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Schroeck H, Whitty MA, Hatton B, Martinez-Camblor P, Wen L, Taenzer AH. Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration. Jt Comm J Qual Patient Saf 2024; 50:308-317. [PMID: 38360445 DOI: 10.1016/j.jcjq.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams. METHODS This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups. RESULTS A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel. CONCLUSION Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.
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Arizmendi BJ, Craven MR, Martinez-Camblor P, Tormey LK, Salwen-Deremer JK. Engagement in GI Behavioral Health Is Associated with Reduced Portal Messages, Phone Calls, and ED Visits. Dig Dis Sci 2024:10.1007/s10620-024-08428-3. [PMID: 38622464 DOI: 10.1007/s10620-024-08428-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND AIMS Chronic digestive disorders are associated with increased costs for healthcare systems and often require provision of both urgent care and non-face-to-face (non-F2F) care, such as responding to patient messages. Numerous benefits of integrated gastroenterology (GI) behavioral health have been identified; however, it is unclear if integrated care impacts healthcare utilization, including urgent care and non-F2F contact. We sought to investigate the association between patient engagement with GI behavioral health and healthcare utilization. METHODS We performed a retrospective chart review study of adult patients who were referred for and completed at least one behavioral health appointment between January 1, 2019 and December 21, 2021 in the Gastroenterology and Hepatology department of a large academic medical center. Data on electronic medical record (EMR) messages, phone calls, and Emergency Department utilization were collected 6 months before and 9 months after patient engagement with GI behavioral health. RESULTS 466 adult patients completed at least one behavioral health visit from 2019 to 2021. Overall, messages, phone calls, and ED visits all decreased significantly from the 6 months before behavioral health treatment to 6 months after (all P values < 0.001). CONCLUSION Engagement with integrated GI behavioral health is associated with reduced non-F2F care and emergency department utilization in patients with chronic digestive disorders. Increasing access to GI behavioral health may result in reduced provider workload and healthcare system costs.
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Affiliation(s)
- Brian J Arizmendi
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Meredith R Craven
- Department of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, USA
| | - Lauren K Tormey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Henkin S, Kearing SA, Martinez-Camblor P, Zacharias N, Creager MA, Young MN, Goodney PP, Columbo JA. The impact of the Affordable Care Act Medicaid Expansion in Medicare beneficiaries with peripheral artery disease. Vasc Med 2024:1358863X241237776. [PMID: 38607558 DOI: 10.1177/1358863x241237776] [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: 04/13/2024]
Abstract
Background: In 2014, the Affordable Care Act Medicaid Expansion (ME) increased Medicaid eligibility for adults with an income level up to 138% of the federal poverty level. In this study, we examined the impact of ME on mortality and amputation in patients with peripheral artery disease (PAD). Methods: The 100% MedPAR and Part-B Carrier files from 2011 to 2018 were queried to identify all fee-for-service Medicare beneficiaries with PAD using International Classification of Diseases codes. Our primary exposure was whether a state had adopted the ME on January 1, 2014. Our primary outcomes were the change in all-cause 1-year mortality and leg amputation. We used a state-level difference-in-differences (DID) analysis to compare the rates of the primary outcomes among patients who were in states (including the District of Columbia) who adopted ME (n = 25) versus those who were in states that did not (n = 26). We performed a subanalysis stratifying by sex, race, region, and dual-eligibility status. Results: Over the 8-year period, we studied 37,743,929 patients. The average unadjusted 1-year mortality decreased from 2011 to 2018 in both non-ME (9.5% to 8.7%, p < 0.001) and ME (9.1% to 8.3%, p < 0.001) states. The average unadjusted 1-year amputation rate did not improve in either the non-ME (0.86% to 0.87%, p = 0.17) or ME (0.69% to 0.69%, p = 0.65) states. Across the entire cohort, the DID model revealed that ME did not lead to a significant change in mortality (p = 0.15) or amputation (p = 0.34). Conclusion: Medicaid Expansion was not associated with reduced mortality or leg amputation in Medicare beneficiaries with PAD.
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Affiliation(s)
- Stanislav Henkin
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Stephen A Kearing
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Nikolaos Zacharias
- Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mark A Creager
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael N Young
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Philip P Goodney
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jesse A Columbo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Fernandez-Sanjurjo M, Fernandez J, Martinez-Camblor P, Rodriguez-Alonso M, Ortolano-Rios R, Pinto-Hernandez P, Castilla-Silgado J, Coto-Vilcapoma A, Ruiz L, Villar CJ, Tomas-Zapico C, Margolles A, Fernandez-Garcia B, Iglesias-Gutierrez E, Lombó F. Dynamics of Gut Microbiota and Short-Chain Fatty Acids during a Cycling Grand Tour Are Related to Exercise Performance and Modulated by Dietary Intake. Nutrients 2024; 16:661. [PMID: 38474789 DOI: 10.3390/nu16050661] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/11/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Regular exercise has been described to modify both the diversity and the relative abundance of certain bacterial taxa. To our knowledge, the effect of a cycling stage race, which entails extreme physiological and metabolic demands, on the gut microbiota composition and its metabolic activity has not been analysed. OBJECTIVE The aim of this cohort study was to analyse the dynamics of faecal microbiota composition and short-chain fatty acids (SCFAs) content of professional cyclists over a Grand Tour and their relationship with performance and dietary intake. METHODS 16 professional cyclists competing in La Vuelta 2019 were recruited. Faecal samples were collected at four time points: the day before the first stage (A); after 9 stages (B); after 15 stages (C); and on the last stage (D). Faecal microbiota populations and SCFA content were analysed using 16S rRNA sequencing and gas chromatography, respectively. A principal component analysis (PCA) followed by Generalised Estimating Equation (GEE) models were carried out to explore the dynamics of microbiota and SCFAs and their relationship with performance. RESULTS Bifidobacteriaceae, Coriobacteriaceae, Erysipelotrichaceae, and Sutterellaceae dynamics showed a strong final performance predictive value (r = 0.83, ranking, and r = 0.81, accumulated time). Positive correlations were observed between Coriobacteriaceae with acetate (r = 0.530) and isovalerate (r = 0.664) and between Bifidobacteriaceae with isobutyrate (r = 0.682). No relationship was observed between SCFAs and performance. The abundance of Erysipelotrichaceae at the beginning of La Vuelta was directly related to the previous intake of complex-carbohydrate-rich foods (r = 0.956), while during the competition, the abundance of Bifidobacteriaceae was negatively affected by the intake of simple carbohydrates from supplements (r = -0.650). CONCLUSIONS An ecological perspective represents more realistically the relationship between gut microbiota composition and performance compared to single-taxon approaches. The composition and periodisation of diet and supplementation during a Grand Tour, particularly carbohydrates, could be designed to modulate gut microbiota composition to allow better performance.
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Affiliation(s)
- Manuel Fernandez-Sanjurjo
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Translational Interventions for Health (ITS) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Javier Fernandez
- University Institute of Oncology (IUOPA), University of Oviedo, 33006 Oviedo, Spain
- Department of Functional Biology (Microbiology), University of Oviedo, 33006 Oviedo, Spain
- Biotechnology of Nutraceuticals and Bioactive Compounds (BIONUC) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Pablo Martinez-Camblor
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia 7500912, Chile
| | | | - Raquel Ortolano-Rios
- Research Centre for High Performance Sport, Catholic University of Murcia, 30107 Murcia, Spain
| | - Paola Pinto-Hernandez
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Translational Interventions for Health (ITS) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Juan Castilla-Silgado
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Basic-Clinical Research in Neurology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Almudena Coto-Vilcapoma
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Basic-Clinical Research in Neurology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Lorena Ruiz
- Department of Microbiology and Biochemistry of Dairy Products, Dairy Research Institute of Asturias-Spanish Research Council (IPLA-CSIC), 33300 Villaviciosa, Spain
- Functionality and Ecology of Beneficial Microbes (MicroHealth) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Claudio J Villar
- University Institute of Oncology (IUOPA), University of Oviedo, 33006 Oviedo, Spain
- Department of Functional Biology (Microbiology), University of Oviedo, 33006 Oviedo, Spain
- Biotechnology of Nutraceuticals and Bioactive Compounds (BIONUC) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Cristina Tomas-Zapico
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Translational Interventions for Health (ITS) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Abelardo Margolles
- Department of Microbiology and Biochemistry of Dairy Products, Dairy Research Institute of Asturias-Spanish Research Council (IPLA-CSIC), 33300 Villaviciosa, Spain
- Functionality and Ecology of Beneficial Microbes (MicroHealth) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Benjamin Fernandez-Garcia
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Department of Morphology and Cell Biology (Anatomy), University of Oviedo, 33006 Oviedo, Spain
| | - Eduardo Iglesias-Gutierrez
- Department of Functional Biology (Physiology), University of Oviedo, 33006 Oviedo, Spain
- Translational Interventions for Health (ITS) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Felipe Lombó
- University Institute of Oncology (IUOPA), University of Oviedo, 33006 Oviedo, Spain
- Department of Functional Biology (Microbiology), University of Oviedo, 33006 Oviedo, Spain
- Biotechnology of Nutraceuticals and Bioactive Compounds (BIONUC) Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
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He L, Robb JF, Martinez-Camblor P, Andrus BW, Greene LJ, Gongal P, Reddy DS, DeVries JT. Longitudinal outcomes of final kissing balloon inflation in coronary bifurcation lesions treated with a single stent. Front Cardiovasc Med 2023; 10:1290024. [PMID: 38099223 PMCID: PMC10720711 DOI: 10.3389/fcvm.2023.1290024] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background Final kissing balloon inflation (FKBI) is a percutaneous coronary intervention (PCI) technique that is considered mandatory to improve outcomes in two-stent strategies, but its use in single-stent bifurcation PCI remains controversial. Methods In this retrospective cohort study, we identified patients with coronary bifurcation lesions treated with one stent from January 2012 to March 2021 at a single academic medical center. Incidence rates per 1,000 patient-years (IR1000) were calculated for the outcomes of all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), coronary artery bypass graft (CABG), and cardiac readmission between patients who received FKBI and those who did not over a median follow up of 2.3 years. Studied outcomes were adjusted for all baseline clinical and procedural characteristics. Results This study included 893 consecutive patients of which 256 received FKBI and 637 did not. The IR1000 for MI were 51.1 and 27.6 for patients who received FKBI and patients who did not, respectively (adjusted HR = 2.44, p = 0.001). The IR1000 for death were 31.2 and 52.3 for patients who received FKBI and patients who did not, respectively (adjusted HR = 0.68, p = 0.141). The incidence rates of ST, TLR, CABG, and cardiac readmissions were similar between patients who received FKBI and those who did not. Conclusions These results suggest that performing FKBI in a one-stent technique was associated with higher rates of myocardial infarction, particularly in the first 6 months, and no difference in death, ST, TLR, CABG, and cardiac readmission rates.
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Affiliation(s)
- Lefan He
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, United States
| | - John F. Robb
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Bruce W. Andrus
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Lily J. Greene
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Prajesh Gongal
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Dhruthi S. Reddy
- Homer Stryker School of Medicine, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, United States
| | - James T. DeVries
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Abess AT, Deiner SG, Briggs A, Whitlock EL, Charette KE, Chow VW, Shaefi S, Martinez-Camblor P, O'Malley AJ, Boone MD. Association of neurocognitive disorders with morbidity and mortality in older adults undergoing major surgery in the USA: a retrospective, population-based, cohort study. Lancet Healthy Longev 2023; 4:e608-e617. [PMID: 37924842 PMCID: PMC10654795 DOI: 10.1016/s2666-7568(23)00194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Neurocognitive disorders become increasingly common as patients age, and increasing numbers of surgical interventions are done on older patients. The aim of this study was to understand the clinical characteristics and outcomes of surgical patients with neurocognitive disorders in the USA in order to guide future targeted interventions for better care. METHODS This retrospective cohort study used claims data for US Medicare beneficiaries aged 65 years and older with a record of inpatient admission for a major diagnostic or therapeutic surgical procedure between Jan 1, 2017, and Dec 31, 2018. Data were retrieved through a data use agreement between Dartmouth Hitchcock Medical Center and US Centers for Medicare and Medicaid Services via the Research Data Assistance Center. The exposure of interest was the presence of a pre-existing neurocognitive disorder as defined by diagnostic code within 3 years of index hospital admission. The primary outcome was mortality at 30 days, 90 days, and 365 days from date of surgery among all patients with available data. FINDINGS Among 5 263 264 Medicare patients who underwent a major surgical procedure, 767 830 (14·59%) had a pre-existing neurocognitive disorder and 4 495 434 (85·41%) had no pre-existing neurocognitive disorder. Adjusting for demographic factors and comorbidities, patients with a neurocognitive disorder had higher 30-day (hazard ratio 1·24 [95% CI 1·23-1·25]; p<0·0001), 90-day (1·25 [1·24-1·26]; p<0·0001), and 365-day mortality (1·25 [1·25-1·26]; p<0·0001) compared with patients without a neurocognitive disorder. INTERPRETATION Our findings suggest that the presence of a neurocognitive disorder is independently associated with an increased risk of mortality. Identification of a neurocognitive disorder before surgery can help clinicians to better disclose risks and plan for patient care after hospital discharge. FUNDING Department of Anesthesiology and Perioperative Medicine at Dartmouth Hitchcock Medical Center.
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Affiliation(s)
- Alexander T Abess
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Stacie G Deiner
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alexandra Briggs
- Department of Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elizabeth L Whitlock
- Department of Anesthesia and Perioperative Care, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Kristin E Charette
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Vinca W Chow
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Pablo Martinez-Camblor
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alistair James O'Malley
- Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Myles Dustin Boone
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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de Gonzalo-Calvo D, Martinez-Camblor P, Belmonte T, Barbé F, Duarte K, Cowie MR, Angermann CE, Korte A, Riedel I, Labus J, Koenig W, Zannad F, Thum T, Bär C. Circulating miR-133a-3p defines a low-risk subphenotype in patients with heart failure and central sleep apnea: a decision tree machine learning approach. J Transl Med 2023; 21:742. [PMID: 37864227 PMCID: PMC10588036 DOI: 10.1186/s12967-023-04558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/22/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnea (CSA) are at a very high risk of fatal outcomes. OBJECTIVE To test whether the circulating miRNome provides additional information for risk stratification on top of clinical predictors in patients with HFrEF and CSA. METHODS The study included patients with HFrEF and CSA from the SERVE-HF trial. A three-step protocol was applied: microRNA (miRNA) screening (n = 20), technical validation (n = 60), and biological validation (n = 587). The primary outcome was either death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening of heart failure, whatever occurred first. MiRNA quantification was performed in plasma samples using miRNA sequencing and RT-qPCR. RESULTS Circulating miR-133a-3p levels were inversely associated with the primary study outcome. Nonetheless, miR-133a-3p did not improve a previously established clinical prognostic model in terms of discrimination or reclassification. A customized regression tree model constructed using the Classification and Regression Tree (CART) algorithm identified eight patient subphenotypes with specific risk patterns based on clinical and molecular characteristics. MiR-133a-3p entered the regression tree defining the group at the lowest risk; patients with log(NT-proBNP) ≤ 6 pg/mL (miR-133a-3p levels above 1.5 arbitrary units). The overall predictive capacity of suffering the event was highly stable over the follow-up (from 0.735 to 0.767). CONCLUSIONS The combination of clinical information, circulating miRNAs, and decision tree learning allows the identification of specific risk subphenotypes in patients with HFrEF and CSA.
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Affiliation(s)
- David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, IRBLleida, University Hospital Arnau de Vilanova and Santa Maria, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Camblor
- Anesthesiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Faculty of Health Sciences, Universidad Autonoma de Chile, Providencia, Chile
| | - Thalia Belmonte
- Translational Research in Respiratory Medicine, IRBLleida, University Hospital Arnau de Vilanova and Santa Maria, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, IRBLleida, University Hospital Arnau de Vilanova and Santa Maria, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Kevin Duarte
- INSERM 1433, CHRU de Nancy, Centre d'Investigations Cliniques Plurithématique, Institut Lorrain du Cœur et des Vaisseaux, Université de Lorraine, Nancy, France
| | - Martin R Cowie
- Department of Cardiology, Royal Brompton Hospital (Guy's & St Thomas's NHS Foundation Trust), London, UK
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Andrea Korte
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Isabelle Riedel
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Josephine Labus
- Cellular Neurophysiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT Network, Nancy, France
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Nikolai-Fuchs-Str. 1, 30625, Hannover, Germany.
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Nikolai-Fuchs-Str. 1, 30625, Hannover, Germany.
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Shah ED, Curley MA, Ostler TL, Martinez-Camblor P, Chey WD. Clinical History Does Not Reliably Predict Clinical Outcomes With Pelvic Floor Physical Therapy to Treat Chronic Constipation. Clin Gastroenterol Hepatol 2023; 21:2960-2964.e1. [PMID: 36257509 DOI: 10.1016/j.cgh.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/15/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023]
Abstract
Chronic constipation affects 10%-20% of the population and impacts quality-of-life similarly to rheumatoid arthritis or congestive heart failure.1 We recently showed in a prospective clinical trial that up-front, community-based pelvic floor physical therapy is effective to treat chronic constipation for patients seeking general gastroenterology care after failing a brief trial of osmotic laxative or soluble fiber supplementation2 and can be guided by anorectal function testing.3,4 In this post hoc analysis, we aimed to evaluate whether factors on clinical history including specific symptoms, work-productivity impairment, health-related quality-of-life impairment, and psychological factors are useful to inform patient selection on the expected likelihood of clinical response without using anorectal function tests.
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Affiliation(s)
- Eric D Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Michael A Curley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tracy L Ostler
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - William D Chey
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
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Schroeck H, Whitty MA, Martinez-Camblor P, Voicu S, Burian BK, Taenzer AH. Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room. Br J Anaesth 2023; 131:598-606. [PMID: 37202262 DOI: 10.1016/j.bja.2023.04.028] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Anaesthesia care outside of the standard operating room (OR) can be challenging. This prospective matched case-pair study describes the difference in anaesthesia clinicians' perception of safety, workload, anxiety, and stress in two settings by comparing similar neurosurgical procedures performed in either the OR or a remote hybrid room with intraoperative MRI (MRI-OR). METHODS A visual numeric scale for safety perception and validated instruments for workload, anxiety, and stress were administered to enrolled anaesthesia clinicians after induction of anaesthesia and at the end of eligible cases. The difference in outcomes reported by the same clinician for unique pairs of similar operations performed in both settings (OR vs MRI-OR) was compared using the Student t-test with the general bootstrap algorithm to address the presence of clusters. RESULTS Over 15 months, 37 clinicians provided data for 53 case pairs. Working in the remote MRI-OR vs OR was associated with lower perceived safety (7.3 [2.0] vs 8.8 [0.9]; P<0.001), higher scores in the workload subdomains effort and frustration (41.6 [24.1] vs 31.3 [21.6]; P=0.006 and 32.4 [22.9] vs 20.7 [17.2]; P=0.002, respectively), and higher anxiety (33.6 [10.1] vs 28.4 [9.2]; P=0.003) at the end of the case. Stress was rated higher in the MRI-OR after induction of anaesthesia (26.5 [15.5] vs 20.9 [13.4]; P=0.006). Effect sizes (Cohen's D) were moderate to good. CONCLUSIONS Anaesthesia clinicians reported lower perceived safety and higher workload, anxiety, and stress in a remote MRI-OR compared with a standard OR. Improving non-standard work settings should benefit clinician well-being and patient safety. CLINICAL TRIAL REGISTRATION .
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Affiliation(s)
- Hedwig Schroeck
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Pablo Martinez-Camblor
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Stefana Voicu
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Mountain View, CA, USA
| | - Andreas H Taenzer
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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10
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Park S, Cubillos L, Martinez-Camblor P, Bartels SM, Torrey WC, John DT, Cepeda M, Bell K, Castro S, Suárez-Obando F, Uribe-Restrepo JM, Gómez-Restrepo C, Marsch LA. Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis. Psychiatr Serv 2023; 74:950-962. [PMID: 36852551 DOI: 10.1176/appi.ps.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.
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Affiliation(s)
- Sena Park
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez-Camblor
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sophia M Bartels
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - William C Torrey
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Deepak T John
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
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Columbo JA, Stone DH, Martinez-Camblor P, Goodney PP, O’Malley AJ. Adoption and Diffusion of Transcarotid Artery Revascularization in Contemporary Practice. Circ Cardiovasc Interv 2023; 16:e012805. [PMID: 37725675 PMCID: PMC10516509 DOI: 10.1161/circinterventions.122.012805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND In 2015, the FDA approved transcarotid artery revascularization (TCAR) as an alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS) for high-risk patients with carotid stenosis. This was granted in the absence of level 1 evidence to support TCAR. We aimed to document trends in TCAR utilization, its diffusion over time, and the clinical phenotypes of patients undergoing TCAR, CEA, and TF-CAS. METHODS We used the Vascular Quality Initiative to study patients who underwent TCAR. We calculated the number of TCARs performed and the percent of TCAR utilization versus CEA/TF-CAS. Using data from before TCAR was widespread, we calculated propensity scores for patients to receive CEA. We applied this model to patients undergoing carotid revascularization from 2016 to 2022 and grouped patients by the procedure they ultimately underwent, examining overlap in score distribution to measure patient similarity. We measured the trend of in-hospital stroke/death after TCAR. RESULTS We studied 31 447 patients who underwent TCAR from January 1, 2016 to March 31, 2022. The number of centers performing TCAR increased from 29 to 606. In 2021, TCAR represented 22.5% of carotid revascularizations at centers offering all 3 procedures. The percentage of patients that underwent TCAR who met approved high-risk criteria decreased from 88.5% to 80.9% (P<0.001). Those with a prior ipsilateral carotid procedure decreased from 20.6% in 2016 to 12.0% in 2021 (P<0.001). Patients undergoing TCAR after stroke increased from 19.7% to 30.7% (P<0.001). Propensity-score overlap was 55.4% for TCAR/CEA, and 58.6% for TCAR/TF-CAS, demonstrating that TCAR patients have a clinical phenotype mixed between those who undergo CEA and TF-CAS. The average in-hospital stroke/death risk after TCAR was 2.3% in 2016 and 1.7% in 2022 (P trend: 0.954). CONCLUSIONS TCAR now represents nearly 1-in-4 procedures at centers offering it. TCAR was increasingly performed among standard-risk patients and as a first-line procedural option after stroke. The absence of level 1 evidence underscores the importance of high-quality registry-based analyses to document TCAR's real-world outcomes and durability.
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Affiliation(s)
- Jesse A. Columbo
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - David H. Stone
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Pablo Martinez-Camblor
- Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire
| | - Philip P. Goodney
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - A. James O’Malley
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
- Department of Biomedical Data Science, Dartmouth College, Hanover, New Hampshire
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12
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Fernández-Iglesias R, Martinez-Camblor P, Fernández-Somoano A, Rodríguez-Dehli C, Venta-Obaya R, Karagas MR, Tardón A, Riaño-Galán I. Tracking between cardiovascular-related measures at 4 and 8 years of age in the INMA-Asturias cohort. Eur J Pediatr 2023; 182:3893-3906. [PMID: 37338691 PMCID: PMC10570156 DOI: 10.1007/s00431-023-05051-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Identifying cardiovascular-related measures that track from early childhood into later ages may help inform early prevention targets for cardiovascular disease. In this study, the tracking of triglycerides (TG), high-density cholesterol (HDL-c), atherogenic coefficient (AC), waist circumference to height ratio (WC/Height), mean arterial pressure (MAP), and homeostatic model assessment of insulin resistance (HOMA-IR) was examined in the INMA-Asturias cohort between 4 and 8 years of age. The analysis was conducted in 307 children who participated in the INMA-Asturias cohort (Spain) at 4 and at 8 years of age. Quantile regression models were used to evaluate tracking between measures at both ages, with each measure at 8 years as the dependent variable and the rank transformation of the same measure at 4 years as the independent variable. We found a positive association between HDL-c rank at 4 years and higher quantiles of the HDL-c distribution at 8 years, with an increase of 2.93 mg/dL (95% CI: 1.98, 3.87) per decile in the 0.9 quantile. A positive association was also found for WC/Height, with an increase of 0.008 (95% CI: 0.004, 0.012) per decile in the 0.9 quantile. We observed that tracking for AC increased in the higher quantiles of the distribution at 8 years, with an increase of 0.11 (95% CI: 0.09, 0.14) in the 0.6 quantile compared to an effect of 0.15 (95% CI: 0.09, 0.21) in the 0.9 quantile. Conclusions: Adult markers of dyslipidemia and central obesity tracked between ages 4 and 8 years. For AC, tracking increased in the higher quantiles of the distribution. What is Known: • Atherosclerosis begins in early life, so preventive efforts that start in childhood may delay progression to clinical disease. Determine what cardiovascular risk factors track into time since childhood bring the opportunity to identified those subjects at risk for later cardiovascular disease. • The study of risk factors in health populations and, particularly in children, copes with not clear and/or controversial thresholds definition. This makes it challenging to study tracking in pediatric ages. What is New: • Quantile regression is a useful tool for assessing the tracking of risk factors for which there are no clinically meaningful thresholds. The increasing trend observed in the tracking of dyslipidemia suggests the possible difficulty that children with abnormal values at 4 years of age might have in normalizing them in future years. • The findings of this article may help to determine which cardiovascular-related measures could be screened and followed-up in children.
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Affiliation(s)
- Rocío Fernández-Iglesias
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Monforte de Lemos Avenue, 3-5, 28029, Madrid, Spain
- Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA), Department of Medicine, University of Oviedo, Julian Clavería Street S/N, 33006, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue S/N, 33001, Oviedo, Asturias, Spain
| | - Pablo Martinez-Camblor
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Faculty of Health Sciences, Universidad Autonoma de Chile, 7500912, Providencia, Chile
| | - Ana Fernández-Somoano
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Monforte de Lemos Avenue, 3-5, 28029, Madrid, Spain.
- Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA), Department of Medicine, University of Oviedo, Julian Clavería Street S/N, 33006, Oviedo, Asturias, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue S/N, 33001, Oviedo, Asturias, Spain.
| | - Cristina Rodríguez-Dehli
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue S/N, 33001, Oviedo, Asturias, Spain
- Servicio de Pediatría, Hospital San Agustín, Heros Street, 4, 33410, Avilés, Asturias, Spain
| | - Rafael Venta-Obaya
- Servicio de Bioquímica, Hospital San Agustín, Heros Street, 4, 33410, Avilés, Asturias, Spain
- Departamento de Bioquímica y Biología Molecular, University of Oviedo, Fernando Bongera Street, S/N, 33006, Oviedo, Asturias, Spain
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Adonina Tardón
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Monforte de Lemos Avenue, 3-5, 28029, Madrid, Spain
- Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA), Department of Medicine, University of Oviedo, Julian Clavería Street S/N, 33006, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue S/N, 33001, Oviedo, Asturias, Spain
| | - Isolina Riaño-Galán
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Monforte de Lemos Avenue, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue S/N, 33001, Oviedo, Asturias, Spain
- Endocrinología Pediátrica, Servicio de Pediatría, HUCA, Roma Avenue S/N, 33001, Oviedo, Asturias, Spain
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Wechsler EV, Martinez-Camblor P, Curley MA, Shah ED. Chronic Pain and Mood Disorders Are Not Barriers to Symptom Improvement Under Collaborative Co-managed Care (C 3). Dig Dis Sci 2023; 68:3569-3572. [PMID: 37540390 DOI: 10.1007/s10620-023-08055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Patients with comorbid chronic pain and mood disorders have more severe gastrointestinal disease and higher healthcare expenses than their peers. We sought to determine whether management under our innovative Collaborative Co-Managed Care (C3) general gastroenterology care model improved outcomes. METHODS Patient questionnaires completed by outpatients at our GI Motility Center were analyzed alongside demographic information to determine predictors of response to treatment based on adequate relief of gastrointestinal symptoms and improvement in quality of life. RESULTS These comorbidities did not significantly impair response and may be associated with improved response under our model. CONCLUSIONS The C3 general gastroenterology care model anchors on setting expectations and team-based communication and improves outcomes of, and access to, care.
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Affiliation(s)
- Emily V Wechsler
- Geisel School of Medicine, Hanover, NH, USA
- Section of Gastroenterology and Hepatology, Dartmouth Health, Lebanon, NH, USA
| | | | - Michael A Curley
- Geisel School of Medicine, Hanover, NH, USA
- Section of Gastroenterology and Hepatology, Dartmouth Health, Lebanon, NH, USA
| | - Eric D Shah
- Geisel School of Medicine, Hanover, NH, USA.
- Section of Gastroenterology and Hepatology, Dartmouth Health, Lebanon, NH, USA.
- University of Michigan, 1500 E Medical Center Drive, 3912 Taubman Center SPC 5362, Ann Arbor, MI, 48109, USA.
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Shah ED, Curley MA, Ostler TL, Greeley ARB, Martinez-Camblor P, Chey WD. Empiric Pelvic Rehabilitation Delivered by Pelvic Floor Physical Therapists as an Up-Front Treatment for Chronic Constipation. Clin Gastroenterol Hepatol 2023; 21:2415-2417. [PMID: 35934289 DOI: 10.1016/j.cgh.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Eric D Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Michael A Curley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tracy L Ostler
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - William D Chey
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
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Glaser A, Kanter J, Martinez-Camblor P, Buhl L, Anderson M, Pannu A, Shaefi S, Taenzer A, Boone MD. 775 The Effect of Anti-Seizure Medication Administration on Mortality and Early Post Traumatic Seizures In Critically Ill Older Adults With Traumatic Brain Injury. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_775] [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: 03/18/2023] Open
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Shah ED, Pelletier EA, Greeley C, Sieglinger EE, Sanchez JD, Northam KA, Perrone JA, Curley MA, Navas CM, Ostler TL, Burnett Greeley AR, Martinez-Camblor P, Baker JR, Chey WD. Utility of Anorectal Testing to Predict Outcomes With Pelvic Floor Physical Therapy in Chronic Constipation: Pragmatic Trial. Clin Gastroenterol Hepatol 2023; 21:1070-1081. [PMID: 35640864 DOI: 10.1016/j.cgh.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/21/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a clinical trial that aimed to inform the clinical utility of anorectal manometry (ARM) and balloon expulsion time (BET) as up-front tests to predict outcomes with community-based pelvic floor physical therapy as the next best step to address chronic constipation after failing an empiric trial of soluble fiber supplementation or osmotic laxatives. METHODS We enrolled 60 treatment-naïve patients with Rome IV functional constipation failing 2 weeks of soluble fiber supplementation or osmotic laxatives. All patients underwent ARM/BET (London protocol) followed by community-based pelvic floor physical therapy. Outcomes were assessed at baseline and 12 weeks. The primary end point was clinical response (Patient Assessment of Constipation-Symptoms instrument). RESULTS Fifty-three patients completed pelvic rehabilitation and the post-treatment questionnaire. Contemporary frameworks define dyssynergia on balloon expulsion time and dyssynergic patterns (ARM), but these parameters did not inform clinical outcomes (area under the curve [AUC], <0.6). Squeeze pressure (>192.5 mm Hg on at least 1 of 3 attempts; sensitivity, 47.6%; specificity, 83.9%) and limited squeeze duration (inability to sustain 50% of squeeze pressure for >20 seconds; sensitivity, 71.4%; specificity, 58.1%) were the strongest predictors of clinical outcomes. Combining BET with squeeze duration (BET greater than 6.5 seconds and limited squeeze duration) improved predictive accuracy (AUC, 0.75; 95% CI, 0.59-0.90). BET poorly predicted outcomes as a single test (AUC, 0.54; 95% CI, 0.38-0.69). CONCLUSIONS Using ARM to evaluate squeeze profiles, rather than dyssynergia, appears useful to screen patients with chronic constipation for up-front pelvic floor physical therapy based on likelihood of response. BET appears noninformative as a single screening test (ClinicalTrials.gov: NCT04159350).
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Affiliation(s)
- Eric D Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Elizabeth A Pelletier
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Carol Greeley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emily E Sieglinger
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jamie D Sanchez
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kayla A Northam
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jessica A Perrone
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Michael A Curley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Christopher M Navas
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tracy L Ostler
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jason R Baker
- Division of Gastroenterology, Atrium Health, Charlotte, North Carolina
| | - William D Chey
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
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Shah ED, Pelletier EA, Greeley C, Sieglinger EE, Sanchez JD, Northam KA, Perrone JA, Curley MA, Navas CM, Ostler TL, Burnett Greeley AR, Martinez-Camblor P, Baker JR, Harris A, Siegel CA, Chey WD. An Office-Based, Point-of-Care Test Predicts Treatment Outcomes With Community-Based Pelvic Floor Physical Therapy in Patients With Chronic Constipation. Clin Gastroenterol Hepatol 2023; 21:1082-1090. [PMID: 35341952 DOI: 10.1016/j.cgh.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/26/2022] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Rectal evacuation disorders are common among constipated patients. We aimed to evaluate the accuracy of an investigational point-of-care test (rectal expulsion device [RED]) to predict outcomes with community-based pelvic floor physical therapy. METHODS We enrolled patients meeting Rome IV criteria for functional constipation failing fiber/laxatives for more than 2 weeks. RED was inserted and self-inflated, and then time-to-expel was measured in a left lateral position. All patients underwent empiric community-based pelvic floor physical therapy in routine care with outcomes measured at 12 weeks. The primary end point was global clinical response (Patient Assessment of Constipation Symptoms score reduction, >0.75 vs baseline). Secondary end points included improvement in health-related quality-of-life (Patient Assessment of Constipation Quality of Life score reduction, >1.0) and complete spontaneous bowel movement frequency (Food and Drug Administration complete spontaneous bowel movement responder definition). RESULTS Thirty-nine patients enrolled in a feasibility phase to develop the use-case protocol. Sixty patients enrolled in a blinded validation phase; 52 patients (mean, 46.9 y; 94.2% women) were included in the intention-to-treat analysis. In the left lateral position, RED predicted global clinical response (generalized area under the curve [gAUC], 0.67; 95% CI, 0.58-0.76]), health-related quality-of-life response (gAUC, 0.67; 95% CI, 0.58-0.77; P < .001), and complete spontaneous bowel movement response (gAUC, 0.63; 95% CI, 0.57-0.71; P < .001). As a screening test, a normal RED effectively rules out evacuation disorders (expected clinical response, 8.9%; P = .042). Abnormal RED in the left lateral position (defined as expulsion within 5 seconds or >120 seconds) predicted 48.9% clinical response to physical therapy. A seated maneuver enhanced the likelihood of clinical response (71.1% response with seated RED retained >13 seconds) but likely is unnecessary in most settings. CONCLUSIONS RED offers an opportunity to disrupt the paradigm by offering a personalized approach to managing chronic constipation in the community (Clinicaltrials.gov: NCT04159350).
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Affiliation(s)
- Eric D Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Elizabeth A Pelletier
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Carol Greeley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emily E Sieglinger
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jamie D Sanchez
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kayla A Northam
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jessica A Perrone
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Michael A Curley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Christopher M Navas
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tracy L Ostler
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jason R Baker
- Division of Gastroenterology, Atrium Health, Charlotte, North Carolina
| | | | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - William D Chey
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
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Hennessey KC, Zeitler E, Welch T, Dodge S, Bachour K, Martinez-Camblor P, Douglas PS, Coylewright M, Forcino R. THE CURRENT STATE OF WOMEN IN CARDIOVASCULAR LEADERSHIP AND THEIR IMPACT ON TRAINEE PROGRAM SELECTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02828-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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19
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Almagro P, Martinez-Camblor P. Comment on: Combination therapy with long-acting bronchodilators and the risk of major adverse cardiovascular events in patients with COPD: a systematic review and meta-analysis. Eur Respir J 2023; 61:13993003.02208-2022. [PMID: 36549702 DOI: 10.1183/13993003.02208-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Pere Almagro
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Faculty of Health Sciences, Universidad Autonoma de Chile, Providencia, Chile
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20
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Song Y, Surgenor JV, Leeds ZT, Kanter JH, Martinez-Camblor P, Smith WJ, Boone MD, Abess AT, Evans LT, Kobylarz EJ. Variables associated with cortical motor mapping thresholds: A retrospective data review with a unique case of interlimb motor facilitation. Front Neurol 2023; 14:1150670. [PMID: 37114230 PMCID: PMC10128911 DOI: 10.3389/fneur.2023.1150670] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Intraoperative neuromonitoring (IONM) is crucial to preserve eloquent neurological functions during brain tumor resections. We observed a rare interlimb cortical motor facilitation phenomenon in a patient with recurrent high-grade glioma undergoing craniotomy for tumor resection; the patient's upper arm motor evoked potentials (MEPs) increased in amplitude significantly (up to 44.52 times larger, p < 0.001) following stimulation of the ipsilateral posterior tibial nerve at 2.79 Hz. With the facilitation effect, the cortical MEP stimulation threshold was reduced by 6 mA to maintain appropriate continuous motor monitoring. It likely has the benefit of reducing the occurrence of stimulation-induced seizures and other adverse events associated with excessive stimulation. Methods We conducted a retrospective data review including 120 patients who underwent brain tumor resection with IONM at our center from 2018 to 2022. A broad range of variables collected pre-and intraoperatively were reviewed. The review aimed to determine: (1) whether we overlooked this facilitation phenomenon in the past, (2) whether this unique finding is related to any specific demographic information, clinical presentation, stimulation parameter (s) or anesthesia management, and (3) whether it is necessary to develop new techniques (such as facilitation methods) to reduce cortical stimulation intensity during intraoperative functional mapping. Results There is no evidence suggesting that clinical presentation, stimulation configuration, or intraoperative anesthesia management of the patient with the facilitation effect were significantly different from our general patient cohort. Even though we did not identify the same facilitation effect in any of these patients, we were able to determine that stimulation thresholds for motor mapping are significantly associated with the location of stimulation (p = 0.003) and the burst suppression ratio (BSR) (p < 0.001). Stimulation-induced seizures, although infrequent (4.05%), could occur unexpectedly even when the BSR was 70%. Discussion We postulated that functional reorganization and neuronal hyperexcitability induced by glioma progression and repeated surgeries were probable underlying mechanisms of the interlimb facilitation phenomenon. Our retrospective review also provided a practical guide to cortical motor mapping in brain tumor patients under general anesthesia. We also underscored the need for developing new techniques to reduce the stimulation intensity and, hence, seizure occurrence.
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Affiliation(s)
- Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- *Correspondence: Yinchen Song,
| | - James V. Surgenor
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Haverford College, Haverford, PA, United States
| | - Zachary T. Leeds
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - John H. Kanter
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - William J. Smith
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - M. Dustin Boone
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alexander T. Abess
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Erik J. Kobylarz
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
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Malik K, Diaz-Coto S, de la Asunción Villaverde M, Martinez-Camblor P, Navarro-Rolon A, Pujalte F, De la Sierra A, Almagro P. Impact of Spirometrically Confirmed Chronic Obstructive Pulmonary Disease on Arterial Stiffness and Surfactant Protein D After Percutaneous Coronary Intervention. The CATEPOC Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2577-2587. [PMID: 36267326 PMCID: PMC9578359 DOI: 10.2147/copd.s373853] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Several mechanisms have been proposed to explain why chronic obstructive pulmonary disease (COPD) impairs the prognosis of coronary events. We aimed to explore COPD variables related to a worse prognosis in patients undergoing percutaneous coronary intervention (PCI). Methods Patients with an acute coronary event treated by PCI were prospectively included. One month after discharge, clinical characteristics, comorbidities measured with the Charlson index, and prognostic coronary scales (logistic EuroSCORE; GRACE 2.0) were collected. Post-bronchodilator spirometry, arterial stiffness, and serum inflammatory and myocardial biomarkers were measured. Lung plasmatic biomarkers (Surfactant protein D, desmosine, and Clara cell secretory protein-16) were determined with ELISA. COPD was defined by the fixed ratio (FEV1/FVC <70%). Spirometric values were also analyzed as continuous variables using adjusted and non-adjusted ANCOVA analysis. Finally, we evaluated the presence of a respiratory pattern defined by non-stratified spirometric values and pulmonary biomarkers. Results A total of 164 patients with a mean age of 65 (±10) years (79% males) were included. COPD was diagnosed in 56 (34%) patients (68% previously undiagnosed). COPD patients had a longer smoking history, higher scores on the EuroSCORE (p < 0.0001) and GRACE 2.0 (p < 0.001) scales, and more comorbidities (p = 0.006). Arterial stiffness determined by pulse wave velocity was increased in COPD patients (7.35 m/s vs 6.60 m/s; p = 0.006). Serum values of high sensitive T troponin (p = 0.007) and surfactant protein D (p = 0.003) were also higher in COPD patients. FEV1% remained significantly associated with arterial stiffness and surfactant protein D in the adjusted ANCOVA analysis. In the cluster exploration, 53% of the patients had a respiratory pattern. Conclusion COPD affects one-third of patients with an acute coronary event and frequently remains undiagnosed. Several mechanisms, including arterial stiffness and SPD, were increased in COPD patients. Their relationship with the prognosis should be confirmed with longitudinal follow-up of the cohort.
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Affiliation(s)
- Komal Malik
- Internal Medicine Service, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain
| | - Susana Diaz-Coto
- Epidemiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA,Faculty of Health Sciences, Universidad Autonoma de Chile, Providencia, 7500912, Chile
| | - Annie Navarro-Rolon
- Pneumology Service, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain,Immunology Department, Catlab Laboratory, Barcelona, Spain
| | | | - Alejandro De la Sierra
- Internal Medicine Service, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain
| | - Pere Almagro
- Internal Medicine Service, University Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain,Correspondence: Pere Almagro, Email
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22
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Columbo JA, Martinez-Camblor P, Stone DH, Goodney PP, O'Malley AJ. Procedural Safety Comparison Between Transcarotid Artery Revascularization, Carotid Endarterectomy, and Carotid Stenting: Perioperative and 1-Year Rates of Stroke or Death. J Am Heart Assoc 2022; 11:e024964. [PMID: 36172943 DOI: 10.1161/jaha.121.024964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcarotid artery revascularization (TCAR) was approved by the Food and Drug Administration in 2015 for patients with carotid artery stenosis. However, no randomized trial to evaluate TCAR has been performed to date, and previous reports have important limitations. Accordingly, we measured stroke or death after TCAR compared with carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Methods and Results We used the Vascular Quality Initiative registry to study patients who underwent TCAR, CEA, or TF-CAS from September 2016 to June 2021. Our primary outcomes were perioperative and 1-year stroke or death. We used logistic regression for risk adjustment for perioperative outcomes and Cox regression for risk adjustment for 1-year outcomes. We used a 2-stage residual inclusion instrumental variable (IV) method to adjust for selection bias and other unmeasured confounding. Our instrument was a center's preference to perform TCAR versus CEA or TF-CAS. We performed a subgroup analysis stratified by presenting neurologic symptoms. We studied 21 234 patients who underwent TCAR, 82 737 who underwent CEA, and 14 595 who underwent TF-CAS across 662 centers. The perioperative rate of stroke or death was 2.0% for TCAR, 1.7% for CEA, and 3.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted odds ratio of perioperative stroke or death for CEA was 0.74 (95% CI, 0.55-0.99) and for TF-CAS was 1.66 (95% CI, 0.99-2.79). Results were similar among both symptomatic and asymptomatic patients. The 1-year rate of stroke or death was 6.4% for TCAR, 5.2% for CEA, and 9.7% for TF-CAS (P<0.001). Compared with TCAR, the IV-adjusted hazard ratio of 1 year stroke or death for CEA was 0.97 (95% CI, 0.80-1.17), and for TF-CAS was 1.45 (95% CI, 1.04-2.02). IV analysis further demonstrated that symptomatic patients with carotid stenosis had the lowest 1-year likelihood of stroke or death with TCAR (compared with TCAR, symptomatic IV-adjusted hazard ratio for CEA: 1.30 [95% CI, 1.04-1.64], and TF-CAS: 1.86 [95% CI, 1.27-2.71]). Conclusions Perioperative stroke or death was greater following TCAR when compared with CEA. However, at 1 year there was no statistically significant difference in stroke or death between the 2 procedures. TCAR performed favorably compared with TF-CAS at both time points. Although CEA remains the gold standard procedure for patients with carotid stenosis, TCAR appears to be a safe alternative to CEA and TF-CAS when used selectively and may be useful when treating symptomatic patients.
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Affiliation(s)
- Jesse A Columbo
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth College Hanover NH
| | - Pablo Martinez-Camblor
- Department of Anesthesia Dartmouth-Hitchcock Medical Center Lebanon NH.,Department of Biomedical Data Science Dartmouth College Hanover NH
| | - David H Stone
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth College Hanover NH
| | - Philip P Goodney
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth College Hanover NH
| | - A James O'Malley
- Geisel School of Medicine at Dartmouth College Hanover NH.,Department of Biomedical Data Science Dartmouth College Hanover NH
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Signes-Pastor AJ, Díaz-Coto S, Martinez-Camblor P, Carey M, Soler-Blasco R, García-Villarino M, Fernández-Somoano A, Julvez J, Carrasco P, Lertxundi A, Santa Marina L, Casas M, Meharg AA, Karagas MR, Vioque-Lopez J. Arsenic exposure and respiratory outcomes during childhood in the INMA study. PLoS One 2022; 17:e0274215. [PMID: 36083997 PMCID: PMC9462567 DOI: 10.1371/journal.pone.0274215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022] Open
Abstract
Ingested inorganic arsenic (iAs) is a human carcinogen that is also linked to other adverse health effects, such as respiratory outcomes. Yet, among populations consuming low-arsenic drinking water, the impact of iAs exposure on childhood respiratory health is still uncertain. For a Spanish child study cohort (INfancia y Medio Ambiente—INMA), low-arsenic drinking water is usually available and ingestion of iAs from food is considered the major source of exposure. Here, we explored the association between iAs exposure and children’s respiratory outcomes assessed at 4 and 7 years of age (n = 400). The summation of 4-year-old children’s urinary iAs, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) was used as a biomarker of iAs exposure (∑As) (median of 4.92 μg/L). Children’s occurrence of asthma, eczema, sneeze, wheeze, and medication for asthma and wheeze at each assessment time point (i.e., 4- and 7-year) was assessed with maternal interviewer-led questionnaires. Crude and adjusted Poisson regression models using Generalized Estimating Equation (GEE) were performed to account for the association between natural logarithm transformed (ln) urinary ∑As in μg/L at 4 years and repeated assessments of respiratory symptoms at 4 and 7 years of age. The covariates included in the models were child sex, maternal smoking status, maternal level of education, sub-cohort, and children’s consumption of vegetables, fruits, and fish/seafood. The GEE—splines function using Poisson regression showed an increased trend of the overall expected counts of respiratory symptoms with high urinary ∑As. The adjusted expected counts (95% confidence intervals) at ln-transformed urinary ∑As 1.57 (average concentration) and 4.00 (99th percentile concentration) were 0.63 (0.36, 1.10) and 1.33 (0.61, 2.89), respectively. These exploratory findings suggest that even relatively low-iAs exposure levels, relevant to the Spanish and other populations, may relate to an increased number of respiratory symptoms during childhood.
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Affiliation(s)
- Antonio J. Signes-Pastor
- Unidad de Epidemiología de la Nutrición, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- * E-mail:
| | - Susana Díaz-Coto
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Pablo Martinez-Camblor
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Manus Carey
- Institute for Global Food Security, School of Biological Sciences Building, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Raquel Soler-Blasco
- Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain
| | - Miguel García-Villarino
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA)–Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Ana Fernández-Somoano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Molecular Cancer Epidemiology, University Institute of Oncology of the Principality of Asturias (IUOPA)–Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
| | - Jordi Julvez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Paula Carrasco
- Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain
- Department of Medicine, Universitat Jaume I, Castellón de la Plana, Spain
| | - Aitana Lertxundi
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, UPV/EHU, Leioa, Basque Country, Spain
- Health Research Instititue, Biodonostia, Donostia-San Sebastian, Spain
| | - Loreto Santa Marina
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Health Research Instititue, Biodonostia, Donostia-San Sebastian, Spain
- Department of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia-San Sebastián, Spain
| | - Maribel Casas
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Andrew A. Meharg
- Institute for Global Food Security, School of Biological Sciences Building, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Margaret R. Karagas
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Jesús Vioque-Lopez
- Unidad de Epidemiología de la Nutrición, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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Kaden SJ, Light S, Martinez-Camblor P, Wishart H. A-171 Dissociable Dimensions of Multiple Sclerosis-Related Depression. Arch Clin Neuropsychol 2022. [DOI: 10.1093/arclin/acac060.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective: Multiple sclerosis (MS) is associated with increased risk of depression and suicide. Preliminary literature suggests that sadness and anhedonic aspects of depression may dissociate in MS. Based on this, we hypothesized that there would be three subtypes of depression experienced by individuals with MS: primarily sad, primarily anhedonic, and mixed (i.e., elevated anhedonia and sadness), and that certain dimensions would be associated with higher degrees of suicidal ideation.
Method: Participants included 117 patients with MS [Mean (Standard Deviation): age = 47.48 (10.21) years; 78.9% female; 97.3% White non-Hispanic; disease duration = 7.86 (8.30) years; Expanded Disability Status Scale: Median = 3, Range = 0 to 8.0]. Depression was measured using the Beck Depression Inventory-II (BDI-II). Patients’ level of mood symptoms ranged from non-depressed to severely depressed [10.26 (9.35)].
Results: Principle components analysis of BDI-II item-level responses indicated that symptoms in patients with MS dissociated into three dimensions accounting for 59% of variance in total. Dimension 1 included eight items related to negative cognitions, including pessimism, loss of hope and suicidal thoughts. Dimension 2 consisted of eight items characterized by vegetative symptoms and anhedonia. Dimension 3 was comprised of five items pertaining to sadness and emotion regulation issues.
Conclusion(s): There appear to be three dimensions of depression experienced by adults with MS, and the negative cognitions dimension is most strongly related to suicidality, highlighting the importance of screening for this aspect of depression in individuals with MS.
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Glaser AC, Kanter JH, Martinez-Camblor P, Taenzer A, Anderson MV, Buhl L, Shaefi S, Pannu A, Boone MD. The Effect of Antiseizure Medication Administration on Mortality and Early Posttraumatic Seizures in Critically Ill Older Adults with Traumatic Brain Injury. Neurocrit Care 2022; 37:538-546. [PMID: 35641806 DOI: 10.1007/s12028-022-01531-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States. Older adults represent an understudied and growing TBI population. Current Brain Trauma Foundation guidelines support prophylactic antiseizure medication (ASM) administration to reduce the risk of early posttraumatic seizures (within 7 days of injury) in patients with severe TBI. Whether ASM decreases mortality or early seizure risk in this population remains unclear. This study addresses the knowledge gap regarding the impact of ASM administration on the risk of seizure or mortality after TBI in patients more than 65 years of age. METHODS This retrospective cohort study used a publicly available data set from the Medical Information Mart for Intensive Care-III from the Massachusetts Institute of Technology. Our cohort included patients 65 years or older with a primary exposure of early ASM administration with TBI resulting in an intensive care unit (ICU) admission in a level I trauma center from 2001 to 2012. A double-robust inverse propensity scale weighted model on the basis of proportional hazard and logistic regression models was created to assess the association between ASM administration and risk of death within 7 days of admission to the ICU. Secondary outcomes included 30-day mortality and 1-year mortality, early posttraumatic seizures, ICU length of stay, and hospital length of stay. RESULTS Of 1145 patients 65 years or older with TBI admitted to an ICU, 783 (68.4%) received ASM within the first 24 h. Patients meeting inclusion criteria were predominantly white (83.8%) and were male (52.3%), with a median (interquartile range) age of 81 (74-86) years. TBI severity, classified by Glasgow Coma Score, was predominantly mild (71.2%), followed by moderate (16.8%) and severe (11.3%). Patients who received ASM were less likely to have died at 7 days (adjusted death hazard ratio [HR] = 0.48 [95% confidence interval {CI} 0.28-0.88], P = 0.005), at 30 days (adjusted HR 0.67 [95% CI 0.45-0.99], P = 0.045), and at 1 year (adjusted HR 0.72 [95% CI 0.54-0.97], P = 0.029). Groups were not different in regard to seizure (adjusted seizure odds ratio 1.18 [95% CI 0.61-2.26]) compared with those who did not receive ASM. CONCLUSIONS Early ASM administration was associated with reduced mortality at 7 days, 30 days, and 1 year but did not decrease the risk of early seizures among older adults who presented with TBI at an ICU. This benefit was observed in mild, moderate, and severe TBI assessed by Glasgow Coma Score on presentation among patients 65 years old and older and suggests broader recommendations for the use of ASM in older adults who present with TBI of any severity at an ICU.
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Affiliation(s)
- Adam C Glaser
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - John H Kanter
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Health System, Lebanon, NH, USA.,Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Andreas Taenzer
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Health System, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.,Department of Pediatrics, Dartmouth Hitchcock Medical Center, Dartmouth Health System, Lebanon, NH, USA
| | - Matt V Anderson
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Health System, Lebanon, NH, USA
| | - Lauren Buhl
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shahzad Shaefi
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ameeka Pannu
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Myles D Boone
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Health System, Lebanon, NH, USA.,Department of Neurology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Wright MC, Bunning T, Eleswarpu SS, Heflin MT, McDonald S, Lagoo-Deenadalayan S, Whitson H, Martinez-Camblor P, Deiner SG, Berger M. A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesth Analg 2022; 134:149-158. [PMID: 34252066 PMCID: PMC8678136 DOI: 10.1213/ane.0000000000005660] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure of the brain's resistance to volatile anesthetics and hypothesized that low scores on it would be associated with postoperative delirium risk. METHODS We defined the Duke Anesthesia Resistance Scale (DARS) as the average bispectral index (BIS) divided by the quantity (2.5 minus the average age-adjusted end-tidal minimum alveolar concentration [aaMAC] inhaled anesthetic fraction). The relationship between DARS and postoperative delirium was analyzed in 139 older surgical patients (age ≥65) from Duke University Medical Center (n = 69) and Mt Sinai Medical Center (n = 70). Delirium was assessed by geriatrician interview at Duke, and by research staff utilizing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument at Mt Sinai. We examined the relationship between DARS and delirium and used the Youden index to identify an optimal low DARS threshold (for delirium risk), and its associated 95% bootstrap confidence bounds. We used multivariable logistic regression to examine the relationship between low DARS and delirium risk. RESULTS The relationship between DARS and delirium risk was nonlinear, with higher delirium risk at low DARS scores. A DARS threshold of 28.755 maximized the Youden index for the association between low DARS and delirium, with bootstrap 95% confidence bounds of 26.18 and 29.80. A low DARS (<28.755) was associated with increased delirium risk in multivariable models adjusting for site (odds ratio [OR] [95% confidence interval {CI}] = 4.30 [1.89-10.01]; P = .001), or site-plus-patient risk factors (OR [95% CI] = 3.79 [1.63-9.10]; P = .003). These associations with postoperative delirium risk remained significant when using the 95% bootstrap confidence bounds for the low DARS threshold (P < .05 for all). Further, a low DARS (<28.755) was associated with delirium risk after accounting for opioid, midazolam, propofol, phenylephrine, and ketamine dosage as well as site (OR [95% CI] = 4.21 [1.80-10.16]; P = .002). This association between low DARS and postoperative delirium risk after controlling for these other medications remained significant (P < .05) when using either the lower or the upper 95% bootstrap confidence bounds for the low DARS threshold. CONCLUSIONS These results demonstrate that an intraoperative processed EEG-based measure of lower brain anesthetic resistance (ie, low DARS) is independently associated with increased postoperative delirium risk in older surgical patients.
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Affiliation(s)
| | - Thomas Bunning
- Anesthesiology Department, Duke University Medical Center, Durham NC
| | | | - Mitchell T. Heflin
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | - Shelley McDonald
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC
| | | | - Heather Whitson
- Geriatrics Division, Department of Medicine, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC
| | | | - Stacie G Deiner
- Geriatrics and Palliative Care Medicine, Department of Medicine, Mount Sinai Medical Center, New York, NY,Anesthesiology Department, Mount Sinai Medical Center, New York, NY,Neurosurgery Department, Mount Sinai Medical Center, New York, NY,Geisel School of Medicine, Dartmouth College, New Hanover, New Hampshire
| | - Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham NC,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham NC,Center for Cognitive Neuroscience, Duke University, Durham NC
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Ilyas S, Henkin S, Martinez-Camblor P, Suckow BD, Beach JM, Stone DH, Goodney PP, Ebinger JE, Creager MA, Columbo JA. Sex-, Race- and Ethnicity-Based Differences in Thromboembolic Events Among Adults Hospitalized With COVID-19. J Am Heart Assoc 2021; 10:e022829. [PMID: 34845920 PMCID: PMC9075407 DOI: 10.1161/jaha.121.022829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Patients hospitalized with COVID‐19 have an increased risk of thromboembolic events. Whether sex, race or ethnicity impacts these events is unknown. We studied the association between sex, race, and ethnicity and venous and arterial thromboembolic events among adults hospitalized with COVID‐19. Methods and Results We used the American Heart Association Cardiovascular Disease COVID‐19 registry. Primary exposures were sex and race and ethnicity, as defined by the registry. Primary outcomes were venous thromboembolic events and arterial thromboembolic events. We used logistic regression for risk adjustment. We studied 21 528 adults hospitalized with COVID‐19 across 107 centers (54.1% men; 38.1% non‐Hispanic White, 25.4% Hispanic, 25.7% non‐Hispanic Black, 0.5% Native American, 4.0% Asian, 0.4% Pacific Islander, and 5.9% other race and ethnicity). The rate of venous thromboembolic events was 3.7% and was more common in men (4.2%) than women (3.2%; P<0.001), and in non‐Hispanic Black patients (4.9%) than other races and ethnicities (range, 1.3%–3.8%; P<0.001). The rate of arterial thromboembolic events was 3.9% and was more common in men (4.3%) than women (3.5%; P=0.002), and in non‐Hispanic Black patients (5.0%) than other races and ethnicities (range, 2.3%–4.7%; P<0.001). Compared with men, women were less likely to experience venous thromboembolic events (adjusted odds ratio [OR], 0.71; 95% CI, 0.61–0.83) and arterial thromboembolic events (adjusted OR, 0.76; 95% CI, 0.66–0.89). Compared with non‐Hispanic White patients, non‐Hispanic Black patients had the highest likelihood of venous thromboembolic events (adjusted OR, 1.27; 95% CI, 1.04–1.54) and arterial thromboembolic events (adjusted OR, 1.35; 95% CI, 1.11–1.65). Conclusions Men and non‐Hispanic Black adults hospitalized with COVID‐19 are more likely to have venous and arterial thromboembolic events. These subgroups may represent at‐risk patients more susceptible to thromboembolic COVID‐19 complications.
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Affiliation(s)
- Sadia Ilyas
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH
| | - Stanislav Henkin
- Section of Cardiovascular Medicine, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Pablo Martinez-Camblor
- Department of Anesthesiology Dartmouth-Hitchcock Medical Center Lebanon NH.,Department of Biomedical Data Science Dartmouth College Hanover NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Jocelyn M Beach
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - David H Stone
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Joseph E Ebinger
- Section of Cardiovascular Medicine Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA
| | - Mark A Creager
- Section of Cardiovascular Medicine, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Jesse A Columbo
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
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Signes-Pastor AJ, Martinez-Camblor P, Baker E, Madan J, Guill MF, Karagas MR. Prenatal exposure to arsenic and lung function in children from the New Hampshire Birth Cohort Study. Environ Int 2021; 155:106673. [PMID: 34091160 PMCID: PMC8353991 DOI: 10.1016/j.envint.2021.106673] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 05/03/2023]
Abstract
Prenatal arsenic exposure is associated with an increased risk of lung cancer along with multiple non-carcinogenic outcomes, including respiratory diseases in arsenic-contaminated areas. Limited epidemiologic data exist on whether in utero arsenic exposure influences lung development and subsequent respiratory health. We investigated the association between gestational arsenic exposure and childhood lung function in the New Hampshire Birth Cohort Study. Urinary arsenic speciation including inorganic arsenic (iAs), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) and arsenobetaine was measured in maternal urine samples collected during pregnancy and spirometry was performed in offspring at a median age of 7.4 years. Forced vital capacity (FVC), forced expiratory volume in the first second of exhalation (FEV1), and forced expiratory flow between 25% and 75% of FVC (FEF25-75) standardized z-scores were assessed in linear models as dependent variables with the log2-transformed summation of urinary arsenic species (ΣAs = iAs + MMA + DMA) corrected for specific gravity as an independent variable and with adjustment for maternal smoking status, children's age, sex and height. Among the 358 children in the study, a doubling of ΣAs was associated with a -0.08 (ß) decrease in FVC z-scores (95% confidence interval (CI) from -0.14 to -0.01) and -0.10 (ß) (95% CI from -0.18 to -0.02) decrease in FEV1 z-scores. The inverse association appeared stronger among those mothers with lower secondary methylation index (urinary DMA/MMA), especially among girls. No association was observed for FEF25-75 z-scores. Our results suggest that gestation arsenic exposure at levels relevant to the general US population during the vulnerable period of lung formation may adversely affect lung function in childhood.
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Affiliation(s)
- Antonio J Signes-Pastor
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Emily Baker
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Juliette Madan
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Margaret F Guill
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
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Berkowitz J, Martinez-Camblor P, Stevens G, Elwyn G. The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice. Patient Educ Couns 2021; 104:2327-2337. [PMID: 33744056 DOI: 10.1016/j.pec.2021.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice. METHODS incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance. RESULTS The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations. CONCLUSIONS incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice. PRACTICE IMPLICATIONS incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.
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Affiliation(s)
- Julia Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Columbo JA, Martinez-Camblor P, O’Malley AJ, Suckow BD, Hoel AW, Stone DH, Schanzer A, Schermerhorn ML, Sedrakyan A, Goodney PP. Long-term Reintervention After Endovascular Abdominal Aortic Aneurysm Repair. Ann Surg 2021; 274:179-185. [PMID: 31290764 PMCID: PMC10683776 DOI: 10.1097/sla.0000000000003446] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the long-term reintervention rate after endovascular abdominal aortic aneurysm repair (EVR), and identify factors predicting reintervention. SUMMARY OF BACKGROUND DATA EVR is the most common method of aneurysm repair in America, and reintervention after EVR is common. Clinical factors predicting reintervention have not been described in large datasets with long-term follow-up. METHODS We studied patients who underwent EVR using the Vascular Quality Initiative registry linked to Medicare claims. Our primary outcome was reintervention, defined as any procedure related to the EVR after discharge from the index hospitalization. We used classification and regression tree modeling to inform a multivariable Cox-regression model predicting reintervention after EVR. RESULTS We studied 12,911 patients treated from 2003 to 2015. Mean age was 75.5 ± 7.3 years, 79.9% were male, and 89.1% of operations were elective. The 3-year reintervention rate was 15%, and the 10-year rate was 33%. Five factors predicted reintervention: operative time ≥3.0 hours, aneurysm diameter ≥6.0 cm, an iliac artery aneurysm ≥2.0 cm, emergency surgery, and a history of prior aortic surgery. Patients with no risk factors had a 3-year reintervention rate of 12%, and 10-year rate of 26% (n = 7310). Patients with multiple risk factors, such as prior aortic surgery and emergent surgery, had a 3-year reintervention rate 72%, (n = 32). Modifiable factors including EVR graft manufacturer or supra-renal fixation were not associated with reintervention (P = 0.76 and 0.79 respectively). CONCLUSIONS All patients retain a high likelihood of reintervention after EVR, but clinical factors at the time of repair can predict those at highest risk.
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Affiliation(s)
- Jesse A. Columbo
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- The Veterans Health Administration Quality Scholars Program, White River Junction, Vermont
- The Veterans Health Administration Outcomes Group, White River Junction, Vermont
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Bjoern D. Suckow
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andrew W. Hoel
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David H. Stone
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andres Schanzer
- Vascular and Endovascular Surgery, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Marc L. Schermerhorn
- Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Art Sedrakyan
- Department of Surgery, Weill-Cornell Medical School, New York, New York
| | - Philip P. Goodney
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- The Veterans Health Administration Outcomes Group, White River Junction, Vermont
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Bhatta L, Leivseth L, Mai XM, Henriksen AH, Carslake D, Chen Y, Martinez-Camblor P, Langhammer A, Brumpton BM. Spirometric Classifications of Chronic Obstructive Pulmonary Disease Severity as Predictive Markers for Clinical Outcomes: The HUNT Study. Am J Respir Crit Care Med 2021; 203:1033-1037. [PMID: 33332249 PMCID: PMC8048755 DOI: 10.1164/rccm.202011-4174le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Laxmi Bhatta
- Norwegian University of Science and TechnologyTrondheim, Norway
| | | | - Xiao-Mei Mai
- Norwegian University of Science and TechnologyTrondheim, Norway
| | - Anne Hildur Henriksen
- Norwegian University of Science and TechnologyTrondheim, Norway
- Trondheim University HospitalTrondheim, Norway
| | - David Carslake
- MRC Integrative Epidemiology Unit at the University of BristolBristol, United Kingdom
| | - Yue Chen
- University of OttawaOttawa, Ontario, Canada
| | | | - Arnulf Langhammer
- Norwegian University of Science and Technology, Levanger, Norwayand
- Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ben Michael Brumpton
- Norwegian University of Science and TechnologyTrondheim, Norway
- Trondheim University HospitalTrondheim, Norway
- MRC Integrative Epidemiology Unit at the University of BristolBristol, United Kingdom
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MacKenzie TA, Martinez-Camblor P, O'Malley AJ. Time dependent hazard ratio estimation using instrumental variables without conditioning on an omitted covariate. BMC Med Res Methodol 2021; 21:56. [PMID: 33743583 PMCID: PMC7981853 DOI: 10.1186/s12874-021-01245-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background Estimation that employs instrumental variables (IV) can reduce or eliminate bias due to confounding. In observational studies, instruments result from natural experiments such as the effect of clinician preference or geographic distance on treatment selection. In randomized studies the randomization indicator is typically a valid instrument, especially if the study is blinded, e.g. no placebo effect. Estimation via instruments is a highly developed field for linear models but the use of instruments in time-to-event analysis is far from established. Various IV-based estimators of the hazard ratio (HR) from Cox’s regression models have been proposed. Methods We extend IV based estimation of Cox’s model beyond proportionality of hazards, and address estimation of a log-linear time dependent hazard ratio and a piecewise constant HR. We estimate the marginal time-dependent hazard ratio unlike other approaches that estimate the hazard ratio conditional on the omitted covariates. We use estimating equations motivated by Martingale representations that resemble the partial likelihood score statistic. We conducted simulations that include the use of copulas to generate potential times-to-event that have a given marginal structural time dependent hazard ratio but are dependent on omitted covariates. We compare our approach to the partial likelihood estimator, and two other IV based approaches. We apply it to estimation of the time dependent hazard ratio for two vascular interventions. Results The method performs well in simulations of a stepwise time-dependent hazard ratio, but illustrates some bias that increases as the hazard ratio moves away from unity (the value that typically underlies the null hypothesis). It compares well to other approaches when the hazard ratio is stepwise constant. It also performs well for estimation of a log-linear hazard ratio where no other instrumental variable approaches exist. Conclusion The estimating equations we propose for estimating a time-dependent hazard ratio using an IV perform well in simulations. We encourage the use of our procedure for time-dependent hazard ratio estimation when unmeasured confounding is a concern and a suitable instrumental variable exists.
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Affiliation(s)
- Todd A MacKenzie
- Department of Biomedical Data Science, Dartmouth College, New Hampshire, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, New Hampshire, USA.
| | - Pablo Martinez-Camblor
- Department of Biomedical Data Science, Dartmouth College, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, New Hampshire, USA
| | - A James O'Malley
- Department of Biomedical Data Science, Dartmouth College, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, New Hampshire, USA
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Columbo JA, Martinez-Camblor P, O’Malley AJ, Stone DH, Kashyap VS, Powell RJ, Schermerhorn ML, Malas M, Nolan BW, Goodney PP. Association of Adoption of Transcarotid Artery Revascularization With Center-Level Perioperative Outcomes. JAMA Netw Open 2021; 4:e2037885. [PMID: 33616666 PMCID: PMC7900862 DOI: 10.1001/jamanetworkopen.2020.37885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Transcarotid artery revascularization (TCAR) may serve as a safer alternative to carotid endarterectomy (CEA) for certain patients with carotid artery stenosis. OBJECTIVE To determine the center-level association of TCAR adoption with overall perioperative outcomes for TCAR and CEA combined at centers performing both procedures. DESIGN, SETTING, AND PARTICIPANTS This comparative-effectiveness research was conducted with a difference-in-difference analysis using retrospective data from 2015 to 2019 from the Vascular Quality Initiative registry, a consortium of more than 400 centers in North America. Included patients underwent TCAR or CEA for carotid artery stenosis. Patients who underwent transfemoral carotid stenting were excluded. Data were analyzed from December 2019 through August 2020. EXPOSURES Center-level adoption of TCAR vs not. MAIN OUTCOMES AND MEASURES The rate of major adverse cardiovascular events (MACE), a composite of in-hospital stroke, myocardial infarction, or death at 30 days, was measured. RESULTS Among 86 027 patients who underwent revascularization for carotid artery stenosis, 7664 patients (8.9%) underwent TCAR (mean [SD] age, 73.1 [9.6] years; 2788 [36.4%] women; 6938 White patients [90.6%]; and 3741 patients with symptoms [48.8%]) and 78 363 patients (91.1%) underwent CEA (mean [SD] age, 70.6 [9.2] years; 30 928 [39.5%] women; 70 663 White patients [90.2%]; and 37 883 patients with symptoms [48.3%]). The number of centers performing both TCAR and CEA increased from 15 centers in 2015 to 247 centers in 2019, a more than 16-fold increase. The proportion of all carotid procedures that were TCARs increased from 90 of 12 276 (0.7%) in 2015 to 2718 of 15 956 (17.0%) in 2019, a 24-fold increase. Overall, the crude rate of MACE was similar for TCAR and CEA (178 patients [2.3%] after TCAR vs 1842 patients [2.4%] after CEA; P = .91). However, the rate of MACE over time decreased for CEA (406 of 16 404 patients [2.5%] in 2015 vs 189 of 10 097 patients [1.9%] in 2019; P for trend < .001). The rate of MACE over time decreased for TCAR as well, but the change was not statistically significant (4 of 128 patients [3.1%] in 2016 vs 59 of 2718 patients [2.2%] in 2019; P for trend = .07). Difference-in-difference analysis demonstrated that centers that adopted TCAR had a 10% decrease in the likelihood of MACE at 12 months after TCAR adoption vs if those centers had continued to perform CEA alone (odds ratio, 0.90; 95% CI, 0.81-0.99; P = .04). CONCLUSIONS AND RELEVANCE This comparative-effectiveness study of a cohort of patients who underwent TCAR or CEA found that availability of TCAR at a hospital was associated with a decrease in the likelihood of perioperative MACE after carotid revascularization.
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Affiliation(s)
- Jesse A. Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Pablo Martinez-Camblor
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - A. James O’Malley
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - David H. Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Vikram S. Kashyap
- Vascular Center, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Richard J. Powell
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mahmoud Malas
- Division of Vascular and Endovascular Surgery, University of California, San Diego Health, San Diego
| | - Brian W. Nolan
- Section of Vascular Surgery, Maine Medical Center, Portland
| | - Philip P. Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
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Horner A, Almagro P, Soriano JB, Kaiser B, Martinez-Camblor P, Lang D, Alfageme I, Ciro C, Esteban C, Soler-Cataluña JJ, De-Torres JP, Miravitlles M, Celli BR, Marin JM, Puhan MA, Sobradillo P, Lange P, Garcia-Aymerich J, Turner AM, Han MK, Langhammer A, Bakke P, Johannessen A, Oga T, Cosío BG, Ancochea-Bermúdez J, Echazarreta AL, Roche N, Burgel PR, Sin DD, Ramírez AS, Studnicka M, Flamm M, Lamprecht B. Risk charts of five-year mortality in COPD patients. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.pa3322] [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: 11/05/2022]
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Almagro P, Martinez-Camblor P, Soriano JB. Inhaled corticosteroids and pneumonia mortality in COPD patients. Eur Respir J 2019; 54:1901035. [PMID: 31488585 DOI: 10.1183/13993003.01035-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/30/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Pere Almagro
- Multimorbidity Patients Unit, Internal Medicine Dept, University Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Joan B Soriano
- Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, España
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Columbo JA, Ramkumar N, Martinez-Camblor P, Kang R, Suckow BD, O'Malley AJ, Sedrakyan A, Goodney PP. Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative. J Vasc Surg 2019; 71:799-805.e1. [PMID: 31471231 DOI: 10.1016/j.jvs.2019.05.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients who undergo endovascular abdominal aortic aneurysm repair (EVR) remain at risk for reintervention and rupture. We sought to define the 5-year rate of reintervention and rupture after EVR in the Vascular Quality Initiative (VQI). METHODS We identified all patients in the VQI who underwent EVR from 2003 to 2015. We linked patients in the VQI to Medicare claims for long-term outcomes. We stratified patients on baseline clinical and procedural characteristics to identify those at risk for reintervention. Our primary outcomes were 5-year rates of reintervention and late aneurysm rupture after EVR. We assessed these with Kaplan-Meier survival estimation. RESULTS We studied 12,911 patients who underwent EVR. The mean age was 75.5 years, 79.9% were male, 3.9% were black, and 89.1% of operations were performed electively. The 5-year rate of reintervention for the entire cohort was 21%, and the 5-year rate of late aneurysm rupture was 3%. Reintervention rates varied across categories of EVR urgency. Patients who underwent EVR electively had the lowest 5-year rate of reintervention at 20%. Those who underwent surgery for symptomatic aneurysms had higher rates of reintervention at 25%. Patients undergoing EVR emergently for rupture had the highest rate of reintervention, 27% at 4 years (log-rank across the three groups, P < .001). Black race and aneurysm size of 6.0 cm or greater were associated with significantly elevated reintervention rates (black, 31% vs white, 20% [log-rank, P < .001]; aneurysm size 6.0 cm or greater, 27% vs all others, <20% [log-rank, P < .001]). There were no significant associations between age or gender and the 5-year rate of reintervention. CONCLUSIONS More than one in five Medicare patients undergo reintervention within 5 years after EVR in the VQI; late rupture remains low at 3%. Black patients, those with large aneurysms, and those who undergo EVR urgently and emergently have a higher likelihood of adverse outcomes and should be the focus of diligent long-term surveillance.
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Affiliation(s)
- Jesse A Columbo
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Niveditta Ramkumar
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ravinder Kang
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Art Sedrakyan
- Department of Surgery, Weill-Cornell Medical School, New York, NY
| | - Philip P Goodney
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Fernández AF, Bayón GF, Urdinguio RG, Toraño EG, García MG, Carella A, Petrus-Reurer S, Ferrero C, Martinez-Camblor P, Cubillo I, García-Castro J, Delgado-Calle J, Pérez-Campo FM, Riancho JA, Bueno C, Menéndez P, Mentink A, Mareschi K, Claire F, Fagnani C, Medda E, Toccaceli V, Brescianini S, Moran S, Esteller M, Stolzing A, de Boer J, Nisticò L, Stazi MA, Fraga MF. Corrigendum: H3K4me1 marks DNA regions hypomethylated during aging in human stem and differentiated cells. Genome Res 2019; 29:710.2. [PMID: 30936177 DOI: 10.1101/gr.249417.119] [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: 11/24/2022]
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Columbo JA, Martinez-Camblor P, MacKenzie TA, Staiger DO, Kang R, Goodney PP, O’Malley AJ. Comparing Long-term Mortality After Carotid Endarterectomy vs Carotid Stenting Using a Novel Instrumental Variable Method for Risk Adjustment in Observational Time-to-Event Data. JAMA Netw Open 2018; 1:e181676. [PMID: 30646140 PMCID: PMC6324509 DOI: 10.1001/jamanetworkopen.2018.1676] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Choosing between competing treatment options is difficult for patients and clinicians when results from randomized and observational studies are discordant. Observational real-world studies yield more generalizable evidence for decision making than randomized clinical trials, but unmeasured confounding, especially in time-to-event analyses, can limit validity. OBJECTIVES To compare long-term survival after carotid endarterectomy (CEA) and carotid artery stenting (CAS) in real-world practice using a novel instrumental variable method designed for time-to-event outcomes, and to compare the results with traditional risk-adjustment models used in observational research for survival analyses. DESIGN, SETTING, AND PARTICIPANTS A multicenter cohort study was performed. The Vascular Quality Initiative, an observational quality improvement registry, was used to compare long-term mortality after CEA vs CAS. The study included 86 017 patients who underwent CEA (n = 73 312) or CAS (n = 12 705) between January 1, 2003, and December 31, 2016. Patients were followed up for long-term mortality assessment by linking the registry data to Medicare claims. Medicare claims data were available through September 31, 2015. EXPOSURE Procedure type (CEA vs CAS). MAIN OUTCOMES AND MEASURES The hazard ratios (HRs) of all-cause mortality using unadjusted, adjusted, propensity-matched, and instrumental variable methods were examined. The instrumental variable was the proportion of CEA among the total carotid procedures (endarterectomy and stenting) performed at each hospital in the 12 months before each patient's index operation and therefore varies over the study period. RESULTS Participants who underwent CEA had a mean (SD) age of 70.3 (9.4) years compared with 69.1 (10.4) years for CAS, and most were men (44 191 [60.4%] for CEA and 8117 [63.9%] for CAS). The observed 5-year mortality was 12.8% (95% CI, 12.5%-13.2%) for CEA and 17.0% (95% CI, 16.0%-18.1%) for CAS. The unadjusted HR of mortality for CEA vs CAS was 0.67 (95% CI, 0.64-0.71), and Cox-adjusted and propensity-matched HRs were similar (0.69; 95% CI, 0.65-0.74 and 0.71; 95% CI, 0.65-0.77, respectively). These findings are comparable with published observational studies of CEA vs CAS. However, the association between CEA and mortality was more modest when estimated by instrumental variable analysis (HR, 0.83; 95% CI, 0.70-0.98), a finding similar to data reported in randomized clinical trials. CONCLUSIONS AND RELEVANCE The study found a survival advantage associated with CEA over CAS in unadjusted and Cox-adjusted analyses. However, this finding was more modest when using an instrumental variable method designed for time-to-event outcomes for risk adjustment. The instrumental variable-based results were more similar to findings from randomized clinical trials, suggesting this method may provide less biased estimates of time-dependent outcomes in observational analyses.
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Affiliation(s)
- Jesse A. Columbo
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
- Section of Vascular Surgery, Dartmouth-Hitchcock
Medical Center, Lebanon, New Hampshire
| | | | - Todd A. MacKenzie
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
- Department of Biomedical Data Science, Geisel School
of Medicine, Lebanon, New Hampshire
| | - Douglas O. Staiger
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
- Department of Economics, Dartmouth College, Hanover,
New Hampshire
| | - Ravinder Kang
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
| | - Philip P. Goodney
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
- Section of Vascular Surgery, Dartmouth-Hitchcock
Medical Center, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, New Hampshire
- Department of Biomedical Data Science, Geisel School
of Medicine, Lebanon, New Hampshire
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Guerra B, Haile SR, Lamprecht B, Ramírez AS, Martinez-Camblor P, Kaiser B, Alfageme I, Almagro P, Casanova C, Esteban-González C, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Marin JM, ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Antó JM, Turner AM, Han MK, Langhammer A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosio B, Ancochea-Bermúdez J, Echazarreta A, Roche N, Burgel PR, Sin DD, Soriano JB, Puhan MA. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease. BMC Med 2018; 16:33. [PMID: 29495970 PMCID: PMC5833113 DOI: 10.1186/s12916-018-1013-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/26/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.
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Affiliation(s)
- Beniamino Guerra
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- Faculty of Medicine, Johannes Kepler Universitat Linz, Linz, Austria
| | - Ana S. Ramírez
- Facultad de Medicina UASLP, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | | | - Bernhard Kaiser
- Department of Pulmonary Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | | | - Pere Almagro
- Internal Medicine, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - Ciro Casanova
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Tenerife, Spain
| | | | | | - Juan P. de-Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marc Miravitlles
- European Respiratory Society (ERS) Guidelines Director, Barcelona, Spain
| | - Bartolome R. Celli
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Jose M. Marin
- IISAragón and CIBERES, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peter Lange
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Judith Garcia-Aymerich
- ISGlobal, CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M. Antó
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meilan K. Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Norvegian University of Science and Technology, Trondheim, Norway
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodø, Norway
| | - Per Bakke
- University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Borja Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain
| | - Julio Ancochea-Bermúdez
- Instituto de Investigación Sanitaria Princesa (IISP)-Servicio de Neumología- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andres Echazarreta
- Universidad Nacional de la Plata, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Nicolas Roche
- Hopitaux Universitaires Paris Centre, Service de Pneumologie AP-HP, Paris, France
| | | | - Don D. Sin
- University of British Columbia, James Hogg Research Centre, Vancouver, Canada
| | - Joan B. Soriano
- Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Servicio de Neumología, Madrid, Spain
- Scientific and Methodological Consultant of SEPAR www.separ.es, Barcelona, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Room HRS G29, CH -8001 Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - for the 3CIA collaboration
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- Faculty of Medicine, Johannes Kepler Universitat Linz, Linz, Austria
- Facultad de Medicina UASLP, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Dartmouth College Geisel School of Medicine, Dartmouth, NH USA
- Department of Pulmonary Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
- Hospital Universitario de Valme, Sevilla, Spain
- Internal Medicine, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Tenerife, Spain
- Network and Health Services Research Chronic Diseases (REDISSEC), Hospital Galdakao, Bizkaia, Spain
- Servicio de Neumología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
- European Respiratory Society (ERS) Guidelines Director, Barcelona, Spain
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
- IISAragón and CIBERES, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Hospital Univarsitario de Cruces, Barakaldo, Vizcaya Spain
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- ISGlobal, CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
- Department of Public Health and Nursing, Norvegian University of Science and Technology, Trondheim, Norway
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodø, Norway
- University of Bergen, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria Princesa (IISP)-Servicio de Neumología- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Universidad Nacional de la Plata, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
- Hopitaux Universitaires Paris Centre, Service de Pneumologie AP-HP, Paris, France
- Hopital Cochin; Universite Paris Descartes, Paris, France
- University of British Columbia, James Hogg Research Centre, Vancouver, Canada
- Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Servicio de Neumología, Madrid, Spain
- Scientific and Methodological Consultant of SEPAR www.separ.es, Barcelona, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Room HRS G29, CH -8001 Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Burgel PR, Paillasseur JL, Janssens W, Piquet J, Ter Riet G, Garcia-Aymerich J, Cosio B, Bakke P, Puhan MA, Langhammer A, Alfageme I, Almagro P, Ancochea J, Celli BR, Casanova C, de-Torres JP, Decramer M, Echazarreta A, Esteban C, Gomez Punter RM, Han MK, Johannessen A, Kaiser B, Lamprecht B, Lange P, Leivseth L, Marin JM, Martin F, Martinez-Camblor P, Miravitlles M, Oga T, Sofia Ramírez A, Sin DD, Sobradillo P, Soler-Cataluña JJ, Turner AM, Verdu Rivera FJ, Soriano JB, Roche N. A simple algorithm for the identification of clinical COPD phenotypes. Eur Respir J 2017; 50:50/5/1701034. [PMID: 29097431 DOI: 10.1183/13993003.01034-2017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/28/2017] [Indexed: 11/05/2022]
Abstract
This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient grouping differed markedly between patients with isolated respiratory disease (FEV1, dyspnoea grade) and those with multi-morbidity (dyspnoea grade, age, FEV1 and body mass index). Application of this algorithm to the 3CIA cohorts confirmed that it identified subgroups of patients with different clinical characteristics, mortality rates (median, from 4% to 27%) and age at death (median, from 68 to 76 years).A simple algorithm, integrating respiratory characteristics and comorbidities, allowed the identification of clinically relevant COPD phenotypes.
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Affiliation(s)
- Pierre-Régis Burgel
- University Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France .,Dept of Respiratory Medicine, Cochin Hospital, AP-HP, Paris, France
| | | | - Wim Janssens
- Respiratory Division, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium
| | - Jacques Piquet
- Dept of Respiratory Medicine, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Gerben Ter Riet
- Dept General Practice - Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Borja Cosio
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Per Bakke
- Dept of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Milo A Puhan
- Epidemiology, Biostatistics und Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Arnulf Langhammer
- Dept of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | | | - Pere Almagro
- Internal Medicine, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Julio Ancochea
- Pneumology Service, La Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Ciro Casanova
- Hospital Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | - Marc Decramer
- Respiratory Division, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium
| | - Andrés Echazarreta
- Servicio de Neumonología Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | | | | | | | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Bernhard Kaiser
- Dept of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Bernd Lamprecht
- Dept of Pulmonary Medicine, General Hospital Linz (AKH), Linz, Austria
| | - Peter Lange
- Section of Social Medicine, Dept of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromso, Norway
| | - Jose M Marin
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Francis Martin
- Pneumologie, Centre Hospitalier de Compiègne, Compiègne, France
| | - Pablo Martinez-Camblor
- Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.,Universidad Autónoma de Chile, San Miguel, Chile
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitary Vall d'Hebron. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Toru Oga
- Dept of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Don D Sin
- James Hogg Research Centre, University of British Columbia; Division of Respiratory Medicine, Dept of Medicine, St Paul's Hospital, Vancouver, Canada
| | | | | | - Alice M Turner
- Queen Elizabeth Hospital Research Laboratories, Birmingham, UK
| | | | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Nicolas Roche
- University Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France.,Dept of Respiratory Medicine, Cochin Hospital, AP-HP, Paris, France
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Columbo JA, Martinez-Camblor P, MacKenzie TA, Staiger DO, Kang R, Goodney PP, O'Malley AJ. Long-Term Survival After Carotid Endarterectomy and Carotid Stenting: A Propensity-Matched Analysis. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.05.022] [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: 10/19/2022]
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Sánchez-Alvarez JE, Nuñez-Moral M, Martinez-Camblor P, Méndez-González A, Peláez-Requejo B, Fernández-Pérez M, González-Díaz I, Rodríguez-Suárez C. MP541MULPA: A MULTICOMPONENT INDEX FOR A QUICK DIAGNOSIS OF PERITONITIS IN PERITONEAL DIALYSIS PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx176.mp541] [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: 11/15/2022] Open
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Arboleya S, Martinez-Camblor P, Solís G, Suárez M, Fernández N, de Los Reyes-Gavilán CG, Gueimonde M. Intestinal Microbiota and Weight-Gain in Preterm Neonates. Front Microbiol 2017; 8:183. [PMID: 28228752 PMCID: PMC5296308 DOI: 10.3389/fmicb.2017.00183] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023] Open
Abstract
The involvement of the gut microbiota on weight-gain and its relationship with childhood undernutrition and growth has been reported. Thus, the gut microbiota constitutes a potential therapeutic target for preventing growth impairment. However, our knowledge in this area is limited. In this study we aimed at evaluating the relationship among early microbiota, growth, and development in preterm infants. To this end we assessed the levels of specific microorganisms by qPCR, and those of short chain fatty acids by mean of gas-chromatography, in feces from 63 preterm newborns and determined their weight-gain during the first months. The statistical analyses performed indicate an influence of the intestinal microbiota in weight-gain, with the levels of some microorganisms showing a significant association with the weight-gain of the infant. The levels of specific microbial groups during the first days of life were found to affect weight gain by the age of 1 month. Moreover, clustering of the infants on the basis of the microbiota composition at 1 month of age rendered groups which showed differences in weight z-scores. Our results suggest an association between the gut microbiota composition and weight-gain in preterm infants at early life and point out potential microbial targets for favoring growth and maturation in these infants.
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Affiliation(s)
- Silvia Arboleya
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (CSIC) Villaviciosa, Spain
| | - Pablo Martinez-Camblor
- Geisel School of Medicine at Dartmouth, Dartmouth CollegeHanover (NH), USA; Universidad Autónoma de ChileSantiago, Chile
| | - Gonzalo Solís
- Pediatrics Service, Hospital Universitario Central de Asturias, Servicio de Salud del Principado de Asturias (SESPA) Oviedo, Spain
| | - Marta Suárez
- Pediatrics Service, Hospital Universitario Central de Asturias, Servicio de Salud del Principado de Asturias (SESPA) Oviedo, Spain
| | - Nuria Fernández
- Pediatrics Service, Hospital Universitario Central de Asturias, Servicio de Salud del Principado de Asturias (SESPA)Oviedo, Spain; Pediatrics Service, Hospital de Cabueñes, Servicio de Salud del Principado de Asturias (SESPA)Gijón, Spain
| | - Clara G de Los Reyes-Gavilán
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (CSIC) Villaviciosa, Spain
| | - Miguel Gueimonde
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias (CSIC) Villaviciosa, Spain
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Vidal-Castiñeira JR, López-Vázquez A, Diaz-Peña R, Diaz-Bulnes P, Martinez-Camblor P, Coto E, Coto-Segura P, Bruges-Armas J, Pinto JA, Blanco FJ, Sánchez A, Mulero J, Queiro R, Lopez-Larrea C. A Single Nucleotide Polymorphism in the Il17ra Promoter Is Associated with Functional Severity of Ankylosing Spondylitis. PLoS One 2016; 11:e0158905. [PMID: 27415816 PMCID: PMC4945092 DOI: 10.1371/journal.pone.0158905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/26/2016] [Accepted: 06/23/2016] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to identify new genetic variants associated with the severity of ankylosing spondylitis (AS). We sequenced the exome of eight patients diagnosed with AS, selected on the basis of the severity of their clinical parameters. We identified 27 variants in exons and regulatory regions. The contribution of candidate variants found to AS severity was validated by genotyping two Spanish cohorts consisting of 180 cases/300 controls and 419 cases/656 controls. Relationships of SNPs and clinical variables with the Bath Ankylosing Spondylitis Disease Activity and Functional Indices BASDAI and BASFI were analyzed. BASFI was standardized by adjusting for the duration of the disease since the appearance of the first symptoms. Refining the analysis of SNPs in the two cohorts, we found that the rs4819554 minor allele G in the promoter of the IL17RA gene was associated with AS (p<0.005). This variant was also associated with the BASFI score. Classifying AS patients by the severity of their functional status with respect to BASFI/disease duration of the 60th, 65th, 70th and 75th percentiles, we found the association increased from p60 to p75 (cohort 1: p<0.05 to p<0.01; cohort 2: p<0.01 to p<0.005). Our findings indicate a genetic role for the IL17/ILRA axis in the development of severe forms of AS.
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Affiliation(s)
| | | | - Roberto Diaz-Peña
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Paula Diaz-Bulnes
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Martinez-Camblor
- Department of Statistics, Hospital Universitario Central de Asturias, Oviedo, Spain
- Facultad de Ciencias de la Educación, Universidad Autónoma de Chile, Santiago de Chile, Chile
| | - Eliecer Coto
- Molecular Genetics Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Coto-Segura
- Dermatology II Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jacome Bruges-Armas
- Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Jose Antonio Pinto
- Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Francisco Jose Blanco
- Rheumatology Service, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Alejandra Sánchez
- Rheumatology Service, Puerta del Hierro University Hospital, Majadahonda, Madrid
| | - Juan Mulero
- Rheumatology Service, Puerta del Hierro University Hospital, Majadahonda, Madrid
| | - Ruben Queiro
- Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Lopez-Larrea
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Fundación Renal Iñigo Álvarez de Toledo, Madrid, Spain
- * E-mail:
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Boeck L, Soriano JB, Brusse-Keizer M, Blasi F, Kostikas K, Boersma W, Milenkovic B, Louis R, Lacoma A, Djamin R, Aerts J, Torres A, Rohde G, Welte T, Martinez-Camblor P, Rakic J, Scherr A, Koller M, van der Palen J, Marin JM, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Tamm M, Stolz D. Prognostic assessment in COPD without lung function: the B-AE-D indices. Eur Respir J 2016; 47:1635-44. [PMID: 27103389 PMCID: PMC5394475 DOI: 10.1183/13993003.01485-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 09/07/2015] [Accepted: 01/18/2016] [Indexed: 02/02/2023]
Abstract
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05).The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk.
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Affiliation(s)
- Lucas Boeck
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
| | | | - Wim Boersma
- Dept of Pneumology, Medisch Centrum, Alkmaar, The Netherlands
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Renaud Louis
- Dept of Pneumology, University of Liege, Liege, Belgium
| | - Alicia Lacoma
- Dept of Microbiology, Hospital Universitari Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Remco Djamin
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Joachim Aerts
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Antoni Torres
- Dept of Pneumology, Hospital Clinic, Barcelona, Spain
| | - Gernot Rohde
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tobias Welte
- Dept of Pneumology, Medizinische Hochschule, Hannover, Germany
| | | | - Janko Rakic
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Andreas Scherr
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Michael Koller
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jose M Marin
- Respiratory Dept, Hospital Universitario Miguel Servet, Zaragoza, CIBER Enfermedades Respiratoria, Madrid, Spain
| | | | - Pere Almagro
- Internal Medicine Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Ciro Casanova
- Respiratory Dept, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Juan P de-Torres
- Respiratory Dept, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bartolome R Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Michael Tamm
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
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Touza Pol P, Rey Galán C, Medina Villanueva J, Martinez-Camblor P, López-Herce J. Severe acute kidney injury in critically ill children: Epidemiology and prognostic factors. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lange P, Celli B, Agustí A, Boje Jensen G, Divo M, Faner R, Guerra S, Marott JL, Martinez FD, Martinez-Camblor P, Meek P, Owen CA, Petersen H, Pinto-Plata V, Schnohr P, Sood A, Soriano JB, Tesfaigzi Y, Vestbo J. Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease. N Engl J Med 2015; 373:111-22. [PMID: 26154786 DOI: 10.1056/nejmoa1411532] [Citation(s) in RCA: 793] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD. (Funded by an unrestricted grant from GlaxoSmithKline and others.).
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Affiliation(s)
- Peter Lange
- From the Institute of Public Health, Section of Social Medicine (P.L.), Respiratory Section, Hvidovre Hospital (P.L.), Copenhagen City Heart Study, Frederiksberg Hospital (P.L., G.B.J., J.L.M., P.S.), and the Department of Respiratory Medicine, Gentofte Hospital (J.V.), Copenhagen University, Copenhagen, and University of Southern Denmark, Odense (G.B.J.) - all in Denmark; Brigham and Women's Hospital, Harvard Medical School, Boston (B.C., M.D., C.A.O., V.P.-P.); Servei de Pneumologia, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona (A.A.), and Fundació Clínic per a la Recerca Biomèdica (R.F.) - both in Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (A.A., R.F.) and Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid (UAM), Cátedra UAM-Linde (J.B.S.) - both in Madrid; Arizona Respiratory Center, University of Arizona, Tucson (S.G., F.D.M.); Universidad Autónoma de Chile, Santiago, Chile (P.M.-C.); University of Colorado, Denver, Denver (P.M.); Lovelace Respiratory Research Institute (H.P., Y.T.) and University of New Mexico (A.S.) - both in Albuquerque; and the Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom (J.V.)
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48
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Touza Pol P, Rey Galán C, Medina Villanueva JA, Martinez-Camblor P, López-Herce J. [Severe acute kidney injury in critically ill children: Epidemiology and prognostic factors]. An Pediatr (Barc) 2015; 83:367-75. [PMID: 25754312 DOI: 10.1016/j.anpedi.2015.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/05/2014] [Revised: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a severe complication in critically ill children. The aim of the study was to describe the characteristics of AKI, as well as to analyse the prognostic factors for mortality and renal replacement therapy (RRT) in children admitted to Paediatric Intensive Care Units (PICUs) in Spain. PATIENTS AND METHODS Prospective observational multicentre study including children from 7 days to 16 years old who were admitted to a PICU. A univariate and multivariate logistic regression analysis of the risk factors for mortality and renal replacement therapy at PICU discharge were performed. RESULTS A total of 139 cases of AKI were analysed. RRT was necessary in 60.1% of cases. Mortality rate was 32.6%. At PICU discharge RRT was necessary in 15% of survivors. Thrombopenia and low creatinine clearance values were prognostic markers of RRT at PICU discharge. High values of platelets, serum creatinine and weight were associated with higher survival. CONCLUSIONS Critically ill children with AKI had a high mortality and morbidity rate. Platelet values and creatinine clearance are markers of RRT at PICU discharge, whereas number of platelets, serum creatinine and weight were associated with mortality.
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Affiliation(s)
- P Touza Pol
- Unidad de Cuidados Intensivos Pediátricos, Hospital Madrid Torrelodones, Torrelodones, Madrid, España.
| | - C Rey Galán
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España
| | - J A Medina Villanueva
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Martinez-Camblor
- Oficina de Investigación Biosanitaria de Asturias (OIB) , Chile; Universidad Autónoma de Chile, Chile
| | - J López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España
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49
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Fernández AF, Bayón GF, Urdinguio RG, Toraño EG, García MG, Carella A, Petrus-Reurer S, Ferrero C, Martinez-Camblor P, Cubillo I, García-Castro J, Delgado-Calle J, Pérez-Campo FM, Riancho JA, Bueno C, Menéndez P, Mentink A, Mareschi K, Claire F, Fagnani C, Medda E, Toccaceli V, Brescianini S, Moran S, Esteller M, Stolzing A, de Boer J, Nisticò L, Stazi MA, Fraga MF. H3K4me1 marks DNA regions hypomethylated during aging in human stem and differentiated cells. Genome Res 2014; 25:27-40. [PMID: 25271306 PMCID: PMC4317171 DOI: 10.1101/gr.169011.113] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In differentiated cells, aging is associated with hypermethylation of DNA regions enriched in repressive histone post-translational modifications. However, the chromatin marks associated with changes in DNA methylation in adult stem cells during lifetime are still largely unknown. Here, DNA methylation profiling of mesenchymal stem cells (MSCs) obtained from individuals aged 2 to 92 yr identified 18,735 hypermethylated and 45,407 hypomethylated CpG sites associated with aging. As in differentiated cells, hypermethylated sequences were enriched in chromatin repressive marks. Most importantly, hypomethylated CpG sites were strongly enriched in the active chromatin mark H3K4me1 in stem and differentiated cells, suggesting this is a cell type–independent chromatin signature of DNA hypomethylation during aging. Analysis of scedasticity showed that interindividual variability of DNA methylation increased during aging in MSCs and differentiated cells, providing a new avenue for the identification of DNA methylation changes over time. DNA methylation profiling of genetically identical individuals showed that both the tendency of DNA methylation changes and scedasticity depended on nongenetic as well as genetic factors. Our results indicate that the dynamics of DNA methylation during aging depend on a complex mixture of factors that include the DNA sequence, cell type, and chromatin context involved and that, depending on the locus, the changes can be modulated by genetic and/or external factors.
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Affiliation(s)
- Agustín F Fernández
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Gustavo F Bayón
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Rocío G Urdinguio
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Estela G Toraño
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - María G García
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Antonella Carella
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Sandra Petrus-Reurer
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Cecilia Ferrero
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Pablo Martinez-Camblor
- Oficina de Investigación Biosanitaria (OIB-FICYT) de Asturias, 33005 Oviedo, Spain and Universidad Autónoma de Chile, Chile
| | - Isabel Cubillo
- Unidad de Biotecnología Celular, Área de Genética Humana, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier García-Castro
- Unidad de Biotecnología Celular, Área de Genética Humana, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jesús Delgado-Calle
- Department of Internal Medicine, Hospital U.M. Valdecilla, University of Cantabria, IDIVAL, 39011 Santander, Spain
| | - Flor M Pérez-Campo
- Department of Internal Medicine, Hospital U.M. Valdecilla, University of Cantabria, IDIVAL, 39011 Santander, Spain
| | - José A Riancho
- Department of Internal Medicine, Hospital U.M. Valdecilla, University of Cantabria, IDIVAL, 39011 Santander, Spain
| | - Clara Bueno
- Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Pablo Menéndez
- Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; Institut Català de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - Anouk Mentink
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, 7500 AE Enschede, The Netherlands
| | - Katia Mareschi
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, 10126 Turin, Italy; Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Fabian Claire
- Translational Centre for Regenerative Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Corrado Fagnani
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Emanuela Medda
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Virgilia Toccaceli
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Sonia Brescianini
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Sebastián Moran
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Catalonia, Spain
| | - Manel Esteller
- Institut Català de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain; Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Catalonia, Spain; Department of Physiological Sciences II, School of Medicine, University of Barcelona, 08036 Barcelona, Catalonia, Spain
| | - Alexandra Stolzing
- Translational Centre for Regenerative Medicine, University of Leipzig, 04103 Leipzig, Germany; Loughborough University, Wolfson School of Mechanical and Manufacturing Engineering, LE11 3TU Loughborough, United Kingdom
| | - Jan de Boer
- MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, 7500 AE Enschede, The Netherlands; cBITE laboratory, Merln Institute of Technology-inspired Regenerative Medicine, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lorenza Nisticò
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Maria A Stazi
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Viale Regina Elena 299, 00161, Rome, Italy
| | - Mario F Fraga
- Cancer Epigenetics Laboratory, Institute of Oncology of Asturias (IUOPA), HUCA, Universidad de Oviedo, 33006 Oviedo, Spain; Department of Immunology and Oncology, National Center for Biotechnology, CNB-CSIC, Cantoblanco, 28049 Madrid, Spain
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Zelt JGE, McCabe K, Shobeiri N, Maio-Twofoot T, Holden RM, Adams MA, Dionisi MP, Fernandez-Martin JL, Martinez-Camblor P, Floege JF, Ketteler M, London G, Locatelli F, Gorriz JL, Rutkowski B, Ferreira A, Covic A, Cannata-Andia JB, Roman-Garcia P, Alonso-Montes C, Quiros-Gonzalez I, Barrio-Vazquez S, Carrillo-Lopez N, Naves-Diaz M, Cannata-Andia JB, Fernandez-Martin JL, Kanbay M, Siriopol D, Saglam M, Kurt YG, Gok M, Cetinkaya H, Karaman M, Unal HU, Oguz Y, Sari S, Eyileten T, Vural A, Covic A, Yilmaz MI, McCabe KM, Burgesson B, Kaufmann M, Shobeiri N, Jones G, Adams MA, Holden RM. CKD MBD. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu112] [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: 11/14/2022] Open
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