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Qiu X, Guo JJ, Jin CC, He J, Wang L, Yang BC, Zhang YH, Zhu BS, Tang XH. [Efficiency of CNV-seq in detecting fetal DMD gene deletion or duplication in prenatal diagnosis]. Zhonghua Fu Chan Ke Za Zhi 2024; 59:279-287. [PMID: 38644274 DOI: 10.3760/cma.j.cn112141-20230919-00107] [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] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objective: To evaluate the diagnostic efficiency of copy number variation sequencing (CNV-seq) to detect the deletion or duplication of DMD gene in prenatal diagnosis. Methods: A retrospective analysis was carried out on the CNV-seq results of 34 544 fetuses diagnosed in the First People's Hospital of Yunnan Province from January 2018 to July 2023. A total of 156 cases of fetuses were collected, including Group 1:125 cases with family history of Duchenne muscular dystrophy or Becker muscular dystrophy (DMD/BMD), and Group 2:31 cases with no family history but a DMD gene deletion or duplication was detected unexpectedly by CNV-seq. Multiplex ligation-dependent probe amplification (MLPA) was used as a standard method to detect the deletion or duplication. Consistency test was carried out basing on the results of CNV-seq and MLPA of all 156 cases. Results: Comparing to MLPA, CNV-seq had a coincidence rate of 92.3% (144/156) for DMD gene deletion or duplication, with a sensitivity and positive predictive value of 88.2%, with a specificity and negative predictive value of 94.3%, a missed detection rate of 3.8%, and a Kappa value of 0.839. CNV-seq missed 4 cases with deletions and 2 with duplications due to involved fragments less than 100 Kb, among 20 cases of deletions and 6 cases of duplications detected by MLPA in Group 1. In Group 2, the deletions and duplications detected by CNV-seq were 42% (13/31) and 58% (18/31), respectively, in which the percentage of duplication was higher than that in Group 1. Among those 18 cases with duplications, 3 cases with duplication locating in exon 42~67 were likely pathogenic; while 9 cases with duplication covering the 5' or 3' end of the DMD gene, containing exon 1 or 79 and with only one breakpoint within the gene, along with the last 6 cases with duplications locating at chrX: 32650635_32910000 detected only by CNV-seq, which might be judged as variants of uncertain significance. Conclusions: CNV-seq has a good efficiency to detect fetal DMD gene deletion or duplication in prenatal diagnosis, while a further verification test by MLPA is recommended. The duplications on chrX: 32650635_32910000, 5' or 3' end of DMD gene detected by CNV-seq should be carefully verified and assessed because those variants appear to be nonpathogenic polymorphisms.
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Affiliation(s)
- X Qiu
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - J J Guo
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - C C Jin
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - J He
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - L Wang
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - B C Yang
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - Y H Zhang
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - B S Zhu
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
| | - X H Tang
- Department of Medical Genetics, NHC Key Laboratory of Health Birth and Birth Defect Prevention in Western China, Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming 650032, China
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Alsuhibani AA, Al-Obeed OA, Wigle PR, Alsultan MM, Guo JJ, Lin AC, Rao MB, Hincapie AL. Factors Associated with Statin Discontinuation Following Metabolic and Bariatric Surgery: A Retrospective Analysis of 2012-2021 Electronic Medical Records Network Data. Obes Surg 2024; 34:1267-1278. [PMID: 38386174 PMCID: PMC11026246 DOI: 10.1007/s11695-024-07110-x] [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] [Received: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Bariatric surgery has been shown to improve hyperlipidemia, decreasing the need for statin medications. Although maintaining statin therapy post-surgery for those with a history of atherosclerotic cardiovascular disease (ASCVD) is advised, it is uncertain if discontinuation risks differ between those with and without ASCVD history. AIM The study aims to analyze the rate and reasons for statin cessation post-bariatric surgery in the US using real-world data. METHODS Using the TriNetX electronic medical records network from 2012 to 2021, the study involved patients aged 18 or older on statins at the time of bariatric surgery. They were categorized into primary and secondary prevention groups based on prior ASCVD. Statin discontinuation was defined as a 90-day gap post the last statin dosage. The Cox model assessed factors influencing statin cessation. RESULTS Seven hundred and thirty-three statin users undergoing bariatric surgery were identified, with 564 (77%) in primary prevention. Six months post-surgery, 48% of primary prevention patients and 34.5% of secondary ones stopped statins. Primary prevention patients had a 30% higher likelihood of cessation compared to secondary prevention (hazard ratio, 1.30; 95% CI, 1.06-1.60) as shown by multivariable analysis. CONCLUSIONS Post-bariatric surgery, primary prevention patients are more likely to discontinue statins than secondary prevention patients.
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Affiliation(s)
- Abdulrahman A Alsuhibani
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Buraidah, 51452, Saudi Arabia.
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA.
| | - Omar A Al-Obeed
- Department of surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Patricia R Wigle
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
| | - Mohammed M Alsultan
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Jeff J Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
| | - Alex C Lin
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
| | - Marepalli B Rao
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ana L Hincapie
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, 45267, USA
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Gari MH, Alsuhibani A, Alashgar A, Guo JJ. Utilization, reimbursement, and price trends for Hepatitis C virus medications in the US Medicaid programs: 2001-2021. Explor Res Clin Soc Pharm 2023; 12:100383. [PMID: 38145237 PMCID: PMC10746553 DOI: 10.1016/j.rcsop.2023.100383] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 12/26/2023] Open
Abstract
Background Hepatitis C Virus (HCV) remains a challenging health problem worldwide, with increasing incidence despite being curable with Direct Acting Antiviral (DAA) agents. Objective This study aimed to describe the utilization, reimbursement, and price trends of HCV treatments and evaluate the influence of treatment guidelines and policies. Methods A retrospective, descriptive drug utilization study conducted using the outpatient pharmacy data extracted from the Centers for Medicaid and Medicare Services State Drug Utilization Data between 2001 and 2021. All HCV treatments approved in the US were included, conventional therapy (CT), and DAA agents. The annual secular trends were calculated for each medication's total number of prescriptions, reimbursements, and prices. The average reimbursement per prescription was calculated and utilized as a proxy of prices. The HCV treatment guideline and policies and legislation were evaluated overtime to measure the impact on the trends. Results Despite CT having a higher total utilization, DAA agents commanded significantly greater reimbursements, with 4.1 billion USD for CT and 19.45 billion USD for DAA agents. CT utilization increased rapidly and dominated the market until 2011, peaking at 379,696 prescriptions in 2003 but declining afterward. DAA agents' utilization increased rapidly in their first year: i.e., sofosbuvir reached 50,377 prescriptions with 1.3 billion USD in 2014, while ledipasvir/sofosbuvir reached 79,387 prescriptions with 2 billion USD in 2015. The average price per prescription was high for the DAA agents, like 24,992 USD for sofosbuvir and 22,787 USD for ledipasvir/sofosbuvir, compared to CT medications ribavirin, around 500 USD, and pegINF, around 3000 USD. The new DAA agents replaced CT, and initiating market competition among DAA agents. Conclusion The introduction of multiple DAA agents slightly changed their prescription prices but remained high during the study period. The recent increase in HCV incidence cases indicates accessibility issues for costly and effective DAA agents, with treatment guidelines and policies playing a critical role in shaping these trends.
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Affiliation(s)
- Musaab H. Gari
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
| | - Abdulrahman Alsuhibani
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Amin Alashgar
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Jeff J. Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
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Carrao AM, Coleman JC, Guo JJ, Kumari H. A novel online survey approach designed to measure consumer sunscreen application thickness-implications for estimating environmental emissions. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00608-z. [PMID: 37898625 DOI: 10.1038/s41370-023-00608-z] [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] [Received: 11/22/2022] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The effects of ultraviolet (UV) filters in the aquatic environment have been well studied, but environmental exposures remain unclear and understudied. Consumer usage directly influences the amount of sunscreen products, and subsequently UV filters, potentially released into the environment. OBJECTIVE To conduct a literature review of previous research into sunscreen application thickness, develop a questionnaire protocol designed to semi-quantify sunscreen usage by US consumers, and conduct a large-scale survey to determine a sunscreen application thickness (to face and body) that is more refined than conservative defaults. The United States Food & Drug Administration (US FDA) recommends a sunscreen application rate of 2 mg/cm2. This value is typically used as a worst-case assumption in environmental exposure assessments of UV filters. METHODS Designed a novel approach to estimate lotion sunscreen application thickness using an online questionnaire protocol employing visual references and self-reported height and weight of the respondents. A literature review was also conducted to collect historical sunscreen usage. RESULTS Over 9000 people were surveyed in the US, and after the dataset was refined, their sunscreen application thickness was estimated based on calculated body surface area and reported sunscreen amounts. The mean and median values for survey respondents are 3.00 and 1.78 mg/cm2, respectively, for facial application thickness and 1.52 and 1.35 mg/cm2, respectively, for body application thickness. Earlier research from 1985-2020 reported 36 of the 38 values are below the US FDA's recommended application thickness of 2 mg/cm2 (range 0.2-5 mg/cm2). IMPACT STATEMENT This web-based survey is the first of its kind, designed specifically to quantify sunscreen application in a large and diverse set of consumers. This method provides a greater reach to larger populations thus enabling more granular data analysis and understanding. Exposure assessments of sunscreen ingredients typically use conservative parameters. These data can refine those assessments and allow for more informed and science-based risk management decisions.
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Affiliation(s)
- Andrea M Carrao
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, 45267, USA.
- Kao USA Inc., Cincinnati, OH, USA.
| | | | - Jeff J Guo
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Harshita Kumari
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, 45267, USA
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Du YQ, Xu JP, Guo JJ, Cao SY, Xu N, Wang DD. [Transcatheter closure in a patient with atrial septal dissection and recurrent cerebral infarction]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:191-193. [PMID: 36789600 DOI: 10.3760/cma.j.cn112148-20211029-00934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Y Q Du
- Department of Ultrasonography, First Hospital of Shanxi Medical University,Taiyuan 030001, China
| | - J P Xu
- Department of Ultrasonography, First Hospital of Shanxi Medical University,Taiyuan 030001, China
| | - J J Guo
- Department of Cardiothoracic Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - S Y Cao
- Department of Cardiothoracic Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - N Xu
- Department of Ultrasonography, First Hospital of Shanxi Medical University,Taiyuan 030001, China
| | - D D Wang
- Department of Ultrasonography, First Hospital of Shanxi Medical University,Taiyuan 030001, China
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Ye JH, Li DM, Lyu T, Zhao WJ, Guo JJ, He J, Zhu BS. [Genetic analysis of a child with ectodermal dysplasia caused by variant of EDA gene]. Zhonghua Er Ke Za Zhi 2022; 60:834-835. [PMID: 35922200 DOI: 10.3760/cma.j.cn112140-20211201-01007] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- J H Ye
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
| | - D M Li
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
| | - T Lyu
- School of Medicine, Kunming University of Science and Technology, Kunming 650500, China
| | - W J Zhao
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
| | - J J Guo
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
| | - J He
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
| | - B S Zhu
- Department of Medical Genetics, the First people's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Provincial Clinical Medicine Research Center for Birth Defects and Rare Diseases, Kunming 650032, China
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Jiang HY, Jiang ND, Wang L, Guo JJ, Chen KX, Dai YJ. Characterization of nitrilases from Variovorax boronicumulans that functions in insecticide flonicamid degradation and β-cyano-L-alanine detoxification. J Appl Microbiol 2022; 133:311-322. [PMID: 35365856 DOI: 10.1111/jam.15561] [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: 12/09/2021] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
AIMS To characterize the functions of nitrilases of Variovorax boronicumulans CGMCC 4969 and evaluate flonicamid (FLO) degradation and β-cyano-L-alanine (Ala(CN)) detoxification by this bacterium. METHODS AND RESULTS V. boronicumulans CGMCC 4969 nitrilases (NitA and NitB) were purified and substrate specificity assay indicated that both of them degraded insecticide FLO to N-(4-trifluoromethylnicotinoyl)glycinamide (TFNG-AM) and 4-(trifluoromethyl)nicotinol glycine (TFNG). Ala(CN), a plant detoxification intermediate, was hydrolyzed by NitB. Escherichia coli overexpressing NitA and NitB degraded 41.2 and 93.8% of FLO (0.87 mmol·L-1 ) within 1 h, with half-lives of 1.30 and 0.25 h, respectively. NitB exhibited the highest nitrilase activity toward FLO. FLO was used as a substrate to compare their enzymatic properties. NitB was more tolerant to acidic conditions and organic solvents than NitA. Conversely, NitA was more tolerant to metal ions than NitB. CGMCC 4969 facilitated FLO degradation in soil and surface water and utilized Ala(CN) as a sole nitrogen source for growth. CONCLUSIONS CGMCC 4969 efficiently degraded FLO mediated by NitA and NitB; NitB was involved in Ala(CN) detoxification. SIGNIFICANCE AND IMPACT OF THE STUDY This study promotes our understanding of versatile functions of nitrilases from CGMCC 4969 that is promising for environmental remediation.
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Affiliation(s)
- H Y Jiang
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Industrialization of Microbial Resources, College of Life Science, Nanjing Normal University, Nanjing, People's Republic of China
| | - N D Jiang
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Industrialization of Microbial Resources, College of Life Science, Nanjing Normal University, Nanjing, People's Republic of China
| | - L Wang
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Industrialization of Microbial Resources, College of Life Science, Nanjing Normal University, Nanjing, People's Republic of China
| | - J J Guo
- Nanjing Normal University Zhongbei College, Zhenjiang, People's Republic of China
| | - K X Chen
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Industrialization of Microbial Resources, College of Life Science, Nanjing Normal University, Nanjing, People's Republic of China
| | - Y J Dai
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Industrialization of Microbial Resources, College of Life Science, Nanjing Normal University, Nanjing, People's Republic of China
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Liu L, Su X, Zhao L, Li J, Xu W, Yang L, Yang Y, Gao Y, Chen K, Gao Y, Guo JJ, Wang H, Lin J, Han J, Fan L, Fang X. Association of Homocysteine and Risks of Long-Term Cardiovascular Events and All-Cause Death among Older Patients with Obstructive Sleep Apnea: A Prospective Study. J Nutr Health Aging 2022; 26:879-888. [PMID: 36156680 DOI: 10.1007/s12603-022-1840-6] [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] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to assess whether raised baseline plasma tHcy concentrations increased the risks of major adverse cardiovascular events (MACE) and all-cause death outcomes in older patients with obstructive sleep apnea (OSA). DESIGN A multicenter, prospective, observational study. SETTING Beijing, Shandong Province, Gansu Province of China. PARTICIPANTS A total of 1, 290 OSA patients aged 60 to 96 years from sleep centers of six hospitals in China consecutively recruited between January 2015 and October 2017. MEASUREMENTS Cox proportional models assessed the association between tHcy and the risk of new-onset all events among Chinese older OSA patients. RESULTS The final analysis (60.1% male; median age, 66 years) used data from 1, 100 subjects during a median follow-up of 42 months, a total of 105 (9.5%) patients developed MACE and 42 (3.8%) patients died. Multivariable Cox regression analysis showed higher adjusted hazard ratios (aHRs) of MACE, myocardial infarction (MI), hospitalization for unstable angina, and composite of all events with tHcy levels in the 4th quartile (HR=5.93, 95% CI: 2.79-12.59; HR=4.72, 95% CI:1.36-4.61; HR=4.26, 95% CI:1.62-5.71; HR=4.17, 95% CI:2.23-7.81) and the 3rd quartile (HR=3.79, 95% CI:1.76-8.20; HR=3.65, 95% CI:1.04-2.98; HR=2.75, 95% CI:1.08-3.76; HR=2.51, 95% CI:1.31-4.83) compared to reference tHcy levels in quartile 1, respectively, while the aHRs (95% CIs) of all-cause death showed significantly higher only in the highest tHcy level quartile than in the lowest quartile (HR=3.20, 95% CI=1.16-8.84, P=0.025) with no significant differences in risks of cardiovascular death and hospitalisation for heart failure among groups (P>0.05). CONCLUSIONS tHcy, a marker of prognosis for older OSA patients, was significantly associated with the increased risk of MACE and all-cause death in this population independent of BMI, smoking status, and other potential risk factors, but not all clinical components events of MACE. New therapeutic approaches for older patients with OSA should mitigate tHcy-associated risks of MACE, and even all-cause death.
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Affiliation(s)
- L Liu
- Xiangqun Fang, Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China. ; Li Fan, Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China. ; Jiming Han, Medical College, Yan'an University,Yan'an, Shaanxi Province, China.
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Sun SG, Guo JJ, Qu XY, Tang XY, Lin YY, Hua KQ, Qiu JJ. The extracellular vesicular pseudogene LGMNP1 induces M2-like macrophage polarization by upregulating LGMN and serves as a novel promising predictive biomarker for ovarian endometriosis recurrence. Hum Reprod 2021; 37:447-465. [PMID: 34893848 DOI: 10.1093/humrep/deab266] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/05/2020] [Revised: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION How does ectopic endometrial stromal cell (Ecto-ESC)-derived extracellular vesicular Legumain pseudogene 1 (EV-LGMNP1), a newly identified pseudogene of Legumain (LGMN), contribute to M2-phenotype macrophage polarization, and does it predict recurrence in patients with ovarian endometriosis (EMs)? SUMMARY ANSWER EV-LGMNP1, which is abundant in Ecto-ESCs and serum from ovarian EMs, can direct macrophages towards an M2 phenotype by upregulating LGMN expression and is a promising biomarker for predicting ovarian EMs recurrence. WHAT IS KNOWN ALREADY Extracellular vesicles (EVs) can mediate cell-to-cell crosstalk to promote disease progression via cargo molecule transport. Recently, LGMNP1, a newly identified pseudogene of LGMN, has been reported to promote cancer progression by upregulating LGMN. LGMN is a well-studied protein that can induce M2-like polarization. STUDY DESIGN, SIZE, DURATION An in vitro study was conducted with Ecto-ESCs isolated from ectopic endometrial samples, collected from two patients with ovarian EMs (diagnosed by laparoscopy and histological analysis). A clinical retrospective cohort study of 52 ovarian EMs patients and 21 controls with available preoperative serum samples was carried out (2013-2017). The follow-up period ended either at the time of recurrence or on 31 December 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Ecto-ESC-derived EVs (EV/Ecto-ESCs) were characterized by nanoparticle tracking analysis, transmission electron microscopy and western blotting. EV internalization by THP-1 cells, which are the most widely used primary human macrophages model, was detected by fluorescence labelling. After EV treatment, THP-1 cell polarization was detected by quantitative real-time PCR (qRT-PCR) and western blot analyses of CD86 (M1-related marker) and CD206 (M2-related marker). LGMNP1 mRNA expression level in EVs from both primary ectopic endometrioc stromal cells and serum was examined using qRT-PCR. Additionally, the expression of LGMN, the downstream target gene of LGMNP1, in THP-1 cells was evaluated using qRT-PCR and western blotting. Kaplan-Meier and multivariate Cox regression analyses were applied to evaluate the independent predictive factors of EMs recurrence-free survival. A novel nomogram model based on serum EV-LGMNP1 was then formulated to predict EMs recurrence. MAIN RESULTS AND THE ROLE OF CHANCE In vitro assays demonstrated that EV/Ecto-ESCs drove macrophages towards an M2-like phenotype. Moreover, LGMNP1 contributed to EV/Ecto-ESC-induced M2 macrophage polarization by upregulating LGMN mRNA expression levels. Clinically, serum EV-LGMNP1 was more highly expressed in recurrent EMs patients than in controls and EMs patients without recurrence. Survival analysis and our novel nomogram reconfirmed that serum EV-LGMNP1 was a novel promising and meaningful non-invasive biomarker for predicting EMs recurrence. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION In vitro experiments were only performed on samples from two patients with ovarian endometriosis, and a larger sample size is needed. ESCs isolated from the eutopic endometrium of EMs and non-EMs patients should be studied in the future. Additionally, in vitro experiments should be performed using endometrial epithelium cells and further in vivo experiments, such as using mice endometriotic models to investigate whether EV/Ecto could induce M2 macrophage polarization, should be conducted. Moreover, multicentre, large-sample data are needed to validate our predictive nomogram model. WIDER IMPLICATIONS OF THE FINDINGS Our study provides novel insights into the mechanism of M2 polarization involved in ovarian EMs progression mediated by an 'EV-shuttled pseudogene LGMNP1' mode. In addition, serum EV-LGMNP1 may serve as a novel non-invasive biomarker for predicting recurrence, providing a new therapeutic target for ovarian EMs. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by funding from the National Natural Science Foundation of China (81971361), the Natural Science Foundation of Shanghai Science and Technology (19ZR1406900), the Shanghai 'Rising Stars of Medical Talent' Youth Development Program (AB83030002019004), the Clinical Research Plan of SHDC (SHDC2020CR4087), the Shanghai Municipal Health Commission (202040498), the Research and Innovation Project of the Shanghai Municipal Education Commission (2019-01-07-00-07-E00050) and the Clinical Research Plan of SHDC (SHDC2020CR1045B). There are no competing interests to declare.
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Affiliation(s)
- S G Sun
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - J J Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Y Qu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Y Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Y Y Lin
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - K Q Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - J J Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Yue X, Hincapie AL, Li Y, Guo JJ. Safety and cost-effectiveness of ponatinib versus other tyrosine kinase inhibitors as second-line therapy in patients with chronic myeloid leukemia in the United States. Leuk Lymphoma 2021; 63:946-954. [PMID: 34775888 DOI: 10.1080/10428194.2021.2002320] [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: 10/19/2022]
Abstract
To evaluate the cost-effectiveness of ponatinib compared with second-line TKIs in the treatment of adult patients with CML who failed, or were intolerant to, first-line TKIs. A Markov state transition model was conducted. Model transition, adverse-effect probabilities, utility data and medical costs were obtained from clinical trials and literature. Measurements included medications, follow-ups, adverse events, allogeneic stem cell transplantation and quality-adjusted life years (QALYs). Univariable and Bayesian multivariable probabilistic sensitivity analyses were conducted using Monte Carlo simulations. Dasatinib resulted in an ICER of $79,086/QALY compared to nilotinib. Ponatinib yielded an ICER of $176,278/QALY and $141,563/QALY compared to dasatinib and nilotinib, respectively. Dasatinib was the optimal treatment at a $100,000/QALY threshold. The probability (36%-40%) for ponatinib or dasatinib optimal treatment was associated with thresholds of $160,000-$180,000/QALY. Dasatinib and ponatinib can be considered cost-effective options and provide clinical benefits compared to other second-line TKIs for CML in the US.
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Affiliation(s)
- Xiaomeng Yue
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ana L Hincapie
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yuxiang Li
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeff J Guo
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
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Fung A, Yue X, Wigle PR, Guo JJ. Off-label medication use in rare pediatric diseases in the United States. Intractable Rare Dis Res 2021; 10:238-245. [PMID: 34877235 PMCID: PMC8630459 DOI: 10.5582/irdr.2021.01104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/19/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
Many pediatric patients with rare diseases use drugs off-label due to limited data in pediatric patients. Off-label treatment remains an important public health issue for neonates, infants, children, and adolescents, especially for pediatric patients with rare diseases. For patients with rare diseases, the majority of medications have no or limited information in labelling for pediatric use. Children present unique considerations in clinical trials due to ethical and clinical concerns, which have limited and even discouraged testing of drugs in the pediatric population. Numerous legislative measures have been enacted to address barriers in pediatric drug testing. This research reviewed off-label medication use in rare pediatric diseases, evaluated recent medication uses in pediatric clinical practice, discussed key regulations for rare pediatric diseases, and summarized recent drug approvals for rare pediatric diseases. This study demonstrates the ongoing medical need for newly approved medications to treat pediatric rare diseases and revealed the positive impact of regulations from the Orphan Drug Act of 1983 to the Research to Accelerate Cures and Equity (RACE) for Children Act on drug development and off-label medication practice in rare pediatric disease management. This article provides informative historical background and current considerations of off-label use of medications in neonates, infants, children, and adolescents with rare diseases.
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Affiliation(s)
- Albert Fung
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Xiaomeng Yue
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
- Joulé, Edison, New Jersey, USA
- Address correspondence to:Xiaomeng Yue, Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, 3225 Eden Ave., Cincinnati, OH 45267, USA. E-mail:
| | - Patricia R. Wigle
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Jeff J. Guo
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
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Shang GQ, Xiang S, Guo CC, Guo JJ, Zhang HN, Wang YZ, Xu H. [Diagnostic value of platelet associated biomarkers in chronic periprosthetic joint infection]. Zhonghua Wai Ke Za Zhi 2021; 59:767-772. [PMID: 34404175 DOI: 10.3760/cma.j.cn112139-20210401-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the diagnostic value of platelet count(PC),PC to mean platelet volume(MPV) ratio(PC/MPV) and plateletcrit(PCT) in chronic periprosthetic joint infection(PJI). Method: The medical records of 159 patients who underwent hip or knee revisions at Department of Joint Surgery,Affiliated Hospital of Qingdao University from August 2013 to June 2019 were retrospectively reviewed. There were 51 patients(26 knees and 25 hips) in the PJI group,which included 28 males and 23 females,aged (68.0±11.8)years (range:32 to 84 years)with a body mass index(BMI)of (26.1±3.6) kg/m².There were 116 patients(19 knees and 97 hips) in the aseptic loosening(AL) group,including 67 males and 49 females,aged (70.3±8.9)years(range:49 to 89 years)with a BMI of (25.0±3.6)kg/m².The plasma C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),PC,MPV,PC/MPV and PCT levels of the two groups were recorded and analyzed. Receiver operating characteristic curve was used to calculate the sensitivity and specificity of each biomarker,expect for MPV,and the diagnostic value of each biomarker was compared according to the area under the curve(AUC).Independent-sample t test or Mann-Whitney U test were used for comparison between groups. Result: Compared with AL group,AJI group had significantly higher levels of CRP,ESR,PC,PC/MPV and PCT(all P<0.05),but lower level of MPV (P<0.05).The AUCs for CRP,ESR,PC,PC/MPV and PCT were 0.820, 0.829, 0.689, 0.668 and 0.676,respectively. Based on the Youden index,the optimal predictive cutoff for CRP was 11.12 mg/L,with a sensitivity of 74.4% and a specificity of 87.1%.The optimal predictive cutoff for ESR was 17.60 mm/1 h,with a sensitivity of 81.4% and a specificity of 75.3%.The optimal predictive cutoff for PC was 243.00×109/L,with a sensitivity of 60.6% and a specificity of 71.8%.The optimal predictive cutoff for PC/MPV was 24.95,the sensitivity was 58.1% and the specificity was 74.1%.And the optimal predictive cutoff for PCT was 0.24%,with a sensitivity of 69.8% and a specificity of 63.5%. Conclusion: PC,PC to MPV ratio and PCT were of limited value to diagnose PJI.
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Affiliation(s)
- G Q Shang
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - S Xiang
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - C C Guo
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - J J Guo
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - H N Zhang
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - Y Z Wang
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
| | - H Xu
- Department of Joint Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China
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Yue X, Huang B, Hincapie AL, Wigle PR, Li Y, Qiu T, Lovell DJ, Morgan EM, Guo JJ. Comparative effectiveness and persistence of TNFi and non-TNFi in juvenile idiopathic arthritis: a large paediatric rheumatology centre in the USA. Rheumatology (Oxford) 2021; 60:4063-4073. [PMID: 34469569 PMCID: PMC10452955 DOI: 10.1093/rheumatology/keaa877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/13/2020] [Revised: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the persistence and effectiveness of TNF inhibitors (TNFi) vs non-TNFi among newly diagnosed JIA patients after initiation of biologic DMARD (bDMARD). METHODS Using longitudinal patient-level data extracted from electronic medical records in a large Midwestern paediatric hospital from 2009 to 2018, we identified JIA patients initiating TNFi and non-TNFi treatment. Treatment effectiveness was assessed based on disease activity. Inverse probability of treatment weighting of propensity score was used to estimate the treatment effectiveness and Kaplan-Meier analyses were conducted to assess persistence. RESULTS Of 667 JIA patients, most (92.0%) were prescribed one of the class of TNFi as their initial biologic treatment. Etanercept was the most frequently prescribed (67.1%) treatment, followed by adalimumab (27.5%). Only around 5% of patients were prescribed off-label bDMARDs as their first-course treatment; however, >20% were prescribed off-label biologics as their second-course therapy. Some 7.2% of patients received four or more bDMARDs. The median persistence of the first-course bDMARD is 320 days, with TNFi being significantly longer than the non-TNFi (395 vs 320 days, P = 0.010). The clinical Juvenile Disease Activity Score (cJADAS) reduction of TNFi users (6.6, 95% CI 5.7, 7.5) was significant greater compared with non-TNFi users (3.0, 95% CI 1.5, 4.6, P < 0.0001) at 6-month follow-up visit. CONCLUSION Persistence was significantly longer among patients initiating TNFi as their first biologic therapy than those receiving non-TNFi. Patients receiving TNF therapy had significant greater reduction of cJADAS at the 6-month follow-up visit compared with patients in the non-TNF cohort.
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Affiliation(s)
- Xiaomeng Yue
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Patricia R Wigle
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Yuxiang Li
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
| | - Daniel J Lovell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Esi M Morgan
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Feng DD, Chen XH, Guo JJ, Wang KK, Zhang XM, Gao JM. [Preliminary study of the fourth-generation CAR-T cells targeting CS1 in the treatment of refractory and recurrent multiple myeloma]. Zhonghua Zhong Liu Za Zhi 2021; 43:657-665. [PMID: 34289557 DOI: 10.3760/cma.j.cn112152-20200415-00347] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To design the fourth-generation chimeric antigen receptor-T (CAR-T) cells that secrete interleukin-7 (IL7) and chemokine C legend 19 (CCL19) on the basis of the second-generation CAR, and to analyze and compare the differences in proliferation, chemotaxis, tumor cell clearance and persistence in the microenvironment of multiple myeloma (MM) between them. Methods: The fourth-generation CAR vector plasmid was constructed by using 2A self-cleaving peptide technology. The third-generation lentiviral packaging system was used to prepare high-titer lentivirus. Flow cytometry was used to monitor the transduction efficiency of lentivirus and the subtype changes of CAR-T cells. The enzyme-linked immunosorbent assay (ELISA) was used to quantify the IL7 and CCL19 secreted by CAR-T cells.The calculation of absolute number of CAR-T cells during culture was used to analysis cell proliferation activity. Transwell migration assay was used to verify the chemotactic ability of CAR-T cells. The specific killing activity of CAR-T cells was detected by using the luciferase bioluminescence method. The NOD-Prkdcem26Cd52Il2rgem26Cd22/Nju (NOD) mouse xenograft model was used to verify the anti-myeloma activity and safety of CAR-T cells in vivo. Results: Flow cytometry results showed that the stable CAR expression rates of the second-generation anti-CS1 CAR-T and fourth-generation anti-CS1-IL7-CCL19 CAR-T cells were (91.50±0.29)% and (46.7±0.12)%, respectively. CAR-T cells were successfully constructed. Subtype analysis demonstrated that the ratio of stem memory T cell (TSCM) in anti-CS1-IL7-CCL19 CAR-T cells was (67.58±0.59)%, which was significantly higher than (50.74 ± 1.01)% of anti-CS1 CAR-T (P=0.000 1), with more strong immune memory function and better durability. Anti-CS1-IL7-CCL19 CAR-T cells can continuously secrete IL7 and CCL19 compared to MOCK-T and anti-CS1 CAR-T (P<0.000 1). The number of anti-CS1-IL7-CCL19 CAR-T cells reached (22.77±0.79)×10(6) on the 9th day after lentivirus transduction, which was significantly higher than (9.40±0.79)×10(6) of anti-CS1 CAR-T cells (P=0.000 1), with stronger proliferation ability. The number of chemotaxis cells of anti-CS1-IL7-CCL19 CAR-T cells to reactive T cells was (109.0±4.04), which was significantly higher than (9.33±1.20) of MOCK-T (P<0.000 1) and (7.33±0.88) of anti-CS1 CAR-T (P<0.000 1), with stronger chemotactic ability. The specific killing activity showed that both anti-CS1-IL7-CCL19 CAR-T and anti-CS1 CAR-T cells had specific killing efficacies when compared with the MOCK-T cells (P<0.000 1). Animal experiment indicated that anti-CS1-IL7-CCL19 CAR-T cells significantly reduced the tumor burden (P<0.000 1) and extended the overall survival time (P=0.006 1) of tumor-bearing mice. Conclusions: The anti-CS1-IL7-CCL19 CAR-T cells designed in this study show stronger proliferative activity, chemotactic ability, and durability without affecting the anti-myeloma activity in vivo and in vivo, which provides strategies for overcoming the defects of low survival rate, poor durability and inhibition by tumor microenvironment of traditional CAR-T cells, and offers preliminary experimental basis for the clinical application of the fourth-generation CAR-T cells.
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Affiliation(s)
- D D Feng
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - X H Chen
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - J J Guo
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - K K Wang
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - X M Zhang
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - J M Gao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
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15
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Fan WJ, Xu TT, Guo JJ, Li YF, Jiang ZX. [Prognostic analysis of patients with mutations in the JAK/STAT signaling pathway in adult acute lymphoblastic leukemia]. Zhonghua Xue Ye Xue Za Zhi 2021; 42:594-597. [PMID: 34455748 PMCID: PMC8408485 DOI: 10.3760/cma.j.issn.0253-2727.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W J Fan
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - T T Xu
- Department of Blood Transfusion, Henan Provincial People's Hospital, Zhengzhou 450000, China
| | - J J Guo
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y F Li
- Department of Hematology Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Z X Jiang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
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Pi MY, Xu LY, Guo JJ, Dong XS, Kuna T, Pack I, Han F. [Feasibility study of telemedicine model for diagnosis and treatment of patients with obstructive sleep apnea hypopnea syndrome in China]. Zhonghua Yi Xue Za Zhi 2021; 101:1671-1675. [PMID: 34126715 DOI: 10.3760/cma.j.cn112137-20210202-00321] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the feasibility of applying telemedicine model in disease management for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) in China. Methods: A total of 24 patients were enrolled with suspected OSAHS who were admitted to the Sleep Center of Peking University People's Hospital from October 2015 to September 2016. Patients were diagnosed by electronic questionnaire assessment and home sleep apnea monitoring (HSAT) and were treated with remote automatic positive airway pressure (APAP). After 1 week, 1 month and 3 months of treatment, the patients were followed up by video. The follow-up questionnaire was completed by the patients through an independent data management platform. The APAP treatment data and compliance data were obtained through a built-in digital card of the APAP device. Linear regression model was used to explore the factors related to patient compliance. One-way repeated-measure analysis of variance was used to compare the changes of APAP duration and apnea hypopnea index (AHI) among patients at different treatment time points. Paired t-test was used to compare the EPWORTH scale (ESS) scores before and after treatment. Results: A total of 22 patients were diagnosed with OSAHS, including 20 males (90.9%), aged (45.6±10.2) years and AHI before treatment was (46.9±20.4) times/h. A total of 20 OSAHS patients received APAP treatment, and the proportion of patients with good compliance after 1 week, 1 month and 3 months of treatment were 15/19, 10/19 and 8/18, respectively. The severity of sleepiness before treatment affected compliance. Each 1-point increase in ESS score was associated with a 6.16% (95%CI: 3.01%, 9.31%) increase in compliance. Age, body mass index and AHI before treatment had no effect on compliance (all P values>0.05). The AHI of the patients who had been treated for 1 week, 1 month and 3 months were (2.5±2.1), (2.2±1.6) and (1.9±1.0) times/h, respectively. (P=0.195). After 3 months of treatment, the ESS score was (7.0±3.3), lower than that before treatment (10.6±3.1) (P=0.079). Conclusion: Telemedicine mode of diagnosis and treatment of OSAHS patients has good therapeutic effect and patient compliance, which is practical and feasible.
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Affiliation(s)
- M Y Pi
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - L Y Xu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - J J Guo
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - X S Dong
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - T Kuna
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia PA 19104, United States
| | - I Pack
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Pennsylvania PA 19104, United States
| | - F Han
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
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Yue X, Huang B, Hincapie AL, Wigle PR, Qiu T, Li Y, Morgan EM, Guo JJ. Prescribing Patterns and Impact of Factors Associated with Time to Initial Biologic Therapy among Children with Non-systemic Juvenile Idiopathic Arthritis. Paediatr Drugs 2021; 23:171-182. [PMID: 33651370 DOI: 10.1007/s40272-021-00436-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine patterns of initial prescriptions, investigate time to initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs), and evaluate the impact of clinical and other baseline factors associated with the time to first bDMARD in treating children with newly diagnosed non-systemic juvenile idiopathic arthritis (JIA). METHODS Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009 to 2018, the initial prescriptions and prescribing patterns of bDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids within 3 months of JIA diagnosis were examined. Kaplan-Meier analyses were performed to assess time to initiation of bDMARDs. Cox proportional hazard models were used to identify factors associated with time to first bDMARD. RESULTS Of 821 children, the proportion of patients with initial csDMARDs increased from 45.3% in 2009 to 60.3% in 2018. Around 57.5% of polyarthritis rheumatoid factor-positive (Poly RF+) patients and 43.2% of polyarthritis rheumatoid factor-negative (Poly RF-) patients received a bDMARD therapy within 3 months of diagnosis, 14.4% as monotherapy and 28.3% in combination with a csDMARD. Among patients who received combination therapy, combination of methotrexate with adalimumab increased from 16.7% in 2009 to 40% in 2018. The proportion of patients treated with adalimumab gradually increased and passed etanercept in 2016. The predictors of earlier initiation of biologic therapy were JIA category enthesitis-related arthritis (ERA) [hazard ratio (HR) vs persistent oligoarthritis 4.82; p < 0.0001], psoriatic arthritis (PsA) (HR 2.46; p = 0.0002), or Poly RF- (HR 2.43; p = 0.0002); the number of joints with limited range of motion (HR 1.02; p = 0.0222), and erythrocyte sedimentation rate (ESR, HR 1.01; p = 0.0033). CONCLUSIONS There was a substantial increase in the proportion of patients receiving the combination of methotrexate and adalimumab among patients receiving combination therapy. Adalimumab overtook etanercept as the most frequently prescribed bDMARD. Multiple factors affect the time to biologic initiation, including the number of joints with limited range of motion, ESR, and JIA category.
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Affiliation(s)
- Xiaomeng Yue
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA.
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
| | - Patricia R Wigle
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yuxiang Li
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Esi M Morgan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeff J Guo
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
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Alrasheed M, Hincapie AL, Guo JJ. Drug Expenditure, Price, and Utilization in the U.S. Medicaid: A Trend Analysis for SSRI and SNRI Antidepressants from 1991 to 2018. J Ment Health Policy Econ 2021; 24:3-11. [PMID: 33739932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND SSRIs and SNRIs are antidepressants that have largely substituted old antidepressants like Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs). They have been widely used since 1987 when the FDA approved the first SSRI Fluoxetine and the first SNRI Venlafaxine in 1993. Since then, several new SSRIs and SNRIs have been approved and entered the market. Utilization, pricing, and spending trends of SSRIs and SNRIs have not been analyzed yet in Medicaid. AIM To assess the trends of drug expenditure, utilization, and price of SSRI and SNRI antidepressants in the US Medicaid program, and to highlight the market share of SSRIs and SNRIs and the effect of generic drug entry on Medicaid drug expenditure. METHODS A retrospective descriptive data analysis was conducted for this study. National pharmacy summary data for study brand and generic drugs were retrieved from the Medicaid State Outpatient Drug Utilization Data. These data were collected by the US Centers for Medicare and Medicaid Services (CMS). The study period was between 1991 and 2018. Study drugs include 12 different SSRI and SNRI brands and their generics available in the market, such as citalopram, escitalopram, paroxetine, fluoxetine, sertraline, venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran. Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending), and cost per prescription as the proxy of the price for each drug. RESULTS From 1991 to 2018, total prescriptions of SSRI and SNRI drugs rose by 3001%. Total Medicaid spending on SSRIs and SNRIs increased from USD 64.5 million to USD 2 billion in 2004, then decreased steadily until it reached USD 755 million in 2018. The SSRIs average utilization market share was 87% compared to 13% of the SNRIs utilization market share. About 72% of total Medicaid spending on the two groups goes to SSRIs, while the remaining 28% goes to SNRIs. Brand SSRIs and SNRIs prices increased over time. On the contrary, generic drugs prices steadily decreased over time. DISCUSSION An increase in utilization and spending for both SSRI and SNRI drugs was observed. After each generic drug entered the market, utilization shifted from the brand name to the respective generic due to their lower price. These generic substitutions demonstrate a meaningful cost-containment policy for Medicaid programs. IMPLICATIONS FOR HEALTH POLICIES Our findings show the overall view of Medicaid expenditure on one of the most commonly prescribed drug classes in the US. They also provide an important insight toward the antidepressant market and the importance of monitoring different drugs and their alternatives.
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Affiliation(s)
- Marwan Alrasheed
- Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave, Cincinnati, OH 45267-0004, USA,
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Peng Y, Zhang YY, Wang SC, Wu JB, Tong FZ, Liu P, Cao YM, Zhou B, Cheng L, Liu M, Liu HJ, Guo JJ, Xie F, Yang HP, Wang SY, Wang CB, Wang S. [Prognosis analysis of local recurrence after excision of breast phyllodes tumors]. Zhonghua Wai Ke Za Zhi 2021; 59:116-120. [PMID: 33378803 DOI: 10.3760/cma.j.cn112139-20201012-00748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence. Methods: This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People's Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm (M(QR)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results: According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% (P=0.300). Conclusion: Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.
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Affiliation(s)
- Y Peng
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - Y Y Zhang
- Department of Pathology, Peking University People's Hospital, Beijing 100044, China
| | - S C Wang
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - J B Wu
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - F Z Tong
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - P Liu
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - Y M Cao
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - B Zhou
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - L Cheng
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - M Liu
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - H J Liu
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - J J Guo
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - F Xie
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - H P Yang
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - S Y Wang
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - C B Wang
- Breast Center, Peking University People's Hospital, Beijing 100044, China
| | - S Wang
- Breast Center, Peking University People's Hospital, Beijing 100044, China
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Guo JJ, Qiu LH. [Prevention and treatment of root surface caries]. Zhonghua Kou Qiang Yi Xue Za Zhi 2021; 56:27-32. [PMID: 34645231 DOI: 10.3760/cma.j.cn112144-20201106-00554] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the acceleration of population aging in China, the incidence of root surface caries is increasing year by year. Different from coronal caries, lesions of root surface caries mostly occur on the exposed root surfaces after gingival recession in elderly patients, mainly involving cementum and dentin. Root surface caries shows specificity in the pathogenic characteristics, clinical manifestations, diagnosis, treatment, and prevention. This review mainly summarizes the etiology and prevalence, pathology and clinical manifestations, classification, as well as three-level-prevention of root caries, in order to provide relevant guidance for the clinical prevention and treatment of root caries.
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Affiliation(s)
- J J Guo
- Department of Endodontics, School and Hospital of Stomatology, China Medical University & Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110002, China
| | - L H Qiu
- Department of Endodontics, School and Hospital of Stomatology, China Medical University & Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang 110002, China
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Yue X, Li Y, Wu J, Guo JJ. Current Development and Practice of Pharmacoeconomic Evaluation Guidelines for Universal Health Coverage in China. Value Health Reg Issues 2020; 24:1-5. [PMID: 33349598 DOI: 10.1016/j.vhri.2020.07.580] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND China has achieved near-universal health coverage (UHC) for 95 percent of its population (>1.3 billion lives) as a result of healthcare reforms that began in 2009. However, one of many remaining issues in the Chinese healthcare system is the need to better optimize the allocation and use of healthcare resources in order to meet growing healthcare demands. OBJECTIVES The goals are to highlight the components of the China Guidelines for Pharmacoeconomic Evaluations (CGPE) 2020 Edition and discuss its future development for UHC in China. METHODS We review the development process of the CGPE 2020 edition, discuss the contemporary practice of the CGPE for UHC in China, describe new opportunities and challenges to the CGPE, and provide suggestions on the future development of the CGPE based on the current state of the healthcare system in China. RESULTS Pharmacoeconomics provides tools to evaluate the health returns and economic costs of pharmaceutical products in a scientific way for the optimal allocation of healthcare resources. Considering the great potential of pharmacoeconomics in China, demonstrated by its rapid development and recognition as a research field in the past decade, the standardization of pharmacoeconomic evaluations has become particularly important to improve the accuracy of evaluation results used for drug selection, price negotiations and adjustments. CONCLUSION Suggestions are made for the integration of CGPE into current framework of UHC in China, including standardizing the pharmacoeconomic evaluation process and updating CGPE on topics such as ethics and real-world research. The CGPE 2020 edition offers a standard to improve the quality of pharmacoeconomic evaluation research and enhance the value and efficiency of UHC in China.
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Affiliation(s)
- Xiaomeng Yue
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Yuxiang Li
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jiuhong Wu
- Beijing Health Economics Association, Beijing, China
| | - Jeff J Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Yue X, Pruemer JM, Hincapie AL, Almalki ZS, Guo JJ. Economic burden and treatment patterns of gynecologic cancers in the United States: evidence from the Medical Expenditure Panel Survey 2007-2014. J Gynecol Oncol 2020; 31:e52. [PMID: 32266801 PMCID: PMC7286759 DOI: 10.3802/jgo.2020.31.e52] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/03/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This study estimated nationally representative medical expenditures of gynecologic cancers, described treatment patterns and assessed key risk factors associated with the economic burden in the United States. Methods A retrospective repeated measures design was used to estimate the effect of gynecologic cancers on medical expenditures and utilization among women. Data were extracted from the Medical Expenditure Panel Survey (weighted sample of 609,787 US adults) from 2007 to 2014. Using the behavioral model of health services utilization, characteristics of cancer patients were examined and compared among uterine, cervical, and ovarian cancer patients. Multivariable linear regression models were conducted on medical expenditure with a prior logarithmic transformation. Results The estimated annual medical expenditure attributed to gynecologic cancers was $3.8 billion, with an average cost of $6,293 per patient. The highest annual cost per person was ovarian cancer ($13,566), followed by uterine cancer ($6,852), and cervical cancer ($2,312). The major components of medical costs were hospital inpatient stays (53%, $2.03 billion), followed by office-based visits (15%, $559 million), and outpatient visits (13%, $487 million). Two key prescription expenditures were antineoplastic hormones (10.3%) and analgesics (9.2%). High expenditures were significantly associated with being a married woman (p<0.001), having private health insurance (p<0.001), being from a low- and middle-income family (p<0.001), or living in the Midwest or the South (p<0.001). Conclusion The key risk factors and components were well described for the economic burden of gynecologic cancers. With a growing population of cancer patients, efforts to reduce the burden of gynecologic cancers are warranted.
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Affiliation(s)
- Xiaomeng Yue
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA.
| | - Jane M Pruemer
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Ana L Hincapie
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | - Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Jeff J Guo
- Division of Pharmacy Practice & Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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Han H, Liu ZY, Guo JJ, Fu XL, He J, Guo YD, Cai JF. Prospects of Application of Microbial Biofilm to Estimate PMI of Corpses in Water. Fa Yi Xue Za Zhi 2019; 35:596-601. [PMID: 31833296 DOI: 10.12116/j.issn.1004-5619.2019.05.016] [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] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/30/2022]
Abstract
Abstract In forensic pathology, the estimation of postmortem interval (PMI) has always been a difficult issue, and there is still lack of effective methods to estimate PMI of corpses in water. Microbial biofilm refers to the microbial population attached to non-biological or biological surfaces by microorganisms during microbial growth, that has a three-dimensional structure, surrounded by extracellular polymers and matrix networks created by itself. A series of community succession phenomena of microorganisms occur during the occurrence and development of microbial population. The microbial community and its succession process of this kind of biofilm attached to the surface of a corpse in water may become a new basis for estimation of the PMI of corpses in water. This review elucidates on the concept, classification, research methods, and influencing factors of biofilm and analyzes its application prospects in PMI estimation of corpses in water, which would provide new ideas for the researches in this field.
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Affiliation(s)
- H Han
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - Z Y Liu
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - J J Guo
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - X L Fu
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - J He
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - Y D Guo
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
| | - J F Cai
- Department of Forensic Medicine, College of Basic Medicine, Central South University, Changsha 410013, China
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Guo JJ, Fu XL, Cai JF. Research Progress of Aquatic Corpse Decomposition and Postmortem Submersion Interval Estimation. Fa Yi Xue Za Zhi 2019; 35:459-466. [PMID: 31532158 DOI: 10.12116/j.issn.1004-5619.2019.04.016] [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] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 11/30/2022]
Abstract
Abstract Human corpses can be found in a variety of aquatic environments. The decomposition of corpses in aquatic environments is different from those on land. A large number of factors influence the decomposition process in water, therefore postmortem submersion interval (PMSI) is difficult to estimate. To date, while studies on aquatic corpses are obviously fewer than those on terrestrial corpses, there are many problems in practical work. This review summarizes the stages and influencing factors of aquatic corpse decomposition, and introduces the relevant research progress of PMSI estimation based on decomposition stages, postmortem phenomena, aquatic insects, biofilm, and physical and chemical methods, in order to provide reference for aquatic decomposition researches and practices.
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Affiliation(s)
- J J Guo
- Department of Forensic Medicine, School of Basic Medical Science, Central South University, Changsha 410013, China
| | - X L Fu
- Department of Forensic Medicine, School of Basic Medical Science, Central South University, Changsha 410013, China
| | - J F Cai
- Department of Forensic Medicine, School of Basic Medical Science, Central South University, Changsha 410013, China
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Fu XL, Guo JJ, Liu ZY, Shen X, Cai JF. Application of High-throughput Sequencing in Researches of Cadaveric Microorganisms and Postmortem Interval Estimation. Fa Yi Xue Za Zhi 2018; 34:475-481. [PMID: 30468048 DOI: 10.12116/j.issn.1004-5619.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 11/30/2022]
Abstract
Necrobiome is the main factor causing the cadaver decomposition. Studying the microbial succession during decomposition is one of the main tasks of forensic microbiology. The interactive relationships among cadaver, environment and microorganisms are complicated. The microbial succession study relies on macroscopic monitoring of community composition and the diversity change in each decomposition stage. With the maturity and development of high-throughput sequencing (HTS), the structure and diversity of microbial communities in different environments have been successively revealed. A new breakthrough to explore the cadaveric microorganisms has been opened as well. It has become the research hotspots in forensic microbiology to reveal the microbial succession in the process of cadaver decomposition and to interpret the essence of various decomposition phenomena by using HTS, which can provide a new reference for postmortem interval (PMI) estimation. The present paper reviews studies on PMI estimation by using cadaveric microorganism. Problems and application prospects of forensic microbiology studies are discussed on the basis of the current application of HTS technology in the exploration of microbial succession.
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Affiliation(s)
- X L Fu
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - J J Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - Z Y Liu
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - X Shen
- Public Security Department of Lhasa, Liuwu Xintong Railway Station of Lhasa, Lhasa 850000, China
| | - J F Cai
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
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Su QQ, Miao KC, Zhang XY, Guo JJ, Chen YB. [Cryptococcus bloodstream infection: a retrospectively analysis of 16 cases in one tertiary hospital]. Zhonghua Yi Xue Za Zhi 2018; 98:2824-2826. [PMID: 30248786 DOI: 10.3760/cma.j.issn.0376-2491.2018.35.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical characteristics of cryptococcus bloodstream infection. Methods: A retrospectively analysis was performed by collecting data of clinical manifestations, underlying diseases, susceptible factors, therapy and prognosis of cryptococcus bloodstream infection in the First Affiliated Hospital of Soochow University from December 2006 to December 2017. Results: The most common symptom of the 16 patients was fever (12/16). When combined with cryptococcus infection of central nervous system, the manifestations may include dizziness, headache, nausea and vomiting.Among the 16 patients, 11 cases had underlying diseases, which listed as leukemia, lymphoma, diabetes mellitus, hepatitis B, cirrhosis, chronic kidney disease and carcinoma of the liver; 12 cases had invasive procedures, 6 cases had hypoproteinemia, 4 cases had long-term usage of glucocorticoids, and 5 cases received broad spectrum antibiotics longer than 1 week.8 cases died, 6 cases improved and 2 cases were transferred to the specialized hospital for their newly diagnosed AIDS. Conclusions: Bloodstream infection of cryptococcus is a relatively rare disease.Fever is one of the most common symptoms of cryptococcus bloodstream infection.Underlying diseases, invasive procedures, hypoproteinemia, long-term application of glucocorticoids and antibiotics are the risk factors for cryptococcus bloodstream infection.
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Affiliation(s)
- Q Q Su
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
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Xue LJ, Yang AC, Chen H, Huang WX, Guo JJ, Liang XY, Chen ZQ, Zheng QL. [Study the impacts of diagnosis on occupational noise-induced deafness after bring into the different high frequency hearing threshold weighted value]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2018; 35:812-817. [PMID: 29316750 DOI: 10.3760/cma.j.issn.1001-9391.2017.11.003] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Study of the results and the degree on occupational noise-induced deafness in-to the different high frequency hearing threshold weighted value, in order to provide theoretical basis for the re-vision of diagnostic criteria on occupational noise-induced deafness. Methods: A retrospective study was con-ducted to investigate the cases on the diagnosis of occupational noise-induced deafness in Guangdong province hospital for occupational disease prevention and treatment from January 2016 to January 2017. Based on the re-sults of the 3 hearing test for each test interval greater than 3 days in the hospital, the best threshold of each frequency was obtained, and based on the diagnostic criteria of occupational noise deafness in 2007 edition, Chi square test, t test and variance analysis were used to measure SPSS21.0 data, their differences are tested among the means of speech frequency and the high frequency weighted value into different age group, noise ex-posure group, and diagnostic classification between different dimensions. Results: 1. There were totally 168 cases in accordance with the study plan, male 154 cases, female 14 cases, the average age was 41.18 ±6.07 years old. 2. The diagnosis rate was increased into the weighted value of different high frequency than the mean value of pure speech frequency, the weighted 4 kHz frequency increased by 13.69% (χ(2)=9.880, P=0.002) , 6 kHz increased by 15.47% (χ(2)=9.985, P=0.002) and 4 kHz+6 kHz increased by15.47% (χ(2)=9.985, P=0.002) , the difference was statistically significant. The diagnostic rate of different high threshold had no obvious differ-ence between the genders. 3. The age groups were divided into less than or equal to 40years old group (A group) and 40-50 years old group (group B) , there were higher the diagnostic rate between high frequency weighted 4 kHz (A group χ(2)=3.380, P=0.050; B group χ(2)=4.054, P=0.032) , weighted 6 kHz (A group χ(2)=6.362, P=0.012; B group χ(2)=4.054, P=0.032) , high frequency weighted 4 kHz+6 kHz (A group χ(2)=6.362, P=0.012; B group χ(2)=4.054, P=0.032) than those of speech frequency average value in the same group on oc-cupational noise-induced deafness diagnosis rate, the difference was statistically significant. There was no sig-nificant difference between age groups (χ(2)=2.265, P=0.944) . 4. The better ear's mean value of pure speech fre-quency and the weighted values into different high frequency of working years on each group were compared, working years more than 10 years group was significantly higher than that of average thresholds of each frequen-cy band in 3-5 group (F=2.271, P=0.001) , 6-10 group (F=1.563, P=0.046) , the difference was statistically significant. The different high frequency weighted values were higher than those of the mean value of pure speech frequency, and the high frequency weighted 4 kHz+6 kHz had the highest frequency difference, with an average increase of 2.83 dB. 5. The diagnostic rate into weighted different high frequency was higher in the mild, moderate and severe grades than in the pure speech frequency. In the comparison of diagnosis for mild occupational noise-induced deafness, in addition to the weighted 3 kHz high frequency (χ(2)=3.117, P=0.077) had no significant difference, the weighted 4 kHz (χ(2)=10.835, P=0.001) , 6 kHz (χ(2)=9.985, P=0.002) , 3 kHz+4 kHz (χ(2)=6.315, P=0.012) , 3 kHz+6 kHz (χ(2)=6.315, P=0.012) , 4 kHz+6 kHz (χ(2)=9.985, P=0.002) , 3 kHz+4 kHz+6 kHz (χ(2)=7.667, P=0.002) were significantly higher than the diagnosis rate of the mean value of pure speech frequency. There was no significant difference between the two groups in the moderate and se-vere grades (P>0.05) . Conclusion: Bring into different high frequency hearing threshold weighted value in-creases the diagnostic rate of occupational noise-induced deafness, the weighted 4 kHz, 6 kHz and 4 kHz+ 6 kHz high frequency value affects the result greatly, and the weighted 4 kHz+6 kHz high frequency hearing threshold value is maximum the effect on occupational noise-induced deafness diagnosis.
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Affiliation(s)
- L J Xue
- Qingyuan City Hospital for Occupational Disease Prevention and Treatment, Qingyuan 511500, China
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Chen H, Fan JH, Chen WX, Guo JJ, Huang Y. [Association of HLA-DQ and IFNL4 polymorphisms with hepatitis B virus infection and clearance]. Zhonghua Gan Zang Bing Za Zhi 2018; 25:506-511. [PMID: 29055988 DOI: 10.3760/cma.j.issn.1007-3418.2017.07.006] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To confirmed the polymorphisms of HLA-DQ and IFNL4 were associated with HBV infection and clearance in a Chinese population. Methods: The Sequenom MassARRAY MALDI-TOF system was used to genotype the HLA-DQrs9275319 and IFNL4rs368234815, rs12971396, rs12979860, and rs8099917. A binary logistic regression test was conducted to estimate the relative risk of these SNPs with HBV infection and clearance. Haploview4.2 software and PHASE software (v2.0.2) were employed to analyze linkage disequilibrium (LD) and haplotype frequencies. The MDR program was applied to analyze interactions between SNP and SNP.Statistical analysis was performed using SPSS 19.0 and P-values were corrected by Bonferroni's corrections. Results: A total of 1,069 subjects were recruited and divided into three groups: 238 healthy controls(HC), 397 with HBV-related chronic liver disease (CLD), 434 with spontaneous clearance (SC). The rs9275319TT was most frequently identified among all groups(86.2% in the CLD group, 77.6% in the SC group, and 75.9% in the HC group).Carriage of the rs9275319 C allele was a protective factor for chronic HBV infection (the allele model: P = 0.000 3, OR,0.514; 95% CI, 0.359-0.738) and clearance (the allele model: P = 0.002, OR, 1.659; 95% CI, 1.197-2.300). HLA-DQ rs9275319 showed a significant association with HBV infection (allele model, OR, 0.514; 95% CI, 0.359-0.738, adjusted P = 0.000 3) and spontaneous clearance (allele model, OR, 1.659; 95% CI, 1.197-2.300, adjusted P = 0.002). However, there was no association between IFNL4 polymorphism and HBV infection((allele model: P = 0.082 for rs368234815; P = 0.063 for rs12971396; P = 0.517 for rs12979860; P =0.695 for rs8099917) or spontaneous clearance ((allele model: P = 0.358 for rs368234815; P = 0.105 for rs12971396; P = 0.640 for rs12979860; P = 0.640 for rs8099917;all P > 0.05). The multifactor dimensionality reduction (MDR) test showed there was a three-way interaction (rs12971396, rs12979860, and rs9275319) between IFNL4 and HLA-DQ polymorphisms for HBV infection (permutation P = 0.009 for the best factor model) and clearance (permutation P = 0.014 for the best factor model). Conclusion: The SNP-SNP interaction between HLA-DQ and IFNL4 is associated with the regulation of HBV infection and natural clearance.
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Affiliation(s)
- H Chen
- Department of Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - J H Fan
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - W X Chen
- Department of Laboratory, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - J J Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Y Huang
- Department of Infectious Disease, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Yuan H, Ali MS, Brouwer ES, Girman CJ, Guo JJ, Lund JL, Patorno E, Slaughter JL, Wen X, Bennett D. Real-World Evidence: What It Is and What It Can Tell Us According to the International Society for Pharmacoepidemiology (ISPE) Comparative Effectiveness Research (CER) Special Interest Group (SIG). Clin Pharmacol Ther 2018; 104:239-241. [PMID: 29733448 DOI: 10.1002/cpt.1086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/13/2018] [Accepted: 04/06/2018] [Indexed: 12/28/2022]
Abstract
On December 8, 2016, the New England Journal of Medicine published a sounding board on Real World Evidence (RWE)1 by the US Food and Drug Administration (FDA) leadership. While the value of RWE based on nonrandomized observational studies was appreciated, such as for hypothesis generating, safety, and measuring quality in healthcare delivery, the authors expressed concerns on the quality of data sources and the ability of methodologies to control for confounding. In response, we offer a few considerations regarding these concerns.
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Affiliation(s)
- Hongbo Yuan
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | - M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Emily S Brouwer
- Shire Pharmaceuticals, Lexington, Massachusetts, USA.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | | | - Jeff J Guo
- Pharmacy Practice & Administrative Sciences, University of Cincinnati College of Pharmacy, Cincinnati, Ohio, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan L Slaughter
- Center for Perinatal Research, Nationwide Children's Hospital and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Xuerong Wen
- Health Outcomes, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Dimitri Bennett
- Department of Pharmacoepidemiology, Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
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Ma JY, Guo JJ, Hou L, Zhang F, Yao K, Huang D, Lu H, Dai YX, Li CG, Chang SF, Qin Q, Ge L, Qian JY, Ge JB. [Safety and efficacy of rotational atherectomy in the interventional treatment of coronary chronic total occlusion lesions]. Zhonghua Xin Xue Guan Bing Za Zhi 2018; 46:274-278. [PMID: 29747322 DOI: 10.3760/cma.j.issn.0253-3758.2018.04.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the safety and efficacy of rotational atherectomy in the interventional treatment of coronary chronic total occlusion lesions. Methods: In this retrospective study,a total of 31 consecutive patients with coronary chronic total occlusion(CTO) lesions underwent rotational atherectomy in our hospital from February 2004 to December 2016 were enrolled,and the clinical features were analyzed. Coronary atherectomy was performed if balloon failed to cross the CTO lesions or balloon could not be fully dilated in the CTO lesions after wire crossing. The definition of procedure success was defined as residual stenosis less than 20% after implantation of drug eluting stent and rotational atherectomy. After the procedure, the patients were followed up to observe major adverse cardiac and cerebral vascular events which including cardiogenic death, myocardial infarction, cerebrovascular accident, and target lesion revascularization. Results: The 1.25 mm diameter burr was firstly selected in 80.6% (25/31) patients,and 96.8%(30/31) patients used only 1 burr to complete the rotational atherectomy procedure. The complication rate was 9.8% (3/31) including 1 patient with coronary dissection and 3 patients with slow flow or no flow. There was 1 patent with both coronary dissection and slow flow. The procedure success rate was 96.8%(30/31). Interventional treatment related myocardial infarction occurred in 3 patients during hospitalization.The 30 patients with procedure success were followed up 36(11, 96) months. The incidence rate of major adverse cardiac and cerebral vascular events was 13.3% (4/30), of which the cardiogenic death rate was 3.3% (1/30), the myocardial infarction rate was 6.7% (2/30), cerebrovascular accident rate was 3.3%(1/30),and the target lesion revascularization rate was 6.7% (2/30). Conclusion: Rotational atherectomy is safe and effective in the interventional treatment of coronary CTO lesions.
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Affiliation(s)
- J Y Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
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Xu K, Shu KY, Li FF, Chen T, Liu J, Jin SS, Guo JJ, Zhang ZH, Jiang MH. [Analysis on the novel compound heterozygous mutation FⅪ of a patient with hereditary factor Ⅺ deficiency]. Zhonghua Yi Xue Za Zhi 2017; 97:3774-3778. [PMID: 29325334 DOI: 10.3760/cma.j.issn.0376-2491.2017.48.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical phenotype and genotype characteristics of a Chinese hereditary factor Ⅺ deficiency pedigree. Methods: The activated partial thromboplastin time (APTT), prothrombin time (PT), FⅪ activity (FⅪ: C) were measured by clotting method using automatic coagulation analyzer. The FⅪ antigen (FⅪ: Ag) was assayed by enzyme-linked immunosorbent assay (ELISA). Fifteen exons of F11 from the proband and his pedigree members were amplified by polymerase chain reaction (PCR), then sequenced. Pymol software was used to analyze the novel mutations. Results: APTT, FⅪ: C and FⅪ: Ag of proband was 74.2 s, 4.0% and 2.9%, respectively. For his older sister, APTT, FⅪ: C and FⅪ: Ag was 67.1 s, 3.0% and 1.8%, respectively. APTT, FⅪ: C and FⅪ: Ag of healthy controls were 34.5 s, 100.0% and 100.0%. FⅪ: C of proband's father, mother and brother were 72.0%, 62.0%, and 78.0%, respectively. FⅪ: Ag of them were 50.0%, 43.0%, and 51.8%, respectively. The other coagulant parameters of the proband and his pedigree were all in the normal range. Sequence analysis showed two heterozygous gene mutations in F11 of the proband and his older sister. One was a deletion of T at nucleotide 1 491 in exon 12, resulting in a frameshift. A substitution of leucine 465 by tryptophan and a terminal coden after 7 amino acid: F11NM_13142c.1491delT (p.Leu465Trp.fs*7). The other was a G to A substitution at nucleotide 1 815 in exon 15, resulting in a substitution of glycine 573 by aspartic acid: F11 NM_13142c.1815G>A (p.Gly573Asp). F11NM_13142c.1491delT (p.Leu465Trp.fs*7) heterozygotes were found both in the proband's father and his brother while p. Gly573Asp heterozygote was only found in his mother. F11 of the proband's uncle was wild. Conclusion: The novel compound heterozygous mutations of F11NM_13142c.1491delT (p.Leu465Trp.fs*7) and F11 NM_13142 c. 1815G>A (p.Gly573Asp) are responsible for FⅪ deficiency to the proband, which induced the decrease of FⅪ: C and FⅪ: Ag.
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Affiliation(s)
- K Xu
- Department of Laboratory Medicine, the People's Hospital of Wenzhou, Wenzhou 325000 , China
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Xu X, Rao Y, Abdullah AS, Sharma M, Guo JJ, Zhao Y. Preventive behaviours in avoiding indoor secondhand smoke exposure among pregnant women in China. Tob Control 2017; 26:483-484. [PMID: 27432912 PMCID: PMC5520250 DOI: 10.1136/tobaccocontrol-2016-053047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/03/2016] [Accepted: 06/27/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yunshuang Rao
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan, Jiangsu Province, China
- Duke Global Health Institute, Duke University, Durham, USA
| | - Manoj Sharma
- Behavioral & Environmental Health, Jackson State University, Jackson, Mississippi, USA
| | - Jeff J Guo
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
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Guo JJ, Liu JY, Wang SL. [Kounis sysdrome secondary to crucian allergy:a case report]. Zhonghua Xin Xue Guan Bing Za Zhi 2017; 45:438-439. [PMID: 28511332 DOI: 10.3760/cma.j.issn.0253-3758.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
A stable hollow Au20Si12 cage with Ih symmetry has been predicted using first-principles density functional theory. The stability of the cage-like Au20Si12 structure is verified by vibrational frequency analysis and molecular dynamics simulations. A relatively large highest occupied molecular orbital-lowest unoccupied molecular orbital gap of 1.057 eV is found. Electronic structure analysis shows that clearly p-d hybridizations between Si atoms and Au atoms are of great importance for the stability of Au20Si12 cage. The cage-like Au20Si12 structure may have potential applications in semiconductor industry and microelectronics.
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Affiliation(s)
- J J Guo
- Department of Physics and Hebei Advanced Thin Film Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024, China
| | - H Y Zhao
- Department of Physics and Hebei Advanced Thin Film Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024, China
| | - J Wang
- Department of Physics and Hebei Advanced Thin Film Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024, China
| | - L Y Ai
- Department of Physics and Hebei Advanced Thin Film Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024, China
| | - Y Liu
- Department of Physics and Hebei Advanced Thin Film Laboratory, Hebei Normal University, Shijiazhuang, Hebei 050024, China
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Atzinger CB, Guo JJ. Biologic Disease-Modifying Antirheumatic Drugs in a National, Privately Insured Population: Utilization, Expenditures, and Price Trends. Am Health Drug Benefits 2017; 10:27-36. [PMID: 28465766 PMCID: PMC5394542] [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] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/20/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Spending on biologic drugs is a significant driver of drug expenditures for payers in private health plans. Biologic disease-modifying antirheumatic drugs (DMARDs) are some of the most effective and costly treatments in a physician's arsenal. Understanding the total annual expenditure, the average cost per prescription, and the impact of cost-sharing is important for drug benefit managers. OBJECTIVE To assess drug utilization, expenditures, out-of-pocket (OOP) cost, and price trends of biologic DMARDs in patients with rheumatoid arthritis (RA) in a large managed care organization. METHODS We conducted a retrospective database analysis of pharmacy claims data from January 2004 to December 2013 using the Optum Clinformatics Data Mart database, which covers 13.3 million lives. Pharmacy claims for 40,373 patients with RA were identified during the study period. In all, 9 biologic DMARDs approved for the treatment of RA, including infliximab, etanercept, adalimumab, certoizumab, golimumab, tocilizumab, anakinra, abatacept, and rituximab, and 1 nonbiologic oral, small molecule-targeted synthetic drug, tofacitinib, were included in this study. Descriptive statistics were used to analyze the total annual number of prescriptions, the total annual expenditures, the average annual cost per drug (a proxy of drug price), and the average OOP cost (copay plus deductible and coinsurance). All measurements were also stratified by study drugs and by insurance type. RESULTS Of the 40,373 patients with RA included in the study, approximately 76% were female (mean age, 55 years at diagnosis). Approximately 77% of the patients were white, and almost 48% lived in the South or Midwest region of the United States. Approximately 62% of patients had a point of service insurance plan. Expenditures on biologic DMARDs increased from $166 million in 2004 to $243 million in 2013, and the number of prescriptions and refills increased from 59,960 in 2004 to 105,295 in 2013. Prescriptions for biologic DMARDs increased more than 20% per patient from 2004 to 2013. The average cost per prescription remained relatively unchanged, at approximately $2300 per prescription, but the OOP expenditures increased from $36 (2.5%) per prescription to $128 (7%) during the study period. The OOP expenditures increased the most in HMO plans and in plans categorized as other (284% and 388%, respectively). CONCLUSIONS Spending on biologic DMARDs has been primarily driven by an increase in prescribing rates, as the average amount reimbursed per prescription remained relatively unchanged over time, despite a regular annual increase to the average wholesale acquisition cost of 2% to 10%. The OOP burden for patients has increased, but this does not appear to have limited the use of biologic DMARDs. The entrance of new biologic and nonbiologic DMARDs into the market in the past few years is eroding the market share for several established drugs, and may lead to different results, warranting a study of new trends.
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Affiliation(s)
- Christopher B Atzinger
- Graduate student, College of Pharmacy, University of Cincinnati, OH, and Associate Director, Pharmerit International, Bethesda, MD
| | - Jeff J Guo
- Professor, Pharmacoepidemiology & Pharmacoeconomics, College of Pharmacy, University of Cincinnati
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Abstract
BACKGROUND Findings on smoking among pregnant women were mostly from high income countries and were rarely from China. This study aimed to estimate the prevalence of smoking and its influencing factors among pregnant women living in China. METHODS A cross-sectional analysis was conducted in this study. Data from pregnant women were collected in this study from June to August 2015 from 5 provinces of mainland China. A total of 2345 pregnant women were included in this study, the mean age of the participants was 28.12 years (SD 4.13). RESULTS About 82.9% of smoking women quit smoking after they were pregnant. The prevalence of smoking among pregnant women was 3.8%. Among the participants, 40.0, 30.7, 1.8, 29.9, 0.8, 31.4, 31.2, and 26.7% had husbands, fathers-in-law, mothers-in-law, fathers, mothers, colleagues, friends, and relatives, respectively, who were smokers. Compared with pregnant women of basic education level (junior middle school or below), those of the higher education level (undergraduate or above) were at higher risk of smoking (OR, 5.17; 95% CI, 2.00-13.39). Compared with pregnant women from rural areas, urban pregnant women were less likely to be current smokers (OR, 0.55; 95% CI, 0.32-0.94). Compared with pregnant women whose mothers-in-law did not smoke, those whose mothers-in-law smoked were at higher risk of smoking (OR, 4.67; 95% CI, 1.87-11.70). However, compared with pregnant women whose husband did not smoke, those whose husband smoked were not significantly at higher risk of smoking (OR, 1.12; 95% CI, 0.73-1.73). CONCLUSIONS Most of smoking women quit smoking after they became pregnant. Tailored intervention programs to reduce smoking in pregnant women should focus on those with higher education level, from rural areas, and pregnant women whose mothers-in-law smoke.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Yunshuang Rao
- School of Nursing, Chongqing Medical University, Chongqing, 400016 China
| | - Lianlian Wang
- The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
- Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
- Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, 400016 China
| | - Sheng Liu
- School of Public Health and Management, Chongqing Medical University, No, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Jeff J. Guo
- Division of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45267 USA
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, 39213 USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016 China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
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Lu G, Wang L, Zhou AH, Han YL, Zhou J, Guo JJ, Song PX, Zhou HY, Cong H, Hou M, He SY. Structural and antigenic analysis and cloning of surface antigen protein 5 in Toxoplasma gondii. Trop Biomed 2016; 33:675-688. [PMID: 33579064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Toxoplasma gondii is identified as an obligate intracellular apicomplexan parasite that infects warm blooded animals and humans worldwide. SAG5 protein includes SAG5A, -5B, -5C, -5D, and -5E five subtypes. SAG5A, -5B, -5C, and -5D are expressed on the surface of Toxoplasma gondii. In this study, we used online T-Coffee tool to analyze SAG5 proteins sequence alignment. SMART software was used to predict secondary structures of SAG5A, -5B, -5C, and -5D. The 3D models of SAG5 proteins were constructed and analyzed with SWISS-MODEL server and VMD software. Results indicated that SAG5A, -5B, -5C, and -5D are highly homologous proteins. Furthermore, liner-B cell epitopes and Th-cell epitopes of the four proteins were predicted using DNAMAN software and Epitope Database online service. The bioinformatics analysis of SAG5A, -5B, -5C, and -5D proteins could provide valuable information on prevention and treatment of toxoplasmosis. In addition, the four genes were obtained by PCR and inserted into an eukaryotic expression vector pEGFP-C1 respectively. Identified by restriction enzyme digestion, the four recombinant plasmids were transfected into HEK 293-T cells and tested by RT-PCR. Results showed that the constructed plasmids were all transfected to HEK 293-T cells successfully.
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Affiliation(s)
- G Lu
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - L Wang
- Department of Ji Nan Children's Hospital, 250022, Jinan, Shandong Province, Peoples Republic of China
| | - A H Zhou
- Department of Pediatrics, Provincial Hospital Affiliated to Shandong University, Shandong University School of Medicine, 250021, Jinan, Shandong Province, Peoples Republic of China
| | - Y L Han
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - J Zhou
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - J J Guo
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - P X Song
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - H Y Zhou
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - H Cong
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
| | - M Hou
- Department of Hematology, Qilu Hospital, Shandong University, 250012, Jinan, China
| | - S Y He
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province 250012, Peoples Republic of China
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Guo JJ, Chen Y, Du W, Peng H, Wang R, Xia Y, Xin P, Wigle PR, Papadimitropoulos EA. Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China. Value Health Reg Issues 2016; 9:93-98. [PMID: 27881268 DOI: 10.1016/j.vhri.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 06/06/2015] [Revised: 12/16/2015] [Accepted: 01/16/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide. OBJECTIVES To describe patient profile, treatment patterns, and disease burden for patients with ACS. METHODS A retrospective descriptive cohort study was conducted. Data were obtained from electronic medical records from seven Shanghai medical centers. Patients with at least one primary diagnosis of ACS from 2006 to 2012 were included. Patient ACS-related antithrombotic medication use, laboratory tests, key comorbidities, health care utilization, and direct medical costs were examined. Log-linear regression was conducted to explore factors associated with total direct medical costs. RESULTS The mean age for the 6601 patients included was 69.7 ± 12.5 years, and most of the patients (73%) were men. Comorbidities included diabetes (18.2%), hypertension (21.2%), and hyperlipidemia (8.6%). Out of these, 6466 (98%) patients had been hospitalized for ACS with an average length of stay of 14.0 ± 16.4 days per hospitalization. A total of 914 (13.8%) patients had emergency room visits. Of these, 93.5% received any antithrombotic therapy, including antiplatelet agents (92.7%) and anticoagulants (20.8%). ACS-related direct medical costs (in yuan renminbi [¥]) were ¥18,421 ± ¥24,741 per hospitalization, including costs for medications (¥6,776) and laboratory tests (¥1,355), and ¥2,894 ± ¥7,060 per outpatient visit, including costs for medications (¥620) and laboratory tests (¥464). The higher direct medical cost was associated significantly (P < 0.05) with age, being male, antiplatelet and anticoagulant use, and several comorbid disease states (diabetes, hyperlipidemia, hypertension, and chronic kidney disease). CONCLUSIONS Antithrombotic therapeutic treatments were commonly used among patients with ACS in Shanghai, China. Higher treatment costs for patients with ACS in Shanghai, China, involved their antithrombotic medication use and key comorbidities.
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Affiliation(s)
- Jeff J Guo
- Pharmacoepidemiology and Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Yun Chen
- Lilly Suzhou Pharmaceutical Co., Ltd., Shanghai, China
| | - Wenmin Du
- Adverse Drug Reaction Reporting Center, Shanghai Food and Drug Administration, Shanghai, China
| | - Hongying Peng
- Pharmacoepidemiology and Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Rui Wang
- Pharmacoepidemiology and Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Ying Xia
- Pharmacoepidemiology and Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Ping Xin
- Lilly Suzhou Pharmaceutical Co., Ltd., Shanghai, China
| | - Patricia R Wigle
- Pharmacoepidemiology and Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Emmanuel A Papadimitropoulos
- Global Patient Outcomes and Real World Evidence, Eli Lilly & Company, Indianapolis, IN, USA; Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Zou Y, Guo JJ, Li QP, Zuo DH, Liu JS, Guo YD, Yan J, Zha L, Cai JF, Lan LM. Genetic Polymorphisms of 21 STR Loci in Hunan Province-based Han Population. Fa Yi Xue Za Zhi 2016; 32:356-362. [PMID: 29205006 DOI: 10.3969/j.issn.1004-5619.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the genetic polymorphisms of 21 short tandem repeat (STR) loci (D3S1358, D13S317, D7S820, D16S539, Penta E, D2S441, TPOX, TH01, D2S1338, CSF1PO, Penta D, D10S1248, D19S433, vWA, D21S11, D18S51, D6S1043, D8S1179, D5S818, D12S391 and FGA). METHODS A total of 560 blood samples were collected from unrelated healthy individuals of Han population in Hunan Province. Chelex-100 extraction method was applied to the extraction of genomic DNA, and an AGCU EX22 Kit and 9700 STR amplification was used in amplification reactions. The products were separated and analyzed on 310 Genetic Analyzer. RESULTS A total of 248 alleles were observed, the allelic frequencies ranging from 0.001 to 0.518. Observation of genotype distributions for each locus showed no deviations from Hardy-Weinberg equilibrium except Penta E (P=0.023). The combined power of discrimination, combined power of exclusion, and combined matching probability of the 21 STR loci were approximately 0.999 999 999 999 999 999 999 999 8, 0.999 999 998, and 1.36×10⁻²⁵, respectively. CONCLUSIONS The 21 STR loci show high polymorphisms in the Han population, which can provide valuable data and a theoretical basis for forensic individual identification and paternity testing.
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Affiliation(s)
- Y Zou
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - J J Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - Q P Li
- Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - D H Zuo
- Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - J S Liu
- Department of Internal Medicine, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao 028000, China
| | - Y D Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - J Yan
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - L Zha
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - J F Cai
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
| | - L M Lan
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha 410013, China
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Xia Y, Kelton CML, Wigle PR, Heaton PC, Guo JJ. Twenty years of triptans in the United States Medicaid programs: Utilization and reimbursement trends from 1993 to 2013. Cephalalgia 2016; 36:1305-1315. [DOI: 10.1177/0333102416629237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/12/2015] [Accepted: 12/24/2015] [Indexed: 11/15/2022]
Abstract
Objective After sumatriptan was approved by the Food and Drug Administration in 1992, triptans became first-line anti-migraine therapies. Rapidly rising triptan expenditures, however, led payers, including Medicaid, to implement cost-containment policies. We describe triptan utilization and reimbursement trends in Medicaid. Methods Using national summary files for outpatient drug utilization, utilization and expenditure data from 1993 to 2013 were extracted and summed for all triptan national drug codes reimbursed by Medicaid. Data were collected separately for tablets, injections and sprays. Results The number of triptan prescriptions increased from 87,348 in 1993 to 0.9 million in 2004; fell to 0.4 million in 2009; rose to 1 million in 2011; and rose 1.2 million in 2013. In 2013, Medicaid spent $96.8 million on triptans: 74.4%, 18.4% and 7.2% for tablets, injections and sprays, respectively. Average reimbursement per prescription was $54 for tablets, $351 for injections and $235 for sprays in 2013. From 1993 to 2013, sumatriptan was the most widely prescribed among the triptans. Conclusions The substantial increase in triptan prescriptions from 2009 to 2011, without being convincingly explained by either rising migraine prevalence or rising Medicaid enrollment, is suggestive of reduced access to these medications prior to 2009. Cost-containment policies may have inadvertently prevented Medicaid migraineurs from obtaining appropriate pharmacotherapy. Prior presentations An earlier version of this paper was presented as a poster at the Annual Meeting of the International Society for Pharmacoeconomics and Outcomes Research, Philadelphia, PA, May 2015, where it received a finalist award.
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Affiliation(s)
| | - Christina ML Kelton
- Carl H Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
- James L Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Patricia R Wigle
- James L Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Pamela C Heaton
- James L Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Jeff J Guo
- James L Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Guo JJ, Bao MR, Qiu LH. [Differential diagnosis of periapical radiographic translucent lesions]. Zhonghua Kou Qiang Yi Xue Za Zhi 2016; 51:570-1. [PMID: 27596350 DOI: 10.3760/cma.j.issn.1002-0098.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J J Guo
- Department of Endodontics, School of Stomatology, China Medical University & Liaoning Institute of Dental Research, Shengyang 110002, China
| | - M R Bao
- Department of Endodontics, School of Stomatology, China Medical University & Liaoning Institute of Dental Research, Shengyang 110002, China
| | - L H Qiu
- Department of Endodontics, School of Stomatology, China Medical University & Liaoning Institute of Dental Research, Shengyang 110002, China
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Guo JJ. [Exercise prescription for diabetes]. Zhonghua Nei Ke Za Zhi 2016; 55:725-727. [PMID: 27586984 DOI: 10.3760/cma.j.issn.0578-1426.2016.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Alahmari AK, Almalki ZS, Alahmari AK, Guo JJ. Thromboembolic Events Associated with Bevacizumab plus Chemotherapy for Patients with Colorectal Cancer: A Meta-Analysis of Randomized Controlled Trials. Am Health Drug Benefits 2016; 9:221-232. [PMID: 27688834 PMCID: PMC5004819] [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] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bevacizumab is a recombinant, humanized monoclonal antibody that hinders the proliferation of new blood vessels required for malignant progression. The drug is considered safe and tolerable; however, some controversy remains about whether it is linked to venous and arterial thromboembolic events (TEEs). OBJECTIVE To evaluate the risk for overall, venous, and arterial TEEs in patients with colorectal cancer (CRC) who are administered bevacizumab plus chemotherapy in randomized controlled trials (RCTs). METHODS We searched PubMed and CENTRAL databases to extract reports of relevant trials that were published in English between January 1, 2003, and December 31, 2014. All RCTs in which bevacizumab plus chemotherapy was compared with standard chemotherapy or with placebo plus chemotherapy for the treatment of CRC, and TEEs were reported, were included in a meta-analysis. Risk ratios (RRs) with 95% confidence intervals (CIs) of TEEs were calculated for each RCT. Because the between-study heterogeneities (I2) were insignificant, a fixed-effect model was used to determine the effect size of each TEE. A funnel plot was created to assess publication bias, and 2 forms of sensitivity analyses were performed for each outcome. RESULTS This meta-analysis included 22 RCTs with a total of 13,185 patients. Overall, compared with the control groups, patients with CRC who received bevacizumab were at significant risk for overall TEEs (RR, 1.334; 95% CI, 1.191-1.494; P <.001; I2 = 1.37%). Regarding venous TEEs, a significant risk was observed for patients who received bevacizumab versus control patients (RR, 1.244; 95% CI, 1.091-1.415; P = .001; I2 = 0.0%). Similarly, the risk for arterial TEEs was significant in bevacizumab-treated patients (RR, 1.627; 95% CI, 1.162-2.279; P = .005; I2 = 0.0%). Sensitivity analyses did not affect the level of significance of the effect size for each outcome, and no significant publication bias was observed. CONCLUSION In all the studies reviewed in this meta-analysis, the risk for venous or arterial TEEs was associated with bevacizumab use in patients with CRC. Healthcare providers are encouraged to consider thromboprophylaxis agents, periodically monitor their patients who receive bevacizumab, and carefully manage patients who are at increased risk for those complications.
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Affiliation(s)
| | - Ziyad S Almalki
- Graduate student, University of Cincinnati, College of Pharmacy, OH
| | - Ahmed K Alahmari
- Student, King Khalid University, College of Medicine, Abha, Kingdom of Saudi Arabia
| | - Jeff J Guo
- Professor, Pharmacoepidemiology & Pharmacoeconomics, College of Pharmacy, University of Cincinnati Academic Health Center, OH
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He GY, Huang HW, Deng ZZ, Guo JJ. [Effect of mouse nerve growth factor on cognitive impairment in whole brain irradiation rats]. Zhonghua Yi Xue Za Zhi 2016; 96:1530-4. [PMID: 27266502 DOI: 10.3760/cma.j.issn.0376-2491.2016.19.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the positive effects of mouse nerve growth factor(mNGF) on cognitive impairment in whole brain irradiation rats. METHODS Fifty-five male Sprague-Dawley rats were randomly divided into normal control group, mNGF treated group, saline treated group.mNGF treated group and saline treated group were cranial irradiated at a single dose of 12 Gy by X-ray.30 days after radiation each group were treated with correspondent drugs.60 days after radiation, Morris water maze experiment, EB leakage of the brain, and expressions of neuN, vWF, ZO-1 in hippocampus by immunofluorescence, and expressions of neuN, vWF, ZO-1, VEGF and GFAP in hippocampus by Western blot were tested and analyzed. RESULTS The escape latencies: normal control group< mNGF treated group< saline treated group; the numbers of crossing hidden platform in these 3 groups were 3.00± 1.08, 1.50± 1.08, 0.38± 0.48 times (P<0.01). EB leakage of these 3 groups were 0.14±0.14, 0.66±0.20 and 1.36±0.27 μg/g (P<0.05). In immunofluorescence, expressions of neuN, vWF and ZO-1: normal control group> mNGF treated group> saline treated group.In Western blot, expressions of neuN, vWF and ZO-1: normal control group> mNGF treated group> saline treated group, yet the expressions of VEGF and GFAP: normal control group< mNGF treated group< saline treated group. CONCLUSION mNGF ameliorates cognitive impairment after whole brain irradiation.
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Affiliation(s)
- G Y He
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Almalki ZS, Alahmari AK, Guo JJ, Cavanaugh TM. Off-label use of oral fluoroquinolone antibiotics in outpatient settings in the United States, 2006 to 2012. Pharmacoepidemiol Drug Saf 2016; 25:1042-51. [PMID: 27133913 DOI: 10.1002/pds.4021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to evaluate the practice pattern of off-label use of fluoroquinolones (FQs) in ambulatory settings and to identify the related risk factors. METHODS The National Ambulatory Medical Care Surveys from 2006 through 2012 was used to identify subjects who received FQ off-label prescriptions. We defined off-label use as the use of FQs for indications other than those in the FDA-approved drug label. Descriptive statistics were calculated by using a series of weighted chi-squared statistics. Multivariate logistic regression was conducted to identify factors associated with off-label FQ drug use. RESULTS There were 93 million ambulatory visits in which an FQ was prescribed, and 53.16% of these visits involved the prescribing of FQs in an off-label manner. The percentage of off-label prescriptions was the highest among individuals ≥80 years old (61.6%) and male patients (60.9%). The FQ drug prescribed most for an off-label indication in our study was ciprofloxacin (29.5% of the total visits). The multivariate analysis showed that age of ≥80 years and male patient was significantly associated with off-label use of FQs (adjusted odds ratio (OR) 3.66, 1.72-7.80 and OR 3.26, 2.32-4.56, respectively). Medicaid or private insurance versus Medicare were associated with significantly higher off-label prescribing of FQs (OR 2.53, 1.28-5.01 and 1.77, 1.03-3.03, respectively). CONCLUSION The percentage of visits involving off-label FQs in US ambulatory settings is substantial. Efforts are needed consolidate and evaluate what high-quality scientific evidence is available and what is needed to support the safety and effectiveness of such off-label uses. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ziyad S Almalki
- James L. Winkle College of Pharmacy, Academic Health Center, University of Cincinnati, Cincinnati, OH, USA
| | - Abdullah K Alahmari
- James L. Winkle College of Pharmacy, Academic Health Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jeff J Guo
- James L. Winkle College of Pharmacy, Academic Health Center, University of Cincinnati, Cincinnati, OH, USA
| | - Teresa M Cavanaugh
- James L. Winkle College of Pharmacy, Academic Health Center, University of Cincinnati, Cincinnati, OH, USA
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Galling B, Roldán A, Nielsen RE, Nielsen J, Gerhard T, Carbon M, Stubbs B, Vancampfort D, De Hert M, Olfson M, Kahl KG, Martin A, Guo JJ, Lane HY, Sung FC, Liao CH, Arango C, Correll CU. Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis. JAMA Psychiatry 2016; 73:247-59. [PMID: 26792761 DOI: 10.1001/jamapsychiatry.2015.2923] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern. OBJECTIVE To assess T2DM risk associated with antipsychotic treatment in youth. DATA SOURCES Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015. STUDY SELECTION Longitudinal studies reporting on T2DM incidence in youth 2 to 24 years old exposed to antipsychotics for at least 3 months. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted study-level data for a random-effects meta-analysis and meta-regression of T2DM risk. MAIN OUTCOMES AND MEASURES The coprimary outcomes were study-defined T2DM, expressed as cumulative T2DM risk or as T2DM incidence rate per patient-years. Secondary outcomes included the comparison of the coprimary outcomes in antipsychotic-treated youth with psychiatric controls not receiving antipsychotics or with healthy controls. RESULTS Thirteen studies were included in the meta-analysis, including 185,105 youth exposed to antipsychotics and 310,438 patient-years. The mean (SD) age of patients was 14.1 (2.1) years, and 59.5% were male. The mean (SD) follow-up was 1.7 (2.3) years. Among them, 7 studies included psychiatric controls (1,342,121 patients and 2,071,135 patient-years), and 8 studies included healthy controls (298,803 patients and 463,084 patient-years). Antipsychotic-exposed youth had a cumulative T2DM risk of 5.72 (95% CI, 3.45-9.48; P < .001) per 1000 patients. The incidence rate was 3.09 (95% CI, 2.35-3.82; P < .001) cases per 1000 patient-years. Compared with healthy controls, cumulative T2DM risk (odds ratio [OR], 2.58; 95% CI, 1.56-4.24; P < .0001) and incidence rate ratio (IRR) (IRR, 3.02; 95% CI, 1.71-5.35; P < .0001) were significantly greater in antipsychotic-exposed youth. Similarly, compared with psychiatric controls, antipsychotic-exposed youth had significantly higher cumulative T2DM risk (OR, 2.09; 95% CI, 1.50-52.90; P < .0001) and IRR (IRR, 1.79; 95% CI, 1.31-2.44; P < .0001). In multivariable meta-regression analyses of 10 studies, greater cumulative T2DM risk was associated with longer follow-up (P < .001), olanzapine prescription (P < .001), and male sex (P = .002) (r(2) = 1.00, P < .001). Greater T2DM incidence was associated with second-generation antipsychotic prescription (P ≤ .050) and less autism spectrum disorder diagnosis (P = .048) (r(2) = 0.21, P = .044). CONCLUSIONS AND RELEVANCE Although T2DM seems rare in antipsychotic-exposed youth, cumulative risk and exposure-adjusted incidences and IRRs were significantly higher than in healthy controls and psychiatric controls. Olanzapine treatment and antipsychotic exposure time were the main modifiable risk factors for T2DM development in antipsychotic-exposed youth. Antipsychotics should be used judiciously and for the shortest necessary duration, and their efficacy and safety should be monitored proactively.
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Affiliation(s)
- Britta Galling
- Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Alexandra Roldán
- Department of Psychiatry, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - René E Nielsen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jimmi Nielsen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark5Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tobias Gerhard
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey7Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Maren Carbon
- Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley National Health Service Foundation Trust, Denmark Hill, London, England9Institute of Psychiatry, King's College London, De Crespigny Park, London, England
| | - Davy Vancampfort
- Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Olfson
- New York State Psychiatric Institute, Department of Psychiatry, The College of Physicians and Surgeons, Columbia University, New York
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andres Martin
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Jeff J Guo
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan16Department of Psychiatry, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Hui Liao
- Department of Psychiatry, China Medical University, Taichung, Taiwan17Department of Public Health, China Medical University, Taichung, Taiwan
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York19Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York20The Feinstein Institute for Medical Research, Manhasset, New
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Xia Y, Kelton CML, Guo JJ, Bian B, Heaton PC. Treatment of obesity: Pharmacotherapy trends in the United States from 1999 to 2010. Obesity (Silver Spring) 2015; 23:1721-8. [PMID: 26193062 DOI: 10.1002/oby.21136] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/18/2015] [Accepted: 04/06/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe the antiobesity drug-prescribing patterns of US physicians over the past decade. METHODS Data for adult patients were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Obesity was identified using ICD-9 codes, BMI values, and a chronic-obesity-condition variable. For patients with obesity, a logistic-regression model was estimated to determine the odds of receiving pharmacotherapy. RESULTS Of the 987 million visits by patients with obesity from 2005 to 2010, 2.0% mentioned an antiobesity drug. Additionally, there were 6.5 million visits by patients without obesity but with an antiobesity drug mention. Visits made by females (OR = 2.89; 95% CI: 2.08-4.03), by white patients (OR = 1.55; 95% CI: 1.08-2.24), by younger adults (OR = 1.71; 95% CI: 1.34-2.20), and in the South (OR = 3.39; 95% CI: 1.49-7.72) were more likely to involve an antiobesity drug prescription. CONCLUSIONS Only 1 in 50 patients with obesity received a prescription for an antiobesity medication. Moreover, in contrast to what the 1998 Guidelines suggested, physicians tended to prescribe antiobesity medications to self-paying, young, white females, many of whom lived in the South, and not all of whom had obesity.
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Affiliation(s)
- Ying Xia
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Christina M L Kelton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeff J Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | | | - Pamela C Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
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Guo JJ, Liu L, Du W, Peng H, Wang R, Xin P, Chen Y, Wigle PR, Papadimitropoulos M. Antithrombotic Therapy and Direct Medical Costs in Patients with Acute Coronary Syndrome in Shanghai, China. Value Health 2014; 17:A760. [PMID: 27202780 DOI: 10.1016/j.jval.2014.08.253] [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: 06/05/2023]
Affiliation(s)
- J J Guo
- University of Cincinnati, Cincinnati, OH, USA
| | - L Liu
- Eli Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China
| | - W Du
- Shanghai Food & Drug Administration, Shanghai, China
| | - H Peng
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - R Wang
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - P Xin
- Eli-Lilly Company, Shanghai, China
| | - Y Chen
- Eli Lilly Suzhou Pharmaceutical Co., Ltd., Shanghai, China
| | - P R Wigle
- University of Cincinnati, Cincinnati, OH, USA
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Desai VCA, Kelton CML, Metzger AH, Cavanaugh TM, Guo JJ, Heaton PC. Comparative persistence on β-blockers versus calcium channel blockers for ventricular rate control in nonelderly patients with atrial fibrillation. Ann Pharmacother 2014; 48:1570-9. [PMID: 25280975 DOI: 10.1177/1060028014552819] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For patients with atrial fibrillation (AF), early treatment is essential to prevent serious complications such as stroke. Several randomized clinical trials have shown that rate-control may be as effective as rhythm-control medications, whereas the latter have serious side effects. Little evidence exists, however, about which class of rate-control medication-β-blockers (BBs) or calcium channel blockers (CCBs)-may be superior. OBJECTIVE The objective was to compare the long-term persistence on BBs versus CCBs in nonelderly adult patients with AF. METHODS A longitudinal retrospective cohort study for patients 40 to 60 years old with newly diagnosed AF (identified by ICD-9 code 427.31) was performed using data from Ohio Medicaid physician, institutional, and pharmacy claims from January 2006 through June 2011. A Cox proportional hazard regression, with time to change out of rate-control therapy as the dependent variable, was estimated to compare persistence on (proxy for effectiveness of) rate-control medication across drug classes. A propensity-score analysis was used to control for selection bias. Additional covariates included age, development of heart failure, and medication adherence. RESULTS Out of 1239 patients included in the cohort, 1016 received a BB; 223 received a CCB. Over time, patients on CCBs were significantly more likely to switch out of rate-control therapy (hazard ratio = 1.89; 95% CI = 1.14-3.09) than patients on BBs. CONCLUSIONS Evidence suggests that nonelderly AF patients, when prescribed rate-control therapy, persist longer on BBs than CCBs. Because this is the first long-term study comparing the 2 drug classes in the nonelderly population, further research is suggested.
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Affiliation(s)
- Vibha C A Desai
- University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | | | - Anne H Metzger
- University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | | | - Jeff J Guo
- University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Pamela C Heaton
- University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Tan X, Wang YY, Chen XY, Xian L, Guo JJ, Liang GB, Chen MW. Quantitative assessment of the effects of the EPHX1 Tyr113His polymorphism on lung and breast cancer. Genet Mol Res 2014; 13:7437-46. [PMID: 25222243 DOI: 10.4238/2014.september.12.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The association between the microsomal epoxide hydrolase 1 gene (EPHX1) Tyr113His polymorphism and lung cancer and breast cancer risk has been reported in many recent studies, but there is no consensus among the results. Thus, we examined the association between the EPHX1 Tyr113His polymorphism and lung cancer through a meta-analysis. A comprehensive literature search was performed using the Pubmed and Embase databases. Odds ratios with 95% confidence intervals were used to assess the strength of associations. Our meta-analysis suggested that the Tyr113His polymorphism was associated with lung cancer risk in Asians under 3 genetic models, including a C vs T, CC vs TT, and recessive model. However, the risk was decreased in Caucasians under the genetic models, including a C vs T, CC vs TT, or CT vs TT, dominant, and recessive model. In contrast, there was no association with breast cancer risk for any of the genetic models. Our meta-analysis suggested that the EPHX1 Tyr113His polymorphism may be a risk factor for lung cancer in Asians, whereas it may be a decreased risk factor among Caucasians. However, this polymorphism was not found to be associated with breast cancer.
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Affiliation(s)
- X Tan
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Y Y Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - X Y Chen
- Department of Oncology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - L Xian
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - J J Guo
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - G B Liang
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - M W Chen
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
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