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Boston D, Hwang J, Lucas JA, Marino M, Larson Z, Sun E, Giebultowicz S, Crookes DM, Rodriguez CJ, Heintzman J. Latino-White Disparities in Identification and Control of Elevated Blood Pressure Among Adults With Hypertension. J Am Heart Assoc 2024; 13:e033151. [PMID: 38456400 PMCID: PMC11010015 DOI: 10.1161/jaha.123.033151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Studies analyzing blood pressure (BP) management using the hypertension control cascade have consistently shown disparities in hypertension awareness, treatment, and BP control between Latino patients and non-Latino White patients. We analyze this cascade using electronic health record data from a multistate network of community health centers. METHODS AND RESULTS Data from 790 clinics in 23 US states from 2012 to 2020, including 1 270 174 patients, were analyzed to compare BP documentation in the electronic health record, clinician acknowledgment (diagnosis or treatment) of incident hypertension (BP ≥140/90), medication prescription, and BP control between non-Latino White patients, English-preferring Latino patients, and Spanish-preferring Latino patients, adjusted for patient-level covariates, and clustered on patients' primary clinics. Among the 429 182 patients with elevated BP (≥140/90) during ambulatory visits from 2012 to 2020, we found that clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients versus non-Latino White patients (adjusted odds ratio [aOR], 1.17 [95% CI, 1.11-1.24]; aOR, 1.07 [95% CI, 1.02-1.12], respectively). In addition, Spanish-preferring Latino patients were more likely to receive a medication versus non-Latino White patients (aOR, 1.21 [95% CI, 1.16-1.28]). Among those receiving medication, Latino patients were as likely as non-Latino White patients to have their BP controlled (<140/90). CONCLUSIONS In a large retrospective study of community health center patients with incident hypertension, the expected disparities in hypertension management between Spanish-preferring Latino, English-preferring Latino, and non-Latino White patients were not identified. These findings add to the hypertension control cascade by examining robust electronic health record data from community health centers and may provide clues to reducing disparities in hypertension management.
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Affiliation(s)
| | - Jun Hwang
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | - Jennifer A. Lucas
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | - Miguel Marino
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
| | | | | | | | | | | | - John Heintzman
- Department of Family MedicineOregon Health & Science UniversityPortlandORUSA
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Yang NE, Lee DH, Hwang J, Son WY, Kim KS, Kim GY, Kim HW. Proteolytic Activity of Silkworm Thorn ( Cudrania tricuspidata) Fruit for Enzymatic Hydrolysis of Food Proteins. Molecules 2024; 29:693. [PMID: 38338437 PMCID: PMC10856028 DOI: 10.3390/molecules29030693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to isolate the proteolytic fraction from the silkworm thorn fruit (Cudrania tricuspidata) through ethanol precipitation at different ratios, and to determine its proteolytic activity and optimal activity conditions. Furthermore, the hydrolysis characteristics and antioxidant activity of soy protein isolate (SPI) and whey protein concentrate (WPC) hydrolyzates obtained through the enzymatic hydrolysis of freeze-dried silkworm thorn fruit powder (SF) were evaluated. For isolation and partial purification of proteolytic fraction, the water-solubilized fraction of the silkworm thorn fruit was purified through ethanol precipitation at four different ratios of 1:1, 1:2, 1:4, and 1:6 (v/v). The protein recovery rate, caseinolytic activity, protein pattern, and optimal activity (pH, temperature, and inhibitors) of fractional ethanol precipitate obtained from the silkworm thorn fruit (ESF) were evaluated. The proteolytic fraction obtained from silkworm thorn fruit exhibited a major protein band around 65-70 kDa and showed the highest proteolytic activity at a 1:4 ratio of ethanol precipitation (p < 0.05). The optimal activity of the measured enzyme fraction was determined to be at pH 9.0 and 50 °C, and the proteolytic activity of ESF was almost inhibited by phenyl methyl sulphonyl fluoride (PMSF, 2 mM), a serine protease inhibitor. Compared to Alcalase and papain, extensively used as commercial enzymes, the silkworm thorn fruit powder was less effective in hydrolyzing SPI and WPC. Nevertheless, SPI and WPC hydrolyzates mediated with silkworm thorn fruit powder showed even better antioxidant activities than those mediated with Alcalase and papain. Thus, our results show the potential application of silkworm thorn fruit as a novel source of plant protease for producing human-grade protein hydrolyzates.
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Affiliation(s)
- Na-Eun Yang
- Department of GreenBio Science, Gyeongsang National University, Jinju 52725, Republic of Korea;
| | - Da-Hoon Lee
- Division of Animal Bioscience & Integrated Biotechnology, Gyeongsang National University, Jinju 52828, Republic of Korea; (D.-H.L.); (J.H.); (W.-Y.S.)
| | - Jun Hwang
- Division of Animal Bioscience & Integrated Biotechnology, Gyeongsang National University, Jinju 52828, Republic of Korea; (D.-H.L.); (J.H.); (W.-Y.S.)
| | - Woo-Young Son
- Division of Animal Bioscience & Integrated Biotechnology, Gyeongsang National University, Jinju 52828, Republic of Korea; (D.-H.L.); (J.H.); (W.-Y.S.)
| | - Kyeong-Soo Kim
- Department of Pharmaceutical Engineering, Gyeongsang National University, Jinju 52725, Republic of Korea;
| | - Gwang-Yeon Kim
- Sancheong Hanbang Kkujippong Farming Association Corporation, Sancheong 52255, Republic of Korea;
| | - Hyun-Wook Kim
- Department of GreenBio Science, Gyeongsang National University, Jinju 52725, Republic of Korea;
- Division of Animal Bioscience & Integrated Biotechnology, Gyeongsang National University, Jinju 52828, Republic of Korea; (D.-H.L.); (J.H.); (W.-Y.S.)
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Marino M, Fankhauser K, Minnier J, Lucas JA, Giebultowicz S, Kaufmann J, Hwang J, Bailey SR, Crookes DM, Bazemore A, Suglia SF, Heintzman J. Disaggregating Latino nativity in equity research using electronic health records. Health Serv Res 2023; 58:1119-1130. [PMID: 36978286 PMCID: PMC10480087 DOI: 10.1111/1475-6773.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To develop and validate prediction models for inference of Latino nativity to advance health equity research. DATA SOURCES/STUDY SETTING This study used electronic health records (EHRs) from 19,985 Latino children with self-reported country of birth seeking care from January 1, 2012 to December 31, 2018 at 456 community health centers (CHCs) across 15 states along with census-tract geocoded neighborhood composition and surname data. STUDY DESIGN We constructed and evaluated the performance of prediction models within a broad machine learning framework (Super Learner) for the estimation of Latino nativity. Outcomes included binary indicators denoting nativity (US vs. foreign-born) and Latino country of birth (Mexican, Cuban, Guatemalan). The performance of these models was compared using the area under the receiver operating characteristics curve (AUC) from an externally withheld patient sample. DATA COLLECTION/EXTRACTION METHODS Census surname lists, census neighborhood composition, and Forebears administrative data were linked to EHR data. PRINCIPAL FINDINGS Of the 19,985 Latino patients, 10.7% reported a non-US country of birth (5.1% Mexican, 4.7% Guatemalan, 0.8% Cuban). Overall, prediction models for nativity showed outstanding performance with external validation (US-born vs. foreign: AUC = 0.90; Mexican vs. non-Mexican: AUC = 0.89; Guatemalan vs. non-Guatemalan: AUC = 0.95; Cuban vs. non-Cuban: AUC = 0.99). CONCLUSIONS Among challenges facing health equity researchers in health services is the absence of methods for data disaggregation, and the specific ability to determine Latino country of birth (nativity) to inform disparities. Recent interest in more robust health equity research has called attention to the importance of data disaggregation. In a multistate network of CHCs using multilevel inputs from EHR data linked to surname and community data, we developed and validated novel prediction models for the use of available EHR data to infer Latino nativity for health disparities research in primary care and health services research, which is a significant potential methodologic advance in studying this population.
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Affiliation(s)
- Miguel Marino
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
- Biostatistics Group, School of Public HealthOregon Health & Science University – Portland State UniversityPortlandOregonUSA
| | - Katie Fankhauser
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
- Mortenson Center in Global EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Jessica Minnier
- Biostatistics Group, School of Public HealthOregon Health & Science University – Portland State UniversityPortlandOregonUSA
| | - Jennifer A. Lucas
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
| | | | - Jorge Kaufmann
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Jun Hwang
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Steffani R. Bailey
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Danielle M. Crookes
- Bouvé College of Health Sciences and College of Social Sciences and HumanitiesNortheastern UniversityBostonMassachusettsUSA
| | | | | | - John Heintzman
- Department of Family MedicineOregon Health & Science UniversityPortlandOregonUSA
- OCHINPortlandOregonUSA
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Hwang J, Chun J, Choi SH, Cho S, Kim JS. Patient-Specific Deep Learning Model for Clinical Target Volume Delineation on Daily CBCT of Breast Cancer Patients based on Intentional Deep Overfit Learning (IDOL) Framework. Int J Radiat Oncol Biol Phys 2023; 117:e181. [PMID: 37784804 DOI: 10.1016/j.ijrobp.2023.06.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Increasingly complex target volumes and the use of modern irradiation techniques emphasize the importance of daily image guidance more than ever. Significant progress has been made in adjuvant breast cancer radiotherapy (RT) and the need for optimized image guidance is growing. Furthermore, the position of the breast during RT after breast-conserving surgery is highly variable than expected. In this context, cone beam computed tomography (CBCT) is a very effective tool enabling prompt and accurate adaptive radiation therapy (ART). In this study, we aim to develop a deep learning (DL)-based algorithm to segment clinical target volume (CTV) from daily CBCT scans. Also, we validate the optimization of further learning when applying the Intentional Deep Overfit Learning (IDOL) framework. MATERIALS/METHODS A total of 240 different CBCT scans obtained from 100 breast cancer patients were used for this study. CTV was defined as whole breast plus margin in all patients. The workflow consists of two training stages: (1) training a novel 'generalized' DL model (Swin_UNETR) to identify and delineate breast CTV on CBCT scans using 90 breast cancer patient cases (2) applying an 'intentional overfitting' to the 'generalized' DL model to generate a 'patient-specific' model using the remaining 10 breast cancer patients. In this study, for the intentionally overfitting stage, we additionally trained with CBCT scans from the patient's 1st fraction to the 14th fractions cases. The results of the proposed method were compared quantitatively with the expert's contours on 1st-15th fractions CBCT scans using Dice Similarity Coefficient (DSC). RESULTS The average DSC between the 'generalized' DL model-based breast CTV contours and reference contours for the patient's 15th fraction was 0.9672. When implementing the IDOL framework with the CBCT scan obtained during the patient's 1st treatment, the average DSC was improved to 0.9809. When additional CBCT scans taken during each of the 1st to 6th fractions were used for training, the average DSC could be most effectively raised to 0.9835. The p-value comparison between the 'generalized' DL model and the 1st fraction was found to be 3.62E-04, while the comparison with the 6th fractions resulted in a p-value of 8.36E-05. The average time required for IDOL training using one CBCT scan and six CBCT scans was 107 seconds and 127 seconds, respectively. CONCLUSION In this study, we developed a patient-specific DL-based training algorithm to segment CTV in CBCT scans for breast cancer patients. The performance improvement was relatively significant and was confirmed that using continual DL with additional CBCT scans, which are taken every day, can be more accurate and efficient than drawing breast CTV using a general model. Our novel patient-specific model can be effectively applied to various ARTs by not only reducing labor and time but also increasing accuracy.
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Affiliation(s)
- J Hwang
- KAIST, Daejeon, Daejeon, Korea, Republic of (South) Korea
| | - J Chun
- Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S H Choi
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - S Cho
- Korea Advanced Institute of Science and Technology, Daejeon, Korea, Republic of (South) Korea
| | - J S Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
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Quiñones AR, Hwang J, Heintzman J, Huguet N, Lucas JA, Schmidt TD, Marino M. Trajectories of Chronic Disease and Multimorbidity Among Middle-aged and Older Patients at Community Health Centers. JAMA Netw Open 2023; 6:e237497. [PMID: 37040114 PMCID: PMC10091154 DOI: 10.1001/jamanetworkopen.2023.7497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Importance Health-related consequences of multimorbidity (≥2 chronic diseases) are well documented. However, the extent and rate of accumulation of chronic diseases among US patients seeking care in safety-net clinics are not well understood. These insights are needed to enable clinicians, administrators, and policy makers to mobilize resources for prevention of disease escalations in this population. Objectives To identify the patterns and rate of chronic disease accumulation among middle-aged and older patients seeking care in community health centers, as well as any sociodemographic differences. Design, Setting, and Participants This cohort study used electronic health record data from January 1, 2012, to December 31, 2019, on 725 107 adults aged 45 years or older with 2 or more ambulatory care visits in 2 or more distinct years at 657 primary care clinics in the Advancing Data Value Across a National Community Health Center network in 26 US states. Statistical analysis was performed from September 2021 to February 2023. Exposures Race and ethnicity, age, insurance coverage, and federal poverty level (FPL). Main Outcomes and Measures Patient-level chronic disease burden, operationalized as the sum of 22 chronic diseases recommended by the Multiple Chronic Conditions Framework. Linear mixed models with patient-level random effects adjusted for demographic characteristics and ambulatory visit frequency with time interactions were estimated to compare accrual by race and ethnicity, age, income, and insurance coverage. Results The analytic sample included 725 107 patients (417 067 women [57.5%]; 359 255 [49.5%] aged 45-54 years, 242 571 [33.5%] aged 55-64 years, and 123 281 [17.0%] aged ≥65 years). On average, patients started with a mean (SD) of 1.7 (1.7) morbidities and ended with 2.6 (2.0) morbidities over a mean (SD) of 4.2 (2.0) years of follow-up. Compared with non-Hispanic White patients, patients in racial and ethnic minoritized groups had marginally lower adjusted annual rates of accrual of conditions (-0.03 [95% CI, -0.03 to -0.03] for Spanish-preferring Hispanic patients; -0.02 [95% CI, -0.02 to -0.01] for English-preferring Hispanic patients; -0.01 [95% CI, -0.01 to -0.01] for non-Hispanic Black patients; and -0.04 [95% CI, -0.05 to -0.04] for non-Hispanic Asian patients). Older patients accrued conditions at higher annual rates compared with patients 45 to 50 years of age (0.03 [95% CI, 0.02-0.03] for 50-55 years; 0.03 [95% CI, 0.03-0.04] for 55-60 years; 0.04 [95% CI, 0.04-0.04] for 60-65 years; and 0.05 [95% CI, 0.05-0.05] for ≥65 years). Compared with those with higher income (always ≥138% of the FPL), patients with income less than 138% of the FPL (0.04 [95% CI, 0.04-0.05]), mixed income (0.01 [95% CI, 0.01-0.01]), or unknown income levels (0.04 [95% CI, 0.04-0.04]) had higher annual accrual rates. Compared with continuously insured patients, continuously uninsured and discontinuously insured patients had lower annual accrual rates (continuously uninsured, -0.003 [95% CI, -0.005 to -0.001]; discontinuously insured, -0.004 [95% CI, -0.005 to -0.003]). Conclusions and Relevance This cohort study of middle-aged patients seeking care in community health centers suggests that disease accrued at high rates for patients' chronological age. Targeted efforts for chronic disease prevention are needed for patients near or below the poverty line.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Jun Hwang
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
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Kim N, Song JY, Yang H, Kim MJ, Lee K, Shin YH, Rhee SY, Hwang J, Kim MS, Fond G, Boyer L, Kim SY, Shin JI, Lee SW, Yon DK. National trends in suicide-related behaviors among youths between 2005-2020, including COVID-19: a Korean representative survey of one million adolescents. Eur Rev Med Pharmacol Sci 2023; 27:1192-1202. [PMID: 36808368 DOI: 10.26355/eurrev_202302_31226] [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: 02/23/2023]
Abstract
OBJECTIVE It is difficult to conclude that COVID-19 is associated with a decrease in the suicide attempts rate by comparing only a short-term period. Therefore, it is necessary to examine attempted suicide rates through a trend analysis over a longer period. This study aimed to investigate an estimated long-term trend regarding the prevalence of suicide-related behaviors among adolescents in South Korea from 2005 to 2020, including COVID-19. SUBJECTS AND METHODS We sourced data from a national representative survey (Korea Youth Risk Behavior Survey) and analyzed one million Korean adolescents aged 13 to 18 years (n=1,057,885) from 2005 to 2020. The 16-year trends regarding the prevalence of sadness or despair and suicidal ideation and attempt and the trend changes before and during COVID-19. RESULTS Data of 1,057,885 Korean adolescents was analyzed (weighted mean age, 15.03 years; males, 52.5%; females, 47.5%). Although the 16-year trend in the prevalence of sadness or despair and suicide ideation and attempt consistently decreased (prevalence of sadness or despair between 2005-2008, 38.0% with 95% confidence interval [CI], 37.7 to 38.4 vs. prevalence in 2020, 25.0% [24.5 to 25.6]; suicide ideation between 2005-2008, 21.9% [21.6 to 22.1] vs. prevalence in 2020, 10.7% [10.3 to 11.1]; and suicide attempt between 2005-2008, 5.0% [4.9 to 5.2] vs. prevalence in 2020, 1.9% [1.8 to 2.0]), the downward slope decreased during COVID-19 (βdiff in sadness, 0.215 with 95% CI 0.206 to 0.224; βdiff in suicidal ideation, 0.245 [0.234 to 0.256]; and βdiff in suicide attempt, 0.219 [0.201 to 0.237]) compared with pre-pandemic period. CONCLUSIONS This study found that the observed risk of suicide-related behaviors during the pandemic was higher than expected through long-term trend analysis of the prevalence of sadness/despair and suicidal ideation and attempts among South Korean adolescents. We need a profound epidemiologic study of the change in mental health due to the pandemic's impact and the establishment of prevention strategies for suicide ideation and attempt.
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Affiliation(s)
- N Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, South Korea.
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Song TJ, Shin JI, Yon DK, Lee SW, Hwang SY, Hwang J, Park SH, Lee SB, Lee MH, Kim MS, Koyanagi A, Tizaoui K, Kim JH, Smith L. Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review. Eur Rev Med Pharmacol Sci 2023; 27:404-410. [PMID: 36647889 DOI: 10.26355/eurrev_202301_30894] [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: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.
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Affiliation(s)
- T-J Song
- Department of Neurology, Seoul Hospital, Ewha University College of Medicine, Seoul, Republic of Korea.
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Huguet N, Dinh D, Hwang J, Marino M, Larson AE, Suchocki A, DeVoe JE. The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients. J Prim Care Community Health 2023; 14:21501319231171437. [PMID: 37139559 PMCID: PMC10161334 DOI: 10.1177/21501319231171437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE This study evaluates whether patients residing in expansion states have a greater increase in outpatient diagnoses of acute diabetes complications than those living in non-expansion states following the implementation of the Affordable Care Act (ACA). METHODS This retrospective cohort study uses electronic health records (EHR) from 10,665 non-pregnant patients, aged 19 to 64 years old who were diagnosed with diabetes in 2012 or 2013 from 347 community health centers (CHCs) across 16 states (11 expansion and 5 non-expansion states). Patients included had ≥1 outpatient ambulatory visit in each of these periods: pre-ACA: 2012 to 2013, post-ACA: 2014 to 2016, and post-ACA: 2017 to 2019. Acute diabetes-related complications were identified using International Classification Diseases (ICD-9-CM and ICD-10-CM) codes classification and could occur on or after diagnosis of diabetes. We performed difference-in-differences (DID) analysis using a generalized estimating equation to compare the change in rates of acute diabetes complications by year and by Medicaid expansion status. RESULTS There was a greater increase after year 2015 in visits related to abnormal blood glucose among patient living in Medicaid expansion states than in non-expansion states (2017 DID = 0.041, 95% CI = 0.027-0.056). Although both visits due to any acute diabetes complications and infection-related diabetes complications were higher among patients living in Medicaid expansion states, there was no difference in the trend overtime between expansion and non-expansion states. CONCLUSION We found a significantly greater rate of visits for abnormal blood glucose in patients receiving care in expansion states relative to patients in CHCs in non-expansion states starting in 2015. Additional resources for these clinics, such as the ability to provide blood glucose monitoring devices or mailed/delivered medications, could substantially benefit patients with diabetes.
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Affiliation(s)
| | - Dang Dinh
- Oregon Health & Science University, Portland, OR, USA
| | - Jun Hwang
- Oregon Health & Science University, Portland, OR, USA
| | - Miguel Marino
- Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University—Portland State University, Portland, OR, USA
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Wu H, Kumar M, Fray E, Siliciano R, Smedley J, Meyers G, Maziarz R, Burwitz B, Stanton J, Sacha J, Weber W, Waytashek C, Boyle C, Bateman K, Reed J, Hwang J, Shriver-Munsch C, Northrup M, Armantrout K, Price H, Robertson-LeVay M, Uttke S, Junell S, Moats C, Bochart R, Sciurba J, Bimber B, Sullivan M, Dozier B, MacAllister R, Hobbs T, Martin L, Siliciano J, Axthelm M. OP 6.7 – 00044 Long-term ART-free SIV Remission Following Allogeneic Hematopoietic Cell Transplantation in Mauritian Cynomolgus Macaques. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Park S, Han JH, Hwang J, Yon DK, Lee SW, Kim JH, Koyanagi A, Jacob L, Oh H, Kostev K, Dragioti E, Radua J, Eun HS, Shin JI, Smith L. The global burden of sudden infant death syndrome from 1990 to 2019: a systematic analysis from the Global Burden of Disease study 2019. QJM 2022; 115:735-744. [PMID: 35385121 DOI: 10.1093/qjmed/hcac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS. AIMS To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI). DESIGN Systematic analysis based on the Global Burden of Disease (GBD) 2019 data. METHODS Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modeled. Crude mortality and mortality rates per 100 000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed. RESULTS In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval, 9.15-46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; furthermore, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019. CONCLUSIONS The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed.
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Affiliation(s)
- S Park
- From the Yonsei College of Medicine, Seoul, 03722, Republic of Korea
| | - J H Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - J Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - D K Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, 02447, Republic of Korea
| | - S W Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, 05006, Republic of Korea
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - J H Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - A Koyanagi
- Department of Research and Development Unit, Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Life and Medical Sciences, ICREA, Pg. Lluis Companys 23, Barcelona, 08010, Spain
| | - L Jacob
- Department of Research and Development Unit, Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, 08830, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, 28029, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, 78180, France
| | - H Oh
- School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - K Kostev
- University Clinic of Marburg, Marburg, 35043, Germany
| | - E Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 58183, Sweden
| | - J Radua
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, WC2R 2LS, UK
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, Barcelona, 08036, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, 17176, Sweden
| | - H S Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - L Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
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Koffler D, Chitti B, Ma D, Hwang J, Potters L, Chen W. Futility of the Third-Party Peer-to-Peer Review Process and Entailed Delays to Cancer-Directed Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Koffler D, Chitti B, Ma D, Sidiqi B, Hwang J, Potters L, Chen W. Evaluating the Inter-Reviewer Reliability and Evidentiary Grounds for Third-Party Peer-to-Peer Mandated Downgrading of Radiation Therapy Prescriptions. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Chamine I, Hwang J, Valenzuela S, Marino M, Larson AE, Georgescu J, Latkovic-Taber M, Angier H, DeVoe JE, Huguet N. Acute and Chronic Diabetes-Related Complications Among Patients With Diabetes Receiving Care in Community Health Centers. Diabetes Care 2022; 45:e141-e143. [PMID: 35972244 PMCID: PMC9643147 DOI: 10.2337/dc22-0420] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/08/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Irina Chamine
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Jun Hwang
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
- Department of Biostatistics, School of Public Health, Oregon Health & Science University–Portland
| | | | | | | | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
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Bailey SR, Hwang J, Marino M, Quiñones AR, Lucas JA, Chan BL, Heintzman JD. Smoking-Cessation Assistance Among Older Adults by Ethnicity/Language Preference. Am J Prev Med 2022; 63:423-430. [PMID: 35589442 DOI: 10.1016/j.amepre.2022.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Although smoking prevalence is lower among Hispanic adults than among non-Hispanic White adults, smoking remains a leading cause of preventable death among older Hispanics. This study examines the differences in tobacco assessment and smoking-cessation assistance among older patients seen in community health centers by ethnicity and language preference. METHODS Electronic health record data were extracted from the Accelerating Data Value Across a National Community Health Center Network of community health centers from patients aged 55‒80 years with ≥1 primary care visit between January 1, 2017 and December 31, 2018. Binary outcomes included tobacco use assessment and, among those with ≥1 status indicating current smoking, having a smoking-cessation medication ordered. The independent variable combined ethnicity and language preference, categorized as non-Hispanic White (reference), Spanish-preferring Hispanic, and English-preferring Hispanic. Multivariable generalized estimating equation logistic regressions, clustering by primary care clinic using an exchangeable working correlation structure, modeled the odds of tobacco use assessment and cessation medication orders by ethnicity/preferred language, adjusting for patient covariates, health system, and clinic location. Analyses were conducted in 2021. RESULTS The study included 116,328 patients. Spanish-preferring Hispanic patients had significantly lower odds of having tobacco use assessed than non-Hispanic White patients (AOR=0.89, 95% CI=0.82, 0.95). Both Spanish- and English-preferring Hispanic patients had lower odds of having a smoking-cessation medication ordered (AOR=0.53, 95% CI=0.47, 0.60; AOR=0.77, 95% CI=0.67, 0.89, respectively) than non-Hispanic White patients. CONCLUSIONS Significant disparities were found in tobacco assessment and cessation assistance by ethnicity and language preference among older adults seen in safety-net clinics. Future research is needed to understand the etiology of these smoking-related disparities.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
| | - Jun Hwang
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ana R Quiñones
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jennifer A Lucas
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brian L Chan
- OCHIN, Inc., Portland, Oregon; Section of Addiction Medicine, Department of General Internal Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Heintzman
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
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Hwang J, Na Y, Park A, Kim H, Park W. 698 Retinol: A better solution for skin anti-aging than retinyl palmitate. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Nguyen DL, Hwang J, Kim EJ, Lee JH, Han SJ. Production and Characterization of a Recombinant Cold-Active Acetyl Xylan Esterase from Psychrophilic Paenibacillus sp. R4 Strain. APPL BIOCHEM MICRO+ 2022. [DOI: 10.1134/s0003683822040123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Kim MJ, Lee KH, Lee JS, Kim N, Song JY, Shin YH, Yang JM, Lee SW, Hwang J, Rhee SY, Yon DK, Shin JI, Choi YJ. Trends in body mass index changes among Korean adolescents between 2005-2020, including the COVID-19 pandemic period: a national representative survey of one million adolescents. Eur Rev Med Pharmacol Sci 2022; 26:4082-4091. [PMID: 35731079 DOI: 10.26355/eurrev_202206_28978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on weight gain in children and adolescents remains unknown. We aimed to identify an estimated 15-year trend in mean body mass index (BMI) changes and prevalence of obesity and overweight among Korean adolescents from 2005 to 2020, including the period of the COVID-19 pandemic. PATIENTS AND METHODS We analyzed data taken from a nationwide survey (Korea Youth Risk Behavior Survey), between 2005 and 2020. Representative samples of one million Korean adolescents aged 13-18 years (n=1,057,885) were examined. The 15-year trends in mean BMI and proportion of obesity or overweight, and the changes due to the COVID-19 pandemic were analyzed. RESULTS The data of 1,057,885 Korean adolescents were analyzed (mean age: 14.98 years; females, 48.4%). The estimated weighted mean BMI was 20.5 kg/m2 [95% confidence interval (CI), 20.4-20.5] from 2005 to 2008 and 21.5 kg/m2 (95% CI, 21.4-21.6) in 2020 (during the COVID-19 pandemic). Although the 15-year trend of mean BMI gradually increased, the change in mean BMI before and during the pandemic significantly lessened (βdiff, -0.027; 95% CI, -0.028 to -0.026). The 15-year (2005-2020) trend changes in the prevalence of obesity and overweight were similar (obesity prevalence from 2005-2008, 3.2%; 95% CI, 3.1-3.3 vs. obesity prevalence in 2020, 8.6%; 95% CI, 8.2-9.0; βdiff, -0.309; 95% CI, -0.330 to -0.288). CONCLUSIONS The 15-year trend of overall mean BMI and obesity and overweight prevalence demonstrated a significant increase; however, its slope decreased during the pandemic. These landmark results suggest the need for the development of precise strategies to prevent pediatric obesity and overweight during the COVID-19 pandemic.
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Affiliation(s)
- M J Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Shin JI, Kim SE, Lee MH, Kim MS, Lee SW, Park S, Shin YH, Yang JW, Song JM, Moon SY, Kim SY, Park Y, Suh DI, Yang JM, Cho SH, Jin HY, Hong SH, Won HH, Kronbichler A, Koyanagi A, Jacob L, Hwang J, Tizaoui K, Lee KH, Kim JH, Yon DK, Smith L. COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:3760-3770. [PMID: 35647859 DOI: 10.26355/eurrev_202205_28873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use. MATERIALS AND METHODS We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). RESULTS Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19. CONCLUSIONS AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.
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Affiliation(s)
- J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Chamine I, Larson A, Huguet N, Angier H, Valenzuela S, Dinh D, Hwang J. Characterizing acute and chronic complications among patients with diabetes mellitus in community health centers. Ann Fam Med 2022; 20:2659. [PMID: 36857172 PMCID: PMC10548901 DOI: 10.1370/afm.20.s1.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Context: Diabetes mellitus affects about 10% of the world's population and can lead to serious complications, which reduce life quality and expectancy. People with low income have higher risk of diabetes complications than those with high income, but data on the trends of diabetes complications in underserved populations are scarce. Community health centers (CHCs) serve millions of patients in the United States regardless of their health insurance status and are an ideal setting for assessing the rate of diabetes complications in underserved populations. Objectives: To describe diabetes-related acute and chronic complications among patients served by CHCs. Study Design: Retrospective cohort study of electronic health record data from the ADVANCE clinical research network. Population studied: Patients with diabetes between ages 19 and 64 (excluding pregnant women) and ≥1 primary care ambulatory CHC visit in 2017 (N=85,442). Outcome Measures: Rates and type of diabetes-related acute and chronic complications recorded in 2017. Results: The incidence of acute complications among patients with diabetes in 2017 was 14%. Patients experiencing acute diabetes-related complications had on average 1.8 complications (range 1-33). The most common acute complications were infections (58.3%), abnormal blood glucose or related metabolic abnormalities (20.5%), and strokes or transient neurological deficits (6.8%). Patients with acute complications were proportionally more likely to be female, non-Hispanic white, have Medicaid insurance, out-of-control diabetes, a prescription for insulin, a diagnosis of substance use disorder, and co-occurring physical or mental conditions. For chronic complications, the prevalence in 2017 was 77% among patients with diabetes. Patients experiencing chronic diabetes-related complications had on average 2.3 complications (range 1-19). The most common chronic complications were cardiovascular disease (33.9%), endocrine/metabolic symptoms (22.8%), and neurological symptoms (13.0%). Patients with chronic complications were proportionally more likely to be male, non-Hispanic black, have health insurance, obesity, substance use disorder, longer period with diabetes diagnosis, and co-occurring conditions. Conclusions: The vast majority of patients with diabetes receiving care in CHCs had chronic complications. These findings are concerning, as diabetes-related complications are associated with greater healthcare utilization and patient morbidity.
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Heintzman J, Hwang J, Quiñones AR, Guzman CEV, Bailey SR, Lucas J, Giebultowicz S, Chan B, Marino M. Influenza and pneumococcal vaccination delivery in older Hispanic populations in the United States. J Am Geriatr Soc 2022; 70:854-861. [PMID: 34854478 PMCID: PMC9904430 DOI: 10.1111/jgs.17589] [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: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National reports suggest that Hispanic patients may underutilize influenza and pneumococcal vaccination, although studies sometimes conflict on this point. A clearer picture of adult immunization utilization in older Hispanic patients is necessary to ensure equity in adult vaccinations. METHODS Using electronic health records from 648 community health centers (CHCs) across 21 states, we compared English-preferring Hispanic patients, Spanish-preferring Hispanic patients, and Non-Hispanic White (NHW) adults aged ≥50 years across five outcomes between 2012-2017: (1) Odds of ever receiving pneumococcal vaccination after age 65, (2) Odds of ever receiving ≥2 pneumococcal vaccinations for those ≥65, (3) odds of vaccination between the ages of 50 and 64 for those with diabetes or heart disease, (4) odds of influenza vaccine, and (5) annual rate of influenza vaccination. RESULTS Of our total study sample (N = 143,869), 85,562 were age 50-64 during the entire study period, and 65,977 were ≥65 at some point during the study period. In patients aged 50-64, Spanish-preferring Hispanic patients were more likely to have ever had an influenza vaccination (covariate-adjusted odds ratio [aOR] = 1.33, 95% CI = 1.29-1.37), had higher rates of annual influenza vaccination (covariate-adjusted rate ratio [aRR] = 1.41, 95% CI = 1.38-1.44), and higher odds of pneumococcal vaccination (aOR = 1.87, 95% CI = 1.76-1.98) than NHW patients. These findings were similar in Spanish-preferring Hispanic patients ≥65. English-preferring Hispanics ≥65 were less likely than NHW patients to ever have an influenza vaccination (aOR = 0.91, 95% CI = 0.85-0.98) and to have ever received at least one (aOR = 0.92, 95% CI = 0.86-0.99) or two (aOR = 0.86, 95% CI = 0.77-0.95) pneumococcal vaccine doses. CONCLUSIONS In a multistate CHC network, Spanish-preferring Hispanic patients were more likely to receive influenza and pneumococcal vaccinations than NHW patients; older English-preferring Hispanic patients were often less likely than NHW patients to receive these vaccinations. In vaccine initiatives, English-preferring Hispanic patients may be at higher risk of vaccination inequity.
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Affiliation(s)
- John Heintzman
- Associate Professor, Department of Family Medicine, Oregon Health and Science University (OHSU), 3381 Sw Sam Jackson Park Road, Portland, OR 97239
| | - Jun Hwang
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | - Ana R. Quiñones
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | | | - Steffani R Bailey
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | - Jennifer Lucas
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | | | - Brian Chan
- Oregon Health & Science University, Department of General Internal Medicine
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, Portland OR
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Gao Y, Hwang J, Hwang G, Craig T. A review of oral kallikrein inhibitor berotralstat for hereditary angioedema. Drugs Today (Barc) 2022; 58:59-67. [DOI: 10.1358/dot.2022.58.2.3369191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Choi MJ, Yang JW, Lee S, Kim JY, Oh JW, Lee J, Stubbs B, Lee KH, Koyanagi A, Hong SH, Ghayda RA, Hwang J, Dragioti E, Jacob L, Carvalho AF, Radua J, Thompson T, Smith L, Fornaro M, Stickley A, Bettac EL, Han YJ, Kronbichler A, Yon DK, Lee SW, Shin JI, Lee E, Solmi M. Suicide associated with COVID-19 infection: an immunological point of view. Eur Rev Med Pharmacol Sci 2021; 25:6397-6407. [PMID: 34730221 DOI: 10.26355/eurrev_202110_27013] [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: 11/12/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.
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Affiliation(s)
- M J Choi
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Gubbels A, Hwang J, Li R. Primary Umbilical Endometriosis: A Systematic Literature Review. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hwang J, McDowell S, Cole B, Huber AR, Reyes C. Cytologic Analysis of a Glomus Tumor in the Left Second Toe: Case Report. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Glomus bodies reside in the stratum reticularis of the dermis as well as in visceral organs. Their functions involve temperature and blood pressure regulation. The incidence of glomus tumors is approximately 1.5%, occur more frequently in women, and generally manifest during the third to fifth decade of life. A majority of glomus tumors are diagnosed by biopsy and excision. At least 19 case reports exist in the literature where glomus tumors are diagnosed by fine-needle aspiration (FNA). We add to this growing literature by discussing a case report involving the cytologic findings of an FNA-diagnosed glomus tumor.
Methods/Case Report
A 66-year-old female presented with left second toe pain for 41 years but worsening in the past several months. Physical exam revealed 5/5 muscle strength in her toes without loss of sensation. There was no edema, erythema, nor ecchymosis. Pain was notably out of proportion when palpating her second nailbed. Magnetic resonance imaging (MRI) with contrast was performed revealing a 1.1 x 1.0 x 0.9 cm circumscribed, ovoid mass involving the dorsal aspect of the second toe distal phalanx along its dorsal margin (Figure 1). The patient underwent fine needle aspiration and biopsy. Cytologic findings included clusters of uniform cells with round to oval nuclei and scant cytoplasm. There was spindling of cells noted in some of the clusters. Cells were surrounded by thick wisps of magenta colored myxoid material reminiscent of a pleomorphic adenoma (Figure 2). Biopsy showed uniform cells surrounding capillaries. Immunohistochemistry performed on the biopsy showed that lesional cells were positive for alpha-smooth muscle actin (SMA). A diagnosis of glomus tumor was made. Amputation was performed with clear margins.
Results (if a Case Study enter NA)
NA
Conclusion
Glomus tumor is a rare tumor that is usually diagnosed on biopsy; however, it has distinct cytologic features that can aid in its diagnosis on fine needle aspirations.
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Affiliation(s)
- J Hwang
- Pathology, Brooke Army Medical Center, San Antonio, Texas, UNITED STATES
| | - S McDowell
- Department of Orthopaedics, University of Rochester School of Medicine & Dentistry, Rochester, New York, UNITED STATES
| | - B Cole
- Diagnostic Radiology, Ide Imaging Partners, Rochester, New York, UNITED STATES
| | - A R Huber
- Pathology & Laboratory Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, UNITED STATES
| | - C Reyes
- Pathology & Laboratory Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, UNITED STATES
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Kim J, Kim DH, Jee H, Hwang J, Yoon J. Type B valvular and supravalvular pulmonic stenosis with aberrant pre-pulmonic right coronary artery diagnosed by non-electrocardiography-gated, multislice computed tomography in a Boston terrier. J Vet Cardiol 2021; 38:12-17. [PMID: 34689048 DOI: 10.1016/j.jvc.2021.09.003] [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] [Received: 01/31/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
Pulmonic stenosis (PS) is a common congenital heart disease in dogs. It may be associated with an aberrant coronary artery (CA) in brachycephalic breeds. If present, a CA anomaly must be identified before pulmonic valvuloplasty. A 1.7-year-old Boston terrier was referred for a grade V/VI systolic heart murmur and exercise intolerance. Echocardiography revealed combined type B valvular and supravalvular PS; an aberrant CA was also suspected. Non-electrocardiography (ECG)-gated, 160-multislice computed tomographic angiography (CTA) confirmed severe right ventricular wall hypertrophy, a hypoplastic pulmonic valve annulus, and severe supravalvular PS with a marked main pulmonary artery bulge; a single left coronary ostium with an anomalous pre-pulmonic right CA was also identified. Surgical correction with pulmonic valvuloplasty and pulmonary artery patch angioplasty under cardiopulmonary bypass was planned. The patient died intraoperatively due to profound hypotension after weaning from extracorporeal circulation. However, this is the first case report in which type B valvular and supravalvular PS with an aberrant pre-pulmonic right CA was diagnosed by non-ECG-gated, 160-multislice CTA in a Boston terrier, showing a similar level of image quality to ECG-gated CTA. Thus, in PS cases, high-slice CTA may be helpful to determine if CA anomalies are present and to establish a therapeutic plan.
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Affiliation(s)
- J Kim
- Helix Animal Medical Center, Seoul, 06546, South Korea; College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, South Korea
| | - D-H Kim
- College of Veterinary Medicine, Chungnam National University, Daejeon, 34134, South Korea
| | - H Jee
- Helix Animal Medical Center, Seoul, 06546, South Korea
| | - J Hwang
- Helix Animal Medical Center, Seoul, 06546, South Korea
| | - J Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, South Korea.
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Cheung B, Hwang J, Stolarczyk A, Mahlof EN, Block RC. Case study of hypertriglyceridemia from COVID-19 Pfizer-BioNTech vaccination in a patient with familial hypercholesteremia. Eur Rev Med Pharmacol Sci 2021; 25:5525-5528. [PMID: 34533798 DOI: 10.26355/eurrev_202109_26664] [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: 11/12/2022]
Abstract
The Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine is the first novel nucleoside-modified messenger ribonucleic acid (modRNA) vaccine to receive Emergency Use Authorization from the Food and Drug Administration in the United States. It is indicated to be used in patients ≥12 years-of-age as of May 25th, 2021, including populations with high atherosclerotic cardiovascular disease (ASCVD) burden. However, little is known about the potential impact this vaccine may have on serum lipoprotein levels in patients with familial hypercholesteremia (FH), who are predisposed to high ASCVD burden due to elevated low-density lipoprotein cholesterol (LDL-C). We present an interesting case where a patient with heterozygous FH (HeFH) and elevated triglycerides (TG)-controlled for years on medication and apheresis-experienced significantly elevated TG, one day after receiving his second Pfizer-BioNTech COVID-19 vaccine dose. It is not known whether this adverse event may be seen in other FH patients and may be worth assessing in such patients to determine the possibility of a rare adverse reaction from a COVID-19 vaccine.
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Affiliation(s)
- B Cheung
- Saint Bernards Healthcare, Jonesboro, AR, USA.
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Arai H, Baca Y, Xiu J, Battaglin F, Hwang J, Marshall J, Goldberg R, Weinberg B, Sohal D, Lou E, Hall M, Wang J, Kawanishi N, Jayachandran P, Soni S, Zhang W, Magee D, Korn W, Lenz H. 480P Gene expression of NANOG and NANOGP8 in colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ginsburg AS, Mvalo T, Phiri M, Gadama D, Chirombo C, Maliwichi M, Hwang J, May S. Malawian children with chest-indrawing pneumonia with and without comorbidities or danger signs. J Glob Health 2021; 11:04016. [PMID: 33791095 PMCID: PMC7979154 DOI: 10.7189/jogh.11.04016] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Children with comorbidities or danger signs are often excluded from trials evaluating pneumonia treatment. Methods We sought to investigate whether the percentage of children with chest-indrawing pneumonia cured at Day 14 was lower among those with HIV infection or exposure, malaria, moderate or severe acute malnutrition, or anemia enrolled in a prospective observational cohort study than among children without these comorbidities enrolled in a concurrent prospective randomized controlled trial evaluating duration of amoxicillin treatment in Lilongwe, Malawi. Results Children with chest-indrawing pneumonia and comorbidities but without danger signs did not have statistically significant higher treatment failure rates by Day 6 than those in the chest-indrawing pneumonia clinical trial. However, children with chest-indrawing pneumonia and HIV infection or exposure, malaria, or moderate or severe acute malnutrition had higher rates of not being clinically cured at Day 14 when compared to children without these comorbidities (adjusted differences ranging from 7.7% to 17.0%). Furthermore, among children without danger signs at enrollment, but with HIV infection or HIV exposure or moderate or severe acute malnutrition, 12.5% and 15.6% respectively were not clinically cured at Day 14 even though they were without treatment failure by Day 6. Conclusions More intensive follow-up of children with chest-indrawing pneumonia and comorbidities who do not have danger signs may be beneficial.
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Affiliation(s)
| | - Tisungane Mvalo
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Melda Phiri
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Daphne Gadama
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Claightone Chirombo
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Madalitso Maliwichi
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Jun Hwang
- University of Washington, Seattle, Washington, USA
| | - Susanne May
- University of Washington, Seattle, Washington, USA
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Ginsburg AS, Mvalo T, Hwang J, Phiri M, McCollum ED, Maliwichi M, Schmicker R, Phiri A, Lufesi N, May S. Malawian children with fast-breathing pneumonia with and without comorbidities. Pneumonia (Nathan) 2021; 13:3. [PMID: 33627192 PMCID: PMC7905626 DOI: 10.1186/s41479-021-00081-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/15/2021] [Indexed: 01/03/2023] Open
Abstract
Background Due to high risk of mortality, children with comorbidities are typically excluded from trials evaluating pneumonia treatment. Understanding heterogeneity of outcomes among children with pneumonia and comorbidities is critical to ensuring appropriate treatment. Methods We explored whether the percentage of children with fast-breathing pneumonia cured at Day 14 was lower among those with selected comorbidities enrolled in a prospective observational study than among those enrolled in a concurrent randomized controlled trial evaluating treatment with amoxicillin in Lilongwe, Malawi. Results Among 79 children with fast-breathing pneumonia in the prospective observational cohort, 57 (72.2%) had HIV infection/exposure, 20 (25.3%) had malaria, 2 (2.5%) had severe acute malnutrition, and 17 (21.5%) had anemia. Treatment failure rate was slightly (not significantly) lower in children with comorbidities (4.1%, 3/73) compared to those without comorbidities (4.5%, 25/552) similarly treated. There was no significant difference in clinical cure rates by Day 14 (95.8% with vs 96.7% without comorbidity). Conclusions Children with fast-breathing pneumonia excluded from a concurrent clinical trial due to comorbidities did not fare worse. Children at higher risk whose caregivers seek care early and who receive appropriate risk assessment (e.g., pulse oximetry, hemoglobin, HIV/malaria testing) and treatment, can achieve clinical cure by Day 14. Trial registration ClinicalTrials.govNCT02960919; registered November 8, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s41479-021-00081-y.
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Affiliation(s)
- Amy Sarah Ginsburg
- University of Washington Clinical Trial Center, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA.
| | - Tisungane Mvalo
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Jun Hwang
- University of Washington Clinical Trial Center, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA
| | - Melda Phiri
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | | | - Madalitso Maliwichi
- University of North Carolina Project, Lilongwe Medical Relief Fund Trust, Lilongwe, Malawi
| | - Robert Schmicker
- University of Washington Clinical Trial Center, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA
| | - Ajib Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Susanne May
- University of Washington Clinical Trial Center, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA
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Ginsburg AS, Vitorino P, Qasim Z, Lenahan JL, Hwang J, Lamorte A, Valente M, Balouch B, Muñoz Almagro C, Nisar MI, May S, Jehan F, Bassat Q, Volpicelli G. Lung ultrasound patterns in paediatric pneumonia in Mozambique and Pakistan. ERJ Open Res 2021; 7:00518-2020. [PMID: 33569493 PMCID: PMC7861021 DOI: 10.1183/23120541.00518-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
Objective Improved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with paediatric pneumonia. Methods We conducted a prospective, observational study among children aged 2 to 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns. Results LUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%; p=0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (κ=0.915), consolidation (κ=0.915) and interstitial patterns (κ=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (κ=0.159, Pakistan) to fair (κ=0.453, Mozambique). Discussion Pattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with paediatric pneumonia and to evaluate the potential value of LUS as a reference standard. This study explored distinctive lung ultrasound patterns associated with paediatric community-acquired pneumonia in Mozambique and Pakistan, and found reliable pattern recognition critical to identifying pneumoniahttps://bit.ly/3eWWvXr
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Affiliation(s)
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Zunera Qasim
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jun Hwang
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Marta Valente
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Benazir Balouch
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - M Imran Nisar
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Susanne May
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - Fyezah Jehan
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Instituto de Recerca Pediatrica, Hospital Sant Joan de Déu, Barcelona, Spain.,ICREA, Barcelona, Spain.,Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Giovanni Volpicelli
- Dept of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Ginsburg AS, Lenahan JL, Jehan F, Bila R, Lamorte A, Hwang J, Madrid L, Nisar MI, Vitorino P, Kanth N, Balcells R, Baloch B, May S, Valente M, Varo R, Nadeem N, Bassat Q, Volpicelli G. Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan. Pediatr Pulmonol 2021; 56:551-560. [PMID: 33205892 PMCID: PMC7898329 DOI: 10.1002/ppul.25176] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. METHODS We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. RESULTS Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training. CONCLUSIONS Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.
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Affiliation(s)
| | | | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | | | - Jun Hwang
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Lola Madrid
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | | | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Neel Kanth
- Sindh Government Children's Hospital–Poverty Eradication InitiativeKarachiPakistan
| | - Reyes Balcells
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Benazir Baloch
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Susanne May
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Marta Valente
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Naila Nadeem
- Department of RadiologyAga Khan UniversityKarachiPakistan
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
- Institució Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain
- Department of Pediatrics, Hospital Sant Joan de DeuUniversitat de BarcelonaBarcelonaSpain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP)MadridSpain
| | - Giovanni Volpicelli
- Department of Emergency MedicineSan Luigi Gonzaga University HospitalOrbassanoItaly
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Ramiro I, Villa J, Hwang J, Martin AJ, Millunchick J, Phillips J, Martí A. Demonstration of a GaSb/GaAs Quantum Dot Intermediate Band Solar Cell Operating at Maximum Power Point. Phys Rev Lett 2020; 125:247703. [PMID: 33412043 DOI: 10.1103/physrevlett.125.247703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/23/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
Intermediate band solar cells (IBSCs) promise high efficiencies while maintaining a low device structural complexity. A high efficiency can be obtained by harvesting below-band-gap photons, thus increasing the current, while at the same time preserving a high voltage. Here, we provide experimental proof that below-band-gap photons can be used to produce nonzero electrical work in an IBSC without compromising the voltage. For this, we manufacture a GaSb/GaAs quantum-dot IBSC. We use light biasing and make our cell operate at the maximum power point at 9 K. We measure the photocurrent response to absorption of photons with an energy of less than 1.15 eV while the cell is operating at 1.15 V. We also show that this result implies the existence of three quasi-Fermi levels linked to the three electronic bands in our device, as demanded by the IBSC theory to preserve the output voltage of the cell.
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Affiliation(s)
- I Ramiro
- Instituto de Energía Solar, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - J Villa
- Instituto de Energía Solar, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - J Hwang
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A J Martin
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J Millunchick
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J Phillips
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A Martí
- Instituto de Energía Solar, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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Kim I, Hwang J, Lee C, Cho Y, Park H, Chung J, Yoon H, Kim H, Han S, Hur S, Koo B, Doh J, Shin E, Lee J, Nam C. Correlation of coronary microvascular function and diastolic dysfunction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is an important mechanism for heart failure with preserved ejection fraction (HFpEF) which is closely related with diastolic dysfunction on transthoracic echocardiography (TTE).
Purpose
The aim of this study was to evaluate the association of CMD with echocardiographic parameters of diastolic dysfunction.
Methods
Total 385 patients with chest discomfort in the absence of significant coronary artery obstruction were enrolled to this study and underwent invasive coronary physiologic assessment including index of microcirculatory resistance (IMR), and coronary flow reserve (CFR). Echocardiographic parameters for diastolic dysfunction - left atrial volume index (LAVI) and left ventricular filling pressure (E over e') were compared in patients with true CMD (CFR<2.5 with IMR ≥20), mismatched CMD (CFR≥2.5 with IMR ≥20 or CFR<2.5 with IMR <20), and no CMD (CFR≥2.5 with IMR <20).
Results
Among the study population, 55 patients (14.3%) were true CMD, 162 patients (42.1%) were mismatched CMD and 168 patients (43.6%) were no CMD. Age (62.9±10.5 vs. 61.1±9.9 vs. 61.7±10.5, p=0.522) and left ventricular ejection fraction (63.9±8.1 vs. 63.9±6.2 vs. 63.0±6.7, p=0.414) was not different between groups. Patients with true CMD showed significantly larger left atrial size (LAVI: 34.7±18.2 mL/m2 vs. 26.8±10.7 mL/m2, p=0.005) and trend towards higher LV filling pressure (E/e': 10.8±3.5 vs. 9.9±3.5, p=0.073) compared with no CMD. In subgroup analysis, younger patients showed more pronounced increase of LAVI (Age <65: 39.6±22.6 vs. 26.1±11.6, p=0.003; Age ≥65: 28.0±9.13 vs. 28.8±8.2, p=0.266; p for interaction 0.043) in true CMD compared to no CMD. Non-diabetic patients also showed more pronounced increase of E/e' in true CMD (Non-diabetes: 10.2±2.7 vs. 9.2±2.6, p=0.002; Diabetes: 12.1±4.5 vs. 11.9±5.1, p=0.197; p for interaction 0.015).
Conclusions
Coronary microvascular dysfunction is significantly related with echocardiographic parameters of diastolic dysfunction. The effect of CMD on diastolic dysfunction is more prominent in low-risk patients.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I.C Kim
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - J Hwang
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - C.H Lee
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - Y.K Cho
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - H.S Park
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - J.W Chung
- Daegu Dongsan Hospital, Daegu, Korea (Republic of)
| | - H.J Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - H Kim
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - S Han
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - S.H Hur
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
| | - B.K Koo
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - J.H Doh
- Inje University Ilsan Paik Hospital, Ilsan, Korea (Republic of)
| | - E.S Shin
- Ulsan University Hospital, Ulsan, Korea (Republic of)
| | - J.M Lee
- Samsung Medical Center, Seoul, Korea (Republic of)
| | - C.W Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (Republic of)
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Nguyen HGT, Sims CM, Toman B, Horn J, van Zee RD, Thommes M, Ahmad R, Denayer JFM, Baron GV, Napolitano E, Bielewski M, Mangano E, Brandani S, Broom DP, Benham MJ, Dailly A, Dreisbach F, Edubilli S, Gumma S, Möllmer J, Lange M, Tian M, Mays TJ, Shigeoka T, Yamakita S, Hakuman M, Nakada Y, Nakai K, Hwang J, Pini R, Jiang H, Ebner AD, Nicholson MA, Ritter JA, Farrando-Pérez J, Cuadrado-Collados C, Silvestre-Albero J, Tampaxis C, Steriotis T, Řimnáčová D, Švábová M, Vorokhta M, Wang H, Bovens E, Heymans N, De Weireld G. A reference high-pressure CH4 adsorption isotherm for zeolite Y: results of an interlaboratory study. ADSORPTION 2020. [DOI: 10.1007/s10450-020-00253-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThis paper reports the results of an international interlaboratory study led by the National Institute of Standards and Technology (NIST) on the measurement of high-pressure surface excess methane adsorption isotherms on NIST Reference Material RM 8850 (Zeolite Y), at 25 °C up to 7.5 MPa. Twenty laboratories participated in the study and contributed over one-hundred adsorption isotherms of methane on Zeolite Y. From these data, an empirical reference equation was determined, along with a 95% uncertainty interval (Uk=2). By requiring participants to replicate a high-pressure reference isotherm for carbon dioxide adsorption on NIST Reference Material RM 8852 (ZSM-5), this interlaboratory study also demonstrated the usefulness of reference isotherms in evaluating the performance of high-pressure adsorption experiments.
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Rowell SE, Meier EN, McKnight B, Kannas D, May S, Sheehan K, Bulger EM, Idris AH, Christenson J, Morrison LJ, Frascone RJ, Bosarge PL, Colella MR, Johannigman J, Cotton BA, Callum J, McMullan J, Dries DJ, Tibbs B, Richmond NJ, Weisfeldt ML, Tallon JM, Garrett JS, Zielinski MD, Aufderheide TP, Gandhi RR, Schlamp R, Robinson BRH, Jui J, Klein L, Rizoli S, Gamber M, Fleming M, Hwang J, Vincent LE, Williams C, Hendrickson A, Simonson R, Klotz P, Sopko G, Witham W, Ferrara M, Schreiber MA. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. JAMA 2020; 324:961-974. [PMID: 32897344 PMCID: PMC7489866 DOI: 10.1001/jama.2020.8958] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration of tranexamic acid may benefit patients with TBI. OBJECTIVE To determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blinded, randomized clinical trial at 20 trauma centers and 39 emergency medical services agencies in the US and Canada from May 2015 to November 2017. Eligible participants (N = 1280) included out-of-hospital patients with TBI aged 15 years or older with Glasgow Coma Scale score of 12 or less and systolic blood pressure of 90 mm Hg or higher. INTERVENTIONS Three interventions were evaluated, with treatment initiated within 2 hours of TBI: out-of-hospital tranexamic acid (1 g) bolus and in-hospital tranexamic acid (1 g) 8-hour infusion (bolus maintenance group; n = 312), out-of-hospital tranexamic acid (2 g) bolus and in-hospital placebo 8-hour infusion (bolus only group; n = 345), and out-of-hospital placebo bolus and in-hospital placebo 8-hour infusion (placebo group; n = 309). MAIN OUTCOMES AND MEASURES The primary outcome was favorable neurologic function at 6 months (Glasgow Outcome Scale-Extended score >4 [moderate disability or good recovery]) in the combined tranexamic acid group vs the placebo group. Asymmetric significance thresholds were set at 0.1 for benefit and 0.025 for harm. There were 18 secondary end points, of which 5 are reported in this article: 28-day mortality, 6-month Disability Rating Scale score (range, 0 [no disability] to 30 [death]), progression of intracranial hemorrhage, incidence of seizures, and incidence of thromboembolic events. RESULTS Among 1063 participants, a study drug was not administered to 96 randomized participants and 1 participant was excluded, resulting in 966 participants in the analysis population (mean age, 42 years; 255 [74%] male participants; mean Glasgow Coma Scale score, 8). Of these participants, 819 (84.8%) were available for primary outcome analysis at 6-month follow-up. The primary outcome occurred in 65% of patients in the tranexamic acid groups vs 62% in the placebo group (difference, 3.5%; [90% 1-sided confidence limit for benefit, -0.9%]; P = .16; [97.5% 1-sided confidence limit for harm, 10.2%]; P = .84). There was no statistically significant difference in 28-day mortality between the tranexamic acid groups vs the placebo group (14% vs 17%; difference, -2.9% [95% CI, -7.9% to 2.1%]; P = .26), 6-month Disability Rating Scale score (6.8 vs 7.6; difference, -0.9 [95% CI, -2.5 to 0.7]; P = .29), or progression of intracranial hemorrhage (16% vs 20%; difference, -5.4% [95% CI, -12.8% to 2.1%]; P = .16). CONCLUSIONS AND RELEVANCE Among patients with moderate to severe TBI, out-of-hospital tranexamic acid administration within 2 hours of injury compared with placebo did not significantly improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01990768.
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Affiliation(s)
- Susan E Rowell
- Department of Surgery, Oregon Health & Science University, Portland
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Eric N Meier
- Department of Biostatistics, University of Washington, Seattle
| | | | - Delores Kannas
- Department of Biostatistics, University of Washington, Seattle
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle
| | - Kellie Sheehan
- Department of Biostatistics, University of Washington, Seattle
| | | | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ralph J Frascone
- Department of Emergency Medicine, Regions Hospital, St Paul, Minnesota
| | - Patrick L Bosarge
- Department of Surgery, University of Alabama, Birmingham
- Department of Surgery, University of Arizona, Phoenix
| | - M Riccardo Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Jay Johannigman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Bryan A Cotton
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston
| | - Jeannie Callum
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jason McMullan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - David J Dries
- Department of Surgery, Regions Hospital, St Paul, Minnesota
| | - Brian Tibbs
- Trauma Surgery, Texas Health Presbyterian Hospital, Dallas
| | - Neal J Richmond
- Department of Emergency Medicine, John Peter Smith Health Network, Ft Worth, Texas
| | | | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
| | | | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Rajesh R Gandhi
- Department of Surgery, John Peter Smith Health Network, Ft Worth, Texas
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Lauren Klein
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Sandro Rizoli
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mark Gamber
- Department of Emergency Medicine, Medical City Plano, Plano, Texas
| | - Michael Fleming
- Department of Surgery, Oregon Health & Science University, Portland
| | - Jun Hwang
- Department of Biostatistics, University of Washington, Seattle
| | - Laura E Vincent
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston
| | | | - Audrey Hendrickson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Robert Simonson
- Emergency Medicine, Methodist Dallas Medical Center, Dallas, Texas
| | - Patricia Klotz
- Department of Surgery, University of Washington, Seattle
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - William Witham
- Trauma Surgery, Texas Health Harris Methodist Hospital, Ft Worth
| | - Michael Ferrara
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
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Hwang J, Cheung B, Block RC. Different mother and daughter manifestations due to very high cholesterol-containing lipoproteins. Eur Rev Med Pharmacol Sci 2020; 24:9147-9150. [PMID: 32965006 DOI: 10.26355/eurrev_202009_22862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Familial hypercholesterolemia (FH) is an autosomal codominant genetic disorder associated with defective hepatic uptake of circulating low-density lipoproteins (LDL), which can lead to premature atherosclerotic cardiovascular disease (ASCVD). Evidence suggests elevated lipoprotein(a) (Lp(a)) levels in FH patients may also increase their ASCVD risk. We present a case series of 2 FH patients where a daughter has a higher ASCVD burden than her mother due to the daughter having elevated Lp(a). This underscores the importance of including Lp(a) in cascade lipid screening in FH patients and their first-degree relatives.
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Affiliation(s)
- J Hwang
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Ginsburg AS, Mvalo T, Nkwopara E, McCollum ED, Phiri M, Schmicker R, Hwang J, Ndamala CB, Phiri A, Lufesi N, Izadnegahdar R, May S. Amoxicillin for 3 or 5 Days for Chest-Indrawing Pneumonia in Malawian Children. N Engl J Med 2020; 383:13-23. [PMID: 32609979 PMCID: PMC7233470 DOI: 10.1056/nejmoa1912400] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence regarding the appropriate duration of treatment with antibiotic agents in children with pneumonia in low-resource settings in Africa is lacking. METHODS We conducted a double-blind, randomized, controlled, noninferiority trial in Lilongwe, Malawi, to determine whether treatment with amoxicillin for 3 days is less effective than treatment for 5 days in children with chest-indrawing pneumonia (cough lasting <14 days or difficulty breathing, along with visible indrawing of the chest wall with or without fast breathing for age). Children not infected with human immunodeficiency virus (HIV) who were 2 to 59 months of age and had chest-indrawing pneumonia were randomly assigned to receive amoxicillin twice daily for either 3 days or 5 days. Children were followed for 14 days. The primary outcome was treatment failure by day 6; noninferiority of the 3-day regimen to the 5-day regimen would be shown if the percentage of children with treatment failure in the 3-day group was no more than 1.5 times that in the 5-day group. Prespecified secondary analyses included assessment of treatment failure or relapse by day 14. RESULTS From March 29, 2016, to April 1, 2019, a total of 3000 children underwent randomization: 1497 children were assigned to the 3-day group, and 1503 to the 5-day group. Among children with day 6 data available, treatment failure had occurred in 5.9% in the 3-day group (85 of 1442 children) and in 5.2% (75 of 1456) in the 5-day group (adjusted difference, 0.7 percentage points; 95% confidence interval [CI], -0.9 to 2.4) - a result that satisfied the criterion for noninferiority of the 3-day regimen to the 5-day regimen. Among children with day 14 data available, 176 of 1411 children (12.5%) in the 3-day group and 154 of 1429 (10.8%) in the 5-day group had had treatment failure by day 6 or relapse by day 14 (between-group difference, 1.7 percentage points; 95% CI, -0.7 to 4.1). The percentage of children with serious adverse events was similar in the two groups (9.8% in the 3-day group and 8.8% in the 5-day group). CONCLUSIONS In HIV-uninfected Malawian children, treatment with amoxicillin for chest-indrawing pneumonia for 3 days was noninferior to treatment for 5 days. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT02678195.).
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Affiliation(s)
| | - Tisungane Mvalo
- University of North Carolina Project, Lilongwe Medical
Relief Fund Trust, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | | | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences,
Department of Pediatrics, Johns Hopkins School of Medicine and Department of International
Health, Johns Hopkins Bloomberg School of Public Health, 200 N Wolfe Street, Baltimore,
MD, 21287, USA
| | - Melda Phiri
- University of North Carolina Project, Lilongwe Medical
Relief Fund Trust, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Robert Schmicker
- Department of Biostatistics, University of Washington
Clinical Trial Center, Building 29, Suite 250, 6200 NE 74 Street, Seattle,
WA, 98115, USA
| | - Jun Hwang
- Department of Biostatistics, University of Washington
Clinical Trial Center, Building 29, Suite 250, 6200 NE 74 Street, Seattle,
WA, 98115, USA
| | - Chifundo B. Ndamala
- University of North Carolina Project, Lilongwe Medical
Relief Fund Trust, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Ajib Phiri
- Department of Pediatrics and Child Health, College of
Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi
| | - Norman Lufesi
- Acute Respiratory Infection and Emergency Triage
Assessment and Treatment, Malawi Ministry of Health, Private Bag 65, Lilongwe,
Malawi
| | - Rasa Izadnegahdar
- Bill & Melinda Gates Foundation, 500 Fifth Avenue
N, Seattle, WA, 98109, USA
| | - Susanne May
- Department of Biostatistics, University of Washington
Clinical Trial Center, Building 29, Suite 250, 6200 NE 74 Street, Seattle,
WA, 98115, USA
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Bruera S, Zogala R, Lei X, Pundole X, Zhao H, Giordano S, Hwang J, Suarez-Almazor M. FRI0516 FACTORS ASSOCIATED WITH DECREASED CERVICAL CANCER SCREENING IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries an increased risk for both viral illnesses and malignancies, including a greater risk for both human papilloma virus (HPV) infection and cervical cancer. Due to this increased risk, the American Society of Colposcopy and Cervical Pathology guidelines for SLE patients recommend more frequent cervical cancer screening. Few studies have examined patient characteristics associated with decreased cervical cancer screening in patients with autoimmune disease, specifically SLE.Objectives:To estimate cervical cancer screening rates in women with recently diagnosed SLE, and to identify characteristics associated with decreased screening.Methods:We identified women with an initial diagnosis of SLE in the United States MarketScan Commercial Claims and Encounter (CCAE, age 18-64) administrative claims database. We included patients with at least three claims with a lupus diagnosis (first and last at least >90 days apart), no lupus claims within the year before initial claim, and who had been on antimalarial drugs for at least 90 days. We excluded all patients with a previous claim for hysterectomy.Cervical cancer screening was ascertained using diagnosis and procedure codes within 1 year before and 2 years after the first SLE claim. Our covariates included the year of first SLE claim (2001-2014), age at first SLE claim, comorbidity score, insurance type, geographical region, and prescriptions for multiple types of corticosteroids. Control patients included age-matched females without autoimmune disease. Univariate comparison and multivariate logistic regression models were built to evaluate determinants of screening.Results:We included 4,316 SLE patients (median age 45) and 86,544 control patients. The screening rate in SLE patients was 73.4% vs 58.5% in the controls (P < 0.001). The screening rate was 71% in 2001, increased to 75% in 2004, then decreased to 70% in 2014 (trend P =0.005). In the multivariate model the following factors were associated with decreased cervical cancer screening: year of first SLE claim 2012-2014 versus 2001-2005 (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.53 – 0.84, P < 0.001); older age 61-64 versus 21-30 (OR 0.27, 95% CI 0.19 – 0.39, P < 0.001); comorbidity score of ≥2 versus <2 (OR 0.71, 95% CI 0.6 – 0.83, P < 0.001); and use of corticosteroids for ≥ 90 days versus <90 days (OR 0.73, 95% CI 0.59 – 0.9, P = 0.003). Insurance type and geographical region were not associated with cervical cancer screening.Conclusion:About three quarters of women with SLE underwent cervical cancer screening within 3 years of their first lupus claim, at higher rates than controls. However, there was a concerning downward trend in screening rates in recent years. In addition, higher risk populations for cervical cancer (older age, increased comorbidities, and longer duration of corticosteroids) had lower screening rates. These findings highlight the need to enhance education for healthcare providers to improve utilization of screening in women with SLE at high risk of cervical cancer.Disclosure of Interests:Sebastian Bruera: None declared, Richard Zogala: None declared, Xiudong Lei: None declared, Xerxes Pundole: None declared, Hui Zhao: None declared, Sharon Giordano: None declared, Jessica Hwang Grant/research support from: MERCK grant funding unrelated to SLE., Maria Suarez-Almazor: None declared
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Ahn JK, Hwang J, Lee J, Kim H, Seo GH. OP0073 RISK OF DEVELOPING RHEUMATIC DISEASES IN PATIENTS WITH PALINDROMIC RHEUMATISM IN SOUTH KOREA: A NATION-WIDE POPULATION-BASED STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Palindromic rheumatism (PR) has known to be three patterns of disease course: clinical remission of attacks, persistent attacks, and evolution to chronic arthritis or systemic disease. The spectrum in progression to chronic diseases of PR, however, is quite variable; rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren’s syndrome (SjS), ankylosing spondylitis (AS), relapsing polychondritis (RP), Behçet’s disease (BD), sarcoidosis, and psoriatic spondylitis and arthropathy. Because of the small numbers in case-control studies and too aged investigations, now we needs to shed new light on the fate of PR.Objectives:The aim was to investigate the epidemiology of PR and the risk of developing various rheumatic diseases compared with non-PR individuals, employing the National Health Insurance Service (NHIS) medical claims data, which covers all medical institutions of South Korea.Methods:The study used 2007-2018 claims data from the Korean Health Insurance Review and Assessment Service (HIRA). The identified 19,724 PR patients from 2010 to 2016 were assessed for the incidence rate (IR) compared with the population in the given year by 100,000 person-year (py). The date of diagnosis was the index date. After matching with non-PR individuals (1:10) for age, sex and the year of index date, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of developing the various rheumatic diseases and adult immunodeficiency syndrome (AIDS) as the outcome diseases in PR cohort was estimated. This risk was compared with that of matched non-PR cohort.Results:Of 19,724 PR patients (8,665 males and 11,059 females), the mean age was 50.2 ± 14.9 years (47.7 ± 14.4 years in males and 52.6 ± 14.9 years in females,p< 0.001). The ratio of male to female patients with PR was approximately 1:1.28. The annual IR of PR was 7.02 (6.92-7.12) per 100,000 py (6.22 (6.09-6.35) and 7.80 (7.66-7.95) per 100,000 py in males and females, respectively). The mean duration to develop the outcome diseases was significantly shorter in PR cohort compared that of non-PR cohort (19.4 vs. 35.8 months,p< 0.001). The most common outcome disease was RA (7.34% of PR patients; 80.0% of total outcome diseases), followed by AS, SLE, BD, SjS, MCTD, DM/PM, SSc, RP, psoriatic arthropathy, and AIDS in PR cohort. The patients with PR had an increased risk of RA (HR 46.6, 95% CI [41.1-52.7]), psoriatic arthropathy (44.79 [15.2-132.4]), SLE (24.5 [16.2-37.2]), MCTD (22.0 [7.7-63.3]), BD (21.0 [13.8-32.1]), SjS (12.4 [8.5-17.9]), AS (9.0 [6.7-12.2]), DM/PM (6.1 [2.6-14.8]), and SSc (3.8 [1.5-9.6]) but not of AIDS. The risk of developing RA was greater in male patients (HR 58.9, 95% CI [45.6-76.2] vs. 43.2 [37.4-49.8],pfor interaction = 0.037) while female patients encountered a higher risk of developing AS (15.8 [8.9-28.1] vs. 7.2 [5.0-10.3],pfor interaction = 0.023). The risk of developing RA, SLE, SjS, and BD were significantly more highly affected in younger age (pfor interaction < 0.001, = 0.003, 0.002, and 0.017, at each).Conclusion:This nationwide, population-based cohort study demonstrated that patients with PR had an increased risk of developing various rheumatic diseases, not only RA but also psoriatic arthropathy. Therefore, patients with PR needs to be cautiously followed up for their potential of diverse outcome other than RA: RA, SLE, SjS, and BD in younger patients, RA in males, and AS in females, in particular.Disclosure of Interests:None declared
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Abstract
BACKGROUND Needlestick injuries (NSIs) are common healthcare-related injuries and possible consequences include blood-borne infections. Despite that, a large proportion of NSIs are not reported. AIMS To estimate the prevalence of under-reporting of NSIs and to evaluate the knowledge, attitude and behaviour towards NSIs among junior doctors in a tertiary hospital in Singapore. METHODS An explanatory sequential mixed-methods design was employed. Quantitative data were collected through questionnaires completed by 99 junior doctors. Descriptive statistics and bivariate analysis were performed to evaluate socio-demographic characteristics, NSI history and NSI reporting practices. Qualitative data were collected through 12 in-depth interviews. Participants were purposively recruited, and semi-structured topic guides were developed. Data were analysed using a thematic approach. RESULTS Fifty-two per cent of respondents had history of NSI. Of those with history of NSI, 31% did not report injury. NSI reporters were 1.52 times as likely to be aware of how to report injury (P < 0.05), and 1.63 times as likely to feel that reporting benefits their health (P < 0.01) compared with non-reporters. NSI reporters were 83% more likely to report a clean NSI (P = 0.05). For non-reporters, the main reasons for not reporting were perceived low risk of transmission (41%) and lack of time to report (35%). Themes identified in the qualitative data include perceived benefits, perceived barriers, perceived threats, cues to action and organizational culture. CONCLUSION Under-reporting of NSIs may have significant implications for patients and healthcare workers. Addressing identified factors and instituting targeted interventions will help to improve reporting rates.
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Affiliation(s)
- M W Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - J Hwang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - S M Lim
- Occupational Health Clinic, National University Health Systems, Singapore, Singapore
| | - J Sng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Podboy A, Clarke J, Nguyen L, Mooney J, Dhillon G, Hwang J. Outcomes of Gastric Per-Oral Endoscopic Pyloromyotomy for Severe Gastroparesis in a Lung Transplant Patient Population. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Wahl GM, Ma Z, Chung C, Dravis C, Spike BT, Giraddi RT, Balcioglu O, Fan C, Hagos B, Heinz R, Herrera-Valdez J, Hou X, Hwang J, Lasken R, Luna G, Lytle NE, Mehrabad EM, Novotny M, Perou CM, Poirion O, Preissl S, Ren B, Reya T, Trejo CL, Varley KT. Abstract ES10-2: Understanding breast cancer using a developmental perspective. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-es10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Parallels among embryonic development, stem cells, and cancer have long been recognized. We identified, isolated, and characterized stem cells that first become committed to a mammary fate during embryogenesis; we refer to these cells as fetal mammary stem cells (fMaSCs). Lineage tracing, in vitro sphere formation, and in vivo transplantation studies by our group and many others all confirm that cells in the embryo are the bipotent progenitors of the mammary gland. There is debate, however, on whether such bipotent cells persist into the adult, or whether the luminal and basal lineages are maintained by unipotent progenitors. To gain insight into the relationships between fMaSCs and breast cancer, and to investigate their potential persistence in the adult, we have applied bulk and single cell RNA-sequencing (sc-RNA-seq) and single nucleus ATAC-sequencing (snATAC-seq) throughout mammary development. The results to be discussed demonstrate that fMaSC transcriptomes are heterogeneous, but all share co-expression of genes associated with luminal and basal cell fates. This fits a model in which the bipotent state is created by a balance of lineage specifiers. We also find that the fMaSC transcriptome is highly enriched in basal-like human breast cancers and identify potential embryonic pathways that correlate with poor prognosis. We used a variety of computational tools to infer the gene expression programs that ensue when fMaSCs commit to luminal and basal states. The data from scRNA-seq and snATAC-seq demonstrate that the transitions are gradual, not precipitous, and that luminal and basal cells exhibit significant transcriptomic and epigenetic heterogeneity. This challenges the notion that the mammary gland consists of discrete cell types defined by rigid transcriptomic parameters, and reveals a potential for intrinsic phenotypic plasticity of normal mammary cells. Using the combined databases, we identified Sox10 as a significantly differentially expressed cell state regulator. We show that tumors are heterogeneous with regard to Sox10 expression, and that locally invasive cells tend to express high Sox10 levels. Elevated Sox10 correlates with acquisition of a neural-crest like, EMT-related state. Implications for interception of metastasis by targeting neural crest-like cells will be discussed. Finally, we have generated a web resource that is available to the scientific community to enable the transcription and epigenetic characteristics of any gene of interest to be tracked through mammary development (https://wahl-labsalk.shinyapps.io/Mammary_snATAC/).
Citation Format: GM Wahl, Z Ma, C Chung, C Dravis, BT Spike, RR Giraddi, O Balcioglu, C Fan, B Hagos, R Heinz, Herrera-Valdez J, X Hou, J Hwang, R Lasken, G Luna, NE Lytle, EM Mehrabad, M Novotny, CM Perou, O Poirion, S Preissl, B Ren, T Reya, CL Trejo, KT Varley. Understanding breast cancer using a developmental perspective [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES10-2.
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Affiliation(s)
- GM Wahl
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - Z Ma
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - C Chung
- 2Gene Expression Laboratory, Salk Institute for Biological Studies; Current address: Pfizer Inc., San Diego, CA 92121, La Jolla, CA
| | - C Dravis
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - BT Spike
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
| | - RT Giraddi
- 2Gene Expression Laboratory, Salk Institute for Biological Studies; Current address: Pfizer Inc., San Diego, CA 92121, La Jolla, CA
| | - O Balcioglu
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
| | - C Fan
- 4Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - B Hagos
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
| | - R Heinz
- 5Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake Sity, UT
| | - J Herrera-Valdez
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - X Hou
- 6Center for Epigenomics, Department of Cellular and Molecular Medicine, University of California, San Diego, School of Medicine, La Jolla, CA
| | - J Hwang
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
| | - R Lasken
- 7J. Craig Venter Institute, La Jolla, CA
| | - G Luna
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - NE Lytle
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - EM Mehrabad
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
| | - M Novotny
- 7J. Craig Venter Institute, La Jolla, CA
| | - CM Perou
- 4Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - O Poirion
- 6Center for Epigenomics, Department of Cellular and Molecular Medicine, University of California, San Diego, School of Medicine, La Jolla, CA
| | - S Preissl
- 6Center for Epigenomics, Department of Cellular and Molecular Medicine, University of California, San Diego, School of Medicine, La Jolla, CA
| | - B Ren
- 8Center for Epigenomics, Department of Cellular and Molecular Medicine, University of California, San Diego, School of Medicine; Ludwig Institute for Cancer Research, La Jolla, CA
| | - T Reya
- 9Sanford Consortium for Regenerative Medicine; Departments of Pharmacology and Medicine, Moores Cancer Center, University of California San Diego School of Medicine, La Jolla, CA
| | - CL Trejo
- 1Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, CA
| | - KT Varley
- 3Huntsman Cancer Institute, Department of Oncological Sciences, University of Utah, Salt Lake City, UT
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Rubenstein JL, Geng H, Vu K, Mannis G, Formaker P, Hwang J, Munster PN, Damato B. Maintenance lenalidomide in primary CNS lymphoma. Ann Oncol 2020; 30:1397-1398. [PMID: 31046114 DOI: 10.1093/annonc/mdz142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J L Rubenstein
- Department of Medicine, Hematology/Oncology, Ocular Oncology, UCSF, San Francisco, USA; Helen Diller Family Comprehensive Cancer Center, Ocular Oncology, UCSF, San Francisco, USA.
| | - H Geng
- Helen Diller Family Comprehensive Cancer Center, Ocular Oncology, UCSF, San Francisco, USA; Laboratory Medicine, Ocular Oncology, UCSF, San Francisco, USA
| | - K Vu
- Department of Medicine, Hematology/Oncology, Ocular Oncology, UCSF, San Francisco, USA
| | - G Mannis
- Stanford Hematology, Ocular Oncology, UCSF, San Francisco, USA
| | - P Formaker
- Department of Medicine, Hematology/Oncology, Ocular Oncology, UCSF, San Francisco, USA
| | - J Hwang
- Helen Diller Family Comprehensive Cancer Center, Ocular Oncology, UCSF, San Francisco, USA; Biostatistics and Computational Biology, Ocular Oncology, UCSF, San Francisco, USA
| | - P N Munster
- Department of Medicine, Hematology/Oncology, Ocular Oncology, UCSF, San Francisco, USA; Helen Diller Family Comprehensive Cancer Center, Ocular Oncology, UCSF, San Francisco, USA
| | - B Damato
- Helen Diller Family Comprehensive Cancer Center, Ocular Oncology, UCSF, San Francisco, USA; Department of Ophthalmology, Ocular Oncology, UCSF, San Francisco, USA
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Toukhsati S, Jones A, Fletcher S, Milligan D, Kwee J, Justice K, Liu M, Hwang J, Duong V, Galea A, Zheng J, Hare D. 642 Psychological Denial is a Risk Factor for All-Cause Unplanned Rehospitalisations Following Acute Myocardial Infarction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cho SH, Chung I, Bae W, Hwang J. Long-term complication and outcomes after induction chemotherapy with TPF followed by chemoradiotherapy for nasopharyngeal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz428.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lee J, Cheng N, Tai H, Jimmy Juang J, Wu C, Lin L, Hwang J, Lin J, Chiang F, Tsai C. CYP2C19 Polymorphism is Associated With Amputation Rates in Patients Taking Clopidogrel After Endovascular Intervention for Critical Limb Ischaemia. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee CJ, Hwang J, Kang CY, Kim H, Ha J, Chun KH, Oh J, Lee S, Kang SM, Park S, Yoo TH. P5731Optimal blood pressure in diabetic hypertensive patients with overt proteinuria. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence for the benefit of intensive blood pressure lowering in diabetic nephropathy is not clear at this time. The objective of this study was to demonstrate whether lower mean blood pressure (BP) in treated hypertensive patients with diabetic nephropathy is associated with better prognosis.
Methods
From the National Health Insurance Service (NHIS) Health Examination Database, diabetic hypertensive subjects with proteinuria between 2009 and 2010 were selected and followed-up until 2015 (N=8,663). Mean of the recorded systolic and diastolic BP during follow-up health examinations were stratified into five categories (SBP: <120, 120 to <130, 130 to <140, 140 to <150, and ≥150 mmHg; DBP: <70, 70 to <80, 80 to <90, 90 to <100, and ≥100 mmHg). All-cause death, myocardial infarction (MI), stroke, and renal outcome (progression to end stage renal disease or doubling of serum creatinine) were examined by Cox proportional hazard models with the propensity scores adjusted method.
Results
Compared to SBP of 130 to <140 mmHg, SBP of 120 to <130 mmHg was associated with lower risk of all-cause death (HR=0.78; 95% CI, 0.64–0.95), stroke (HR: 0.65; 95% CI, 0.45–0.94), and renal outcome (HR: 0.81; 95% CI, 0.68–0.97). SBP of <120 mmHg was associated with benefit for renal outcomes (HR: 0.69; 95% CI 0.55–0.88) but not with elevated risk of other outcomes. Compared to DBP of 80 to <90 mmHg, DBP of 70 to <80 mmHg were associated with lower risk of all-cause death (HR: 0.75; 95% CI, 0.64–0.88) but with higher risk of MI (HR: 1.52; 95% CI, 1.05–2.21). DBP of <70 mmHg was associated with reduced risk of all-cause death (HR: 0.79; 95% CI, 0.64–0.98).
Conclusion
In diabetic hypertensive subjects with overt proteinuria, deterioration of renal function decreased with decreasing SBP and the lowest risk of all-cause death and stroke were observed in SBP <130 mmHg. Low DBP was associated with low risk of all-cause death but there was a J curve phenomenon for MI in DBP of 70 to <80 mmHg.
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Affiliation(s)
- C J Lee
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Hwang
- Daegu University, Department of Statistics and Computer Science, Gyeongbuk, Korea (Republic of)
| | - C Y Kang
- Daegu University, Department of Statistics and Computer Science, Gyeongbuk, Korea (Republic of)
| | - H Kim
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Ha
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - K.-H Chun
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Oh
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S.H.- Lee
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S.-M Kang
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - S Park
- Yonsei University College of Medicine, Division of cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - T.-H Yoo
- Yonsei University College of Medicine, Division of Nephrology, Department of Internal Medicine, Seoul, Korea (Republic of)
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Ki-Su P, Yoon S, Hwang J, Ahn H. P10.01 Anti-migration and anti-invasion effects of curcumin via suppression of fascin expression in glioblastoma cells. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The natural compound Curcumin was known to inhibit migration and invasion of glioblastoma (GBM) cells. Fascin, a kind of actin-binding proteins, is correlated with migration and invasion of GBM cells. The purpose of this study was to investigate anti-migration and anti-invasion effects of Curcumin via suppression of fascin expression in GBM cells.
MATERIAL AND METHODS
U87 cell line was used as an experimental model of GBM. Fascin was quantified by Western blot analysis. And, the signal transducer and activator of transcription 3 (STAT3), known to play an important role in migration and invasion of tumor cells, were analyzed by sandwich-ELISA. Migration and invasion capacities were assessed by attachment, migration and invasion assays. Cellular morphology was demonstrated by immunofluorescence.
RESULTS
At various concentrations of curcumin and exposure times, fascin expression decreased. After temporarily exposure to 10μM/L Curcumin during 6 hours as less invasive concentration and time, fascin expression temporarily decreased at 12 hours (18.4%, p=0.024), and since then recovered. And, the change of phosphrylated STAT3 level also reflected the temporarily decreased pattern of fascin expression at 12 hours (19.7%, p=0.010). Attachment, migration, and invasion capacities consistently decreased at 6, 12, and 24 hours. And, immunofluorescence showed the change of shape and the reduction of filopodia formation in cells.
CONCLUSION
Curcumin is likely to suppress the fascin expression in GBM cells, and this might be a possible mechanism for anti-migration and anti-invasion effects of Curcumin via inhibition of STAT3 phosphorylation.
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Affiliation(s)
- P Ki-Su
- Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
| | - S Yoon
- Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
| | - J Hwang
- Kyungpook National University Hospital, Daegu, Korea, Republic of
| | - H Ahn
- Kyungpook National University Hospital, Daegu, Korea, Republic of
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Hwang J, An H, Yoon S, Park K. P14.27 The significance of multicentric noncontrast-enhancing lesions distant from surgically resected glioblastoma: Case series of 3 patients. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma is the most malignant primary brain tumor. The tumor location and multiplicity plays an important role in surgical and further treatment. The incidence of multiple lesions at the time of diagnosis was known as 1–20%, which showed a poor prognostic factor. Most researches has focused on multiple contrast-enhancing lesions, however, multicentric non-enhancing lesions distant from glioblastoma has been rarely evaluated. The authors reported the case series of the patient who showed multicentric non contrast-enhancing lesions without connection to histologically-proven glioblastoma.
MATERIAL AND METHODS
Multicentric non contrast-enhancing lesions were defined as areas of FLAIR hyperintensity and mass effect without post-contrast enhancement, separated from the histologically-proven glioblastoma in a newly diagnosed disease. Three patients who showed distant non-enhancing lesions with appearance of a multicentric low-grade glioma were included in this study. The typical enhancing lesions were surgically resected and standard chemo-radiotherapy was followed in all patients.
RESULTS
All patients were male and their age was 38, 60 and 65 years old respectively. Multicentric tumor location was as follows: Case 1, left frontal lobe with non-enhancing lesion in left parahippocampal gyrus; Case 2, left parietal with non-enhancing lesion in left anteromedial temporal lobe; Case 3, left thalamus with non-enhancing lesions in both basal frontal and right temporal lobe. Pathologically, the resected enhancing tumor revealed glioblastoma in 2 patients and diffuse midline glioma in 1. All tumors were IDH-wild type. The resected enhanced lesion showed no progression but all non-enhancing lesions developed contrast-enhancing tumors at 3, 13 and 17 months after initial treatment, with high tracer uptake on 18FDG-PET or 18FDOPA-PET. Despite multidisciplinary treatment, two patients died from disease progression at 30 and 32 months after diagnosis and one patient is still alive with overall survival of 15 months.
CONCLUSION
The appearance of multicentric non-enhancing lesions distant from a typically enhancing tumor showed an uncommon finding in glioblastoma and poor prognostic features. These lesions progress faster than expected for a low-grade glioma. These lesions should be distinguished from typical low-grade glioma and should be considered more advanced lesions than their appearances suggest.
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Affiliation(s)
- J Hwang
- Dept of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea, Republic of
| | - H An
- Dept of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea, Republic of
| | - S Yoon
- Dept of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea, Republic of
| | - K Park
- Dept of Neurosurgery, Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
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Song E, Hwang J, Choi J, Gwon H, Chun J, Choi SG, Chang Y. MON-LB675: Dracocephlaum Moldavica L. Seed Extracts Ameliorate Photo-Aging Andwound Healing in HaCat Cell and 3D Skin Model. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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