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Yow BG, Anderson AB, Aburish Z, Tennent DJ, LeClere LE, Rue JPH, Owens BD, Donohue M, Cameron KL, Posner M, Dickens JF. Beach-Chair Versus Lateral Decubitus Positioning for Primary Arthroscopic Anterior Shoulder Stabilization: A Consecutive Series of 641 Shoulders. Am J Sports Med 2023; 51:3367-3373. [PMID: 37817535 DOI: 10.1177/03635465231200251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND There are limited data comparing the beach-chair (BC) versus lateral decubitus (LD) position for arthroscopic anterior shoulder stabilization. PURPOSE To identify predictors of instability recurrence and revision after anterior shoulder stabilization and evaluate surgical position and glenoid bone loss as independent predictors of recurrence and revision at short- and midterm follow-ups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive series of 641 arthroscopic anterior stabilization procedures were performed from 2005 to 2019. All shoulders were evaluated for glenohumeral bone loss on magnetic resonance imaging. The primary outcomes of interest were recurrence and revision. Multivariable logistic regression models were used to assess the relationships of outcomes with age, position, glenoid bone loss group, and track. RESULTS A total of 641 shoulders with a mean age of 22.3 years (SD, 4.45 years) underwent stabilization and were followed for a mean of 6 years. The overall 1-year recurrent instability rate was 3.3% (21/641) and the revision rate was 2.8% (18/641). At 1 year, recurrence was observed in 2.3% (11/487) and 6.5% (10/154) of BC and LD shoulders, respectively. The 5-year recurrence and revision rates were 15.7% (60/383) and 12.8% (49/383), respectively. At 5 years, recurrence was observed in 16.4% (48/293) and 13.3% (12/90) of BC and LD shoulders, respectively. Multivariable modeling demonstrated that surgical position was not associated with a risk of recurrence after 1 year (odds ratio [OR] for LD vs BC, 1.39; P = .56) and 5 years (OR for LD vs BC, 1.32; P = .43), although younger age at index surgery was associated with a higher risk of instability recurrence (OR, 1.73 per SD [4.1 years] decrease in age; P < .03). After 1 and 5 years, surgical position results were similar in a separate multivariable logistic regression model of revision surgery as the dependent variable, when adjusted for age, surgical position, bone loss group, and track. At 5 years, younger age was an independent risk factor for revision: OR 1.68 per SD (4.1 years) decrease in age (P < .05). CONCLUSION Among fellowship-trained orthopaedic surgeons, there was no difference in rates of recurrence and revision surgery after performing arthroscopic anterior stabilization in either the BC or the LD position at 1- and 5-year follow-ups. In multivariable analysis, younger age, but not surgical position, was an independent risk factor for recurrence.
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Affiliation(s)
- Bobby G Yow
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
- Department of Orthopaedic Surgery, Eisenhower Army Medical Center, Augusta, Georgia, USA
| | - Ashley B Anderson
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Zein Aburish
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David J Tennent
- Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Lance E LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John-Paul H Rue
- The Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, Maryland, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Donohue
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Matthew Posner
- Department of Orthopaedic Surgery, WellSpan York Hospital, York, Pennsylvania, USA
| | - Jonathan F Dickens
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Winston CN, Langford O, Levin N, Raman R, Yarasheski K, West T, Abdel-Latif S, Donohue M, Nakamura A, Toba K, Masters CL, Doecke J, Sperling RA, Aisen PS, Rissman RA. Evaluation of Blood-Based Plasma Biomarkers as Potential Markers of Amyloid Burden in Preclinical Alzheimer's Disease. J Alzheimers Dis 2023; 92:95-107. [PMID: 36710683 DOI: 10.3233/jad-221118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Participant eligibility for the A4 Study was determined by amyloid PET imaging. Given the disadvantages of amyloid PET imaging in accessibility and cost, blood-based biomarkers may serve as a sufficient biomarker and more cost-effective screening tool for patient enrollment into preclinical AD trials. OBJECTIVE To determine if a blood-based screening test can adequately identify amyloid burden in participants screened into a preclinical AD trial. METHODS In this cross-sectional study, 224 participants from the A4 Study received an amyloid PET scan (18Florbetapir) within 90 days of blood sample collection. Blood samples from all study participants were processed within 2 h after phlebotomy. Plasma amyloid measures were quantified by Shimazdu and C2 N Diagnostics using mass spectrometry-based platforms. A corresponding subset of blood samples (n = 100) was processed within 24 h after phlebotomy and analyzed by C2 N. RESULTS Plasma Aβ42/Aβ40 demonstrated the highest association for Aβ accumulation in the brain with an AUC 0.76 (95%CI = 0.69, 0.82) at C2 N and 0.80 (95%CI = 0.75, 0.86) at Shimadzu. Blood samples processed to plasma within 2 h after phlebotomy provided a better prediction of amyloid PET status than blood samples processed within 24 h (AUC 0.80 versus 0.64; p < 0.001). Age, sex, and APOE ɛ4 carrier status did not the diagnostic performance of plasma Aβ42/Aβ40 to predict amyloid PET positivity in A4 Study participants. CONCLUSION Plasma Aβ42/Aβ40 may serve as a potential biomarker for predicting elevated amyloid in the brain. Utilizing blood testing over PET imaging may improve screening efficiency into clinical trials.
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Affiliation(s)
- Charisse N Winston
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Oliver Langford
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, San Diego, CA, USA
| | - Natalie Levin
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, San Diego, CA, USA
| | | | - Tim West
- C2N Diagnostics, St. Louis, MO, USA
| | - Sara Abdel-Latif
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, San Diego, CA, USA
| | - Michael Donohue
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, San Diego, CA, USA
| | - Akinori Nakamura
- Department of Biomarker Research, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Kenji Toba
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, VIC, Australia
| | - James Doecke
- The Commonwealth Scientific and Industrial Research Organization, Brisbane, QLD, Australia
| | | | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, San Diego, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.,Department of Neurosciences, University of California San Diego and VA San Diego Healthcare System, La Jolla, CA, USA
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Vitto C, Donohue M, Best W, Gong D, Aurora T, Suri P. 103 Providing Post Emergency Care (ProPEr Care) Virtually. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.113] [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: 11/17/2022]
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Ngolab J, Donohue M, Belsha A, Salazar J, Cohen P, Jaiswal S, Tan V, Gessert D, Korouri S, Aggarwal NT, Alber J, Johnson K, Jicha G, van Dyck C, Lah J, Salloway S, Sperling RA, Aisen PS, Rafii MS, Rissman RA. Feasibility study for detection of retinal amyloid in clinical trials: The Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) trial. Alzheimers Dement (Amst) 2021; 13:e12199. [PMID: 34430703 PMCID: PMC8369843 DOI: 10.1002/dad2.12199] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The retina and brain exhibit similar pathologies in patients diagnosed with neurodegenerative diseases. The ability to access the retina through imaging techniques opens the possibility for non-invasive evaluation of Alzheimer's disease (AD) pathology. While retinal amyloid deposits are detected in individuals clinically diagnosed with AD, studies including preclinical individuals are lacking, limiting assessment of the feasibility of retinal imaging as a biomarker for early-stage AD risk detection. METHODS In this small cross-sectional study we compare retinal and cerebral amyloid in clinically normal individuals who screened positive for high amyloid levels through positron emission tomography (PET) from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) trial as well as a companion cohort of individuals who exhibited low levels of amyloid PET in the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) study. We quantified the number of curcumin-positive fluorescent retinal spots from a small subset of participants from both studies to determine retinal amyloid deposition at baseline. RESULTS The four participants from the A4 trial showed a greater number of retinal spots compared to the four participants from the LEARN study. We observed a positive correlation between retinal spots and brain amyloid, as measured by the standardized uptake value ratio (SUVr). DISCUSSION The results of this small pilot study support the use of retinal fundus imaging for detecting amyloid deposition that is correlated with brain amyloid PET SUVr. A larger sample size will be necessary to fully ascertain the relationship between amyloid PET and retinal amyloid both cross-sectionally and longitudinally.
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Affiliation(s)
- Jennifer Ngolab
- Department of NeurosciencesSan Diego, School of MedicineUniversity of CaliforniaLa JollaCaliforniaUSA
| | - Michael Donohue
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Alison Belsha
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Jennifer Salazar
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Paula Cohen
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Sandhya Jaiswal
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Veasna Tan
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Devon Gessert
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Shaina Korouri
- Department of NeurosciencesSan Diego, School of MedicineUniversity of CaliforniaLa JollaCaliforniaUSA
| | - Neelum T. Aggarwal
- Department of Neurological Sciences and the Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Jessica Alber
- George & Anne Ryan Institute for NeuroscienceUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Ken Johnson
- NeuroVision Imaging IncSacramentoCaliforniaUSA
| | - Gregory Jicha
- Department of Neurology & the Sanders‐Brown Center on AgingUniversity of Kentucky College of MedicineLexingtonKentuckyUSA
| | - Christopher van Dyck
- Alzheimer's Disease Research UnitDepartments of PsychiatryNeurology, and Neuroscience, Yale School of MedicineNew HavenConnecticutUSA
| | - James Lah
- Department of NeurologyEmory Goizueta Alzheimer's Disease Research CenterEmory University School of MedicineAtlantaGeorgiaUSA
| | - Stephen Salloway
- Memory and Aging ProgramButler HospitalProvidenceRhode IslandUSA
| | - Reisa A. Sperling
- Center for Alzheimer Research and TreatmentBrigham and Women's Hospital Massachusetts General HospitalBostonMassachusettsUSA
| | - Paul S. Aisen
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Michael S. Rafii
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Robert A. Rissman
- Department of NeurosciencesSan Diego, School of MedicineUniversity of CaliforniaLa JollaCaliforniaUSA
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Suzuki K, Hirakawa A, Ihara R, Iwata A, Ishii K, Ikeuchi T, Sun C, Donohue M, Iwatsubo T. Effect of apolipoprotein E ε4 allele on the progression of cognitive decline in the early stage of Alzheimer's disease. Alzheimers Dement (N Y) 2020; 6:e12007. [PMID: 32211510 PMCID: PMC7087431 DOI: 10.1002/trc2.12007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Possession of the apolipoprotein E (APO E) ε4 allele advances amyloid β (Aβ) deposition and symptomatic onset of Alzheimer's disease (AD), whereas its effect on the rate of cognitive decline remained controversial. We examined the effects of APOE ε4 allele on cognition in biomarker-confirmed late mild cognitive impairment (LMCI) and mild AD subjects in the Japanese Alzheimer's Disease Neuroimaging Initiative (J-ADNI) and North American ADNI (NA-ADNI). METHODS The "early AD" (ie, combined LMCI and mild AD) cohort of 649 subjects from J-ADNI and NA-ADNI were selected based on positivity of Aβ confirmed by amyloid positron emission tomography (PET) or cerebrospinal fluid testing. The rates of cognitive decline in the Mini Mental State Examination (MMSE), the Clinical Dementia Rating Sum of Boxes (CDR-SB), and the Alzheimer's Disease Assessment Scale-cognitive subscale 13 (ADAS-Cog) from baseline were examined using mixed-effects model. The effect of ε4 on time to conversion to dementia was also analyzed in LMCI using the Kaplan-Meier estimator and log-rank test. RESULTS The rates of cognitive decline were not significantly different between ε4 carriers and ε4 non-carriers in the total early AD cohort, which were affected neither by region nor by the number of ε4 alleles. In LMCI, ε4 carriers showed almost the same progression rates as ε4 non-carriers, except for a significantly faster decline in MMSE (P = .0282). Time to conversion to demenita was not significantly different between ε4 carriers and ε4 non-carriers. In ε4-positive mild AD, the rates of decline in MMSE (P = .003) and CDR-SB (P = .0071) were slower than those in ε4 non-carriers. DISCUSSION The APOE ε4 allele had little effect on the rates of cognitive decline in the overall biomarker-confirmed early AD, regardless of region and number of ε4 alleles, with a slight variability in different clinical stages, the ε4 allele being slightly accelerative in LMCI, while decelerative in mild AD.
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Affiliation(s)
- Kazushi Suzuki
- Unit for Early and Exploratory Clinical DevelopmentThe University of Tokyo HospitalTokyoJapan
| | - Akihiro Hirakawa
- Department of Biostatistics and BioinformaticsGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Ryoko Ihara
- Unit for Early and Exploratory Clinical DevelopmentThe University of Tokyo HospitalTokyoJapan
| | - Atsushi Iwata
- Department of NeurologyThe University of Tokyo HospitalTokyoJapan
| | - Kenji Ishii
- Tokyo Metropolitan Institute of GerontologyTokyoJapan
| | | | - Chung‐Kai Sun
- Alzheimer's Therapeutics Research InstituteUniversity of Southern CaliforniaSan DiegoCalifornia
| | - Michael Donohue
- Alzheimer's Therapeutics Research InstituteUniversity of Southern CaliforniaSan DiegoCalifornia
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical DevelopmentThe University of Tokyo HospitalTokyoJapan
- Department of NeuropathologyGraduate School of MedicineThe University of TokyoTokyoJapan
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Jimenez-Maggiora GA, Bruschi S, Raman R, Langford O, Donohue M, Rafii MS, Sperling RA, Cummings JL, Aisen PS. TRC-PAD: Accelerating Recruitment of AD Clinical Trials through Innovative Information Technology. J Prev Alzheimers Dis 2020; 7:226-233. [PMID: 32920624 PMCID: PMC7769128 DOI: 10.14283/jpad.2020.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Trial-Ready Cohort for Preclinical/Prodromal Alzheimer's Disease (TRC-PAD) Informatics Platform (TRC-PAD IP) was developed to facilitate the efficient selection, recruitment, and assessment of study participants in support of the TRC-PAD program. OBJECTIVES Describe the innovative architecture, workflows, and components of the TRC-PAD IP. DESIGN The TRC-PAD IP was conceived as a secure, scalable, multi-tiered information management platform designed to facilitate high-throughput, cost-effective selection, recruitment, and assessment of TRC-PAD study participants and to develop a learning algorithm to select amyloid-bearing participants to participate in trials of early-stage Alzheimer's disease. SETTING TRC-PAD participants were evaluated using both web-based and in-person assessments to predict their risk of amyloid biomarker abnormalities and eligibility for preclinical and prodromal clinical trials. Participant data were integrated across multiple stages to inform the prediction of amyloid biomarker elevation. PARTICIPANTS TRC-PAD participants were age 50 and above, with an interest in participating in Alzheimer's research. MEASUREMENTS TRC-PAD participants' cognitive performance and subjective memory concerns were remotely assessed on a longitudinal basis to predict participant risk of biomarker abnormalities. Those participants determined to be at the highest risk were invited to an in-clinic screening visit for a full battery of clinical and cognitive assessments and amyloid biomarker confirmation using positron emission tomography (PET) or lumbar puncture (LP). RESULTS The TRC-PAD IP supported growth in recruitment, screening, and enrollment of TRC-PAD participants by leveraging a secure, scalable, cost-effective cloud-based information technology architecture. CONCLUSIONS The TRC-PAD program and its underlying information management infrastructure, TRC-PAD IP, have demonstrated feasibility concerning the program aims. The flexible and modular design of the TRC-PAD IP will accommodate the introduction of emerging diagnostic technologies.
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Affiliation(s)
- G A Jimenez-Maggiora
- GA Jimenez-Maggiora, Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA,
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Braswell MJ, Anderson A, Donohue M, DiVito MC, White PW, Wagner SC. Delayed Presentation of Gluteal Compartment Syndrome due to Pseudoaneurysm Rupture: A Case Report. JBJS Case Connect 2019; 9:e0346. [PMID: 31390334 DOI: 10.2106/jbjs.cc.18.00346] [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: 11/14/2022]
Abstract
CASE We present a 26-year-old active duty man who sustained a coccygeal fracture and gluteus maximus hematoma after a fall from height during training. The patient returned 3 weeks postinjury with symptoms and physical examination findings concerning for gluteal compartment syndrome. An expanding gluteal hematoma was confirmed on imaging and the patient was taken to the operating room for emergent evacuation and endovascular hemostasis. CONCLUSIONS This case of gluteal compartment syndrome is a unique contribution to the literature with respect to the specific vascular injury observed and the delayed presentation of gluteal compartment syndrome.
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Affiliation(s)
- Matthew J Braswell
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Ashley Anderson
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michael Donohue
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michelle C DiVito
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Paul W White
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Scott C Wagner
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Mattsson N, Insel PS, Donohue M, Jögi J, Ossenkoppele R, Olsson T, Schöll M, Smith R, Hansson O. Predicting diagnosis and cognition with 18F-AV-1451 tau PET and structural MRI in Alzheimer's disease. Alzheimers Dement 2019; 15:570-580. [PMID: 30639421 DOI: 10.1016/j.jalz.2018.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 03/16/2018] [Revised: 11/01/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The relative importance of structural magnetic resonance imaging (MRI) and tau positron emission tomography (PET) to predict diagnosis and cognition in Alzheimer's disease (AD) is unclear. METHODS We tested 56 cognitively unimpaired controls (including 27 preclinical AD), 32 patients with prodromal AD, and 39 patients with AD dementia. Optimal classifiers were constructed using the least absolute shrinkage and selection operator with 18F-AV-1451 (tau) PET and structural MRI data (regional cortical thickness and subcortical volumes). RESULTS 18F-AV-1451 in the amygdala, entorhinal cortex, parahippocampal gyrus, fusiform, and inferior parietal lobule had 93% diagnostic accuracy for AD (prodromal or dementia). The MRI classifier involved partly the same regions plus the hippocampus, with 83% accuracy, but did not improve upon the tau classifier. 18F-AV-1451 retention and MRI were independently associated with cognition. DISCUSSION Optimized tau PET classifiers may diagnose AD with high accuracy, but both tau PET and structural brain MRI capture partly unique information relevant for the clinical deterioration in AD.
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Affiliation(s)
- Niklas Mattsson
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden.
| | - Philip S Insel
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Michael Donohue
- Department of Neurology, Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Rik Ossenkoppele
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; VU University Medical Center, Department of Neurology and Alzheimer Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Tomas Olsson
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Schöll
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Wallenberg Centre for Molecular and Translational Medicine and the Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Ruben Smith
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences, Neurology, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
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Aisen P, Touchon J, Amariglio R, Andrieu S, Bateman R, Breitner J, Donohue M, Dunn B, Doody R, Fox N, Gauthier S, Grundman M, Hendrix S, Ho C, Isaac M, Raman R, Rosenberg P, Schindler R, Schneider L, Sperling R, Tariot P, Welsh-Bohmer K, Weiner M, Vellas B. EU/US/CTAD Task Force: Lessons Learned from Recent and Current Alzheimer's Prevention Trials. J Prev Alzheimers Dis 2018; 4:116-124. [PMID: 29186281 DOI: 10.14283/jpad.2017.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
At a meeting of the EU/US/Clinical Trials in Alzheimer's Disease (CTAD) Task Force in December 2016, an international group of investigators from industry, academia, and regulatory agencies reviewed lessons learned from ongoing and planned prevention trials, which will help guide future clinical trials of AD treatments, particularly in the pre-clinical space. The Task Force discussed challenges that need to be addressed across all aspects of clinical trials, calling for innovation in recruitment and retention, infrastructure development, and the selection of outcome measures. While cognitive change provides a marker of disease progression across the disease continuum, there remains a need to identify the optimal assessment tools that provide clinically meaningful endpoints. Patient- and informant-reported assessments of cognition and function may be useful but present additional challenges. Imaging and other biomarkers are also essential to maximize the efficiency of and the information learned from clinical trials.
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Affiliation(s)
- P Aisen
- PPaul Aisen, Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, San Diego, CA, USA,
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Aisen PS, Petersen RC, Donohue M, Weiner MW. Alzheimer's Disease Neuroimaging Initiative 2 Clinical Core: Progress and plans. Alzheimers Dement 2016; 11:734-9. [PMID: 26194309 DOI: 10.1016/j.jalz.2015.05.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 03/03/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This article reviews the current status of the Clinical Core of the Alzheimer's Disease Neuroimaging Initiative (ADNI), and summarizes planning for the next stage of the project. METHODS Clinical Core activities and plans were synthesized based on discussions among the Core leaders and external advisors. RESULTS The longitudinal data in ADNI-2 provide natural history data on a clinical trials population and continue to inform refinement and standardization of assessments, models of trajectories, and clinical trial methods that have been extended into sporadic preclinical Alzheimer's disease (AD). DISCUSSION Plans for the next phase of the ADNI project include maintaining longitudinal follow-up of the normal and mild cognitive impairment cohorts, augmenting specific clinical cohorts, and incorporating novel computerized cognitive assessments and patient-reported outcomes. A major hypothesis is that AD represents a gradually progressive disease that can be identified precisely in its long presymptomatic phase, during which intervention with potentially disease-modifying agents may be most useful.
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Affiliation(s)
- Paul S Aisen
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA.
| | | | - Michael Donohue
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Michael W Weiner
- Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry and Neurology, University of California San Francisco, San Fransisco, CA, USA
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Mattsson N, Insel PS, Donohue M, Jagust W, Sperling R, Aisen P, Weiner MW. Predicting Reduction of Cerebrospinal Fluid β-Amyloid 42 in Cognitively Healthy Controls. JAMA Neurol 2015; 72:554-60. [PMID: 25775167 DOI: 10.1001/jamaneurol.2014.4530] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Alzheimer disease has a long preclinical stage characterized by β-amyloid (Aβ) accumulation without symptoms. Several trials focus on this stage and use biomarkers to include Aβ-positive participants, but an even earlier prevention of Aβ accumulation may be an effective treatment strategy. OBJECTIVE To determine whether people who appear to be Aβ negative but are at high risk for Aβ positivity within the near future can be identified. DESIGN, SETTING, AND PARTICIPANTS Longitudinal biomarker cohort study involving 35 cognitively healthy individuals who underwent cerebrospinal fluid (CSF) sampling for up to 3 years during the study (October 24, 2005, to September 1, 2014). All participants had normal CSF Aβ42 levels at baseline. MAIN OUTCOMES AND MEASURES Predictors of future Aβ positivity (levels of CSF Aβ42 declining below a previously validated cutoff level of 192 ng/L) tested by random forest models. Tested predictors included levels of protein in the CSF, hippocampal volume, genetics, demographics, and cognitive scores. RESULTS The CSF Aβ42 levels declined in 11 participants, and the CSF became Aβ positive. The baseline CSF Aβ42 level was a strong predictor of future positivity (accuracy, 79% [95% CI, 70%-87%]). Ten of 11 decliners had baseline CSF Aβ42 levels in the lower tertile of the reference range (<225 ng/L), and 22 of 24 nondecliners had baseline CSF Aβ42 levels in the upper 2 tertiles (≥225 ng/L). A high CSF P-tau level was associated with decline (accuracy, 68%; 95% CI, 55%-81%). CONCLUSIONS AND RELEVANCE Baseline CSF Aβ42 levels in the lower part of the reference range are strongly associated with future Aβ positivity. This finding can be used in trials on very early prevention of Alzheimer disease to identify people at high risk for Aβ accumulation as defined by low CSF Aβ42 levels.
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Affiliation(s)
- Niklas Mattsson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden2Department of Radiology and Biomedical Imaging, University of California, San Francisco3Center for Imaging of Neur
| | - Philip S Insel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco3Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, California
| | - Michael Donohue
- Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla
| | - William Jagust
- Helen Wills Neuroscience Institute and School of Public Health, University of California, Berkeley
| | - Reisa Sperling
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul Aisen
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California, San Diego, La Jolla
| | - Michael W Weiner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco3Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, California
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Mattsson N, Insel PS, Donohue M, Landau S, Jagust WJ, Shaw LM, Trojanowski JQ, Zetterberg H, Blennow K, Weiner MW. Independent information from cerebrospinal fluid amyloid-β and florbetapir imaging in Alzheimer's disease. ACTA ACUST UNITED AC 2014; 138:772-83. [PMID: 25541191 DOI: 10.1093/brain/awu367] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [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: 12/15/2022]
Abstract
Reduced cerebrospinal fluid amyloid-β42 and increased retention of florbetapir positron emission tomography are biomarkers reflecting cortical amyloid load in Alzheimer's disease. However, these measurements do not always agree and may represent partly different aspects of the underlying Alzheimer's disease pathology. The goal of this study was therefore to test if cerebrospinal fluid and positron emission tomography amyloid-β biomarkers are independently related to other Alzheimer's disease markers, and to examine individuals who are discordantly classified by these two biomarker modalities. Cerebrospinal fluid and positron emission tomography amyloid-β were measured at baseline in 769 persons [161 healthy controls, 68 subjective memory complaints, 419 mild cognitive impairment and 121 Alzheimer's disease dementia, mean age 72 years (standard deviation 7 years), 47% females] and used to predict diagnosis, APOE ε4 carriage status, cerebral blood flow, cerebrospinal fluid total-tau and phosphorylated-tau levels (cross-sectionally); and hippocampal volume, fluorodeoxyglucose positron emission tomography results and Alzheimer's Disease Assessment Scale-cognitive subscale scores (longitudinally). Cerebrospinal fluid and positron emission tomography amyloid-β were highly correlated, but adjusting one of these predictors for the other revealed that they both provided partially independent information when predicting diagnosis, APOE ε4, hippocampal volume, metabolism, cognition, total-tau and phosphorylated-tau (the 95% confidence intervals of the adjusted effects did not include zero). Cerebrospinal fluid amyloid-β was more strongly related to APOE ε4 whereas positron emission tomography amyloid-β was more strongly related to tau levels (P < 0.05). Discordance (mainly isolated cerebrospinal fluid amyloid-β positivity) differed by diagnostic group (P < 0.001) and was seen in 21% of cognitively healthy people but only 6% in dementia patients. The finding that cerebrospinal fluid and positron emission tomography amyloid-β provide partially independent information about a wide range of Alzheimer's measures supports the theory that these modalities represent partly different aspects of Alzheimer's pathology. The fact that mismatch, with positive cerebrospinal fluid amyloid-β but normal positron emission tomography amyloid-β, is relatively common in cognitively healthy people may be considered when using these biomarkers to identify early stage Alzheimer's disease. Reduced cerebrospinal fluid amyloid-β may be more strongly related to early stage Alzheimer's disease, whereas increased positron emission tomography amyloid-β may be more strongly related to disease progression.
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Affiliation(s)
- Niklas Mattsson
- 1 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA 3 Department of Veterans Affairs Medical Centre, Centre for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Philip S Insel
- 2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA 3 Department of Veterans Affairs Medical Centre, Centre for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Michael Donohue
- 4 Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Susan Landau
- 5 Helen Wills Neuroscience Institute and School of Public Health, University of California, Berkeley, CA, USA
| | - William J Jagust
- 5 Helen Wills Neuroscience Institute and School of Public Health, University of California, Berkeley, CA, USA
| | - Leslie M Shaw
- 6 Department of Pathology and Laboratory Medicine, Institute on Aging, Centre for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - John Q Trojanowski
- 6 Department of Pathology and Laboratory Medicine, Institute on Aging, Centre for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Henrik Zetterberg
- 1 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 7 UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Kaj Blennow
- 1 Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Michael W Weiner
- 2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA 3 Department of Veterans Affairs Medical Centre, Centre for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
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Abstract
A new secondary prevention trial in older people with amyloid accumulation at high risk for Alzheimer's disease dementia should provide insights into whether anti-amyloid therapy can delay cognitive decline.
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Affiliation(s)
- Reisa A Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Mattsson N, Insel PS, Landau S, Jagust W, Donohue M, Shaw LM, Trojanowski JQ, Zetterberg H, Blennow K, Weiner M. Diagnostic accuracy of CSF Ab42 and florbetapir PET for Alzheimer's disease. Ann Clin Transl Neurol 2014; 1:534-43. [PMID: 25356425 PMCID: PMC4184556 DOI: 10.1002/acn3.81] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/13/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Reduced cerebrospinal fluid (CSF) β-amyloid42 (Aβ42) and increased florbetapir positron emission tomography (PET) uptake reflects brain Aβ accumulation. These biomarkers are correlated with each other and altered in Alzheimer's disease (AD), but no study has directly compared their diagnostic performance. METHODS We examined healthy controls (CN, N = 169) versus AD dementia patients (N = 118), and stable (sMCI; no dementia, followed up for at least 2 years, N = 165) versus progressive MCI (pMCI; conversion to AD dementia, N = 59). All subjects had florbetapir PET (global and regional; temporal, frontal, parietal, and cingulate) and CSF Aβ42 measurements at baseline. We compared area under the curve (AUC), sensitivity, and specificity (testing a priori and optimized cutoffs). Clinical diagnosis was the reference standard. RESULTS CSF Aβ42 and (global or regional) PET florbetapir did not differ in AUC (CN vs. AD, CSF 84.4%; global PET 86.9%; difference [95% confidence interval] -6.7 to 1.5). CSF Aβ42 and global PET florbetapir did not differ in sensitivity, but PET had greater specificity than CSF in most comparisons. Sixteen CN progressed to MCI and AD (six Aβ negative, seven Aβ positive, and three PET positive but CSF negative). INTERPRETATION The overall diagnostic accuracies of CSF Aβ42 and PET florbetapir were similar, but PET had greater specificity. This was because some CN and sMCI subjects appear pathological using CSF but not using PET, suggesting that low CSF Aβ42 not always translates to cognitive decline or brain Aβ accumulation. Other factors, including costs and side effects, may also be considered when determining the optimal modality for different applications.
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Affiliation(s)
- Niklas Mattsson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal, Sweden ; Department of Radiology and Biomedical Imaging, University of California San Francisco, California ; Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases San Francisco, California
| | - Philip S Insel
- Department of Radiology and Biomedical Imaging, University of California San Francisco, California
| | - Susan Landau
- Helen Wills Neuroscience Institute and School of Public Health, University of California Berkeley, California
| | - William Jagust
- Helen Wills Neuroscience Institute and School of Public Health, University of California Berkeley, California
| | - Michael Donohue
- Division of Biostatistics and Bioinformatics, Department of Family & Preventive Medicine, University of California, San Diego La Jolla, California
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal, Sweden ; UCL Institute of Neurology Queen Square, London, WC1N 3BG, United Kingdom
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal, Sweden
| | - Michael Weiner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, California ; Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases San Francisco, California
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Sperling R, Downing AC, Salmon D, Rentz D, Siemers E, Sethuraman G, Karlawish J, Johnson K, Donohue M, Aisen P. THE A4 TRIAL: ANTI‐AMYLOID TREATMENT OF ASYMPTOMATIC ALZHEIMER'S DISEASE. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.04.378] [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: 11/16/2022]
Affiliation(s)
- Reisa Sperling
- Brigham and Women's HospitalBostonMassachusettsUnited States
| | | | - David Salmon
- University of California San DiegoLa JollaCaliforniaUnited States
| | | | - Eric Siemers
- Eli Lilly and CompanyIndianapolisIndianaUnited States
| | | | - Jason Karlawish
- University of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | | | - Michael Donohue
- University of California San DiegoLa JollaCaliforniaUnited States
| | - Paul Aisen
- University of California San DiegoLa JollaCaliforniaUnited States
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16
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Mattsson N, Tosun D, Insel PS, Simonson A, Jack CR, Beckett LA, Donohue M, Jagust W, Schuff N, Weiner MW. Association of brain amyloid-β with cerebral perfusion and structure in Alzheimer's disease and mild cognitive impairment. ACTA ACUST UNITED AC 2014; 137:1550-61. [PMID: 24625697 DOI: 10.1093/brain/awu043] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [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: 12/19/2022]
Abstract
Patients with Alzheimer's disease have reduced cerebral blood flow measured by arterial spin labelling magnetic resonance imaging, but it is unclear how this is related to amyloid-β pathology. Using 182 subjects from the Alzheimer's Disease Neuroimaging Initiative we tested associations of amyloid-β with regional cerebral blood flow in healthy controls (n = 51), early (n = 66) and late (n = 41) mild cognitive impairment, and Alzheimer's disease with dementia (n = 24). Based on the theory that Alzheimer's disease starts with amyloid-β accumulation and progresses with symptoms and secondary pathologies in different trajectories, we tested if cerebral blood flow differed between amyloid-β-negative controls and -positive subjects in different diagnostic groups, and if amyloid-β had different associations with cerebral blood flow and grey matter volume. Global amyloid-β load was measured by florbetapir positron emission tomography, and regional blood flow and volume were measured in eight a priori defined regions of interest. Cerebral blood flow was reduced in patients with dementia in most brain regions. Higher amyloid-β load was related to lower cerebral blood flow in several regions, independent of diagnostic group. When comparing amyloid-β-positive subjects with -negative controls, we found reductions of cerebral blood flow in several diagnostic groups, including in precuneus, entorhinal cortex and hippocampus (dementia), inferior parietal cortex (late mild cognitive impairment and dementia), and inferior temporal cortex (early and late mild cognitive impairment and dementia). The associations of amyloid-β with cerebral blood flow and volume differed across the disease spectrum, with high amyloid-β being associated with greater cerebral blood flow reduction in controls and greater volume reduction in late mild cognitive impairment and dementia. In addition to disease stage, amyloid-β pathology affects cerebral blood flow across the span from controls to dementia patients. Amyloid-β pathology has different associations with cerebral blood flow and volume, and may cause more loss of blood flow in early stages, whereas volume loss dominates in late disease stages.
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Affiliation(s)
- Niklas Mattsson
- 1 Department of Veterans Affairs Medical Centre, Centre for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
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Rissman RA, Donohue M, Moghadam S, Sun C, Roe A, Edland S, Aisen P. P4–355: Factors that influence use of plasma beta‐amyloid as a biomarker of Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.08.189] [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: 11/17/2022]
Affiliation(s)
- Robert A. Rissman
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Michael Donohue
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Setareh Moghadam
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Chung‐Kai Sun
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Allyson Roe
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Steven Edland
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
| | - Paul Aisen
- Alzheimer's Disease Cooperative Study UCSD La Jolla California United States
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18
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Axer H, Donohue M, Moore D, Welch T. Training and Supervision of Residential Staff in Community-based Treatment Facilities. Arch Psych Psych 2013. [DOI: 10.12740/app/18144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Dunn W, Sanyal AJ, Brunt EM, Unalp-Arida A, Donohue M, McCullough AJ, Schwimmer JB. Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD). J Hepatol 2012; 57:384-91. [PMID: 22521357 PMCID: PMC3399018 DOI: 10.1016/j.jhep.2012.03.024] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/08/2012] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. METHODS In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. RESULTS The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p=0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers. CONCLUSIONS In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.
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Affiliation(s)
- Winston Dunn
- Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, CA,Gastroenterology and Hepatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Elizabeth M. Brunt
- John Cochran VA Medical Center, Saint Louis and Division of Gastroenterology, Saint Louis University School of Medicine, Saint Louis, MO
| | - Aynur Unalp-Arida
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael Donohue
- Division of Biostatics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | | | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics University of California, San Diego, CA,Department of Gastroenterology, Rady Children’s Hospital, San Diego, CA
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20
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Donohue M, Aisen P, Dartigues J, Jacqmin‐Gadda H, Gamst A, Le Goff M. O4‐01‐03: Validating Alzheimer's pathological cascade by merging ADNI with PAQUID. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.1636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Donohue
- University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Paul Aisen
- University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | | | | | - Anthony Gamst
- University of CaliforniaSan Diego, La JollaCaliforniaUnited States
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21
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Schafer K, Sano M, Donohue M, Sun C, Aisen P, Schneider L. P2‐288: Performance on ADAS‐Cog items across ADCS trials. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.996] [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: 10/28/2022]
Affiliation(s)
- Kimberly Schafer
- University of CaliforniaSan DiegoLa JollaCaliforniaUnited States
| | - Mary Sano
- Mount Sinai School of Medicine & James J. Peters VAMCNew YorkNew YorkUnited States
| | - Michael Donohue
- University of CaliforniaSan DiegoLa JollaCaliforniaUnited States
| | | | - Paul Aisen
- UC San DiegoLa JollaCaliforniaUnited States
| | - Lon Schneider
- University of Southern CaliforniaLos AngelesCaliforniaUnited States
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22
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Burns L, Rueckert D, Bhagwagar Z, Donohue M, Wolz R, Tiller J, Soares H, l'Italien G, Coric V, Hayes W, Fox N, Berman R. P2‐412: A comparison of hippocampal atrophy algorithms to select outcome measures for clinical trials in mild‐to‐moderate Alzheimer's disease. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.2037] [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: 10/28/2022]
Affiliation(s)
- Leah Burns
- Bristol‐Myers SquibbLawrencevilleNew JerseyUnited States
| | | | | | - Michael Donohue
- University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Robin Wolz
- Imperial College LondonLondonUnited Kingdom
| | - Jane Tiller
- Bristol‐Myers SquibbPrincetonNew JerseyUnited States
| | - Holly Soares
- Bristol‐Myers SquibbPrincetonNew JerseyUnited States
| | | | - Vlad Coric
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Wendy Hayes
- Bristol‐Myers SquibbPrincetonNew JerseyUnited States
| | - Nick Fox
- University College LondonLondonUnited Kingdom
| | - Robert Berman
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
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23
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Vellas B, Hampel H, Rougé-Bugat ME, Grundman M, Andrieu S, Abu-Shakra S, Bateman R, Berman R, Black R, Carrillo M, Donohue M, Mintun M, Morris J, Petersen R, Thomas RG, Suhy J, Schneider L, Seely L, Tariot P, Touchon J, Weiner M, Sampaio C, Aisen P. Alzheimer's disease therapeutic trials: EU/US Task Force report on recruitment, retention, and methodology. J Nutr Health Aging 2012; 16:339-45. [PMID: 22499454 DOI: 10.1007/s12603-012-0044-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 02/07/2023]
Abstract
While we may not be able to find a cure for Alzheimer's disease (AD) in the near future, several drugs presently in trials have shown promise as possible modifiers of disease progression. However, we may not be able to demonstrate efficacy due to issues of recruitment, retention, site-to-site variability, and other methodological issues. It is thus incumbent on the scientific community to find solutions to these problems, particularly as the field moves toward preventing illness or treating the disease in its prodromal stages, where these methodological issues will become even more critical. We need to better understand why participants agree or refuse to enter drug trials, and why both primary care physicians and Alzheimer's specialists agree or refuse to involve their patients. We also need to quantify the impact of requiring imaging studies, extensive questionnaires, cognitive testing, and lumbar punctures on recruitment and retention. With these concerns in mind, an international task force meeting of experts from academia and industry in the United States, European Union, and Japan in San Diego, California on November 2, 2011 to focus on recruitment, retention and other methodological issues related to clinical trials for AD. Based on the recommendations of this Task force meeting, this Perspectives article critically reflects on the most critical and timely methodological issues related to recruitment and retention in prevention and therapeutic trials in AD, which are paralleled by a paradigm shift in the diagnostic conceptualization of this disease, as reflected by recently new proposed diagnostic criteria involving preclinical stages of the disease.
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Chojkier M, Elkhayat H, Sabry D, Donohue M, Buck M. Pioglitazone decreases hepatitis C viral load in overweight, treatment naïve, genotype 4 infected-patients: a pilot study. PLoS One 2012; 7:e31516. [PMID: 22412837 PMCID: PMC3296686 DOI: 10.1371/journal.pone.0031516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/09/2012] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Insulin resistance (IR) is induced by chronic hepatitis C virus (HCV) genotypes 1 and 4 infections. It is not known whether drugs that affect IR such as Pioglitazone and Prednisone also affect serum HCV RNA titers independently of PEG-Interferon-α2/ribavirin treatment. The primary aim was to assess whether Pioglitazone by improving IR and/or inflammation decreases HCV viral load independently of standard of care HCV treatment. A secondary aim was to assess whether Prednisone, a drug that induces insulin resistance and stimulates HCV viral entry and replication in replicon culture systems, increases HCV viral load in this population. METHODOLOGY/PRINCIPAL FINDINGS We designed a two-arm, parallel Pilot Study of overweight, treatment naïve genotype 4 HCV-infected patients at a public referral Liver Clinic in Giza, Egypt. The subjects received Pioglitazone (30 mg/day for 14 days) or Prednisone (40 mg/day for 4 days) in a randomized fashion, but the two arms can be considered independent pilot studies. Only changes from baseline within each arm were assessed and no contrasts of the interventions were made, as this was not an aim of the study. Among 105 consecutive HCV genotype 4 patients, 39 were enrolled based on the optimal sample size and power analysis according to the CONSORT statement; 20 to the Pioglitazone group and 19 to the Prednisone group. Pioglitazone was effective in decreasing serum HCV RNA at day-14 (n = 10; difference of means = 205,618 IU/ml; 95% CI 26,600 to 384,600; P<0.001). Although Prednisone did increase serum HCV RNA at day-4 (n = 10; change from baseline = -42,786 IU/ml; 95% CI -85,500 to -15,700; P = 0.049), the log(10) HCV RNA titers were statistically not different from baseline day-0. CONCLUSION/SIGNIFICANCE This is the first documentation that Pioglitazone decreases the serum HCV RNA titers independently of PEG-Interferon-α2/ribavirin treatment. The novel findings of our Study provide the foundation for basic and clinical investigations on the molecular mechanisms responsible for the Pioglitazone-induced decrease in HCV genotype 4 RNA titers. TRIAL REGISTRATION ClinicalTrials.gov NCT01157975.
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Affiliation(s)
- Mario Chojkier
- Department of Medicine, San Diego VA Healthcare System, San Diego, California, United States of America.
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Burns L, Berman R, Guo Z, Soares H, Kaplita S, Yoo B, Donohue M. P1‐300: The relationship between cerebral spinal fluid (CSF) biomarkers and Pittsburgh Compound B (PiB) positron emission tomography (PET) in predicting Alzheimer's disease (AD). Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.579] [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: 10/14/2022]
Affiliation(s)
- Leah Burns
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Robert Berman
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Zhenchao Guo
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Holly Soares
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | | | - Bongin Yoo
- Bristol‐Myers SquibbWallingfordConnecticutUnited States
| | - Michael Donohue
- University of CaliforniaLa JollaSan DiegoCaliforniaUnited States
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Schafer K, Sano M, Aisen P, Donohue M, Sun C, Schneider L. P1‐472: Extent and impact of missing ADAS‐cog items in ADCS clinical trials. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.754] [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: 10/17/2022]
Affiliation(s)
- Kimberly Schafer
- University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Mary Sano
- Mt. Sinai School of MedicineNew YorkNew YorkUnited States
| | - Paul Aisen
- ADCS/University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Michael Donohue
- ADCS/University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Chung‐Kai Sun
- ADCS/University of CaliforniaSan Diego, La JollaCaliforniaUnited States
| | - Lon Schneider
- University of Southern CaliforniaLos AngelesCaliforniaUnited States
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Sano M, Egelko S, Ferris S, Kaye J, Hayes T, Mundt J, Reyes T, Donohue M, Sun C, Whitehair D, Stokes K, Aisen P. O3‐07‐03: Alzheimer disease cooperative study (ADCS) home based assessment: Designing trials with new technology. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1434] [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: 11/29/2022]
Affiliation(s)
- Mary Sano
- Mount Sindi School of MedicineNew YorkN.Y.United States
| | - Susan Egelko
- Mount Sindi School of MedicineNew YorkN.Y.United States
| | | | - Jeffrey Kaye
- Oregon Health & Science UniversityPortlandOregonUnited States
| | | | - James Mundt
- HealthCare Technology SystemMadisonWisconsinUnited States
| | - Tracy Reyes
- HealthCare Technology SystemMadisonWisconsinUnited States
| | | | | | | | | | - Paul Aisen
- ADCS/UCSDLa JollaCaliforniaUnited States
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Messick V, Donohue M, Raman R, Sano M, Quinn J, Thomas R, Emond J, Aisen P. P3‐406: Role of caregiver in subject's compliance with treatment. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1849] [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: 10/14/2022]
Affiliation(s)
- Viviana Messick
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
| | - Michael Donohue
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
| | - Rema Raman
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
| | - Mary Sano
- Mount Sinai School of Medicine & James J Peters VAMCBronxNew YorkUnited States
| | - Joseph Quinn
- Oregon Health and Sciences UniversityPortlandOregonUnited States
| | - Ron Thomas
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
| | - Jennifer Emond
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
| | - Paul Aisen
- Univesity of CaliforniaLa JollaSan DiegoCaliforniaUnited States
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Sharma K, Ix JH, Mathew AV, Cho M, Pflueger A, Dunn SR, Francos B, Sharma S, Falkner B, McGowan TA, Donohue M, Ramachandrarao S, Xu R, Fervenza FC, Kopp JB. Pirfenidone for diabetic nephropathy. J Am Soc Nephrol 2011; 22:1144-51. [PMID: 21511828 DOI: 10.1681/asn.2010101049] [Citation(s) in RCA: 213] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pirfenidone is an oral antifibrotic agent that benefits diabetic nephropathy in animal models, but whether it is effective for human diabetic nephropathy is unknown. We conducted a randomized, double-blind, placebo-controlled study in 77 subjects with diabetic nephropathy who had elevated albuminuria and reduced estimated GFR (eGFR) (20 to 75 ml/min per 1.73 m²). The prespecified primary outcome was a change in eGFR after 1 year of therapy. We randomly assigned 26 subjects to placebo, 26 to pirfenidone at 1200 mg/d, and 25 to pirfenidone at 2400 mg/d. Among the 52 subjects who completed the study, the mean eGFR increased in the pirfenidone 1200-mg/d group (+3.3 ± 8.5 ml/min per 1.73 m²) whereas the mean eGFR decreased in the placebo group (-2.2 ± 4.8 ml/min per 1.73 m²; P = 0.026 versus pirfenidone at 1200 mg/d). The dropout rate was high (11 of 25) in the pirfenidone 2400-mg/d group, and the change in eGFR was not significantly different from placebo (-1.9 ± 6.7 ml/min per 1.73 m²). Of the 77 subjects, 4 initiated hemodialysis in the placebo group, 1 in the pirfenidone 2400-mg/d group, and none in the pirfenidone 1200-mg/d group during the study (P = 0.25). Baseline levels of plasma biomarkers of inflammation and fibrosis significantly correlated with baseline eGFR but did not predict response to therapy. In conclusion, these results suggest that pirfenidone is a promising agent for individuals with overt diabetic nephropathy.
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Affiliation(s)
- Kumar Sharma
- Center for Renal Translational Medicine, University of California-San Diego/Veteran Affairs Medical Center, La Jolla, CA 92093-0711, USA.
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Aisen PS, Andrieu S, Sampaio C, Carrillo M, Khachaturian ZS, Dubois B, Feldman HH, Petersen RC, Siemers E, Doody RS, Hendrix SB, Grundman M, Schneider LS, Schindler RJ, Salmon E, Potter WZ, Thomas RG, Salmon D, Donohue M, Bednar MM, Touchon J, Vellas B. Report of the task force on designing clinical trials in early (predementia) AD. Neurology 2010; 76:280-6. [PMID: 21178097 DOI: 10.1212/wnl.0b013e318207b1b9] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A large number of promising candidate disease-modifying treatments for Alzheimer disease (AD) continue to advance into phase II and phase III testing. However, most completed trials have failed to demonstrate efficacy, and there is growing concern that methodologic difficulties may contribute to these clinical trial failures. The optimal time to intervene with such treatments is probably in the years prior to the onset of dementia, before the neuropathology has progressed to the advanced stage corresponding to clinical dementia. METHOD An international task force of individuals from academia, industry, nonprofit foundations, and regulatory agencies was convened to discuss optimal trial design in early (predementia) AD. RESULTS General consensus was reached on key principles involving the scope of the AD diagnosis, the selection of subjects for trials, outcome measures, and analytical methods. CONCLUSION A consensus has been achieved in support of the testing of candidate treatments in the early (predementia) AD population.
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Affiliation(s)
- P S Aisen
- Department of Neurosciences, UCSD, 9500 Gilman Drive M/C 0949, La Jolla, CA 92093, USA
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Abstract
OBJECTIVE The primary aim of this study was to assess the relationship between adenovirus 36 (AD36)-specific antibodies and obesity in children. METHODS A cross-sectional study of children 8 to 18 years of age was performed. Children were classified according to BMI percentile as nonobese (<95th percentile) or obese (≥95th percentile). The presence of AD36-specific neutralizing antibodies was assessed by using the serum neutralization assay. RESULTS A total of 124 children (median age: 13.6 years) were studied. Of those children, 46% were nonobese and 54% were obese. AD36 positivity was present in 19 children (15%). The majority of children found to be AD36-positive were obese (15 [78%] of 19 children). AD36 positivity was significantly (P<.05) more frequent in obese children (15 [22%] of 67 children) than nonobese children (4 [7%] of 57 children). Among the subset of children who were obese, those who were AD36-positive had significantly larger anthropometric measures, including weight, BMI, waist circumference, and waist/height ratio. CONCLUSION These data support an association of obesity and higher body weight with the presence of neutralizing antibodies to AD36 in children. If a cause-and-effect relationship is established, it would have considerable implications for the prevention and treatment of childhood obesity.
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Affiliation(s)
- Charles Gabbert
- University of California, San Diego, Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, School of Medicine, and Department of Gastroenterology, Rady Children's Hospital San Diego, 200 West Arbor Dr, San Diego, CA 92103-8450, USA
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Beckett LA, Harvey DJ, Gamst A, Donohue M, Kornak J, Zhang H, Kuo JH. The Alzheimer's Disease Neuroimaging Initiative: Annual change in biomarkers and clinical outcomes. Alzheimers Dement 2010; 6:257-64. [PMID: 20451874 DOI: 10.1016/j.jalz.2010.03.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 03/02/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Alzheimer's Disease Neuroimaging Initiative Phase 1 (ADNI-1) is a multisite prospective study designed to examine potential cerebrospinal fluid and imaging markers of Alzheimer's disease (AD) and their relationship to cognitive change. The objective of this study was to provide a global summary of the overall results and patterns of change observed in candidate markers and clinical measures over the first 2 years of follow-up. METHODS Change was summarized for 210 normal controls, 357 mild cognitive impairment, and 162 AD subjects, with baseline and at least one cognitive follow-up assessment. Repeated measures and survival models were used to assess baseline biomarker levels as predictors. Potential for improving clinical trials was assessed by comparison of precision of markers for capturing change in hypothetical trial designs. RESULTS The first 12 months of complete data on ADNI participants demonstrated the potential for substantial advances in characterizing trajectories of change in a range of biomarkers and clinical outcomes, examining their relationship and timing, and assessing the potential for improvements in clinical trial design. Reduced metabolism and greater brain atrophy in the mild cognitive impairment at baseline are associated with more rapid cognitive decline and a higher rate of conversion to AD. Use of biomarkers as study entry criteria or as outcomes could reduce the number of participants required for clinical trials. CONCLUSIONS Analyses and comparisons of ADNI data strongly support the hypothesis that measurable change occurs in cerebrospinal fluid, positron emission tomography, and magnetic resonance imaging well in advance of the actual diagnosis of AD.
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Affiliation(s)
- Laurel A Beckett
- Department of Public Health Sciences, University of California, Davis, CA, USA.
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Murphy EA, Holland D, Donohue M, McEvoy LK, Hagler DJ, Dale AM, Brewer JB. Six-month atrophy in MTL structures is associated with subsequent memory decline in elderly controls. Neuroimage 2010; 53:1310-7. [PMID: 20633660 DOI: 10.1016/j.neuroimage.2010.07.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/02/2010] [Accepted: 07/07/2010] [Indexed: 01/15/2023] Open
Abstract
Neurodegeneration precedes the onset of dementias such as Alzheimer's by several years. Recent advances in volumetric imaging allow quantification of subtle neuroanatomical change over time periods as short as six months. This study investigates whether neuroanatomical change in medial temporal lobe subregions is associated with later memory decline in elderly controls. Using high-resolution, T1-weighted magnetic resonance images acquired at baseline and six-month follow-up, change in cortical thickness and subcortical volumes was measured in 142 healthy elderly subjects (aged 59-90 years) from the ADNI cohort. Regression analysis was used to identify whether change in fourteen subregions, selected a priori, was associated with declining performance on memory tests from baseline to two-year follow-up. Percent thickness change in the right fusiform and inferior temporal cortices and expansion of the right inferior lateral ventricle were found to be significant predictors of subsequent decline on memory-specific neuropsychological measures. These results demonstrate that six-month regional neurodegeneration can be quantified in the healthy elderly and might help identify those at risk for subsequent cognitive decline.
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Affiliation(s)
- E A Murphy
- Department of Neurosciences, University of California, San Diego, CA, USA
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Burns L, L'Italien G, Guo Z, Lapuerta P, Risinger R, Berman RM, Kaplita S, Hill D, Feldman H, Rueckert D, Donohue M. P1‐384: Predicting time to dementia based on selected MRI volumetrics and CSF measures. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.938] [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: 11/30/2022]
Affiliation(s)
- Leah Burns
- Bristol - Myers SquibbWallingford CT USA
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Donohue M, Gamst A, Thomas R, Brewer J, Weiner M, Aisen P. O3‐01‐07: Rate of decline in ADNI normal controls with evidence of amyloid burden. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.395] [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: 10/19/2022]
Affiliation(s)
| | | | - Ron Thomas
- University of California San DiegoSan Diego CA USA
| | - Jim Brewer
- University of California San DiegoSan Diego CA USA
| | | | - Paul Aisen
- University of California San DiegoSan Diego CA USA
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Lorenzi M, Donohue M, Paternicò D, Scarpazza C, Ostrowitzki S, Blin O, Irving E, Frisoni GB. Enrichment through biomarkers in clinical trials of Alzheimer's drugs in patients with mild cognitive impairment. Neurobiol Aging 2010; 31:1443-51, 1451.e1. [PMID: 20541287 DOI: 10.1016/j.neurobiolaging.2010.04.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/25/2022]
Abstract
Clinical trials of disease modifying drugs for Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) might benefit from enrichment with true AD cases. Four hundred five MCI patients (143 converters and 262 nonconverters to AD within 2 years) of the Alzheimer's disease Neuroimaging Initiative (ADNI) were used. Markers for enrichment were hippocampal atrophy on magnetic resonance (MRI), temporoparietal hypometabolism on FDG PET, cerebrospinal fluid (CSF) biomarkers (Abeta42, tau, and phospho-tau), and cortical amyloid deposition (11C-PIB positron emission tomography (PET)). Two separate enrichment strategies were tested to A) maximize the proportion of MCI converters screened in, and B) minimize the proportion of MCI converters screened out. Based on strategy A, when compared with no enrichment and ADAS-Cog as an outcome measure (sample size of 834), enrichment with 18F-FDG PET and hippocampal volume lowered samples size to 260 and 277 cases per arm, but at the cost of screening out 1,597 and 434 cases per arm. When compared with no enrichment and clinical dementia rating (CDR-SOB) as an outcome measure (sample size of 674), enrichment with hippocampal volume and Abeta42 lowered sample sizes to 191 and 291 cases per arm, with 639 and 157 screened out cases. Strategy B reduced the number of screened out cases (740 for [11C]-PIB PET, 101 hippocampal volume, 82 ADAS-COG and 330 for [18F]-FDG PET) but at the expense of decreased power and a relative increase size (740 for [11C]-PIB PET, 676 for hippocampal volume, 744 for ADAS-Cog, and 517 for [18F]-FDG PET). Enrichment comes at the price of an often relevant proportion of screened out cases, and in clinical trial settings, the balance between enrichment of screened in and loss of screened out patients should be critically discussed.
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Affiliation(s)
- M Lorenzi
- LENITEM Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS San Giovanni di Dio-FBF, Brescia, Italy
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Fleisher AS, Donohue M, Chen K, Brewer JB, Aisen PS. Applications of neuroimaging to disease-modification trials in Alzheimer's disease. Behav Neurol 2009; 21:129-36. [PMID: 19847051 PMCID: PMC5444278 DOI: 10.3233/ben-2009-0241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Critical to development of new therapies for Alzheimer’s disease (AD) is the ability to detect clinical or pathological change over time. Clinical outcome measures typically used in therapeutic trials have unfortunately proven to be relatively variable and somewhat insensitive to change in this slowly progressive disease. For this reason, development of surrogate biomarkers that identify significant disease-associated brain changes are necessary to expedite treatment development in AD. Since AD pathology is present in the brain many years prior to clinical manifestation, ideally we want to develop biomarkers of disease that identify abnormal brain structure or function even prior to cognitive decline. Magnetic resonance imaging, fluorodeoxyglucose positron emission tomography, new amyloid imaging techniques, and spinal fluid markers of AD all have great potential to provide surrogate endpoint measures for AD pathology. The Alzheimer’s disease neuroimaging initiative (ADNI) was developed for the distinct purpose of evaluating surrogate biomarkers for drug development in AD. Recent evidence from ADNI demonstrates that imaging may provide more sensitive, and earlier, measures of disease progression than traditional clinical measures for powering clinical drug trials in Alzheimer's disease. This review discusses recently presented data from the ADNI dataset, and the importance of imaging in the future of drug development in AD.
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Affiliation(s)
- Adam S Fleisher
- Department of Neurosciences, University of California, San Diego, USA.
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Rosencrantz MA, Wachs DS, Coffler MS, Malcom PJ, Donohue M, Chang RJ. Comparison of inhibin B and estradiol responses to intravenous FSH in women with polycystic ovary syndrome and normal women. Hum Reprod 2009; 25:198-203. [PMID: 19850592 DOI: 10.1093/humrep/dep373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Inhibin B (Inh B) is produced by pre-antral and early antral follicles whereas estradiol (E(2)) is a product of follicles undergoing antrum formation. This temporal distinction is evident in the patterns of Inh B and E(2) release earlier and later during the follicular phase of the menstrual cycle, respectively. However, in previous studies of women with polycystic ovary syndrome (PCOS) and normal controls, release of these granulosa cell (GC) products appears to be simultaneous in response to FSH stimulation. In order to reconcile these disparate findings, we conducted dose-response studies in both PCOS women and normal controls to determine whether GC product responses were due to the amount of FSH administered. In addition, we compared FSH-stimulated responses in PCOS women at various stages of recovery following ovarian suppression with a long-acting GnRH agonist to examine whether Inh B and E(2) responses reflected the level of ovarian follicle activity (i.e. circulating E(2) levels). METHODS Women with PCOS, 18-35 years (n = 23), and normal ovulatory controls, 18-35 years (n = 10) were recruited for study. Dose-responses were assessed over 24 h following intravenous administration of 0 (saline), 37.5, 75 and 150 IU of recombinant human FSH (r-hFSH) in PCOS and normal women. In addition, E(2) and Inh B responses to 150 IU of r-hFSH were assessed at baseline and 4, 6 and 8 weeks following suppression of ovarian steroidogenesis by a long-acting GnRH agonist in PCOS women. RESULTS In PCOS women and normal controls, serum Inh B and E(2) exhibit similar and simultaneous dose-responsiveness to FSH stimulation. During recovery from ovarian suppression, basal and stimulated Inh B release appear to be restored earlier than that of E(2) in PCOS women. CONCLUSIONS These findings are consistent with the notion that, in PCOS women, the level of ovarian follicle activity largely determines the earlier release of Inh B compared with E(2).
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Affiliation(s)
- Marcus A Rosencrantz
- Departments of Reproductive Medicine, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0633, USA
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Abstract
Muscle wasting is a critical feature of patients afflicted by acquired immune deficiency syndrome (AIDS), cancer, or chronic inflammatory diseases. In a mouse model of muscle wasting, TNF-alpha induces oxidative stress and nitric oxide synthase-2 (NOS2) and decreases myogenin, Jun-D, and creatinine kinase muscle isoform (CKM) expression. Here, we studied 12 patients with muscle wasting due to cancer (N = 10) or AIDS (N = 2) and 4 control subjects. We show that in skeletal muscle of cachectic patients there is 1) increased expression and activity of the TNF-alpha signaling, including TNF-alpha mRNA, activation of TNFR1, and TNF-alpha-associated to TNFR1; 2) increased oxidative stress, as determined by the presence of malondialdehyde-lysine adducts; 3) increased NOS2 mRNA and protein; 4) decreased expression of Jun-D, myogenin, myosin, and CKM mRNA and protein; 5) impaired CKM-E box binding activities, associated with decreased Jun-D/myogenin activities; and 6) oxidative modification and ubiquitination of Jun-D. These studies show that these molecular pathways are modulated in association with muscle wasting in patients with cancer or AIDS, and whether or not they cause muscle wasting remains to be determined.
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Affiliation(s)
- Sonia Ramamoorthy
- Department of Surgery, University of California San Diego, San Diego, California, USA
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Leung AY, Duann JR, McGreevy K, Li E, Xu RH, Donohue M, Taksh T. The Supraspinal Pain Pathway of the Thermal Grill Illusion. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70280-0] [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: 10/20/2022] Open
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Donohue M, Gamst A, Aisen P. P4‐305: Designing Early (pre‐dementia) Alzheimer's Disease Trials: Linear Mixed Models Versus Time To Conversion. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.07.084] [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: 11/24/2022]
Affiliation(s)
| | | | - Paul Aisen
- University of California San DiegoSan DiegoCAUSA
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Leung A, Lefaucheur J, Rollnik J, Donohue M, Xu R, Lee R, André-Obadia N, Khedr E, Saitoh Y, Wallace M, Chan R. RTMS in neuropathic pain management-a meta-analysis. The Journal of Pain 2009. [DOI: 10.1016/j.jpain.2009.01.161] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hayes SL, Waltmann M, Donohue M, Lye DJ, Vesper SJ. Predicting virulence of Aeromonas isolates based on changes in transcription of c-jun and c-fos in human tissue culture cells. J Appl Microbiol 2009; 107:964-9. [PMID: 19320953 DOI: 10.1111/j.1365-2672.2009.04276.x] [Citation(s) in RCA: 2] [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: 11/30/2022]
Abstract
AIMS To screen for the virulence potential of Aeromonas isolates based on the change in regulation of c-jun and c-fos in the human intestinal tissue culture cell line Caco-2. METHODS AND RESULTS Aeromonas cells were added to Caco-2 cells at a ratio of approx. 1 : 1. After 1-, 2- and 3-h incubation at 37 degrees C, mRNA was extracted from the cells and gene expression of two host genes, c-jun and c-fos, quantified. Aeromonas isolates which were pathogenic in the neonatal mouse model demonstrated up-regulation of c-jun and c-fos compared to avirulent isolates. CONCLUSIONS Human cell culture results showed that c-jun and c-fos were predictive of Aeromonas virulence. SIGNIFICANCE AND IMPACT OF THE STUDY An Aeromonas relative virulence scale is proposed for use in the testing of Aeromonas drinking water isolates.
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Affiliation(s)
- S L Hayes
- USEPA, National Risk Management Research Laboratory, Water Supply/Water Resources Division, Cincinnati, OH 45268, USA
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45
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Huang JS, Donohue M, Golnari G, Fernandez S, Walker-Gallego E, Galvan K, Briones C, Tamai J, Becerra K. Pediatricians' weight assessment and obesity management practices. BMC Pediatr 2009; 9:19. [PMID: 19265553 PMCID: PMC2671508 DOI: 10.1186/1471-2431-9-19] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 03/05/2009] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinician adherence to obesity screening guidelines from United States health agencies remains suboptimal. This study explored how personal and career demographics influence pediatricians' weight assessment and management practices. METHODS A web-based survey was distributed to U.S. pediatricians. Respondents were asked to identify the weight status of photographed children and about their weight assessment and management practices. Associations between career and personal demographic variables and pediatricians' weight perceptions, weight assessment and management practices were evaluated using univariate and multivariate modeling. RESULTS 3,633 pediatric medical providers correctly identified the weight status of children at a median rate of 58%. The majority of pediatric clinicians were white, female, and of normal weight status with more than 10 years clinical experience. Experienced pediatric medical providers were less likely than younger colleagues to correctly identify the weight status of pictured children and were also less likely to know and use BMI criteria for assessing weight status. General pediatricians were more likely than subspecialty practitioners to provide diverse interventions for weight management. Non-white and Hispanic general practitioners were more likely than counterparts to consider cultural approaches to weight management. CONCLUSION Pediatricians' perceptions of children's weight and their weight assessment and management practices are influenced by career and personal characteristics. Objective criteria and clinical guidelines should be uniformly applied by pediatricians to screen for and manage pediatric obesity.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Michael Donohue
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, USA
| | - Golnaz Golnari
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
| | - Susan Fernandez
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
| | | | - Kate Galvan
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
| | - Christina Briones
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
| | - Jennifer Tamai
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
| | - Karen Becerra
- Department of Pediatrics, University of California, San Diego, CA 92103, USA
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Abstract
Self-recognition of overweight status is often the initial step toward successful weight management. Among children, parental recognition of overweight status in their child may also be necessary for weight management success given the role of parents in engaging their child in weight-related behaviors. This study explored parental influence on their child's weight self-perception and their child's desire to lose weight. In total, 718 children and their parents were surveyed concerning children's personal weight status. The effect of parental weight perceptions on their child's weight self-perception and their child's desire to lose weight (among children ≥ 85th body mass index percentile for age and sex) was evaluated using generalized estimating equation (GEE) modeling. In GEE regression analyses, children's perceptions of their own weight (correct vs incorrect) were significantly associated with their parents' ability to correctly recognize their child's weight status. Among overweight and obese children, desire to lose weight was strongly associated with parental ability to correctly recognize their child's weight status. Children's self-perceptions of weight and overweight and obese children's desire to lose weight are strongly associated with parental perceptions of their child's weight. Our data indicate that interventions promoting healthy weight perceptions for pediatric weight management should target not only children but also their parents.
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Affiliation(s)
- Jeannie S. Huang
- Department of Pediatrics, University of California,
San Diego, , Rady Children's Hospital, San Diego, California
| | - Michael Donohue
- Division of Biostatistics and Bioinformatics, La Jolla,
California
| | - Karen Becerra
- Department of Pediatrics, University of California,
San Diego
| | - Ronghui Xu
- Division of Biostatistics and Bioinformatics, La Jolla,
California
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Matt GE, Romero R, Ma DS, Quintana PJ, Hovell MF, Donohue M, Messer K, Salem S, Aguilar M, Boland J, Cullimore J, Crane M, Junker J, Tassinario P, Timmermann V, Wong K, Chatfield D. Tobacco use and asking prices of used cars: prevalence, costs, and new opportunities for changing smoking behavior. Tob Induc Dis 2008; 4:2. [PMID: 18822157 PMCID: PMC2547891 DOI: 10.1186/1617-9625-4-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 07/31/2008] [Indexed: 11/26/2022] Open
Abstract
Secondhand smoke (SHS) causes premature death and disease in children and adults, and the scientific evidence indicates that there is no risk-free level of exposure to SHS. Smoking tobacco in a car can pollute the microenvironment of the car with residual SHS, leaving telltale signs to potential buyers (e.g., odor, used ash tray). This study examined (a) the proportion of used cars sold in the private party market that may be polluted with tobacco smoke and (b) whether asking prices of smoker and nonsmoker cars differed for cars of otherwise equivalent value. A random sample of 1,642 private party sellers were interviewed by telephone, and content analyses of print advertisements were conducted. Findings indicate that 22% of used cars were advertised by smokers or had been smoked in during the previous year. Among nonsmokers, 94% did not allow smoking in their car during the past year. Only 33% of smokers had the same restrictions. The smoking status of the seller and tobacco use in the car were significantly (p < .01) associated with the asking price independent of a car's Kelley Blue Book value (KBB). Used nonsmoker cars were offered at a considerable premium above their KBB value (>11%) and above comparable smoker cars (7–9%). These findings suggest that community preferences are affecting the value of smoke-free cars. New directions for research, tobacco control policies, and health education are discussed to further reduce smoking behavior, to help consumers make informed purchasing decisions, and to protect nonsmokers from SHS exposure.
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Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, USA.
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48
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Bashey A, Donohue M, Liu L, Medina B, Corringham S, Ihasz A, Carrier E, Castro JE, Holman PR, Xu R, Law P, Ball ED, Lane TA. Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide, sequential granulocyte-macrophage-colony-stimulating factor and granulocyte-colony-stimulating factor, and scheduled commencement of leukapheresis in 225 patients undergoing autologous transplantation. Transfusion 2008; 47:2153-60. [PMID: 17958545 DOI: 10.1111/j.1537-2995.2007.01440.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Interpatient variability in the kinetics of peripheral blood progenitor cell (PBPC) mobilization is commonly seen with conventional chemotherapy-based mobilization regimens. This necessitates the availability of leukapheresis (LP) facilities 7 days a week. STUDY DESIGN AND METHODS The efficacy of an approach where LP was invariably commenced on Day 11 after intermediate-dose cyclophosphamide followed by sequential administration of granulocyte-macrophage-colony-stimulating factor (CSF) and granulocyte-CSF (Cy/GM/G) was retrospectively analyzed in 225 consecutive, unselected patients undergoing autologous hematopoietic stem cell transplantation for all diagnoses other than acute leukemia at our center. Cy/GM/G was scheduled to avoid weekend LP. RESULTS After Cy/GM/G, a CD34+ cell yield of at least 2.0x10(6) per kg was achieved in 90.7 percent of patients. Optimal yield (OY; >or=5x10(6) or 10x10(6) CD34+ cells/kg depending on diagnosis) was achieved in 67.6 percent of patients. Only three patients (1.3%) required LP on Saturday or Sunday. Febrile neutropenia (FN) was encountered in 5.3 percent. PBPC yield was highest on Day 1 of LP (p<0.001). In multivariate analyses, platelet (PLT) count on Day 1 of LP (PLT-D1LP) was positively associated with achievement of OY (p<0.001). PLT-D1LP and diagnosis of myeloma were associated with a shorter time to achieve a CD34+ cell yield of at least 5x10(6) per kg (p<0.001 and p=0.002, respectively). CONCLUSION Cy/GM/G with scheduled LP commencement on Day 11 enables optimal CD34+ cell yields in most patients undergoing autologous transplantation, despite a low risk of FN and avoidance of weekend LP.
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Affiliation(s)
- Asad Bashey
- Division of Blood and Marrow Transplantation, and Biostatistics Core, Rebecca and John Moores UCSD Cancer Center, La Jolla, California, USA.
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Donohue M, Abramson I, Gamst A. Asynergistic Regression Based on Maximized Rank Correlation. COMMUN STAT-SIMUL C 2007. [DOI: 10.1080/03610910701723716] [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: 10/22/2022]
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50
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Savides TJ, Donohue M, Hunt G, Al-Haddad M, Aslanian H, Ben-Menachem T, Chen VK, Coyle W, Deutsch J, DeWitt J, Dhawan M, Eckardt A, Eloubeidi M, Esker A, Gordon SR, Gress F, Ikenberry S, Joyce AM, Klapman J, Lo S, Maluf-Filho F, Nickl N, Singh V, Wills J, Behling C. EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement. Gastrointest Endosc 2007; 66:277-82. [PMID: 17643700 DOI: 10.1016/j.gie.2007.01.017] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [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: 11/08/2006] [Accepted: 01/08/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnostic yield of EUS-guided FNA (EUS-FNA) of solid pancreatic masses is a potential benchmark for EUS-FNA quality, because the majority of EUS-FNA of solid pancreatic masses should be diagnostic for malignancy. OBJECTIVES To determine the cytologic diagnostic rate of malignancy in EUS-FNA of solid pancreatic masses and to determine if variability exists among endoscopists and centers. DESIGN Multicenter retrospective study. PATIENTS EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, >or=10-mm-diameter, solid pancreatic masses during a 1-year period. MAIN OUTCOME MEASUREMENT Cytology diagnostic of pancreatic malignancy. RESULTS A total of 1075 patients underwent EUS-FNA at 21 centers (81% academic) with 41 endoscopists. The median number of EUS-FNA of solid pancreatic masses performed during the year per center was 46 (range, 4-177) and per endoscopist was 19 (range, 1-97). The mean mass dimensions were 32 x 27 mm, with 73% located in the head. The mean number of passes was 3.5. Of the centers, 90% used immediate cytologic evaluation. The overall diagnostic rate of malignancy was 71%, 95% confidence interval 0.69%-0.74%, with 5% suspicious for malignancy, 6% atypical cells, and 18% negative for malignancy. The median diagnostic rate per center was 78% (range, 39%-93%; 1st quartile, 61%) and per endoscopist was 75% (range, 0%-100%; 1st quartile, 52%). LIMITATIONS Retrospective study, participation bias, and varying chronic pancreatitis prevalence. CONCLUSIONS (1) EUS-FNA cytology was diagnostic of malignancy in 71% of solid pancreatic masses and (2) endoscopists with a final cytologic diagnosis rate of malignancy for EUS-FNA of solid masses that was less than 52% were in the lowest quartile and should evaluate reasons for their low yield.
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Affiliation(s)
- Thomas J Savides
- Division of Gastroenterology, University of California, Naval Medical Center, San Diego, CA 92093-0063, USA
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