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Rogal SS, Taddei TH, Monto A, Yakovchenko V, Patton H, Merante M, Spoutz P, Chia L, Yudkevich J, Aytaman A, Rabiee A, John BV, Blechacz B, Cai CX, Gilles H, Shah AS, McCurdy H, Puri P, Jou J, Mazhar K, Dominitz JA, Anwar J, Morgan TR, Ioannou GN. Hepatocellular Carcinoma Diagnosis and Management in 2021: A National Veterans Affairs Quality Improvement Project. Clin Gastroenterol Hepatol 2024; 22:324-338. [PMID: 37460005 PMCID: PMC10788380 DOI: 10.1016/j.cgh.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/16/2023] [Accepted: 07/02/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND & AIMS The coronavirus disease-2019 pandemic profoundly disrupted preventative health care services including cancer screening. As the largest provider of cirrhosis care in the United States, the Department of Veterans Affairs (VA) National Gastroenterology and Hepatology Program aimed to assess factors associated with hepatocellular carcinoma (HCC) stage at diagnosis, treatment, and survival. METHODS Veterans with a new diagnosis of HCC in 2021 were identified from electronic health records (N = 2306). Structured medical record extraction was performed by expert reviewers in a 10% random subsample of Veterans with new HCC diagnoses. Factors associated with stage at diagnosis, receipt of treatment, and survival were assessed using multivariable models. RESULTS Among 199 patients with confirmed HCC, the average age was 71 years and most (72%) had underlying cirrhosis. More than half (54%) were at an early stage (T1 or T2) at diagnosis. Less-advanced liver disease, number of imaging tests adequate for HCC screening, HCC diagnosis in the VA, and receipt of VA primary care were associated significantly with early stage diagnosis. HCC-directed treatments were administered to 145 (73%) patients after a median of 37 days (interquartile range, 19-54 d) from diagnosis, including 70 (35%) patients who received potentially curative treatments. Factors associated with potentially curative (vs no) treatments included HCC screening, early stage at diagnosis, and better performance status. Having fewer comorbidities and better performance status were associated significantly with noncurative (vs no) treatment. Early stage diagnosis, diagnosis in the VA system, and receipt of curative treatment were associated significantly with survival. CONCLUSIONS These results highlight the importance of HCC screening and engagement in care for HCC diagnosis, treatment, and survival while demonstrating the feasibility of developing a national quality improvement agenda for HCC screening, diagnosis, and treatment.
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Affiliation(s)
- Shari S Rogal
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Tamar H Taddei
- VA Connecticut Healthcare System, West Haven, Connecticut; Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alexander Monto
- San Francisco VA Health Care System, San Francisco, California
| | - Vera Yakovchenko
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Heather Patton
- Gastroenterology Section, Jennifer Moreno VA San Diego Healthcare System, San Diego, California
| | - Monica Merante
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Patrick Spoutz
- Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington
| | - Linda Chia
- Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington
| | - Jennifer Yudkevich
- VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | - Ayse Aytaman
- VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York; SUNY Health Science Center Brooklyn, Brooklyn, New York
| | - Atoosa Rabiee
- Washington DC VA Medical Center, Washington, District of Columbia
| | - Binu V John
- Division of Gastroenterology and Hepatology, Miami VA Healthcare System, Miami, Florida; Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Boris Blechacz
- Department of Gastroenterology and Hepatology, VA South Texas Health Care System, San Antonio, Texas
| | - Cindy X Cai
- Department of Gastroenterology and Hepatology, VA Loma Linda Healthcare System, Loma Linda, California; Loma Linda University, Loma Linda, California; Department of Internal Medicine, University of California, Riverside, Riverside, California
| | - HoChong Gilles
- Division of Gastroenterology and Hepatology, Central Virginia VA Healthcare System, Richmond, Virginia
| | - Anand S Shah
- Division of Gastroenterology, Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia; Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Puneet Puri
- Division of Gastroenterology and Hepatology, Central Virginia VA Healthcare System, Richmond, Virginia; Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Janice Jou
- VA Portland Healthcare System, Portland, Oregon; Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Khurram Mazhar
- VA North Texas Health Care System, Dallas, Texas; Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Jennifer Anwar
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California; Division of Gastroenterology, Department of Medicine, University of California, Irvine, California
| | - George N Ioannou
- VA Puget Sound Health Care System, Seattle, Washington; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
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Adejumo AC, Yakovchenko V, Morgan TR, Spoutz P, Chia L, Bajaj JS, Chang MF, Dominitz JA, Rogal SS. The road to pandemic recovery: Tracking COVID-19's impact on cirrhosis care and outcomes among 111,558 Veterans. Hepatology 2023; 77:2016-2029. [PMID: 36705024 DOI: 10.1097/hep.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/24/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AIMS This study aimed to evaluate quarterly trends in process and health outcomes among Veterans with cirrhosis and assess the factors associated with cirrhosis outcomes before and during the COVID-19 pandemic. APPROACH RESULTS US Veterans with cirrhosis were identified using the Veterans Health Administration Corporate Data Warehouse. Quarterly measures were evaluated from September 30, 2018, through March 31, 2022, including twice yearly screening for hepatocellular carcinoma (HCC-6), new HCC, surveillance for or treatment of esophageal varices, variceal bleeding, all-cause hospitalization, and mortality. Joinpoint analyses were used to assess the changes in trends over time. Logistic regression models were used to identify the demographic and medical factors associated with each outcome over time. Among 111,558 Veterans with cirrhosis with a mean Model for End-stage Liver Disease-Sodium of 11±5, rates of HCC-6 sharply declined from a prepandemic peak of 41%, to a nadir of 28%, and rebounded to 36% by March 2022. All-cause mortality did not significantly change over the pandemic, but new HCC diagnosis, EVST, variceal bleeding, and all-cause hospitalization significantly declined over follow-up. Quarterly HCC diagnosis declined from 0.49% to 0.38%, EVST from 50% to 41%, variceal bleeding from 0.15% to 0.11%, and hospitalization from 9% to 5%. Rurality became newly, significantly associated with nonscreening over the pandemic (aOR for HCC-6=0.80, 95% CI 0.74 to 0.86; aOR for EVST=0.95, 95% CI 0.90 to 0.997). CONCLUSIONS The pandemic continues to impact cirrhosis care. Identifying populations at the highest risk of care disruptions may help to address ongoing areas of need.
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Affiliation(s)
- Adeyinka C Adejumo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Patrick Spoutz
- Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington, USA
| | - Linda Chia
- Pharmacy Benefits Management, Veterans Integrated Service Network 8, Bay Pines, Florida, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
- VA Richmond Health Care System, Richmond, Virginia, USA
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon, USA
| | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shari S Rogal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Allen AL, Kibert J, Wall S, Chia L, Spoutz P. A POPULATION HEALTH APPROACH TO STROKE PREVENTION IN ATRIAL FIBRILLATION/FLUTTER: TARGETING THE UNTREATED WHILE PRIORITIZING HEALTH DISPARITIES (SPAFF-TNT-D). J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02718-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Chaudhari RB, Duong N, Shrestha S, Badal B, Dharia N, Robalino Gonzaga E, Spoutz P, Chia L, Wade JB, Rogal S, Bajaj JS. Patient- and provider-level factors that underlie alcohol use disorder treatment offer and acceptance in veterans with cirrhosis. Alcohol Res 2022; 46:809-814. [PMID: 35312086 DOI: 10.1111/acer.14809] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration. METHODS Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1-year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ-2) from the electronic health record. RESULTS The cohort included 654 veterans, 68 of whom were engaged in AUD treatment at baseline and 174 who were documented as being in AUD remission. Treatment was offered to 264 (64%) of the 412 veterans with opportunities to initiate it. AUD treatment discussions were most often documented by practitioners in primary care (n = 162), hepatology (n = 45), or both (n = 41). Multivariable logistic regression modeling revealed that treatment was significantly more likely to be offered to patients with co-occurring bipolar disorder (OR 2.94, p = 0.03) or depression (1.50, p = 0.05) or who were younger (0.97, p = 0.01). Of the 264 patients offered AUD treatment, 107 (40%) agreed to initiate it. Acceptance of an offer of treatment was significantly associated with hospitalization in the prior year (OR 1.74, p = 0.05), prior AUD treatment (9.92, p < 0.0001), and a higher PHQ-2 depression score (2.85, p = 0.004). CONCLUSIONS We identified factors associated with an offer of AUD treatment and its initiation among veterans with cirrhosis. Application of these findings could increase the likelihood that veterans with alcoholic cirrhosis initiate AUD treatment.
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Affiliation(s)
- Rahul B Chaudhari
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Nikki Duong
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Shreesh Shrestha
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Bryan Badal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | - Neerav Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
| | | | - Patrick Spoutz
- Pharmacy Benefits Management, Veterans Integrated Service Network 20, Vancouver, Washington, USA
| | - Linda Chia
- Pharmacy Benefits Management, Veterans Integrated Service Network 8, Bay Pines, Florida, USA
| | - James B Wade
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shari Rogal
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA
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Thai B, Chia L, Nguyen A, Hutchinson D, Kompa A, White P, May L. Adenosine Receptor-Mediated Cardioprotection Post-Myocardial Infarction Associated With Advanced Age. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, Chia L, Sipe A. Shifting the Paradigm: A Population Health Approach to the Management of Direct Oral Anticoagulants. J Am Heart Assoc 2021; 10:e022758. [PMID: 34796718 PMCID: PMC9075229 DOI: 10.1161/jaha.121.022758] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past decade, direct oral anticoagulants (DOACs) have contributed to a major paradigm shift in thrombosis management, replacing vitamin K antagonists as the most commonly prescribed anticoagulants in many countries. While DOACs provide distinct advantages over warfarin (eg, convenience, simplicity, and safety), they are frequently associated with inappropriate prescribing and adverse events. These events have prompted regulatory agencies to mandate oversight, which individual institutions may find difficult to comply with given limited resources. Veterans Health Administration (VHA) has leveraged technology to develop the DOAC Population Management Tool (PMT) to address these challenges. This tool has empowered VHA to update a 60‐year standard of care from one‐to‐one provider‐to‐patient anticoagulation monitoring to a population‐based management approach. The DOAC PMT allows for the oversight of all patients prescribed DOACs and leads to intervention only when clinically indicated. Using the DOAC PMT, facilities across VHA have maximized DOAC oversight while minimizing resource usage. Herein, we discuss how the DOAC PMT was conceived, developed, and implemented, along with the challenges encountered throughout the process. Additionally, we share the impact of the DOAC PMT across VHA, and the potential of this approach beyond anticoagulation and VHA.
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Affiliation(s)
- Arthur L Allen
- Veterans Affairs Salt Lake City Health Care System Salt Lake City UT
| | - Jessica Lucas
- North Florida/South Georgia Veterans Affairs Health Care System Gainesville FL
| | - David Parra
- Pharmacy Benefits Management Veterans Integrated Service Network 8 Bay Pines FL.,University of Minnesota College of Pharmacy Minneapolis MN
| | - Patrick Spoutz
- Pharmacy Benefits Management Veterans Integrated Service Network 20 Vancouver WA
| | | | - Bishoy Ragheb
- Veterans Affairs Tennessee Valley Health System Murfreesboro TN
| | - Linda Chia
- Pharmacy Benefits Management Veterans Integrated Service Network 8 Bay Pines FL
| | - Amy Sipe
- Academic Detailing Veterans Integrated Service Network 15 Kansas City MO
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Ho MQ, Chia L, Cole M, Nguyen T, Slazinski K. 1352. Changing Quality Indicators by Monitoring Veterans Using the Sexually TRansmitted Infection Key Evaluation (STRIKE) Dashboard. Open Forum Infect Dis 2021. [PMCID: PMC8689739 DOI: 10.1093/ofid/ofab466.1544] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
During the COVID-19 pandemic, there have been multiple reports concerning patients falling out of healthcare. The National VA HIV and Hepatitis and Related Conditions (HHRC) has created the Sexually TRansmitted Infection Key Evaluation (STRIKE) Dashboard to help clinicians identify Veterans who need to complete co-testing for sexually transmitted infections (STIs) or human immunodeficiency virus (HIV) and allows providers to document if the Veteran was offered pre-exposure prophylaxis (PrEP).
STRIKE Interface Screen
Methods
A national VA Veteran dataset was generated from data within the Corporate Data Warehouse (CDW) that included all active PLWH. Positive HIV status is evaluated based on positive antibody test and positive confirmatory result or positive viral load lab result. Negative HIV status is evaluated based on a negative antibody test in the past year. Of the 140 sites, 39 participated but only 9 were active throughout the period of October 1, 2020 to March 31, 2021. Active and nonactive participating sites had metrics assessed across the study period at 3 time points: October 1, 2020, January 1, 2021 and April 1, 2021. Sites with at least 48 visits to report across the 6-month QI period were considered active.
Patient level data for review
Additional patient level data for review
Results
Multiple sites had scarcity of supplies due to the national shortage of CT/NG Test Kits during COVID-19. To improve access to CT/NG testing, the dashboard suppress the list of Veterans with + syphlis who were not co-tested for CT/NG. Co-testing improved from 60.2% to 77.2% in active sites and from 61.9% to 68.7% for nonactive across the study period. Percent of Veterans with completed HIV testing on or after STI diagnosis in active sites had an upward trend of 2.1% compared to the nonactive which increased 0.6%. Likewise, new diagnosis of STI for those on PrEP increased 2.6% in active and 0.5% increase in nonactive. On average, active sites increased percent of high risk veterans with active PrEP prescriptions by 2%, compared with nonactive that only increased 1%.
STRIKE Co Testing and HIV Screen performed
This graph shows average of Syphilis Co Testing and HIV screen performed by active and nonactive sites as measured at three different time point.
Number of Veterans on PrEP with STIs
This graph shows the average percent of veterans on PrEP with STIs between active versus nonactive sites as measured at three time points
Active PrEP Prescriptions Across All Sites
This graph shows average percent of active PrEP prescriptions for high risk patients between active versus nonactive sites as measured at three time points
Conclusion
The STRIKE Dashboard efficiently flags Veterans with STI diagnosis who need completion of STI co-testing, including HIV testing and PrEP offer. Active participating facilities who used the STRIKE Dashboard improved STI Co-testing and PrEP prescription in a short 6 month period even during COVID-19.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
- Minh Q Ho
- Orlando VA Healthcare System, 14014 Deep Forest Court, Florida
| | | | - Matthew Cole
- VA Capital Health Care Network (VISN 5), Veterans Health Administration, Huntsville, Alabama
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8
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Sumter TF, Xian L, Huso T, Koo M, Chang YT, Almasri TN, Chia L, Inglis C, Reid D, Resar LMS. The High Mobility Group A1 (HMGA1) Transcriptome in Cancer and Development. Curr Mol Med 2016; 16:353-93. [PMID: 26980699 DOI: 10.2174/1566524016666160316152147] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/15/2016] [Accepted: 03/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND & OBJECTIVES Chromatin structure is the single most important feature that distinguishes a cancer cell from a normal cell histologically. Chromatin remodeling proteins regulate chromatin structure and high mobility group A (HMGA1) proteins are among the most abundant, nonhistone chromatin remodeling proteins found in cancer cells. These proteins include HMGA1a/HMGA1b isoforms, which result from alternatively spliced mRNA. The HMGA1 gene is overexpressed in cancer and high levels portend a poor prognosis in diverse tumors. HMGA1 is also highly expressed during embryogenesis and postnatally in adult stem cells. Overexpression of HMGA1 drives neoplastic transformation in cultured cells, while inhibiting HMGA1 blocks oncogenic and cancer stem cell properties. Hmga1 transgenic mice succumb to aggressive tumors, demonstrating that dysregulated expression of HMGA1 causes cancer in vivo. HMGA1 is also required for reprogramming somatic cells into induced pluripotent stem cells. HMGA1 proteins function as ancillary transcription factors that bend chromatin and recruit other transcription factors to DNA. They induce oncogenic transformation by activating or repressing specific genes involved in this process and an HMGA1 "transcriptome" is emerging. Although prior studies reveal potent oncogenic properties of HMGA1, we are only beginning to understand the molecular mechanisms through which HMGA1 functions. In this review, we summarize the list of putative downstream transcriptional targets regulated by HMGA1. We also briefly discuss studies linking HMGA1 to Alzheimer's disease and type-2 diabetes. CONCLUSION Further elucidation of HMGA1 function should lead to novel therapeutic strategies for cancer and possibly for other diseases associated with aberrant HMGA1 expression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - L M S Resar
- Department of Medicine, Faculty of the Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Room 1025, Baltimore, MD 21205-2109, USA.
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Envuladu E, Agbo H, Mohammed A, Chia L, Kigbu J, Zoakah A. Utilization of modern contraceptives among female traders in Jos South LGA of Plateau state, Nigeria. ACTA ACUST UNITED AC 2012. [DOI: 10.14194/ijmbr.1310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Pelosi U, Porcu G, Chia L, Firinu D. Bronchiolitis today. J Chemother 2008; 19 Suppl 2:5-7. [PMID: 18073169 DOI: 10.1080/1120009x.2007.11782433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- U Pelosi
- Pediatrics Department, University of Cagliari, Italy.
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Pelosi U, Porcu G, Chia L, Firinu D. Bronchiolitis today. J Chemother 2008. [PMID: 18073169 DOI: 10.1080/1120009x.2007.11782433.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Affiliation(s)
- U Pelosi
- Pediatrics Department, University of Cagliari, Italy.
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Verstichel P, Chia L. [Difficulties in face identification after lesion in the left hemisphere]. Rev Neurol (Paris) 1999; 155:937-43. [PMID: 10603638] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A 82 year-old right-handed man, without any intellectual impairment, suffered from an acute neurological deficit consisting in letter-by-letter reading, right superior quadrant hemianopia with achromatopia in the lower quadrant, and anomia. Cerebral MRI showed an infarct involving the ventral structures of the left hemisphere sparing the splenium of the corpus callosum and the thalamus. Neuropsychological examination revealed that the patient easily identified the objects, the animals and the famous places he could not name: his comments attested normal visual recognition. Conversely, when he was presented with famous faces, he always had a strong feeling of familiarity, but could not provide accurate information about the corresponding individual. Biographic information about personalities was not impaired in the semantic-biographic store, because it could be accessed from the names. Activation of face recognition units (where the visual description provided by the structural encoding and the stored sets of descriptions of familiar faces are compared), was effective, since the patient could distinguish famous faces from unknown ones. In a modular-sequential model of face recognition, this deficit is interpreted as a disconnection between face recognition units and person identity nodes (which are considered to contain semantic-biographic information about individuals). This kind of disturbance differs from classic prosopagnosia in which, characteristically, the patients are unable to experience a feeling of familiarity when viewing famous faces, and to perform a categorization between famous and unknown faces. Right hemisphere has a preponderant role in structural analysis of faces and in activation of face recognition units. The integrity of this hemisphere in this patient could explain the preservation of these two steps of processing. Left-hemisphere specific function in facial recognition enabled access to semantic-biographic store in a conscious, verbal and explicit way, after the right hemisphere had achieved basic visual analysis and activation of facial representation in memory. We compare the cognitive impairment in our patient to those encountered in classical prosopagnosic patients. This case illustrates the validity of the modular-sequential model considered. In addition it throws a light on the poor-known role of the left hemisphere in face recognition.
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Affiliation(s)
- P Verstichel
- Service de Neurologie, Centre Hospitalier Intercommunal, Créteil
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13
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Verstichel P, Chia L, Meyrignac C. [Common ocular motor nerve palsy and ipsilateral cerebellar hemisyndrome from mesencephalic infarct: A variant of Claude syndrome]. Rev Neurol (Paris) 1999; 155:601-2. [PMID: 10486853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Chia L, Fernandez A, Lacroix C, Adams D, Planté V, Said G. Contribution of nerve biopsy findings to the diagnosis of disabling neuropathy in the elderly. A retrospective review of 100 consecutive patients. Brain 1996; 119 ( Pt 4):1091-8. [PMID: 8813273 DOI: 10.1093/brain/119.4.1091] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Peripheral neuropathy is an important factor of disability in the elderly. In order to learn more on the usefulness of intensive evaluation of patients over 65 years of age with subacute or chronic disabling peripheral neuropathy, we reviewed the clinical and nerve biopsy findings of the last 100 patients of this age group who suffered from a peripheral neuropathy severe enough to justify performance of a nerve biopsy for a diagnostic or prognostic purpose. Normal nerve biopsy findings led to the diagnosis of lower motor neuron disease in three patients and pointed to lesions of the spinal roots in six other patients. Necrotizing arteritis was demonstrated in the biopsy specimens of 23 patients, and non-necrotizing vasculitis in five. In five additional patients the diagnosis of vasculitic neuropathy was kept in spite of non-contributive biopsy findings. In two diabetic patients who had a multifocal neuropathy the biopsy also revealed the presence of vasculitis. Thus 35% of the patients included in this series had one form or another of vasculitic neuropathy. Fourteen patients had a chronic inflammatory demyelinating polyneuropathy. In 11 patients the neuropathy was associated with monoclonal gammopathy, which was benign in nine and associated with malignant plasma cell dyscrasia in two. Among the six patients with diabetes mellitus, two patients who presented with a multifocal neuropathy were found to have vasculitis in the nerve specimen; in the others the biopsy was performed because of uncommonly severe pains or motor involvement due to an extremely severe diabetic neuropathy. Six patients suffered from a long-lasting disability secondary to a drug-induced neuropathy. The remaining 15% had neuropathies of different origin, including amyloidosis, lepromatous leprosy, carcinomatous neuropathy and alcoholic neuropathy. Six patients had a mild, non-progressive or slowly progressive axonopathy of unknown origin, ageing of the peripheral nervous system may have played a role in its development. Our findings show that vasculitis is an important and treatable cause of disabling neuropathy in the elderly and that the proportion of patients with severe neuropathy of unknown origin is small.
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Affiliation(s)
- L Chia
- Service de Neurologie, Centre Hospitalo-Universitaire de Bicêtre, Paris, France
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Masson C, Chia L, Lehéricy S, Rey A, Masson M. [Subarachnoid hemorrhage and onset of marginal hemosiderosis caused by a spinal cord cavernoma]. Rev Neurol (Paris) 1996; 152:44-6. [PMID: 8729396] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An intradural cavernoma of the spinal cord located at T12 was identified in a 39-year-old man presenting with recurrent episodes of lower back pain on the basis of MRI findings. The patient was hospitalized for severe subarachnoid hemorrhage complicated with hydrocephalia requiring ventriculo-peritoneal draining. Marginal asymptomatic hemosiderosis of the spinal cord above the malformation was observed. The cavernoma which did not involve nervous tissue was removed surgically to avoid the risk of recurrent bleeding and further development of marginal hemosiderosis.
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Affiliation(s)
- C Masson
- Service de Neurologie, Hôpital Beaujon, Clichy
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Abstract
1. Interneurones mediating reciprocal inhibition between wrist flexors and extensors in man are characterized using both Renshaw cells and transarticular group I afferent activation. 2. Renshaw cells were activated by reflex discharges evoked by a tendon tap. The tendon tap was applied to the tendon of the muscles from which the Ia fibres responsible for the reciprocal inhibition originated. Contrary to what was observed both in the cat hindlimb and in human elbow muscles, this Renshaw cell activation never resulted in a long depression of the reciprocal inhibition between wrist flexors and extensors. 3. Convergence from group I elbow muscle afferents and antagonistic group I afferents onto interneurones mediating reciprocal inhibition between wrist muscles was revealed in post-stimulus time histogram (PSTH) experiments using the technique of spatial facilitation. 4. The characteristics of the interneurones mediating reciprocal inhibition between wrist flexors and extensors could therefore be summarized as follows: (a) they are fed by antagonistic group I afferents and group I afferents originating from both flexor and extensor elbow muscles; (b) they are not inhibited by Renshaw cells; (c) they are not excited by low threshold cutaneous afferents; and (d) they are probably interposed in a disynaptic pathway. 5. It is therefore concluded that interneurones mediating reciprocal inhibition between wrist flexors and extensors in man differ both from Ia interneurones and from interneurones interposed in the Ib reflex pathways and these characteristics are related to the complex circumduction movements developed in the wrist.
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Affiliation(s)
- C Aymard
- Clinical Neurophysiology, Rééducation, Hôpital de la Salpétrière, Paris, France
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Chou JZ, Hewitt SA, Hershberger JF, Brady BB, Spector GB, Chia L, Flynn GW. Diode laser probing of the high‐frequency vibrational modes of baths of CO2, N2O, and CO excited by relaxation of highly excited NO2. J Chem Phys 1989. [DOI: 10.1063/1.457588] [Citation(s) in RCA: 11] [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: 12/13/2022] Open
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