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Wandling M, Cuschieri J, Kozar R, O'Meara L, Celii A, Starr W, Burlew CC, Todd SR, de Leon A, McIntyre RC, Urban S, Biffl WL, Bayat D, Dunn J, Peck K, Rooney AS, Kornblith LZ, Callcut RA, Lollar DI, Ambroz E, Leichtle SW, Aboutanos MB, Schroeppel T, Hennessy EA, Russo R, McNutt M. Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate in blunt bowel and mesenteric injuries. Injury 2022; 53:122-128. [PMID: 34380598 DOI: 10.1016/j.injury.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/25/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Bowel Injury Prediction Score (BIPS) is a tool for identifying patients at risk for blunt bowel and mesenteric injury (BBMI) requiring surgery. BIPS is calculated by assigning one point for each of the following: (1) WBC ≥ 17,000, (2) abdominal tenderness, and (3) injury grade ≥ 4 (mesenteric contusion or hematoma with bowel wall thickening or adjacent interloop fluid collection) on CT scan. A total score ≥ 2 is associated with BBMI requiring surgery. We aimed to validate the BIPS as a predictor for patients with BBMIs requiring operative intervention in a multi-center prospective study. MATERIALS AND METHODS Patients were prospectively enrolled at 15 U.S. trauma centers following blunt trauma with suspicion of BBMI on CT scan between July 1, 2018 and July 31, 2019. The BIPS was calculated for each patient enrolled in the study. RESULTS Of 313 patients, 38% had BBMI requiring operative intervention. Patients were significantly more likely to require surgery in the presence of abdominal tenderness (OR, 3.6; 95% CI, 1.6-8.0) and CT grade ≥ 4 (OR, 11.7; 95% CI, 5.7-23.7). Patients with a BIPS ≥ 2 were more than ten times more likely to require laparotomy than those with a BIPS < 2 (OR, 10.1; 95% CI, 5.0-20.4). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a BIPS ≥ 2 for BBMI requiring surgery was 72% (CI 0.6-0.8), 78% (CI 0.7-0.8), 67% (CI 0.6-0.8), and 82% (CI 0.8-0.9), respectively. The AUROC curve for BIPS ≥ 2 was 0.75. The sensitivity, specificity, PPV, and NPV of a BIPS ≥ 2 for BBMI requiring surgery in patients with severe alteration in mental status (GCS 3-8) was 70% (CI 0.5-0.9), 92% (CI 0.8-1.0), 82% (CI 0.6-1.0), and 86% (CI 0.7-1.0), respectively. CONCLUSION This prospective multi-center trial validates BIPS as a predictor of BBMI requiring surgery. Calculation of BIPS during the initial evaluation of trauma patients is a useful adjunct to help general surgeons taking trauma call determine operative versus non-operative management of patients with BBMI including those with severe alteration in mental status.
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Affiliation(s)
- Michael Wandling
- McGovern Medical School at UT Health, 6410 Fannin St, Houston, TX 77030, USA
| | - Joseph Cuschieri
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Rosemary Kozar
- University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA
| | - Lindsay O'Meara
- University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA
| | - Amanda Celii
- Oklahoma University Health Science Center, 865 Research Pkwy, Oklahoma, OK 73104, USA
| | - William Starr
- Oklahoma University Health Science Center, 865 Research Pkwy, Oklahoma, OK 73104, USA
| | | | - S Rob Todd
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | | | | | - Shane Urban
- University of Colorado, 13001 E 17(th) Pl, Aurora, CO 80045, USA
| | - Walt L Biffl
- Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, San Diego, CA 92037, USA
| | - Dunya Bayat
- Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, San Diego, CA 92037, USA
| | - Julie Dunn
- UC Health Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA
| | - Kimberly Peck
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Alexandra S Rooney
- Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA 92103, USA
| | - Lucy Z Kornblith
- University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Rachael A Callcut
- University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Daniel I Lollar
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Eric Ambroz
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Stefan W Leichtle
- Virginia Commonwealth University Medical Center, 1204 E Marshal St #4-100, Richmond, VA 23298, USA
| | - Michel B Aboutanos
- Virginia Commonwealth University Medical Center, 1204 E Marshal St #4-100, Richmond, VA 23298, USA
| | - Thomas Schroeppel
- UCHealth Memorial Hospital Central, 1400 E Boulder St, Colorado Springs, CO 80909, USA
| | - Elizabeth A Hennessy
- UCHealth Memorial Hospital Central, 1400 E Boulder St, Colorado Springs, CO 80909, USA
| | - Rachel Russo
- University of Michigan, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Michelle McNutt
- McGovern Medical School at UT Health, 6410 Fannin St, Houston, TX 77030, USA.
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Biffl WL, Zhao FZ, Morse B, McNutt M, Lees J, Byerly S, Weaver J, Callcut R, Ball CG, Nahmias J, West M, Jurkovich GJ, Todd SR, Bala M, Spalding C, Kornblith L, Castelo M, Schaffer KB, Moore EE. A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries. J Trauma Acute Care Surg 2021; 90:776-786. [PMID: 33797499 DOI: 10.1097/ta.0000000000003080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/18/2022]
Abstract
BACKGROUND Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III-V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time. METHODS Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010-2013; POST, 2014-2018) using various statistical tests where appropriate. RESULTS Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs. CONCLUSION Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice. LEVEL OF EVIDENCE Retrospective diagnostic/therapeutic study, level III.
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Affiliation(s)
- Walter L Biffl
- From the Scripps Memorial Hospital La Jolla (WLB, FZZ, MC, KBS), La Jolla, CA; Maine Medical Center (BM), Portland, ME; Memorial Hermann Hospital (MM), Houston, TX; University of Oklahoma (JL), Oklahoma City, OK; Ryder Trauma Center (SB), Miami, FL; University of California-San Diego (JW), San Diego, CA; San Francisco General Hospital (RC, LK), San Francisco, CA; University of Calgary (CCGB), Calgary, Alberta, Canada; University of California-Irvine (JN), Irvine, CA; North Memorial Health Hospital (MW), Robbinsdale, MN; University of California-Davis (GJJ), Sacramento, CA; Grady Memorial Hospital (SRT), Atlanta, GA; Hadassah- Hebrew University Medical Center (MB), Jerusalem, Israel; Grant Medical Center (CS), Columbus, OH; Ernest E. Moore Shock Trauma Center at Denver Health (EEM), Denver, CO
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Kim C, Niekamp A, Pillai A, Leon R, Soni J, McNutt M, Pillai A. Abstract No. 637 Implementation of American College of Surgeons Committee on Trauma guidelines for interventional radiology: a retrospective review of prospective data compared with historic cohort. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kim C, Niekamp A, Pillai AS, Leon R, Soni J, McNutt M, Zhang X, Ghobryal B, Kalva S, Pillai AK. Quality Improvement Project: Improving Interventional Radiology Response Times for Level I Trauma Embolization. J Am Coll Radiol 2020; 17:791-795. [PMID: 32068007 DOI: 10.1016/j.jacr.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Charissa Kim
- Division of Interventional Radiology, McGovern Medical School at UTHealth, Houston, Texas.
| | - Andrew Niekamp
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Akshita S Pillai
- School of Medicine, The University of Texas Medical Branch at Galveston University in Galveston, Galveston, Texas
| | - Roger Leon
- Memorial Hermann Texas Medical Center, Houston, Texas
| | - Jayesh Soni
- Division of Vascular Interventional Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle McNutt
- Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Xu Zhang
- Division of Clinical and Translational Sciences, McGovern Medical School at UTHealth, Houston, Texas
| | - Bishoy Ghobryal
- School of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anil K Pillai
- Division of Vascular Interventional Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Fitch JL, Dieffenbaugher S, McNutt M, Miller CC, Wainwright DJ, Villarreal JA, Wilson CT, Todd SR. Are We Out of the Woods Yet? The Aftermath of Resuscitative Thoracotomy. J Surg Res 2019; 245:593-599. [PMID: 31499365 DOI: 10.1016/j.jss.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.
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Affiliation(s)
- Jamie L Fitch
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of General Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia.
| | - Sean Dieffenbaugher
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Michelle McNutt
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - C Cody Miller
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - D'Arcy J Wainwright
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Joshua A Villarreal
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Chad T Wilson
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - S Rob Todd
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Ferrada P, Callcut RA, Skarupa DJ, Duane TM, Garcia A, Inaba K, Khor D, Anto V, Sperry J, Turay D, Nygaard RM, Schreiber MA, Enniss T, McNutt M, Phelan H, Smith K, Moore FO, Tabas I, Dubose J. Circulation first - the time has come to question the sequencing of care in the ABCs of trauma; an American Association for the Surgery of Trauma multicenter trial. World J Emerg Surg 2018; 13:8. [PMID: 29441123 PMCID: PMC5800048 DOI: 10.1186/s13017-018-0168-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee. We performed a retrospective analysis of all patients that presented to trauma centers with presumptive hypovolemic shock indicated by pre-hospital or emergency department hypotension and need for intubation from January 1, 2014 to July 1, 2016. Data collected included demographics, timing of intubation, vital signs before and after intubation, timing of the blood transfusion initiation related to intubation, and outcomes. Results From 440 patients that met inclusion criteria, 245 (55.7%) received intravenous blood product resuscitation first (CAB), and 195 (44.3%) were intubated before any resuscitation was started (ABC). There was no difference in ISS, mechanism, or comorbidities. Those intubated prior to receiving transfusion had a lower GCS than those with transfusion initiation prior to intubation (ABC: 4, CAB:9, p = 0.005). Although mortality was high in both groups, there was no statistically significant difference (CAB 47% and ABC 50%). In multivariate analysis, initial SBP and initial GCS were the only independent predictors of death. Conclusion The current study highlights that many trauma centers are already initiating circulation first prior to intubation when treating hypovolemic shock (CAB), even in patients with a low GCS. This practice was not associated with an increased mortality. Further prospective investigation is warranted. Trial registration IRB approval number: HM20006627. Retrospective trial not registered.
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Affiliation(s)
- Paula Ferrada
- 1Trauma, Emergency surgery and Critical Care, Virginia Commonwealth University, 417 N 11th St, Richmond, VA 23298, Richmond, VA 23298-0454 USA
| | | | - David J Skarupa
- 3University of Florida College of Medicine, Gainesville, USA
| | | | - Alberto Garcia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili Hospital, Cali, Colombia
| | - Kenji Inaba
- 6University of Southern California, California, USA
| | - Desmond Khor
- 6University of Southern California, California, USA
| | | | | | | | | | | | - Toby Enniss
- 11University of Utah School Medicine, Salt Lake City, USA
| | - Michelle McNutt
- 12McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, USA
| | - Herb Phelan
- 13University of Texas-Southwestern Medical Center, Dallas, USA
| | - Kira Smith
- 13University of Texas-Southwestern Medical Center, Dallas, USA
| | | | - Irene Tabas
- 15Dell Medical School, University of Texas at Austin, Austin, USA
| | - Joseph Dubose
- 16Shock Trauma Centre, University of Maryland, Baltimore, USA
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Jasny BR, Wigginton N, McNutt M, Bubela T, Buck S, Cook-Deegan R, Gardner T, Hanson B, Hustad C, Kiermer V, Lazer D, Lupia A, Manrai A, McConnell L, Noonan K, Phimister E, Simon B, Strandburg K, Summers Z, Watts D. Fostering reproducibility in industry-academia research. Science 2017; 357:759-761. [PMID: 28839064 DOI: 10.1126/science.aan4906] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
| | - N Wigginton
- University of Michigan, Ann Arbor, MI 48109, USA
| | - M McNutt
- National Academy of Sciences, Washington, DC 20001, USA.
| | - T Bubela
- Faculty of Health Sciences, Simon Fraser University, British Columbia, BC V5A 1S6, Canada
| | - S Buck
- Laura and John Arnold Foundation, Houston, TX 77056, USA
| | - R Cook-Deegan
- Consortium for Science Policy and Outcomes at Arizona State University, Washington, DC 20009, USA
| | - T Gardner
- Riffyn, Inc., Oakland, CA 94612, USA
| | - B Hanson
- American Geophysical Union, Washington, DC 20009, USA
| | - C Hustad
- Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - V Kiermer
- Public Library of Science (PLOS), San Francisco, CA 94111, USA
| | - D Lazer
- Northeastern University, Boston, MA 02115, USA
| | - A Lupia
- University of Michigan, Ann Arbor, MI 48109, USA
| | - A Manrai
- Harvard Medical School, Boston, MA 02115, USA
| | - L McConnell
- Bayer U.S., Research Triangle Park, NC 27709, USA
| | - K Noonan
- McDonnell Boehnen Hulbert & Berghoff LLP, Chicago, IL 60606, USA
| | - E Phimister
- The New England Journal of Medicine, Boston, MA 02115, USA
| | - B Simon
- Thomas Jefferson School of Law, San Diego, CA 92101, USA
| | - K Strandburg
- New York University School of Law, New York, NY 10012, USA
| | - Z Summers
- ExxonMobil Research and Engineering Company, Annandale, NJ 08801, USA
| | - D Watts
- Microsoft Research, New York, NY 10003, USA
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Dai H, Zhang VW, El-Hattab AW, Ficicioglu C, Shinawi M, Lines M, Schulze A, McNutt M, Gotway G, Tian X, Chen S, Wang J, Craigen WJ, Wong LJ. FBXL4 defects are common in patients with congenital lactic acidemia and encephalomyopathic mitochondrial DNA depletion syndrome. Clin Genet 2017; 91:634-639. [PMID: 27743463 DOI: 10.1111/cge.12894] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Abstract
Mutations in FBXL4 have recently been recognized to cause a mitochondrial disorder, with clinical features including early onset lactic acidosis, hypotonia, and developmental delay. FBXL4 sequence analysis was performed in 808 subjects suspected to have a mitochondrial disorder. In addition, 28 samples from patients with early onset of lactic acidosis, but without identifiable mutations in 192 genes known to cause mitochondrial diseases, were examined for FBXL4 mutations. Definitive diagnosis was made in 10 new subjects with a total of 7 novel deleterious variants; 5 null and 2 missense substitutions. All patients exhibited congenital lactic acidemia, most of them with severe encephalopathic presentation, and global developmental delay. Overall, FBXL4 defects account for at least 0.7% (6 out of 808) of subjects suspected to have a mitochondrial disorder, and as high as 14.3% (4 out of 28) in young children with congenital lactic acidosis and clinical features of mitochondrial disease. Including FBLX4 in the mitochondrial diseases panel should be particularly important for patients with congenital lactic acidosis.
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Affiliation(s)
- H Dai
- Baylor Genetics, Houston, TX, USA
| | - V W Zhang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - A W El-Hattab
- Division of Clinical Genetics and Metabolic Disorders, Pediatric Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - C Ficicioglu
- Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Shinawi
- Division of Genetics and Genomics, Washington University School of Medicine, St. Louis, MO, USA
| | - M Lines
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - A Schulze
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - M McNutt
- Children's Medical Center, Dallas, TX, USA
| | - G Gotway
- Children's Medical Center, Dallas, TX, USA
| | - X Tian
- Baylor Genetics, Houston, TX, USA
| | - S Chen
- Baylor Genetics, Houston, TX, USA
| | - J Wang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - W J Craigen
- Baylor Genetics, Houston, TX, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - L-J Wong
- Baylor Genetics, Houston, TX, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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9
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McNutt M. Whither (wither?) tenure? Science 2015; 350:1295. [DOI: 10.1126/science.aad9966] [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: 11/02/2022]
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Nosek BA, Alter G, Banks GC, Borsboom D, Bowman SD, Breckler SJ, Buck S, Chambers CD, Chin G, Christensen G, Contestabile M, Dafoe A, Eich E, Freese J, Glennerster R, Goroff D, Green DP, Hesse B, Humphreys M, Ishiyama J, Karlan D, Kraut A, Lupia A, Mabry P, Madon TA, Malhotra N, Mayo-Wilson E, McNutt M, Miguel E, Paluck EL, Simonsohn U, Soderberg C, Spellman BA, Turitto J, VandenBos G, Vazire S, Wagenmakers EJ, Wilson R, Yarkoni T. SCIENTIFIC STANDARDS. Promoting an open research culture. Science 2015; 348:1422-5. [PMID: 26113702 DOI: 10.1126/science.aab2374] [Citation(s) in RCA: 954] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B A Nosek
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials.
| | - G Alter
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - G C Banks
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - D Borsboom
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - S D Bowman
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - S J Breckler
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - S Buck
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - C D Chambers
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - G Chin
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - G Christensen
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - M Contestabile
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - A Dafoe
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - E Eich
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - J Freese
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - R Glennerster
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - D Goroff
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - D P Green
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - B Hesse
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - M Humphreys
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - J Ishiyama
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - D Karlan
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - A Kraut
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - A Lupia
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - P Mabry
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - T A Madon
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - N Malhotra
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - E Mayo-Wilson
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - M McNutt
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - E Miguel
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - E Levy Paluck
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - U Simonsohn
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - C Soderberg
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - B A Spellman
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - J Turitto
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - G VandenBos
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - S Vazire
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - E J Wagenmakers
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - R Wilson
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
| | - T Yarkoni
- Affiliations for the authors, all of whom are members of the TOP Guidelines Committee, are given in the supplementary materials
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McNutt M, Leshner AI. Science Advances. Science 2014; 343:709. [DOI: 10.1126/science.1251654] [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: 11/02/2022]
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Learn PA, Yeh IT, McNutt M, Chisholm GB, Pollock BH, Rousseau DL, Sharkey FE, Cruz AB, Kahlenberg MS. HER-2/neu expression as a predictor of response to neoadjuvant docetaxel in patients with operable breast carcinoma. Cancer 2005; 103:2252-60. [PMID: 15834928 DOI: 10.1002/cncr.21037] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [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: 12/30/2022]
Abstract
BACKGROUND The use of biologic markers to predict response to neoadjuvant chemotherapy may permit tailoring regimens to achieve maximal tumor response. Taxanes have demonstrated excellent activity in breast carcinoma; however, tumor-specific factors that predict clinical response have not been characterized thoroughly. METHODS The authors performed a historic review evaluating the association of tumor prognostic factors and response to neoadjuvant cyclophosphamide and doxorubicin (AC) with or without docetaxel (D) (AC vs. AC+D) in 121 women who previously were enrolled in a Phase III, randomized, clinical trial. Using pretreatment biopsy materials, immunohistochemical studies were performed for estrogen receptor (ER), progesterone receptor (PR), HER-2/neu, p53, and Ki-67. Outcome variables were pathologic complete response (pCR) and positive clinical response (cPOS), which was defined as a >/= 50% regression in clinical tumor size prior to surgery. RESULTS In a multivariate analysis that controlled for tumor size and lymph node status, improved cPOS rates were observed with the addition of docetaxel in women with HER-2/neu-negative tumors (81% vs. 51%; P < 0.05), yielding an adjusted odds ratio of 3.5 (95% confidence interval, 1.2-13.0) in favor of docetaxel. Women who had HER-2/neu-negative tumors appeared to have a lower response rate with AC alone compared with women who had HER-2/neu-positive tumors (51% vs. 75%; P = 0.06), but response rates were matched when docetaxel was added (81% vs. 78%; P = 0.99). ER, PR, p53, and Ki-67 results were not associated significantly with response rates. CONCLUSIONS HER-2/neu status may predict improved clinical response rates from the addition of docetaxel to anthracycline-based neoadjuvant chemotherapy. Docetaxel may "rescue" the response in women who have HER-2/neu-negative tumors to match that observed in women who have HER-2/neu-positive tumors treated with AC alone.
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Affiliation(s)
- Peter A Learn
- Department of Surgery, University of Texas Health Science Center-San Antonio, San Antonio, Texas 78284, USA
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Learn PA, Yeh IT, McNutt M, Chisholm GB, Pollock BH, Rousseau DL, Sharkey FE, Cruz AB, Kahlenberg MS. HER-2/neu expression as a predictor of response to neoadjuvant docetaxel in operable breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9569] [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: 11/20/2022] Open
Affiliation(s)
- P. A. Learn
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - I.-T. Yeh
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - M. McNutt
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - G. B. Chisholm
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - B. H. Pollock
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - D. L. Rousseau
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - F. E. Sharkey
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - A. B. Cruz
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
| | - M. S. Kahlenberg
- Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX; Univ of Texas Health Science Ctr, San Antonio, TX; Univ of Texas Health Science Ctr, Houston, TX
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West SL, Richter A, Melfi CA, McNutt M, Nennstiel ME, Mauskopf JA. Assessing the Saskatchewan database for outcomes research studies of depression and its treatment. J Clin Epidemiol 2000; 53:823-31. [PMID: 10942865 DOI: 10.1016/s0895-4356(99)00237-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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: 10/18/2022]
Abstract
This study was conducted to evaluate the validity of using the Saskatchewan Health administrative claims databases for conducting depression research. To develop a claims-based definition of depression, we identified a cohort of individuals who began a "new" period of antidepressant use (no use 180 days prior) from which we selected a stratified random sample (n = 600) for medical record abstraction. The medical record diagnosis was used as the gold standard for judging our database definitions of depression. After defining a primary database definition of depression, we tried to refine it using medically probable scenarios and assessed refinement by agreement statistics. Defining depression with ICD9 codes 296 (affective disorders), 309 (adjustment reaction), and 311 (depressive disorders), the sensitivity (Se), specificity (Sp), positive (PV+) and negative predictive (PV-) values were: 71%, 85%, 86%, and 70%, respectively. Algorithms that limited the number of false-negatives resulted in: Se = 84% and PV- = 77% whereas those that limited false-positives resulted in: Sp = 90% and PV+ = 86%. Although our depression definition requires treatment with antidepressants, this definition will allow us to conduct future studies of depression and its treatment using the Saskatchewan Health databases.
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Affiliation(s)
- S L West
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
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Sharpe CR, Collet JP, McNutt M, Belzile E, Boivin JF, Hanley JA. Nested case-control study of the effects of non-steroidal anti-inflammatory drugs on breast cancer risk and stage. Br J Cancer 2000; 83:112-20. [PMID: 10883678 PMCID: PMC2374529 DOI: 10.1054/bjoc.2000.1119] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We carried out a nested case-control study to measure the rate ratio (RR) for invasive female breast cancer in relation to non-steroidal anti-inflammatory drug (NSAID) use. The source population consisted of the female beneficiaries of the Saskatchewan Prescription Drug Plan from 1981 to 1995 with no history of cancer since 1970. Four controls/case, matched on age and sampling time, were randomly selected. Dispensing rates during successive time periods characterized NSAID exposure. RRs associated with exposure during each period were adjusted for exposure during the others. Confounding by other determinants was studied in analyses adjusted with data obtained by interviewing samples of subjects accrued from mid-1991 to mid-1995. We accrued 5882 cases and 23,517 controls. Increasing NSAID exposure 2-5 years preceding diagnosis was associated with a trend towards a decreasing RR (P-trend = 0.003); for the highest exposure level RR = 0.76, 95% confidence interval 0.63-0.92. This protective effect could not be attributed to confounding by other determinants. In analyses involving only the cases, NSAID exposure 2-5 and 6-10 years preceding diagnosis was associated with significantly reduced risks of presenting with a large tumour (> 5 cm diameter) or distant metastasis, but not regional lymph node metastasis. The use of NSAIDs may retard the growth of breast cancers and prevent distant metastasis.
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Affiliation(s)
- C R Sharpe
- Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B Davis-Jewish General Hospital, Montréal, Québec, Canada
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Abstract
BACKGROUND Head and neck osteosarcoma is a comparatively rare and aggressive malignancy. Our goal was to examine the experience of head and neck osteosarcoma patients seen over a 15-year period at the University of Washington Medical Center and compare this with the published experience of other centers in terms of demographics, histology, treatment, and survival rate. METHODS We reviewed surgical pathology slides and clinical treatment records of 13 patients who were treated at the University of Washington Medical Center between 1981 and 1996. A total of 17 cases from 13 patients (13 primary tumors and 4 recurrences) were studied. RESULTS There was a slight male predominance, with a male:female ratio of 1.6:1, and median age at diagnosis of 40.9 years (range 22 to 75 years), both slightly higher than has been generally reported. Three of 13 patients had recognized risk factors for the development of osteosarcoma: 2 with a history of prior radiotherapy and 1 with Paget's disease. All surgical pathology specimens were examined independently by two pathologists for histologic grading and typing. At initial presentation, 9/13 (69%) cases had conventional (osteoblastic) histology; 2/13 (15%) were fibroblastic, 1 chondroblastic (8%) and 1 parosteal (8%). Eight of 13 (62%) cases were high grade at initial presentation. Four of 13 (30%) of the primary tumors were low grade 2, of which did not recur over a median follow-up period of 24 months. The other 2 low-grade tumors later recurred locally, as high-grade osteosarcomas, after disease-free intervals of 1 year and 14 years, respectively. One patient had an intermediate-grade tumor which has not recurred as of last follow-up. Combined-modality treatment, including surgery with or without radiotherapy and/or chemotherapy, was given depending on the histologic grade, surgical margins, and recurrence. Some patients with low-grade tumors had surgery only. There were 5 local recurrences, 1 of these following a disease-free interval of 14 years. One patient had 3 separate recurrences at the same site. Ten of 13 (77%) are alive and disease-free. Of the 3 deaths, 1 was related to radiation-induced brain necrosis, without evidence of recurrent tumor. The project 5-year overall survival in this series is 72%, with a mean follow-up of 58 months (median, 36 months). Of those receiving neoadjuvant chemotherapy, 6/7 have survived to the present. CONCLUSION Given the limitations of a small patient population, our data suggest that neoadjuvant chemotherapy may provide benefit in terms of survival. Longer follow-up will be necessary to support this conclusion. Our data also show that our population has a higher-than-average age of onset, low presence of risk factors, and better survival rate in comparison with the published series from other institutions.
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Affiliation(s)
- D Oda
- Department of Oral Biology, School of Dentistry, University of Washington, Seattle 98195, USA
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Abstract
For 35 years, the prevailing view has been that the hydrophobic effect is the dominant force in protein folding. The importance of hydrogen bonding was always clear, but whether it made a net favorable contribution to protein stability was not. Studies of mutant proteins have improved our understanding of the forces stabilizing proteins. They suggest that hydrogen bonding and the hydrophobic effect make large but comparable contributions to the stability of globular proteins.
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Affiliation(s)
- C N Pace
- Department of Medical Biochemistry and Genetics, Texas A&M University, College Station 77843-1114, USA
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Habbick B, Baker MJ, McNutt M, Cockcroft DW. Recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids in Saskatchewan. CMAJ 1995; 153:1437-43. [PMID: 7585370 PMCID: PMC1487449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To examine recent trends in the use of inhaled beta 2-adrenergic agonists and inhaled corticosteroids for the treatment of asthma among Saskatchewan residents and to determine whether these trends are in keeping with widely publicized guidelines recommending a reduction in the use of agents to treat symptoms (i.e., inhaled beta 2-adrenergic agonists) and increased use of prophylactic agents (i.e., inhaled corticosteroids). DESIGN Descriptive pharmacoepidemiologic study conducted with the use of data from the computerized database of the Saskatchewan Prescription Drug Plan. SETTING Saskatchewan. PATIENTS Saskatchewan residents 5 to 54 years of age who received one or more outpatient prescriptions for drugs to treat asthma (inhaled drugs, ingested beta 2-adrenergic agonists and ingested methylxanthines) from 1989 to 1993. OUTCOME MEASURES Epidemiologic trends, calculated for each year: number of prescriptions per 1,000 persons; number of patients who received prescriptions for inhaled corticosteroids, inhaled beta 2-adrenergic agonists and any type of drug to treat asthma; mean number of such prescriptions per patient; and weighted mean amount of salbutamol, fenoterol and beclomethasone dispensed per patient. RESULTS There has been an increase in the proportion of the population receiving prescriptions for drugs to treat asthma. The number of patients receiving these drugs per 1,000 people rose during the study period from 33.38 to 46.59 for any drug to treat asthma, from 24.70 to 33.77 for inhaled beta 2-adrenergic agonists and from 6.1 to 19.9 for inhaled corticosteroids. The mean number of prescriptions per patient decreased steadily for all drugs to treat asthma (from 5.34 in 1989 to 3.88 in 1993), for inhaled beta 2-adrenergic agonists (from 4.35 to 3.09) and for inhaled corticosteroids (from 2.98 to 2.25). The weighted mean amount of inhaled salbutamol dispensed per patient per year decreased by 40%, from 178.08 mg in 1989 to 109.14 mg in 1993. The weighted amount of fenoterol dispensed per patient per year declined even more, by 58%, from 387.91 mg in 1989 to 164.00 mg in 1993. Conversely, the weighted amount of inhaled beclomethasone dispensed per patient per year increased by 35% from 46.95 mg in 1989 to 63.50 mg in 1992, then dropped to 56.17 mg per year in 1993. CONCLUSION These data demonstrate a substantial change in Saskatchewan in the prescribing of drugs to treat asthma; they suggest that many physicians responded to current guidelines advocating increased attention to prevention of airway inflammation in the treatment of asthma.
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Affiliation(s)
- B Habbick
- Department of Community Health and Epidemiology, Royal University Hospital, Saskatoon SK
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Tennis P, Cole TB, Annegers JF, Leestma JE, McNutt M, Rajput A. Cohort study of incidence of sudden unexplained death in persons with seizure disorder treated with antiepileptic drugs in Saskatchewan, Canada. Epilepsia 1995; 36:29-36. [PMID: 8001505 DOI: 10.1111/j.1528-1157.1995.tb01661.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 5.4] [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: 01/28/2023]
Abstract
To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15-49 years with more than four prescriptions for antiepileptic drugs (AEDs) was identified from the Saskatchewan Health prscription drug file. To exclude subjects whose sudden deaths (SUDs) might be misattributed to another chronic underlying disease, subjects with hospitalizations for cancer or heart problems were excluded. To exclude subjects without epilepsy, subjects with > 2-year AED treatment followed by AED-free time and subjects receiving < 1 U/day were excluded. The final cohort consisted of 3,688 subjects. Follow-up was started at the first AED prescription listed in the prescription drug file and ended at the earliest of the following: age 50 years, death, or last registration in the Saskatchewan Health. For 153 of 163 deaths occurring in the cohort, copies of anonymized death certificates were obtained and copies of anonymized autopsy reports of potential SUDEP cases were examined. There were 18 definite/probable SUDs and 21 possible SUDEPs, yielding a minimum incidence of 0.54 SUDEP per 1,000 person-years and a maximum of 1.35 SUDEP per 1,000 person-years. SUDEP incidence increased with male sex, number of AEDs ever prescribed, and prescription of psychotropic drugs and was highest in males with a history of treatment with three or more AEDs and four or more psychotropic drug prescriptions. Poisson regression showed a 1.7-fold increase in risk of SUDEP for each increment in maximum number of AEDs administered, a likely surrogate for severity and persistence of seizures.
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Affiliation(s)
- P Tennis
- International Surveillance, Epidemiology, and Economic Research Division, Burroughs Wellcome Co, Research Triangle Park, NC 27709
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Suissa S, Ernst P, Boivin JF, Horwitz RI, Habbick B, Cockroft D, Blais L, McNutt M, Buist AS, Spitzer WO. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994; 149:604-10. [PMID: 8118625 DOI: 10.1164/ajrccm.149.3.8118625] [Citation(s) in RCA: 269] [Impact Index Per Article: 9.0] [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: 01/28/2023] Open
Abstract
The association between the use of inhaled beta-agonists and the risk of death and near-death from asthma has previously been reported. It was based on a nested case-control study of 129 cases and 655 control subjects selected from a cohort of 12,301 users of asthma drugs followed during the period 1980 through 1987. In this paper we examine the question of asthma and non-asthma mortality using data from the entire cohort of 12,301 asthmatics. There were 46 asthma and 134 non-asthma deaths in this cohort, for which there were 47,842 person-years of follow-up. The overall rate of asthma death was 9.6 per 10,000 asthmatics per year. This rate varied significantly according to the use of fenoterol, albuterol, or oral corticosteroids in the prior 12 months and the number of asthma hospitalizations in the prior 2 years. The rate decreased significantly, by 0.6 asthma deaths per 10,000 asthmatics per year over the study period, after controlling for the effect of the four other risk factors. It also increased significantly with the use of all beta-agonists, and more so for fenoterol than for albuterol, although this difference was partly explained by the dose inequivalence of the two drugs. Change-point dose-response curves showed that the risk of asthma death began to escalate drastically at about 1.4 canisters (of 20,000 micrograms each) per month of inhaled beta-agonist, the recommended limit. For non-asthma death, the overall rate of 28 deaths per 10,000 asthmatics per year was not related to the use of inhaled beta-agonists.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Suissa
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
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Ernst P, Habbick B, Suissa S, Hemmelgarn B, Cockcroft D, Buist AS, Horwitz RI, McNutt M, Spitzer WO. Is the association between inhaled beta-agonist use and life-threatening asthma because of confounding by severity? Am Rev Respir Dis 1993; 148:75-9. [PMID: 8100409 DOI: 10.1164/ajrccm/148.1.75] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have previously reported an increasing dose-response relationship between the regular use of beta-agonist inhalers and the risk of asthma death and near death among a cohort of 12,301 subjects who had been dispensed 10 or more prescriptions of asthma drugs from January 1980 to April 1987. That analysis was based solely on information obtained from linkable computerized data bases. Such an association might be explained in part by the tendency of patients with more severe asthma, that is, those at greatest risk for an adverse outcome, to use more beta-agonist medication. To further examine this potential confounding by severity, we gathered clinical information independently from the field on the 129 case patients and their 655 control patients from the matched case-control analysis of 12,301 subjects. In 68% of the control patients with a life-threatening episode and 75% of the matched control subjects, we obtained a valid questionnaire from at least one physician who had seen the patient during the previous 2 yr. Acceptable information on hospitalizations because of asthma was obtained in 87% of those hospitalized. Clinical features associated with an increased risk of fatal and near-fatal asthma were: a history of loss of consciousness or seizures during a previous asthma attack (odds ratio, 10.2; 95% CI, 3.9 to 26.7), a history of attacks of asthma precipitated by eating certain foods (odds ratio, 5.1; 95% CI, 2.4 to 11.1), a clinical score designed to reflect the severity of prior attacks of asthma leading to hospitalization, and prior respiratory acidosis among those in whom a blood gas determination was recorded.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Ernst
- Department of Epidemiology and Biostatistics, Montreal General Hospital, McGill University, Quebec, Canada
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Ernst P, Spitzer WO, Suissa S, Cockcroft D, Habbick B, Horwitz RI, Boivin JF, McNutt M, Buist AS. Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. JAMA 1992; 268:3462-4. [PMID: 1460737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. DESIGN Nested case-control analysis of a historical cohort; a further analysis. SETTING The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. PATIENTS The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. MAIN OUTCOME Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. RESULTS After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). CONCLUSION These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.
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Affiliation(s)
- P Ernst
- Department of Epidemiology, Montreal General Hospital, McGill University, Quebec, Canada
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Spitzer WO, Ernst P, Suissa S, Boivin JF, Horwitz RI, Habbick B, Cockcroft D, McNutt M, Buist AS. Fenoterol and death from asthma. Med J Aust 1992; 157:567-8. [PMID: 1479985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326:501-6. [PMID: 1346340 DOI: 10.1056/nejm199202203260801] [Citation(s) in RCA: 807] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Morbidity and mortality from asthma appear to be increasing, and it has been suggested that medications used to treat asthma are contributing to this trend. We investigated a possible association between death or near death from asthma and the regular use of beta 2-agonist bronchodilators. METHODS Using linked health insurance data bases from Saskatchewan, Canada, we conducted a matched case-control study of subjects drawn from a cohort of 12,301 patients for whom asthma medications had been prescribed between 1978 and 1987. We matched 129 case patients who had fatal or near-fatal asthma with 655 controls (who had received medications for asthma but had not had fatal or near-fatal events) with respect to region of residence, age, receipt of social assistance, and previous hospitalization for asthma. RESULTS The use of beta-agonists administered by a metered-dose inhaler was associated with an increased risk of death from asthma (odds ratio, 2.6 per canister per month; 95 percent confidence interval, 1.7 to 3.9) and of death or near death from asthma, considered together (odds ratio, 1.9; 95 percent confidence interval, 1.6 to 2.4). For death from asthma, use of the beta-agonist fenoterol was associated with an odds ratio of 5.4 per canister, as compared with 2.4 for the beta-agonist albuterol. On a microgram-equivalent basis, the odds ratio for this outcome with fenoterol was 2.3, as compared with 2.4 with albuterol. CONCLUSIONS An increased risk of death or near death from asthma was associated with the regular use of inhaled beta 2-agonist bronchodilators, especially fenoterol. Regardless of whether beta-agonists are directly responsible for these adverse effects or are simply a marker for more severe asthma, heavy use of these agents should alert clinicians that it is necessary to reevaluate the patient's condition.
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Affiliation(s)
- W O Spitzer
- Department of Epidemiology and Biostatistics, Montreal General Hospital, Canada
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Horwitz RI, Spitzer W, Buist S, Cockcroft D, Ernst P, Habbick B, Hemmelgarn B, McNutt M, Rebuck AS, Suissa S. Clinical complexity and epidemiologic uncertainty in case-control research. Fenoterol and asthma management. Chest 1991; 100:1586-91. [PMID: 1959400 DOI: 10.1378/chest.100.6.1586] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [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: 12/29/2022] Open
Abstract
Two recent epidemiologic case-control studies suggested that fenoterol, a selective beta-adrenergic agonist, was associated with an increase in the risk of asthma death. The results of these studies were criticized because of methodologic problems in the choice and selection of control subjects; the different methods used to gather exposure data in cases and control subjects; and because of inadequate classification and adjustment for asthma severity. In response to this controversy, a new study is underway, the Saskatchewan Asthma Epidemiology Project. The SAEP includes two complementary studies, an historic cohort and a case-control analysis, that employ the computerized databases of the Saskatchewan Health Department. A unique aspect of the SAEP is the attempt to incorporate knowledge of asthma physiology and management into the design of the studies. Specifically, the study design recognized the role of antiinflammatory drugs in asthma treatment; the distinction between asthma death and near-fatal asthma; the severity of asthma; patterns of drug use; and the distinction between inadequate clinical care and disease severity. The strategies we employed in the SAEP may prove helpful to investigators whenever clinical and biologic processes create sources of potential bias requiring special procedures for the design and analysis of epidemiologic studies.
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Porter PL, Bigler SA, McNutt M, Gown AM. The immunophenotype of hemangiopericytomas and glomus tumors, with special reference to muscle protein expression: an immunohistochemical study and review of the literature. Mod Pathol 1991; 4:46-52. [PMID: 1708501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Glomus tumors and hemangiopericytomas have traditionally been described as neoplasms of pericytes. Ultrastructurally, smooth muscle features have been identified in the cells of the glomus tumor, while the cells of the hemangiopericytoma have been described as more closely resembling normal pericytes. Immunocytochemical studies were performed to demonstrate the immunophenotype of these two tumors and to particularly evaluate expression of muscle-specific actin and desmin. Using the avidin-biotin immunoperoxidase method, formalin-fixed, paraffin-embedded tissue from 16 glomus tumors and 11 hemangiopericytomas was evaluated for the presence of vimentin, low-molecular-weight cytokeratins (35 beta H11), muscle actins (HHF35), desmin (clone 33), S100 protein, nerve growth factor receptor (NGFR5), myelin-associated glycoprotein (CD57), Factor VIII-related antigen, and Ulex lectin. Muscle actins were found in 14 of 16 tumors, and desmin was found in three of 16 of the glomus tumors. None of the 11 hemangiopericytomas expressed either desmin or muscle actins. Variable numbers of both tumors were positive with antibodies to CD57, with the nerve growth factor receptor, and with antibodies to S100 protein. In conclusion, these studies provide immunocytochemical evidence of smooth muscle differentiation in glomus tumors. Although muscle differentiation has been identified in the normal pericyte by expression of muscle-specific actin (HHF35), we find no evidence for analogous differentiation in the population of cells comprising hemangiopericytomas.
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Affiliation(s)
- P L Porter
- Department of Pathology, University of Washington, Seattle
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McNutt M, Mullins LS, Raushel FM, Pace CN. Contribution of histidine residues to the conformational stability of ribonuclease T1 and mutant Glu-58----Ala. Biochemistry 1990; 29:7572-6. [PMID: 1980207 DOI: 10.1021/bi00485a005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pK values of the histidine residues in ribonuclease T1 (RNase T1) are unusually high: 7.8 (His-92), 7.9 (His-40), and 7.3 (His-27) [Inagaki et al. (1981) J. Biochem. 89, 1185-1195]. In the RNase T1 mutant Glu-58----Ala, the first two pK values are reduced to 7.4 (His-92) and 7.1 (His-40). These lower pKs were expected since His-92 (5.5 A) and His-40 (3.7 A) are in close proximity to Glu-58 at the active site. The conformational stability of RNase T1 increases by over 4 kcal/mol between pH 9 and 5, and this can be entirely accounted for by the greater affinity for protons by the His residues in the folded protein (average pK = 7.6) than in the unfolded protein (pk approximately 6.6). Thus, almost half of the net conformational stability of RNase T1 results from a difference between the pK values of the histidine residues in the folded and unfolded conformations. In the Glu-58----Ala mutant, the increase in stability between pH 9 and 5 is halved (approximately 2 kcal/mol), as expected on the basis of the lower pK values for the His residues in the folded protein (average pK = 7.1). As a consequence, RNase T1 is more stable than the mutant below pH 7.5, and less stable above pH 7.5. These results emphasize the importance of measuring the conformational stability as a function of pH when comparing proteins differing in structure.
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Affiliation(s)
- M McNutt
- Biochemistry Department, Texas A&M University, College Station 77843
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Downey W, Strand LM, McNutt M, West R. Isotretinoin Surveillance. Drug Saf 1990. [DOI: 10.2165/00002018-199000051-00036] [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: 11/02/2022]
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