3.352, 95%CI 1.495-7.514; P=0.003). Conclusion Serum aminotransferase levels are useful markers of hepatocellular injury. Patients with elevated AST or AST/ALT ratio are at higher risk of severe disease, as evidenced by intubation, vasopressor use, and inpatient death. These patients should be monitored closely given their propensity for severe disease.
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Affiliation(s)
- Sujani Yadlapati
- Department of Gastroenterology, Cooper University Hospital, NJ (Sujani Yadlapati)
| | - Kevin Brayn Lo
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Robert DeJoy
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Fahad Gul
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Eric Peterson
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Ruchika Bhargav
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Grace Faith Salacup
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Jerald Pelayo
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Zurab Azmaiparashvilli
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
| | - Gabriel Patarroyo-Aponte
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia (Kevin Brayn Lo, Robert DeJoy, Fahad Gul, Eric Peterson, Ruchika Bhargav, Grace Faith Salacup, Jerald Pelayo, Zurab Azmaiparashvilli, Gabriel Patarroyo-Aponte), USA
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Goldstein SA, Li S, Lu D, Matsouaka RA, Rymer J, Fonarow GC, de Lemos JA, Peterson E, Pokorney SD, Wang T, Al-Khatib SM. Implantable Cardioverter Defibrillator Utilization and Mortality Among Patients ≥65 Years of Age With a Low Ejection Fraction After Coronary Revascularization. Am J Cardiol 2021; 138:26-32. [PMID: 33068540 DOI: 10.1016/j.amjcard.2020.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Registry Chest Pain-Myocardial Infarction (MI) Registry who presented with MI from January 2, 2009 to December 31, 2016, had a left ventricular ejection fraction ≤35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1,063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.34 to 1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29 to 1.70), readmission for heart failure (aHR 3.21, 95% CI 2.73 to 3.79), and readmission for MI (aHR 2.18, 95% CI 1.66 to 2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39 to 3.91), and heart failure readmission (aHR 3.14, 95% CI 1.96 to 5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year all-cause mortality (aHR 0.74, 95% CI 0.63 to 0.86). In conclusion, only 1 in 10 Medicare patients with low ejection fraction received an ICD within 1 year after revascularization. Contact with the healthcare system after discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.
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Affiliation(s)
- Sarah A Goldstein
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Shuang Li
- Duke Clinical Research Institute, Durham, North Carolina
| | - Di Lu
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Jennifer Rymer
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Gregg C Fonarow
- Ahmanson Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric Peterson
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Sean D Pokorney
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Tracy Wang
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Sana M Al-Khatib
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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Fox T, Ruddiman K, Lo KB, Peterson E, DeJoy R, Salacup G, Pelayo J, Bhargav R, Gul F, Albano J, Azmaiparashvili Z, Anastasopoulou C, Patarroyo-Aponte G. The relationship between diabetes and clinical outcomes in COVID-19: a single-center retrospective analysis. Acta Diabetol 2021; 58:33-38. [PMID: 32804317 PMCID: PMC7429932 DOI: 10.1007/s00592-020-01592-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
AIMS Coronavirus disease 19 (COVID-19) has become a pandemic. Diabetic patients tend to have poorer outcomes and more severe disease (Kumar et al. in Diabetes Metab Syndr 14(4):535-545, 2020. https://doi.org/10.1016/j.dsx.2020.04.044 ). However, the vast majority of studies are representative of Asian and Caucasian population and fewer represent an African-American population. METHODS In this single-center, retrospective observational study, we included all adult patients (> 18 years old) admitted to Einstein Medical Center, Philadelphia, with a diagnosis of COVID-19. Patients were classified according to having a known diagnosis of diabetes mellitus. Demographic and clinical data, comorbidities, outcomes and laboratory findings were obtained. RESULTS Our sample included a total of 355 patients. 70% were African-American, and 47% had diabetes. Patients with diabetes had higher peak inflammatory markers like CRP 184 (111-258) versus 142 (65-229) p = 0.012 and peak LDH 560 (384-758) versus 499 (324-655) p = 0.017. The need for RRT/HD was significantly higher in patients with diabetes (21% vs 11% p = 0.013) as well as the need for vasopressors (28% vs 18% p = 0.023). Only age was found to be an independent predictor of mortality. We found no significant differences in inpatient mortality p = 0.856, need for RRT/HD p = 0.429, need for intubation p = 1.000 and need for vasopressors p = 0.471 in African-Americans with diabetes when compared to non-African-Americans. CONCLUSIONS Our study demonstrates that patients with COVID-19 and diabetes tend to have more severe disease and poorer clinical outcomes. African-American patients with diabetes did not differ in outcomes or disease severity when compared to non-African-American patients.
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Affiliation(s)
- Tamaryn Fox
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Kathleen Ruddiman
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Robert DeJoy
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Grace Salacup
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Jerald Pelayo
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Ruchika Bhargav
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Fahad Gul
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Jeri Albano
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Zurab Azmaiparashvili
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Catherine Anastasopoulou
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
- Department of Endocrinology, Einstein Medical Center Philadelphia, Philadelphia, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriel Patarroyo-Aponte
- Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
- Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA
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Chen SH, Scott X, Peterson E, Yavagal DR, Starke RM, Dietrich D, Keane RW, Vaccari JPDR. Inflammasomes in Large Vessel Occlusion Stroke Thrombi. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_227] [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: 11/14/2022] Open
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Musoke N, Lo KB, Albano J, Peterson E, Bhargav R, Gul F, DeJoy R, Salacup G, Pelayo J, Tipparaju P, Azmaiparashvili Z, Patarroyo-Aponte G, Rangaswami J. Anticoagulation and bleeding risk in patients with COVID-19. Thromb Res 2020; 196:227-230. [PMID: 32916565 PMCID: PMC7444469 DOI: 10.1016/j.thromres.2020.08.035] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is no current standardized approach to anticoagulation in patients with Coronavirus Disease 2019 (COVID-19) while potential bleeding risks remain. Our study characterizes the patterns of anticoagulation use in COVID-19 patients and the risk of related bleeding. METHODS This is a single center retrospective analysis of 355 adult patients with confirmed diagnosis of COVID-19 from March 1 to May 31, 2020. Chi-square was used to analyze the relationship between degree of anticoagulant dose and bleeding events by site. Multivariable logistic regression was used to look at factors associated with inpatient death. RESULTS 61% of patients were being treated with prophylactic doses of anticoagulation, while 7% and 29% were being treated with sub-therapeutic and therapeutic anticoagulation (TA) doses respectively. In 44% of patients, we found that the decision to escalate the dose of anticoagulation was based on laboratory values characterizing the severity of COVID-19 such as rising D-dimer levels. There were significantly higher rates of bleeding from non-CNS/non-GI sites (p = 0.039) and from any bleeding site overall (p = 0.019) with TA. TA was associated with significantly higher rates of inpatient death (41.6% vs 15.3% p < 0.0001) compared to those without. All patients who developed CNS hemorrhage died p = 0.011. After multivariable logistic regression, only age OR 1.04 95% CI (1.01 to 1.07) p = 0.008 and therapeutic anticoagulation was associated with inpatient mortality OR 6.16 95% CI (2.96 to 12.83) p ≤ 0.0001. CONCLUSION The use of TA was significantly associated with increased risk of bleeding. Bleeding in turn exhibited trends towards higher inpatient death among patients with COVID-19. These findings should be interpreted with caution and larger more controlled studies are needed to verify the net effects of anticoagulation in patients with COVID-19.
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Affiliation(s)
- Nancy Musoke
- Department of Medicine, Einstein Medical Center Philadelphia, USA.
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Jeri Albano
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Ruchika Bhargav
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Fahad Gul
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Robert DeJoy
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Grace Salacup
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | - Jerald Pelayo
- Department of Medicine, Einstein Medical Center Philadelphia, USA
| | | | | | - Gabriel Patarroyo-Aponte
- Department of Medicine, Einstein Medical Center Philadelphia, USA; Division of Pulmonary and Critical Care and Sleep Medicine, Einstein Medical Center Philadelphia, USA; Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center Philadelphia, USA; Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
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Schmitt C, Peterson E, Willis A, Kumar N, McManus M, Subbiah S, Crago J. Transgenerational effects of developmental exposure to chlorpyrifos-oxon in zebrafish (DANIO RERIO). Toxicol Appl Pharmacol 2020; 408:115275. [DOI: 10.1016/j.taap.2020.115275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
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Khan N, Arthur AS, Peterson E, Jabbour P, Nguyen V, Dornbos DL, Peterson JC, Hoit D, Nickele C, Elijovich L, Inoa-Acosta V, Torabi R, Goyal N, Morris D. Predicting the Degree of Difficulty of the Trans-Radial Approach in Cerebral Angiography. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_284] [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: 11/12/2022] Open
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