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Eberly LA, Tennison A, Mays D, Hsu CY, Yang CT, Benally E, Beyuka H, Feliciano B, Norman CJ, Brueckner MY, Bowannie C, Schwartz DR, Lindsey E, Friedman S, Ketner E, Detsoi-Smiley P, Shyr Y, Shin S, Merino M. Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation: The Hózhó Randomized Clinical Trial. JAMA Intern Med 2024:2817466. [PMID: 38583185 PMCID: PMC11000136 DOI: 10.1001/jamainternmed.2024.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
Importance Underutilization of guideline-directed medical therapy for heart failure with reduced ejection fraction is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service, access to care, especially cardiology care, is limited, contributing to poor uptake of recommended therapy. Objective To examine whether a telehealth model in which guideline-directed medical therapy is initiated and titrated over the phone with remote telemonitoring using a home blood pressure cuff improves guideline-directed medical therapy use (eg, drug classes and dosage) in patients with heart failure with reduced ejection fraction in Navajo Nation. Design, Setting, and Participants The Heart Failure Optimization at Home to Improve Outcomes (Hózhó) randomized clinical trial was a stepped-wedge, pragmatic comparative effectiveness trial conducted from February to August 2023. Patients 18 years and older with a diagnosis of heart failure with reduced ejection fraction receiving care at 2 Indian Health Service facilities in rural Navajo Nation (defined as having primary care physician with 1 clinical visit and 1 prescription filled in the last 12 months) were enrolled. Patients were randomized to the telehealth care model or usual care in a stepped-wedge fashion, with 5 time points (30-day intervals) until all patients crossed over into the intervention. Data analyses were completed in January 2024. Intervention A phone-based telehealth model in which guideline-directed medical therapy is initiated and titrated at home, using remote telemonitoring with a home blood pressure cuff. Main Outcomes and Measures The primary outcome was an increase in the number of guideline-directed classes of drugs filled from the pharmacy at 30 days postrandomization. Results Of 103 enrolled American Indian patients, 42 (40.8%) were female, and the median (IQR) age was 65 (53-77) years. The median (IQR) left ventricular ejection fraction was 32% (24%-36%). The primary outcome occurred significantly more in the intervention group (66.2% vs 13.1%), thus increasing uptake of guideline-directed classes of drugs by 53% (odds ratio, 12.99; 95% CI, 6.87-24.53; P < .001). The number of patients needed to receive the telehealth intervention to result in an increase of guideline-directed drug classes was 1.88. Conclusions and Relevance In this heart failure trial in Navajo Nation, a telephone-based strategy of remote initiation and titration for outpatients with heart failure with reduced ejection fraction led to improved rates of guideline-directed medical therapy at 30 days compared with usual care. This low-cost strategy could be expanded to other rural settings where access to care is limited. Trial Registration ClinicalTrials.gov Identifier: NCT05792085.
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Affiliation(s)
- Lauren A. Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Daniel Mays
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chih-Ting Yang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ernest Benally
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Harriett Beyuka
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Benjamin Feliciano
- Office of Quality, Division of Innovations and Improvement, Indian Health Service Headquarters, Rockville, Maryland
| | - C. Jane Norman
- Office of Quality, Division of Innovations and Improvement, Indian Health Service Headquarters, Rockville, Maryland
| | | | - Clybert Bowannie
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Daniel R. Schwartz
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Erica Lindsey
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Stephen Friedman
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Elizabeth Ketner
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | | | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
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Eberly LA, Tennison A, Mays D, Shin S, Merino M. Barriers and Facilitators to Prescribing Guideline-Directed Medical Therapy for Heart Failure in the Indian Health Service. JACC Heart Fail 2024:S2213-1779(23)00753-9. [PMID: 38206229 DOI: 10.1016/j.jchf.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Lauren A Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico, USA; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico, USA
| | - Daniel Mays
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico, USA
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico, USA
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Eberly LA, Shultz K, Merino M, Brueckner MY, Benally E, Tennison A, Biggs S, Hardie L, Tian Y, Nathan AS, Khatana SAM, Shea JA, Lewis E, Bukhman G, Shin S, Groeneveld PW. Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries. JAMA Netw Open 2023; 6:e2334923. [PMID: 37738051 PMCID: PMC10517375 DOI: 10.1001/jamanetworkopen.2023.34923] [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: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023] Open
Abstract
Importance American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
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Affiliation(s)
- Lauren A. Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Kaitlyn Shultz
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | | | - Ernest Benally
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Sabor Biggs
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Lakotah Hardie
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Ye Tian
- Division of Pulmonary and Critical Care, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Eldrin Lewis
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Urrechaga E, Valladares C, Martinez A, Merino M, Muguerza G. T143 The effect of thyroid status on HbA1c. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.622] [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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Urrechaga E, Martinez A, Merino M, Muguerza G, Perez I. T220 Sigma metrics for evaluating the performance of complete blood counts. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.708] [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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Urrechaga E, Perez I, Martinez A, Merino M, Muguerza G. T218 Reticulocyte hemoglobin (CHR) by Mindray BC 6800 plus for the assessment of iron deficient erythropoiesis in rheumatologic disorders. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.706] [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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Ciruelos E, Salvador Bofill F, Perello Martorell A, Conejo EA, González-Farré X, Palacios-Ozores P, Merino M, Villagrasa P, Navarro EV, Pascual T, Prat A, Pernas Simon S. 73TiP SOLTI1710 PROMETEO II: Palbociclib in combination with letrozole in hormone receptor-positive (HR+)/HER2-negative residual disease after standard neoadjuvant chemotherapy (NAC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.087] [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] Open
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Merino M, Colomé E, Esposito F, Beato C, Araújo A, de Miguel Y, Gemas V, Font C. PO-63 Empowering cancer patients for non-pharmacological primary prevention and early recognition of cancer-associated thrombosis (CAT): the EMPATIC-CP survey. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Merino M, Braçe O, González A, Hidalgo-Vega Á, Garrido-Cumbrera M, Gratacos-Masmitja J. THU0548 THE ECONOMIC BURDEN OF ANKYLOSING SPONDYLITIS IN SPAIN. RESULTS OF THE SPANISH ATLAS 2017. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5892] [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:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (<4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (<3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p<0.05) between BASDAI groups (<4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (<3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI<4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)<31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p <0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly
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Amalou A, Seifabadi R, Varble N, Li M, Turkbey B, Anderson V, Mehralivand S, Merino M, Choyke P, Pinto P, Xu S, Wood B. Abstract No. 604 Get the needle and ultrasound out of the rectum in prostate interventions. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.665] [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: 10/25/2022] Open
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Merino M, Fernández L, Moyano MS, De Molina AR, Rubio JM, Colmenarejo G, Raposo CG, Gómez ML, Martínez SF, Zamora CA, Tévar FZ, Gordo AJ, Sáez EC. P1.03-33 Analysis of Lipid Metabolism Genes in Advanced Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Urrechaga E, Merino M, De La Hera P, Javier AF. Markers of hypochromia in the study of erythropoiesis and iron availability in patients with Inflammatory Bowell Disease. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.907] [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: 10/26/2022]
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Hidalgo-Vega Á, Martell N, Orozco-Beltrán D, Galgo A, Muñiz O, Górriz JL, Ferrer-Vidal D, Sabaté N, Merino M. [Tools to improve efficiency in the clinical management of hypertensive patients]. Hipertens Riesgo Vasc 2019; 36:70-84. [PMID: 30037730 DOI: 10.1016/j.hipert.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. MATERIAL AND METHODS A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). RESULTS A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). CONCLUSIONS The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.
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Affiliation(s)
| | - N Martell
- Hospital Clínico San Carlos, Madrid, España
| | | | - A Galgo
- Centro de Salud Espronceda, Madrid, España
| | - O Muñiz
- Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Górriz
- Hospital Clínico Universitario, Valencia, España
| | | | - N Sabaté
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Merino
- Weber, Economía y Salud, Majadahonda, España.
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Lip GYH, Al-Saady N, Hjortshoj SP, Goudev A, Huber K, Cohen AA, Jin J, Merino M, Winters SM, Goette A. P1923Edoxaban vs warfarin in vitamin K antagonist experienced and naive patients from the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
| | - N Al-Saady
- Covance Inc., Maidenshead, United Kingdom
| | | | - A Goudev
- Queen Giovanna University Hospital, Sofia, Bulgaria
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - A.-A Cohen
- University Pierre & Marie Curie Paris VI, Paris, France
| | - J Jin
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - A Goette
- St. Vincenz-Hospital, Paderborn, Germany
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King C, Atwood S, Brown C, Nelson AK, Lozada M, Wei J, Merino M, Curley C, Muskett O, Sabo S, Gampa V, Orav J, Shin S. Primary care and survival among American Indian patients with diabetes in the Southwest United States: Evaluation of a cohort study at Gallup Indian Medical Center, 2009-2016. Prim Care Diabetes 2018; 12:212-217. [PMID: 29229284 DOI: 10.1016/j.pcd.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. METHODS Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. RESULTS Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI)=0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p<0.001). The median survival time for patients who had seen a primary care provider was 2322days versus 2158days for those who had not seen a primary care provider. CONCLUSIONS Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.
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Affiliation(s)
- Caroline King
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States; Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Chris Brown
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Adrianne Katrina Nelson
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Mia Lozada
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Jennie Wei
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States
| | - Cameron Curley
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Olivia Muskett
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Samantha Sabo
- Health Promotion Sciences Department, University of Arizona, Tucson, AZ, United States
| | - Vikas Gampa
- Dept. of Internal Medicine, Cambridge Health Alliance, Boston, MA, United States
| | - John Orav
- Harvard School of Public Health, Boston, MA, United States
| | - Sonya Shin
- Community Outreach and Patient Empowerment (COPE), Gallup, NM, United States; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States; Gallup Indian Medical Center, Indian Health Service, Gallup, NM, United States.
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Cerezuela P, Salgado M, Gallardo E, Muñoz-Langa J, Castellón V, Barbosa M, Beato C, Martínez de Castro E, Martínez V, García-Escobar I, Doménech P, Guijarro R, Hervás D, Merino M, de Miguel Y, Colomé E, Trujillo-Santos J. Characterization of thrombosis risk in patients with cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.121] [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: 10/17/2022]
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17
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Lip GYH, Merino JL, Banach M, Al-Saady N, Jin J, Merino M, Winters SM, Merkely B, Goette A. P1181Clinical factors related to successful or unsuccessful cardioversion in the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Europace 2018. [DOI: 10.1093/europace/euy015.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- GYH Lip
- University of Birmingham, Birmingham, United Kingdom
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
| | - M Banach
- Medical University of Lodz, Lodz, Poland
| | | | - J Jin
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - B Merkely
- Semmelweis University, Budapest, Hungary
| | - A Goette
- St Vincenz-Hosp, Paderborn, Germany
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Calio B, Sidana A, Sugano D, Gaur S, Jain A, Maruf M, Xu S, Yan P, Kruecker J, Merino M, Choyke P, Turkbey B, Wood B, Pinto P. Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve. Prostate Cancer Prostatic Dis 2017; 20:436-441. [PMID: 28762373 DOI: 10.1038/pcan.2017.34] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/04/2017] [Accepted: 06/10/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND To determine the effect of urologist and radiologist learning curves and changes in MRI-TRUS fusion platform during 9 years of NCI's experience with multiparametric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy. METHODS A prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007 to 2016 was reviewed. The patients were stratified based on the timing of first biopsy. Cohort 1 (7/2007-12/2010) accounted for learning curve. Cohort 2 (1/2011-5/2013) and cohort 3 (5/2013-4/2016) included patients biopsied prior to and after debut of a new software platform, respectively. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. McNemar's test compared cancer detection rates (CDRs) of Sbx and Fbx between time periods. RESULTS 1528 patients were included in the study with 230, 537 and 761 patients included in three respective cohorts. Median age (interquartile range) was 61.0 (±9.0), 62.0 (±7.3), and 64.0 (±11.0) years in three cohorts, respectively (P<0.001). Fbx and Sbx had comparable CS CDR in cohort 1 (24.8 vs 22.2%, P=0.377). Fbx detected significantly more CS disease compared to Sbx in the following two periods (cohort 2: 31.5 vs 25.0%, P=0.001; cohort 3: 36.4 vs 30.3%, P<0.001) and detected significantly less low risk disease in the same period (cohort 2: 14.5 vs 19.6%, P<0.001; cohort 3: 12.6 vs 16.7%, P<0.001). Even after multivariate adjustment with age, PSA, race, clinical stage and MRI suspicion score, Fbx CS cancer detection increased in successive cohorts (cohort 2: OR 2.23, P=0.043; cohort 3: OR 2.92, P=0.007). CONCLUSIONS In the past 9 years, there has been significant improvement in the accuracy of Fbx. Our results show that after an early learning period, Fbx detected higher rates of CS cancer and lower rates of clinically insignificant cancer than Sbx. Software advances allowed for even greater detection of CS disease.
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Affiliation(s)
- B Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - D Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Xu
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - P Yan
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - J Kruecker
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - M Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - P Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - P Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Jerez A, Merino M, Buño I, Chen-Liang TH, Iniesta P, Garcia A, Teruel R, Amigo M, Alamo J, Suarez J, Ortuño F, Vicente V. Donor Cell MDS with Rare Complex Karyotype After Mismatch Alobmt for Ph+ALL. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30409-5] [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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Gaur S, Mehralivand S, Bednarova S, Calio B, Sugano D, Mertan F, Merino M, Choyke P, Wood B, Pinto P, Turkbey B. Comparison of PIRADSv2 and in-house system in detection of prostate cancer for subsequent MR/US fusion biopsy. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.760] [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: 12/01/2022] Open
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Pérez A, Merino M, Rumbo-Feal S, Álvarez-Fraga L, Vallejo JA, Beceiro A, Ohneck EJ, Mateos J, Fernández-Puente P, Actis LA, Poza M, Bou G. The FhaB/FhaC two-partner secretion system is involved in adhesion of Acinetobacter baumannii AbH12O-A2 strain. Virulence 2016; 8:959-974. [PMID: 27858524 DOI: 10.1080/21505594.2016.1262313] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acinetobacter baumannii is a hospital-acquired pathogen that shows an extraordinary capacity to stay in the hospital environment. Adherence of the bacteria to eukaryotic cells or to abiotic surfaces is the first step for establishing an infection. The A. baumannii strain AbH12O-A2 showed an exceptional ability to adhere to A549 epithelial cells. The AbFhaB/FhaC 2-partner secretion (TPS) system involved in adhesion was discovered after the screening of the recently determined A. baumannii AbH12O-A2 strain genome (CP009534.1). The AbFhaB is a large exoprotein which transport to the bacterial surface is mediated by the AbFhaC protein. In the present study, the role of this TPS system in the AbH12O-A2 adherence phenotype was investigated. The functional inactivation of this 2-partner secretion system was addressed by analyzing the outer membrane vesicles (OMV) proteomic profile from the wild-type strain and its derivative mutant AbH12O-A2ΔfhaC demonstrating that AbFhaB is no longer detected in the absence of AbFhaC. Scanning electron microscopy (SEM) and adhesion experiments demonstrated that inactivation of the AbFhaB/FhaC system significantly decreases bacterial attachment to A549 alveolar epithelial cells. Moreover, it has been demonstrated that this 2-partner secretion system is involved in fibronectin-mediated adherence of the A. baumannii AbH12O-A2 isolate. Finally, we report that the AbFhaB/FhaC system is involved in virulence when tested using invertebrate and vertebrate hosts. These data suggest the potential role that this AbFhaB/FhaC secretion system could play in the pathobiology of A. baumannii.
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Affiliation(s)
- A Pérez
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain.,b Departamento de Microbiología y Parasitología , Universidad de Santiago de Compostela (USC) , Santiago de Compostela , Spain.,c Department of Microbiology , Miami University , Oxford , OH , USA
| | - M Merino
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - S Rumbo-Feal
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - L Álvarez-Fraga
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - J A Vallejo
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - A Beceiro
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - E J Ohneck
- c Department of Microbiology , Miami University , Oxford , OH , USA
| | - J Mateos
- d Grupo de Proteómica-ProteoRed/Plataforma PBR2-ISCIII, Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC) , A Coruña , Spain.,e Marine Research Institute, Consejo Superior de Investigaciones Científicas (CSIC) , Vigo , Spain
| | - P Fernández-Puente
- d Grupo de Proteómica-ProteoRed/Plataforma PBR2-ISCIII, Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC) , A Coruña , Spain
| | - L A Actis
- c Department of Microbiology , Miami University , Oxford , OH , USA
| | - M Poza
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - G Bou
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
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García-Soidán FJ, Villoro R, Merino M, Hidalgo-Vega Á, Hernando-Martín T, González-Martín-Moro B. [Health status, quality of life, and use of healthcare resources by patients with diabetes mellitus in Spain]. Semergen 2016; 43:416-424. [PMID: 27445223 DOI: 10.1016/j.semerg.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study analyses the health status of patients diagnosed with diabetes mellitus (DM), their health related quality of life (HRQoL) and their use of healthcare resources in Spain. MATERIALS AND METHODS A descriptive analysis was conducted using the Spanish Health National Survey (ENSE, 2012), gathering data on those patients aged 15 and over diagnosed with DM. Their health status, their HRQoL, and their use of healthcare resources were systematically compared with those of patients diagnosed with other chronic conditions (OCC), as well as a population without DM (non-DM). RESULTS Out of 21,007 subjects that took part, 7.4% were diagnosed with DM and 59% with OCC conditions (mean age 65.6±14.2 years with DM, 51.3±18.1 years with OCC, and 45.7±18.2 years with non-DM). When compared to non-DM and OCC, DM was statistically significantly associated with higher frequencies of hypertension, hypercholesterolaemia, obesity, myocardial infraction, hospital admissions in the last year, and drug consumption, but with a lower number of visits to secondary healthcare. The mean quality adjusted life years (QALY) of patients with DM was 0.75 per year, significantly lower (P<.05) to that of individuals with OCC (0.89), and those without DM (0.92). The difference vs. non-DM remained statistically significant after adjusting for age, gender, and number of comorbidities (P<.001). CONCLUSIONS In Spain, DM is associated with a high comorbidity, involves a greater loss in HRQoL than those diagnosed with other chronic conditions as a whole, and generates a significant burden on the healthcare system.
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Affiliation(s)
| | - R Villoro
- Departamento de Economía de la Salud, Weber Economía y Salud, Madrid, España
| | - M Merino
- Departamento de Economía de la Salud, Weber Economía y Salud, Madrid, España
| | - Á Hidalgo-Vega
- Departamento de Fundamentos de Análisis Económico, Universidad de Castilla-La Mancha, Toledo, España
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Merino M, Vega B, Guijarro G, Navea C, Torán C, Civantos S. Hipercalcemia hipocalciúrica familiar: a veces no es lo que parece. Rev Osteoporos Metab Miner 2015. [DOI: 10.4321/s1889-836x2015000100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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24
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Perez de Llano LA, Villoro R, Hidalgo A, Merino M. Cost-Effectiveness of Asthma Management in a Hospital-Based Adult Asthma Clinic in Spain. Value Health 2014; 17:A596-A597. [PMID: 27202051 DOI: 10.1016/j.jval.2014.08.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - A Hidalgo
- University of Castilla La Mancha, Toledo, Spain
| | - M Merino
- Instituto Max Weber, Madrid, Spain
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Sordia-Hernandez L, Martinez AM, Gris J, Herrero J, Uzcanga CH, Merino M, Valdes O, Gonzalez GG. Normal “high” thyroid stimulating hormone (TSH) levels and pregnancy rates in patients undergoing IVF with donor eggs. CLIN EXP OBSTET GYN 2014. [DOI: 10.12891/ceog17372014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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26
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Sereno M, Merino M, López-Gómez M, Gómez-Raposo C, Zambrana Tébar F, Moreno Rubio J, Espinós J, Martín-Algarra S, Casado Sáenz E. MYH polyposis syndrome: clinical findings, genetics issues and management. Clin Transl Oncol 2014; 16:675-9. [DOI: 10.1007/s12094-014-1171-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/21/2014] [Indexed: 12/15/2022]
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27
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Sordia-Hernandez LH, Morales Martinez A, Gris JM, Herrero J, Hernandez Uzcanga C, Merino M, Valdes O, Guerrero G. Normal "high" thyroid stimulating hormone (TSH) levels and pregnancy rates in patients undergoing IVF with donor eggs. CLIN EXP OBSTET GYN 2014; 41:517-520. [PMID: 25864250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine if a relationship exists between pregnancy rates obtained in patients undergoing in vitro fertilization (lVF) with donor eggs and levels of thyroid stimulating hormone greater than 2.5 mlU/L but still within a range considered normal. STUDY DESIGN Retrospective comparative cohort study. With prior approval of the Ethics Committee, 233 patients undergoing IVF with donor eggs, in a two-year period, were included. Patients were grouped depending on the thyroid stimulating hormone (TSH) level. Pregnancy rates were compared. Statistical analysis was made with the Chi-square test. RESULTS Pregnancy rates, depending on the TSH level, were 56.6% in patients with TSH levels below 2.49 mU/L vs. 21.6%, in patients with levels above 2.5 mU/L. This difference was statistically significant (p < 0.001). CONCLUSIONS Mild abnormalities of thyroid function may adversely affect the pregnancy rates in patients un- dergoing in vitro fertilization with donor eggs. A possible alteration in endometrial function may be associated.
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Guadilla AM, Balado P, Baeza A, Merino M. [Effectiveness of topical autologous serum treatment in neurotrophic keratopathy]. ACTA ACUST UNITED AC 2013; 88:302-6. [PMID: 23886361 DOI: 10.1016/j.oftal.2012.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/06/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of 20% autologous serum as a treatment for neurotrophic keratopathy. MATERIAL AND METHODS A longitudinal, observational and descriptive study was performed on 19 patients (22 eyes) with neurotrophic keratopathy in different stages of Mackie's classification. The following variables were evaluated on the first visit, and then 4 months later: best corrected visual acuity (BCVA), subjective patient symptomatology (faces scale), Schirmer's test without anesthesia (mm), tear film break-up time (BUT) (sg) and healing of the epithelial defect (weeks). The Wilcoxon signed-rank test was used for the statistical analysis of the data. RESULTS A symptomatic improvement was observed in 100% of the cases, and a 71% improvement in best corrected visual acuity (P<.05). There was also a statistically significant improvement in the Schirmer's test and BUT (P<.05). Healing of epithelial defect occurred in 71% of the cases within 6 weeks, and in 91% of the cases within 12 weeks of treatment. The remaining 9% of the cases that did not heal had a grade 3 neurotrophic keratopathy. CONCLUSIONS The use of 20% autologous topical serum represents an effective treatment for grades 1 and 2 neurotrophic keratopathy, but is an insufficient treatment for a grade 3 keratopathy. In cases where there is a significant loss of tissue, the application of a higher concentration of autologous serum, or platelet-rich derivatives, or plasma rich in growth factors, may be more effective than the application of 20% autologous serum, due to their greater effect on cell proliferation.
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Affiliation(s)
- A M Guadilla
- Sección de Córnea, Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Zucali PA, Di Tommaso L, Petrini I, Battista S, Lee HS, Merino M, Lorenzi E, Voulaz E, De Vincenzo F, Simonelli M, Roncalli M, Giordano L, Alloisio M, Santoro A, Giaccone G. Reproducibility of the WHO classification of thymomas: practical implications. Lung Cancer 2012; 79:236-41. [PMID: 23279873 DOI: 10.1016/j.lungcan.2012.11.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The WHO-classification was shown to be an independent prognostic marker in some but not all retrospective studies possibly due to lack of reproducibility. We investigated the reproducibility of the WHO-classification and its prognostic implication using a large series of resected thymomas. METHODS Four independent pathologists histologically classified a surgical series of 129 thymic tumors in a blinded fashion. Fleiss' kappa-coefficient was used to assess the pathologists' overall agreement, and Cohen-Kappa to assess the agreement between two observers. Disease-related-survival (DRS) and progression-free-survival (PFS) curves were generated by Kaplan-Meier method and compared by log-rank test. RESULTS In 63/129 (48.8%) cases there was a complete agreement; in 43/129 (33.3%) cases 3/4 pathological diagnoses were identical; in 15/129 (11.6%) cases the diagnoses were identical by pair; in 8/129 (6.2%) cases three different pathological diagnoses were on record. The Kappa-correlation coefficient was only moderate (0.53). A following web review carried out on the 23 cases with at least two different diagnoses reached a complete consensus. The histotype showed a statistically significant impact on PFS and DRS in the classification provided by only two pathologists. CONCLUSIONS In this study, the agreement on WHO classification of thymomas was only moderate and this impacted on patients management. Web consensus conference on the diagnosis, more stringent diagnostic criteria or the adoption of referral diagnostic centres may substantially reduce discrepancies.
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Affiliation(s)
- P A Zucali
- Humanitas Cancer Center, Via Manzoni 56, Rozzano, Milan, Italy
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Moore LE, Jaeger E, Nickerson ML, Brennan P, De Vries S, Roy R, Toro J, Li H, Karami S, Lenz P, Zaridze D, Janout V, Bencko V, Navratilova M, Szeszenia-Dabrowska N, Mates D, Linehan WM, Merino M, Simko J, Pfeiffer R, Boffetta P, Hewitt S, Rothman N, Chow WH, Waldman FM. Genomic copy number alterations in clear cell renal carcinoma: associations with case characteristics and mechanisms of VHL gene inactivation. Oncogenesis 2012; 1:e14. [PMID: 23552698 PMCID: PMC3412648 DOI: 10.1038/oncsis.2012.14] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 12/19/2022] Open
Abstract
Array comparative genomic hybridization was used to identify copy number alterations in clear cell renal cell carcinoma (ccRCC) patient tumors to identify associations with patient/clinical characteristics. Of 763 ccRCC patients, 412 (54%) provided frozen biopsies. Clones were analyzed for significant copy number differences, adjusting for multiple comparisons and covariates in multivariate analyses. Frequent alterations included losses on: 3p (92.2%), 14q (46.8%), 8p (38.1%), 4q (35.4%), 9p (32.3%), 9q (31.8%), 6q (30.8%), 3q (29.4%), 10q (25.7%), 13q (24.5%), 1p (23.5%) and gains on 5q (60.2%), 7q (39.6%), 7p (30.6%), 5p (26.5%), 20q (25.5%), 12q (24.8%), 12p (22.8%). Stage and grade were associated with 1p, 9p, 9q, 13q and 14q loss and 12q gain. Males had more alterations compared with females, independent of stage and grade. Significant differences in the number/types of alterations were observed by family cancer history, age at diagnosis and smoking status. Von Hippel–Lindau (VHL) gene inactivation was associated with 3p loss (P<E-05), and these cases had fewer alterations than wild-type cases. The fragile site flanking the FHIT locus (3p14.2) represented a unique breakpoint among VHL hypermethylated cases, compared with wild-type cases and those with sequence changes. This is the first study of its size to investigate copy number alterations among cases with extensive patient, clinical/risk factor information. Patients characterized by VHL wild-type gene status (vs sequence alterations) and male (vs female) cases had more copy number alterations regardless of diagnostic stage and grade, which could relate to poor prognosis.
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Affiliation(s)
- L E Moore
- Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, MD, USA
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Merino M, Iralu J, Shin S. Global health careers: serving the Navajo community. Narrat Inq Bioeth 2012; 2:86-89. [PMID: 24406824 DOI: 10.1353/nib.2012.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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32
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Cherkasova E, Malinzak E, Rao S, Takahashi Y, Senchenko VN, Kudryavtseva AV, Nickerson ML, Merino M, Hong JA, Schrump DS, Srinivasan R, Linehan WM, Tian X, Lerman MI, Childs RW. Inactivation of the von Hippel-Lindau tumor suppressor leads to selective expression of a human endogenous retrovirus in kidney cancer. Oncogene 2011; 30:4697-706. [PMID: 21602888 PMCID: PMC3161150 DOI: 10.1038/onc.2011.179] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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: 12/16/2022]
Abstract
A human endogenous retrovirus type E was recently found to be selectively expressed in most renal cell carcinomas (RCC). Importantly, antigens derived from this provirus are immunogenic, stimulating cytotoxic T-cells that kill RCC cells in vitro and in vivo. Here we show HERV-E expression is restricted to the clear cell subtype of RCC (ccRCC) characterized by an inactivation of the von Hippel-Lindau (VHL) tumor suppressor gene with subsequent stabilization of hypoxia-inducible transcription factors HIF-1α and -2α. HERV-E expression in ccRCC linearly correlated with HIF-2α levels and could be silenced in tumor cells by either transfection of normal VHL or siRNA inhibition of HIF-2α. Using chromatin immunoprecipitation, we demonstrated that HIF-2α can serve as transcriptional factor for HERV-E by binding with HIF response elements (HRE) localized in the proviral 5′LTR. Remarkably, the LTR was found to be hypomethylated only in HERV-E-expressing ccRCC while other tumors and normal tissues possessed a hypermethylated LTR preventing proviral expression. Taken altogether, these findings provide the first evidence that inactivation of a tumor suppressor gene can result in aberrant proviral expression in a human tumor and give insights needed for translational research aimed at boosting human immunity against antigenic components of this HERV-E.
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Affiliation(s)
- E Cherkasova
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Heery CR, Pinto PA, Schlom J, Tsang KY, Madan RA, Poole D, Vergati M, Walter Rodriguez B, Merino M, Gulley JL. Intraprostatic PSA-TRICOM vaccine administration in patients with locally recurrent prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Merino M, Pinto A, González R, Espinosa E. Antiangiogenic agents and endothelin antagonists in advanced castration resistant prostate cancer. Eur J Cancer 2011; 47:1846-51. [PMID: 21600762 DOI: 10.1016/j.ejca.2011.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/12/2011] [Accepted: 04/13/2011] [Indexed: 11/26/2022]
Abstract
Despite multiple advances in prostate cancer therapy, treatment options for castration resistant disease are very limited. While data from recent studies are encouraging, there is no drug that has significantly improved results of standard chemotherapy. Some of the most consistent results are provided by antiangiogenic agents, showing high response rates and manageable toxicity. We describe some of the main therapeutic angiogenesis inhibitors in metastatic castration resistant prostate cancer. These agents include vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors, antiangiogenic and inmunomodulatory agents and endothelin receptor antagonists.
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Affiliation(s)
- M Merino
- Medical Oncology Department, University Hospital La Paz, Madrid, Spain.
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Heery C, Pinto PA, Schlom J, Tsang KY, Madan RA, Poole D, Vergati M, Walter Rodriguez B, Merino M, Gulley JL. Intraprostatic vaccine administration in patients with locally recurrent prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
141 Background: PSA-TRICOM is a cancer vaccine consisting of recombinant poxviruses with transgenes for PSA and 3 T cell costimulatory molecules (TRICOM). A multicenter randomized vector controlled phase II study showed an 8.5 month improvement in median survival in men with metastatic CRPC. Preclinical studies showed intratumoral administration of TRICOM vaccines may improve anti-tumor outcomes. This study was intended to show safety of intraprostatic (i.p.) vaccine administration. 2° goals included immunologic and tumor response. Methods: 21 pts were enrolled with locally recurrent prostate cancer after radiation into 5 cohorts and received initial vaccination with s.c. recombinant vaccinia (rV)-PSA-TRICOM and booster i.p. recombinant fowlpox (rF)-PSA-TRICOM. Cohorts 3-5 also received i.p. rF-GM-CSF. Cohort 5 received concurrent s.c. and i.p. boosters. Priming was given on day 1, and boosters were given on days 29, 57, and 85. Pts had pre- and post-treatment prostate biopsies. Tumor infiltrate was evaluated when adequate tissue was available. PBMCs were analyzed by ELISPOT for response to PSA and 3-color flow cytometry to characterize regulatory T cells (Treg) or effector T cells. Treg suppression function was assayed by suppression of the CD4+ effector T cell proliferation. Results: Only 1 grade 3 toxicity occurred, a transient fever. Most common grade 2 adverse events for all doses were fever (14.5%) and injection-site reactions (21%). 15 of 21 pts had stable or improved PSA on study, and 16 of 21 pts had stable or improved PSA doubling time. Post-vaccination, 4 of 8 evaluable pts had immunological response by ELISPOT assay and 11 of 15 pts had decreased (n=8) or stable (n=3) Treg function. A paired t-test of 13 biopsies pre- and post- vaccination showed significant increases in immune infiltrates within tumors after vaccination. CD4+ cells increased from 1.3 → 13.1/high power field (hpf). CD8+ cells rose from 6.4 → 14/hpf. Conclusions: I.p. administration of PSA-TRICOM is safe, feasible and can generate a substantial immunologic response. Improved PSA kinetics and intense post-vaccination immune infiltrates were seen in the majority of pts. Trials of i.p. PSA-TRICOM examining clinical endpoints are warranted. No significant financial relationships to disclose.
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Affiliation(s)
- C. Heery
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - P. A. Pinto
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - J. Schlom
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - K. Y. Tsang
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - R. A. Madan
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - D. Poole
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M. Vergati
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - B. Walter Rodriguez
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M. Merino
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - J. L. Gulley
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD; National Cancer Institute, National Institutes of Health, Bethesda, MD
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Merino M, Perez-Llarena FJ, Kerff F, Poza M, Mallo S, Rumbo-Feal S, Beceiro A, Juan C, Oliver A, Bou G. Role of changes in the L3 loop of the active site in the evolution of enzymatic activity of VIM-type metallo- -lactamases--authors' response. J Antimicrob Chemother 2010. [DOI: 10.1093/jac/dkq488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim CR, Sadowska GB, Newton SA, Merino M, Petersson KH, Padbury JF, Stonestreet BS. Na+,K+-ATPase activity and subunit protein expression: ontogeny and effects of exogenous and endogenous steroids on the cerebral cortex and renal cortex of sheep. Reprod Sci 2010; 18:359-73. [PMID: 20959645 DOI: 10.1177/1933719110385137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
We examined the effects of development, exogenous, and endogenous glucocorticoids on Na(+),K(+)-ATPase activity and subunit protein expression in ovine cerebral cortices and renal cortices. Ewes at 60%, 80%, and 90% gestation, newborns, and adults received 4 dexamethasone or placebo injections. Cerebral cortex Na(+),K(+)-ATPase activity was higher (P < .05) in placebo-treated newborns than fetuses of placebo-treated ewes and adults, α(1)-expression was higher at 90% gestation than the other ages; α(2)-expression was higher in newborns than fetuses; α(3)-expression was higher in newborns than 60% gestation; β(1)-expression was higher in newborns than the other ages, and β(2)-expression higher at 60% than 80% and 90% gestation, and in adults. Renal cortex Na(+),K(+)-ATPase activity was higher in placebo-treated adults and newborns than fetuses. Cerebral cortex Na(+),K(+)-ATPase activity was higher in dexamethasone- than placebo-treated adults, and α(1)-expression higher in fetuses of dexamethasone- than placebo-treated ewes at 60% and 80% gestation. Renal cortex Na(+),K(+)-ATPase activity and α(1)-expression were higher in fetuses of dexamethasone- than placebo-treated ewes at each gestational age, and β(1)-expression was higher in fetuses of dexamethasone- than placebo-treated ewes at 90% gestation and in dexamethasone- than placebo-treated adults. Cerebral cortex Na(+),K(+)-ATPase activity, α(1)-expression, β(1)-expression, and renal cortex α(1)-expression correlated directly with increases in fetal cortisol. In conclusion, Na(+),K(+)-ATPase activity and subunit expression exhibit specific developmental patterns in brain and kidney; exogenous glucocorticoids regulate activity and subunit expression in brain and kidney at some ages; endogenous increases in fetal cortisol regulate cerebral Na(+),K(+)-ATPase, but exogenous glucocorticoids have a greater effect on renal than cerebral Na(+),K(+)-ATPase.
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Affiliation(s)
- Chang-Ryul Kim
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI 02905,USA
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Klepac Pulanic T, Venkatesan A, Segars J, Partanen A, Merino M, Stratton P. Pilot study of MR-guided high intensity focused ultrasound (MRGHIFU) ablation of uterine fibroids. Fertil Steril 2010. [DOI: 10.1016/j.fertnstert.2010.07.860] [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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Merino M, Perez-Llarena FJ, Kerff F, Poza M, Mallo S, Rumbo-Feal S, Beceiro A, Juan C, Oliver A, Bou G. Role of changes in the L3 loop of the active site in the evolution of enzymatic activity of VIM-type metallo- -lactamases. J Antimicrob Chemother 2010; 65:1950-4. [DOI: 10.1093/jac/dkq259] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Browne H, Linehan M, Merino M, DeCherney A, Babar N, Stratton P. Bilateral lipid cell tumors in a woman with von hippel-lindau syndrome. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.1038] [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: 10/21/2022]
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Merino M, Morales Martínez A, Saldivar D, Sordia L, González E, Vidal O. Steroidogenic capacity of ovarian tissue post cryopreservation. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.872] [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: 10/21/2022]
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Menefee ME, Huang H, Edgerly M, Kotz H, Merino M, Balis FM, Chen CC, Robey R, Bates SE, Fojo AT. Effects of the P-glycoprotein (Pgp) antagonist tariquidar (XR-9576; TQD) on Pgp function as well as the toxicity and efficacy of combined chemotherapy in patients with metastatic adrenocortical cancer (mACC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.2543] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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Ayala A F, Morales A, Merino M, Juarez B, Absalon L, Enrique G. Sperm motility in baseline spermogram is predictive of total motile sperm after preparation for insemination. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.1268] [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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Ayala A F, Morales A, Merino M, Gonzalez E, Sordia L, Oscar V. Evaluation of sperm chromatin integrity and seminal quality in HIV positive patients. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.079] [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: 11/16/2022]
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Merino M, Maestu I, Tallón M, Almenar D, Casabó VG, Muñoz J, Jiménez NV. Carboplatin (Cb) clearance (Cl) in elderly and young patients with advanced non-small cell lung cancer (ANSCLC): An exploratory analysis of the Calvert’s formula. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18047 Background: It seems that elderly lung cancer patients (p) respond better to combination chemotherapy than to single-agent therapy. Application of pharmacokinetic (pk) modelling to the routine therapeutic drug monitoring in elderly p help to individualize the dosage of anticancer drugs. The aim of this study was to explore the Calvert′s formula usefulness for calculating the Cb dose in elderly p by means of the predicted AUC/actual AUC ratio. Creatinine (Cr) Cl was calculated by Cockdroft-Gault equation. Methods: Between December 2005 and September 2006, 20 chemonaive ANSCLC p were included in two groups: 10 adults p ≤ 65 years and 10 aged p ≥ 75 years. Treatment consisted in Cb day 1 and gemcitabine 1250 mg/m2 days 1 and 8 every 21 days. Cb dose was calculated for a foreseen AUC = 5 in young adults and AUC = 4 in aged p. Three blood samples were collected at 1–2 hours(h), 3–5 h, 12–24 h postinfusion. Total and ultrafiltrated Cb was determined using a flameless atomic absortion spectrometer. For pk analysis non lineal effects models implemented in NONMEM program were used. Individual pk parameters were calculated and predictors in the structural model were analized. Results: Table 1 shows mean and variation coefficient of some biometric characteristics. Pk parameters analysis: ClAUC5 p = 137 mL/min; Clfactor (parameter for measuring Cl changes according to age) = 0.44; Cl AUC4 p = 59.7 mL/min. Cb Cl in elderly p was 43.55% with respect to younger p. In younger p estimated Cb Cl was 5.69% higher than Cb Cl calculated using the Calvert equation. In elderly p, the opposite effect was achieved, estimated Cb Cl was 26.85% lower than Cb Cl calculated Conclusions: The Cb Cl calculation by means of Calvert formula showed underestimation of the dose in younger p and upperestimation of the dose in elderly p. It is necessary to investigate the covariates which contribute to take away the strength of the Calvert equation, which could to affect the efficacy and toxicity of Cb. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Merino
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - I. Maestu
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - M. Tallón
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - D. Almenar
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - V. G. Casabó
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - J. Muñoz
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
| | - N. V. Jiménez
- Facultad de Farmacia, Valencia, Spain; Hospital Virgen de los Lirios, Alcoy, Spain; Hospital Dr. Peset, Valencia, Spain; Universitat de València, Valencia, Spain
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Veillette PA, Merino M, Marcaccio ND, Garcia MM, Specker JL. Cortisol is necessary for seawater tolerance in larvae of a marine teleost the summer flounder. Gen Comp Endocrinol 2007; 151:116-21. [PMID: 17292366 DOI: 10.1016/j.ygcen.2006.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 08/28/2006] [Revised: 11/22/2006] [Accepted: 12/26/2006] [Indexed: 11/20/2022]
Abstract
Larval-stage summer flounder (Paralichthys dentatus) were immersed in the corticosteroid-receptor blocker RU486 to test the effects of cortisol deficiency on salinity tolerance. Premetamorphic larvae held at 10 (near isosmotic) or 30 (hyperosmotic) parts per thousand ( per thousand) seawater survived well over 5d in 0, 0.012, or 0.12 microM RU486. However, at concentrations of 1.2 or 3.6 microM RU486, mortality was significantly greater for larvae in 30 per thousand compared to larvae in 10 per thousand. In a separate experiment, the ability of RU486 to inhibit tolerance to hyperosmotic medium (30 per thousand) was confirmed; immersion at 1.2 microM RU486 induced mortality of larvae in the metamorphic climax stage held at 30 per thousand, but not 0 or 10 per thousand. Mortality due to RU486 in pre- or prometamorphic stage larvae was prevented by concurrent immersion in cortisol at concentrations approximately 10-200 times greater than RU486, indicating that the action of RU486 was specific to antagonism of cortisol. The efficacy of 1.2 microM RU486 in reducing survival in 30 per thousand was found to be stage-dependent and exhibited the following hierarchy for fastest time to 50% mortality: prometamorphosis>metamorphic climax>premetamorphosis. In a 5-d pretreatment of pre- or prometamorphic larvae by immersion in 20 microM cortisol and/or 0.12 microM RU486 at 30 per thousand, only RU486 had a limited effect on decreasing survival when larvae were challenged with abrupt exposure to 50 per thousand. In total, the results evidence for the first time a necessary role for cortisol in seawater tolerance of a larval marine teleost.
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Affiliation(s)
- Philip A Veillette
- Graduate School of Oceanography, University of Rhode Island, 218 South Ferry Rd., Narragansett, RI 02882-1197, USA.
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Pepperell JR, Nemeth G, Yamada Y, Naftolin F, Merino M. Localized accumulation of angiotensin II and production of angiotensin-(1-7) in rat luteal cells and effects on steroidogenesis. Am J Physiol Endocrinol Metab 2006; 291:E221-33. [PMID: 16478781 DOI: 10.1152/ajpendo.00205.2005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/22/2022]
Abstract
These studies aim to investigate subcellular distribution of angiotensin II (ANG II) in rat luteal cells, identify other bioactive angiotensin peptides, and investigate a role for angiotensin peptides in luteal steroidogenesis. Confocal microscopy showed ANG II distributed within the cytoplasm and nuclei of luteal cells. HPLC analysis showed peaks that eluted with the same retention times as ANG-(1-7), ANG II, and ANG III. Their relative concentrations were ANG II >or= ANG-(1-7) > ANG III, and accumulation was modulated by quinapril, an inhibitor of angiotensin-converting enzyme (ACE), Z-proprolinal (ZPP), an inhibitor of prolyl endopeptidase (PEP), and parachloromercurylsulfonic acid (PCMS), an inhibitor of sulfhydryl protease. Phenylmethylsulfonyl fluoride (PMSF), a serine protease inhibitor, did not affect peptide accumulation. Quinapril, ZPP, PCMS, and PMSF, as well as losartan and PD-123319, the angiotensin receptor type 1 (AT1) and type 2 (AT2) receptor antagonists, were used in progesterone production studies. ZPP significantly reduced luteinizing hormone (LH)-dependent progesterone production (P < 0.05). Quinapril plus ZPP had a greater inhibitory effect on LH-stimulated progesterone than either inhibitor alone, but this was not reversed by exogenous ANG II or ANG-(1-7). Both PCMS and PMSF acutely blocked LH-stimulated progesterone, and PCMS blocked LH-sensitive cAMP accumulation. Losartan inhibited progesterone production in permeabilized but not intact luteal cells and was reversed by ANG II. PD-123319 had no significant effect on luteal progesterone production in either intact or permeabilized cells. These data suggest that steroidogenesis may be modulated by angiotensin peptides that act in part through intracellular AT1 receptors.
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Affiliation(s)
- John R Pepperell
- Department of Obstetrics and Gynecology, Yale University Medical School, New Haven, CT, USA.
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Kim CR, Sadowska GB, Petersson KH, Merino M, Sysyn GD, Padbury JF, Stonestreet BS. Effects of postnatal steroids on Na+/K+-ATPase activity and alpha1- and beta1-subunit protein expression in the cerebral cortex and renal cortex of newborn lambs. Reprod Fertil Dev 2006; 18:413-23. [PMID: 16737634 DOI: 10.1071/rd05114] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 01/02/2006] [Indexed: 11/23/2022] Open
Abstract
Na(+)/K(+)-ATPase is a membrane-bound enzyme responsible for Na(+)/K(+) translocation across cell membranes. It is essential for the generation of electrochemical gradients, which control the ionic environment necessary for electrical activity and water and electrolyte balance. Newborn infants who are at risk of developing bronchopulmonary dysplasia (BPD) are frequently treated with corticosteroids. Although these infants are at risk for neurological, water and electrolyte abnormalities, there is little information regarding the effects of clinically relevant doses of corticosteroids on Na(+)/K(+)-ATPase activity and protein isoform expression in the brain and kidney of newborns. In the present study, we examined the effects of dexamethasone on cerebral cortical and renal cortical Na(+)/K(+)-ATPase activity and alpha1- and beta1-protein isoform expression in newborn lambs. Lambs were given four injections of a placebo (n = 11) or one of three different doses of dexamethasone (0.01 mg kg(-1), n = 9; 0.25 mg kg(-1), n = 11; or 0.50 mg kg(-1), n = 9) 12 h apart on Postnatal Days 3 and 4 up to 18 h before harvest of the cerebral cortex and renal cortex. We selected doses in a range to approximate those used to treat infants with BPD. Na(+)/K(+)-ATPase activity was measured in membrane preparations as ouabain-sensitive inorganic phosphate liberation from ATP and alpha1- and beta1-subunit abundance by Western immunoblot. Postnatal treatment of lambs with dexamethasone resulted in a 21.4% increase in Na(+)/K(+)-ATPase activity and a 30.4% increase in catalytic alpha1-protein expression in the cerebral cortex at a dose of 0.50 mg kg(-1) dexamethasone, but not at the lower doses. Dexamethasone treatment was not associated with changes in beta1-isoform expression in the cerebral cortex. In the kidney, dexamethasone treatment was not associated with significant changes in Na(+)/K(+)-ATPase activity or alpha1- or beta1-isoform expression for the doses we examined. Therefore, clinically relevant corticosteroid treatment exerts dose-related, differential organ-specific effects on Na(+)/K(+)-ATPase activity and protein isoform expression in newborn lambs.
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Affiliation(s)
- Chang-Ryul Kim
- Pediatrics, Women & Infants' Hospital of Rhode Island and Brown Medical School, Providence, RI 02905-2499, USA
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Morales F, Maillo A, Díaz-Álvarez A, Merino M, Muñoz-Herrera A, Hernández J, Santamarta D. Meningiomas de la base de cráneo: Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico. Neurocirugia (Astur) 2005. [DOI: 10.4321/s1130-14732005000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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