1
|
Ahmed ST, Li R, Richardson P, Ghosh S, Steele L, White DL, Djotsa AN, Sims K, Gifford E, Hauser ER, Virani SS, Morgan R, Delclos G, Helmer DA. Association of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, and Hyperlipidemia With Gulf War Illness Among Gulf War Veterans. J Am Heart Assoc 2023; 12:e029575. [PMID: 37772504 PMCID: PMC10727258 DOI: 10.1161/jaha.123.029575] [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: 01/20/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). Toxic deployment-related exposures have been implicated in the cause of GWI, some of which contribute to metabolic dysregulation and lipid abnormalities. As this cohort ages, the relationship between GWI and atherosclerotic cardiovascular disease (ASCVD) is a growing concern. We evaluated associations between GWI and ASCVD, diabetes, hyperlipidemia, and hypertension in veterans of the Gulf War (1990-1991). METHODS AND RESULTS Analysis of survey data collected in 2014 to 2016 from a national sample of deployed Gulf War veterans (n=942) and Veterans Health Administration electronic health record data (n=669). Multivariable logistic regression models tested for associations of GWI with self-reported ASCVD, diabetes, hyperlipidemia, and hypertension, controlling for confounding factors. Separate models tested for GWI associations with ASCVD and risk factors documented in the electronic health record. GWI was associated with self-reported hypertension (adjusted odds ratio [aOR], 1.67 [95% CI, 1.18-2.36]), hyperlipidemia (aOR, 1.46 [95% CI, 1.03-2.05]), and ASCVD (aOR, 2.65 [95% CI, 1.56-4.51]). In the subset of veterans with electronic health record data, GWI was associated with documented diabetes (aOR, 2.34 [95% CI, 1.43-3.82]) and hypertension (aOR, 2.84 [95% CI, 1.92-4.20]). Hyperlipidemia and hypertension served as partial mediators of the association between GWI and self-reported ASCVD. CONCLUSIONS Gulf War veterans with GWI had higher odds of hyperlipidemia, hypertension, diabetes, and ASCVD compared with Gulf War veterans without GWI. Further examination of the mechanisms underlying this association, including a possible shared exposure-related mechanism, is necessary.
Collapse
Affiliation(s)
- Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Ruosha Li
- Department of Biostatistics and Data Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Saurendro Ghosh
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Lea Steele
- Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTX
| | - Donna L. White
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Alice Nono Djotsa
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Kellie Sims
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth Gifford
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
- Duke Molecular Physiology Institute and Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamNC
| | - Salim S. Virani
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Cardiology and Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiology, Department of MedicineMichael E. DeBakey VA Medical CenterHoustonTX
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - George Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| |
Collapse
|
2
|
Oluyomi AO, Mazul AL, Dong Y, White DL, Hartman CM, Richardson P, Chan W, Garcia JM, Kramer JR, Chiao E. Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case-control study. Lancet Reg Health Am 2023; 20:100468. [PMID: 36992707 PMCID: PMC10041556 DOI: 10.1016/j.lana.2023.100468] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/31/2023]
Abstract
Background Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans. Methods Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division. Findings Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific. Interpretation Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic. Funding US National Cancer Institute.
Collapse
Affiliation(s)
- Abiodun O. Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Angela L. Mazul
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yongquan Dong
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Donna L. White
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Center for Translational Research in Inflammatory Disease (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Christine M. Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, USA
| | - Jose M. Garcia
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System and Div. of Geriatrics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer R. Kramer
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Elizabeth Chiao
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author. Epidemiology Department, T 713-792-3020 F 713-563-1367, Unit 1340, 1155 Pressler, Duncan Building (CPB), 4th Floor, D 713-792-1860 C 713-303-1978, USA.
| |
Collapse
|
3
|
Garcia JM, Dong Y, Richardson P, Kramer JR, Hartman CM, Royse K, White DL, Chiao EY. Effect of HIV and antiretroviral therapy use on body weight changes in a cohort of U.S. veterans living with and without HIV. HIV Med 2023; 24:180-190. [PMID: 35929183 DOI: 10.1111/hiv.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE People living with HIV have high rates of obesity and obesity-related comorbidities. Our study sought to evaluate weight trajectory in a retrospective cohort of people living with HIV and matched HIV-negative veterans (controls) and to evaluate risk factors for weight gain. METHODS This was a retrospective database analysis of data extracted from the VA Corporate Data Warehouse that included people living with HIV (n = 22 421) and age-matched HIV-negative controls (n = 63 072). The main outcomes were baseline body weight and weight change from baseline at 1, 2, and 5 years after diagnosis (baseline visit for controls). RESULTS Body weight at baseline was lower in people living with HIV than in controls. People living with HIV on antiretroviral therapy (ART) gained more weight than did controls. In a sub-analysis of ART-exposed people living with HIV, age >50 years, African American race, body mass index (BMI) <25, CD4 ≤200, and HIV diagnosis year after 2000 were associated with more weight gain at year 1. Nucleoside reverse transcriptase inhibitors (NRTI) plus non-NRTIs (NNRTIs) were associated with less weight gain than NRTIs plus protease inhibitors, NRTIs plus integrase inhibitors, or NRTIs plus other agents at year 1. CONCLUSIONS Among US veterans, those living with HIV had lower rates of obesity than age-matched HIV-negative controls; however, primarily in the first 2 years after starting ART, people living with HIV gained more weight than did controls.
Collapse
Affiliation(s)
- Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yongquan Dong
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Jennifer R Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Texas Medical Center Digestive Diseases Center, Baylor College of Medicine, Houston, Texas, USA.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christine M Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Kathryn Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Texas Medical Center Digestive Diseases Center, Baylor College of Medicine, Houston, Texas, USA.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Elizabeth Y Chiao
- VA Health Services Research Center of Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of General Oncology and Epidemiology, Division of Cancer Medicine and Cancer Prevention, University of Texas-MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
4
|
Acott TG, Willis C, Ranger S, Cumming G, Richardson P, O'Neill R, Ford A. Coastal transformations and connections: Revealing values through the community voice method. People and Nature 2022. [DOI: 10.1002/pan3.10371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Timothy G. Acott
- University of Greenwich School of Humanities and Social Sciences London UK
| | | | - Sue Ranger
- Marine Conservation Society Herefordshire UK
| | | | | | | | - Adriana Ford
- Department of Life Sciences, Imperial College London London UK
| |
Collapse
|
5
|
Zhang D, Richardson P, Tu H, O’Connor J, Kisi E, Zhang H, Shi L. Radiation damage of MoAlB at elevated temperatures: Investigating MAB phases as potential neutron shielding materials. Ann Ital Chir 2022. [DOI: 10.1016/j.jeurceramsoc.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Ahmed S, Steele L, Richardson P, Ghosh S, White D, Delclos G, Helmer D. ASSOCIATION OF CARDIOVASCULAR DISEASE AND RISK FACTORS WITH MILITARY EXPOSURES OF GULF WAR VETERANS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02169-6] [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: 11/28/2022]
|
7
|
Antoun E, Garratt ES, Taddei A, Burton MA, Barton SJ, Titcombe P, Westbury LD, Baczynska A, Migliavacca E, Feige JN, Sydall HE, Dennison E, Dodds R, Roberts HC, Richardson P, Sayer AA, Shaw S, Cooper C, Holbrook JD, Patel HP, Godfrey KM, Lillycrop KA. Epigenome-wide association study of sarcopenia: findings from the Hertfordshire Sarcopenia Study (HSS). J Cachexia Sarcopenia Muscle 2022; 13:240-253. [PMID: 34862756 PMCID: PMC8818655 DOI: 10.1002/jcsm.12876] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/15/2021] [Accepted: 10/29/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sarcopenia is the age-related loss of muscle mass, strength, and function. Epigenetic processes such as DNA methylation, which integrate both genetic and environmental exposures, have been suggested to contribute to the development of sarcopenia. This study aimed to determine whether differences in the muscle methylome are associated with sarcopenia and its component measures: grip strength, appendicular lean mass index (ALMi), and gait speed. METHODS Using the Infinium Human MethylationEPIC BeadChip, we measured DNA methylation in vastus lateralis muscle biopsies of 83 male participants (12 with sarcopenia) with a mean (standard deviation) age of 75.7 (3.6) years from the Hertfordshire Sarcopenia Study (HSS) and Hertfordshire Sarcopenia Study extension (HSSe) and examined associations with sarcopenia and its components. Pathway, histone mark, and transcription factor enrichment of the differentially methylated CpGs (dmCpGs) were determined, and sodium bisulfite pyrosequencing was used to validate the sarcopenia-associated dmCpGs. Human primary myoblasts (n = 6) isolated from vastus lateralis muscle biopsies from male individuals from HSSe were treated with the EZH2 inhibitor GSK343 to assess how perturbations in epigenetic processes may impact myoblast differentiation and fusion, measured by PAX7 and MYHC immunocytochemistry, and mitochondrial bioenergetics determined using the Seahorse XF96. RESULTS Sarcopenia was associated with differential methylation at 176 dmCpGs (false discovery rate ≤ 0.05) and 141 differentially methylated regions (Stouffer ≤ 0.05). The sarcopenia-associated dmCpGs were enriched in genes associated with myotube fusion (P = 1.40E-03), oxidative phosphorylation (P = 2.78E-02), and voltage-gated calcium channels (P = 1.59E-04). ALMi was associated with 71 dmCpGs, grip strength with 49 dmCpGs, and gait speed with 23 dmCpGs (false discovery rate ≤ 0.05). There was significant overlap between the dmCpGs associated with sarcopenia and ALMi (P = 3.4E-35), sarcopenia and gait speed (P = 4.78E-03), and sarcopenia and grip strength (P = 7.55E-06). There was also an over-representation of the sarcopenia, ALMi, grip strength, and gait speed-associated dmCpGs with sites of H3K27 trimethylation (all P ≤ 0.05) and amongst EZH2 target genes (all P ≤ 0.05). Furthermore, treatment of human primary myoblasts with the EZH2 inhibitor GSK343 inhibitor led to an increase in PAX7 expression (P ≤ 0.05), decreased myotube fusion (P = 0.043), and an increase in ATP production (P = 0.008), with alterations in the DNA methylation of genes involved in oxidative phosphorylation and myogenesis. CONCLUSIONS These findings show that differences in the muscle methylome are associated with sarcopenia and individual measures of muscle mass, strength, and function in older individuals. This suggests that changes in the epigenetic regulation of genes may contribute to impaired muscle function in later life.
Collapse
Affiliation(s)
- Elie Antoun
- Human Development and Health Academic Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Emma S. Garratt
- Human Development and Health Academic Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | | - Mark A. Burton
- Human Development and Health Academic Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Sheila J. Barton
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Phil Titcombe
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Leo D. Westbury
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Alicia Baczynska
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | | | - Holly E. Sydall
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Elaine Dennison
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Richard Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Helen C. Roberts
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | | | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Cyrus Cooper
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | | | - Harnish P. Patel
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Keith M. Godfrey
- Human Development and Health Academic Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Karen A. Lillycrop
- Human Development and Health Academic Unit, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Biological SciencesUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton & University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | |
Collapse
|
8
|
Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, Annane D, Arabi YM, Arnold DM, Beane A, Bégin P, van Bentum-Puijk W, Berry LR, Bhimani Z, Birchall JE, Bonten MJM, Bradbury CA, Brunkhorst FM, Buxton M, Callum JL, Chassé M, Cheng AC, Cove ME, Daly J, Derde L, Detry MA, De Jong M, Evans A, Fergusson DA, Fish M, Fitzgerald M, Foley C, Goossens H, Gordon AC, Gosbell IB, Green C, Haniffa R, Harvala H, Higgins AM, Hills TE, Hoad VC, Horvat C, Huang DT, Hudson CL, Ichihara N, Laing E, Lamikanra AA, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, MacLennan S, Marshall J, McAuley DF, McDyer JF, McGlothlin A, McGuinness S, Miflin G, Montgomery S, Mouncey PR, Murthy S, Nichol A, Parke R, Parker JC, Priddee N, Purcell DFJ, Reyes LF, Richardson P, Robitaille N, Rowan KM, Rynne J, Saito H, Santos M, Saunders CT, Serpa Neto A, Seymour CW, Silversides JA, Tinmouth AA, Triulzi DJ, Turner AM, van de Veerdonk F, Walsh TS, Wood EM, Berry S, Lewis RJ, Menon DK, McArthur C, Zarychanski R, Angus DC, Webb SA, Roberts DJ, Shankar-Hari M. Effect of Convalescent Plasma on Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2021. [PMID: 34606578 DOI: 10.1101/2021.06.11.21258760] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTS The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONS The immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURES The primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, -1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11 secondary outcomes. Serious adverse events were reported in 3.0% (32/1075) of participants in the convalescent plasma group and in 1.3% (12/905) of participants in the no convalescent plasma group. CONCLUSIONS AND RELEVANCE Among critically ill adults with confirmed COVID-19, treatment with 2 units of high-titer, ABO-compatible convalescent plasma had a low likelihood of providing improvement in the number of organ support-free days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
Collapse
Affiliation(s)
- Lise J Estcourt
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Farah Al-Beidh
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital, Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
| | | | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte A Bradbury
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Frank M Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Jeannie L Callum
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queens University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew E Cove
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Daly
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Menno De Jong
- Department of Medical Microbiology, University of Amsterdam Medical Center, University of Amsterdam, the Netherlands
| | - Amy Evans
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Dean A Fergusson
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Matthew Fish
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | | | - Claire Foley
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Anthony C Gordon
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
- Western Sydney University, Sydney, Australia
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - David T Huang
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Emma Laing
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | | | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley
| | | | | | - John Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - John F McDyer
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
| | | | - Stephanie Montgomery
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Srinivas Murthy
- School of Medicine, University of British Columbia, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane C Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicole Priddee
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Damian F J Purcell
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | | | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada
- Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Jennifer Rynne
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Marlene Santos
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christopher W Seymour
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Jon A Silversides
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - Alan A Tinmouth
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Darrell J Triulzi
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne M Turner
- Medical Research Institute of New Zealand, Wellington
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David K Menon
- University Division of Anesthesia, Addenbrooke's Hospital Cambridge, Cambridge, England
| | - Colin McArthur
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Derek C Angus
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- St John of God Hospital, Subiaco, Australia
| | - David J Roberts
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Manu Shankar-Hari
- School of Immunology and Microbial Sciences, Kings College London, London, England
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, England
| |
Collapse
|
9
|
Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, Annane D, Arabi YM, Arnold DM, Beane A, Bégin P, van Bentum-Puijk W, Berry LR, Bhimani Z, Birchall JE, Bonten MJM, Bradbury CA, Brunkhorst FM, Buxton M, Callum JL, Chassé M, Cheng AC, Cove ME, Daly J, Derde L, Detry MA, De Jong M, Evans A, Fergusson DA, Fish M, Fitzgerald M, Foley C, Goossens H, Gordon AC, Gosbell IB, Green C, Haniffa R, Harvala H, Higgins AM, Hills TE, Hoad VC, Horvat C, Huang DT, Hudson CL, Ichihara N, Laing E, Lamikanra AA, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, MacLennan S, Marshall J, McAuley DF, McDyer JF, McGlothlin A, McGuinness S, Miflin G, Montgomery S, Mouncey PR, Murthy S, Nichol A, Parke R, Parker JC, Priddee N, Purcell DFJ, Reyes LF, Richardson P, Robitaille N, Rowan KM, Rynne J, Saito H, Santos M, Saunders CT, Serpa Neto A, Seymour CW, Silversides JA, Tinmouth AA, Triulzi DJ, Turner AM, van de Veerdonk F, Walsh TS, Wood EM, Berry S, Lewis RJ, Menon DK, McArthur C, Zarychanski R, Angus DC, Webb SA, Roberts DJ, Shankar-Hari M. Effect of Convalescent Plasma on Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2021; 326:1690-1702. [PMID: 34606578 PMCID: PMC8491132 DOI: 10.1001/jama.2021.18178] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023]
Abstract
IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTS The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONS The immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURES The primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, -1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11 secondary outcomes. Serious adverse events were reported in 3.0% (32/1075) of participants in the convalescent plasma group and in 1.3% (12/905) of participants in the no convalescent plasma group. CONCLUSIONS AND RELEVANCE Among critically ill adults with confirmed COVID-19, treatment with 2 units of high-titer, ABO-compatible convalescent plasma had a low likelihood of providing improvement in the number of organ support-free days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
Collapse
Affiliation(s)
- Lise J Estcourt
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Farah Al-Beidh
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital, Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
| | | | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte A Bradbury
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Frank M Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Jeannie L Callum
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queens University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew E Cove
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Daly
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Menno De Jong
- Department of Medical Microbiology, University of Amsterdam Medical Center, University of Amsterdam, the Netherlands
| | - Amy Evans
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Dean A Fergusson
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Matthew Fish
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | | | - Claire Foley
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Anthony C Gordon
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
- Western Sydney University, Sydney, Australia
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - David T Huang
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Emma Laing
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | | | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley
| | | | | | - John Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - John F McDyer
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
| | | | - Stephanie Montgomery
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Srinivas Murthy
- School of Medicine, University of British Columbia, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane C Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicole Priddee
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Damian F J Purcell
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | | | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada
- Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Jennifer Rynne
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Marlene Santos
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christopher W Seymour
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Jon A Silversides
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - Alan A Tinmouth
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Darrell J Triulzi
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne M Turner
- Medical Research Institute of New Zealand, Wellington
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David K Menon
- University Division of Anesthesia, Addenbrooke's Hospital Cambridge, Cambridge, England
| | - Colin McArthur
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Derek C Angus
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- St John of God Hospital, Subiaco, Australia
| | - David J Roberts
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Manu Shankar-Hari
- School of Immunology and Microbial Sciences, Kings College London, London, England
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, England
| |
Collapse
|
10
|
Yoder AK, Lakomy DS, Dong Y, Raychaudhury S, Royse K, Hartman C, Richardson P, White DL, Kramer JR, Lin LL, Chiao E. The association between protease inhibitors and anal cancer outcomes in veterans living with HIV treated with definitive chemoradiation: a retrospective study. BMC Cancer 2021; 21:776. [PMID: 34225709 PMCID: PMC8256603 DOI: 10.1186/s12885-021-08514-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The incidence of anal squamous cell carcinoma has been increasing, particularly in people living with HIV (PLWH). There is concern that radiosensitizing drugs, such as protease inhibitors, commonly used in the management of HIV, may increase toxicities in patients undergoing chemoradiation. This study examines treatment outcomes and toxicities in PLWH managed with and without protease inhibitors who are receiving chemoradiation for anal cancer. METHODS Patient demographic, HIV management, and cancer treatment information were extracted from multiple Veterans Affairs databases. Patients were also manually chart reviewed. Among PLWH undergoing chemoradiation for anal carcinoma, therapy outcomes and toxicities were compared between those treated with and without protease inhibitors at time of cancer treatment. Statistical analysis was performed using chi-square, Cox regression analysis, and logistic regression. RESULTS A total of 219 PLWH taking anti-retroviral therapy undergoing chemoradiation for anal cancer were identified and included in the final analysis. The use of protease inhibitors was not associated with any survival outcome including colostomy-free survival, progression-free survival, or overall survival (all adjusted hazard ratio p-values> 0.05). Regarding toxicity, protease inhibitor use was not associated with an increased odds of hospitalizations or non-hematologic toxicities; however, protease inhibitor use was associated with increased hospitalizations for hematologic toxicities, including febrile neutropenia (p < 0.01). CONCLUSION The use of protease inhibitors during chemoradiation for anal carcinoma was not associated with any clinical outcome or increase in non-hematologic toxicity. Their use was associated with increased hospitalizations for hematologic toxicities. Further prospective research is needed to evaluate the safety and efficacy of protease inhibitors for patients undergoing chemoradiation.
Collapse
Affiliation(s)
- Alison K Yoder
- University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Yongquan Dong
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Suchismita Raychaudhury
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Kathryn Royse
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
| | - Christine Hartman
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Peter Richardson
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Donna L White
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jennifer R Kramer
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Chiao
- Department of Medicine, Baylor College of Medicine, 1155 Pressler St. Unit, Houston, 1340, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| |
Collapse
|
11
|
Tayob N, Corley DA, Christie I, Almers L, Rahal AK, Richardson P, White DL, Davila J, Kanwal F, El-Serag HB. Validation of the Updated Hepatocellular Carcinoma Early Detection Screening Algorithm in a Community-Based Cohort of Patients With Cirrhosis of Multiple Etiologies. Clin Gastroenterol Hepatol 2021; 19:1443-1450.e6. [PMID: 32768590 PMCID: PMC8201947 DOI: 10.1016/j.cgh.2020.07.065] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS The Hepatocellular carcinoma (HCC) Early detection Screening (HES) algorithm has been proposed to improve the performance of the serum alpha-fetoprotein (AFP) test in surveillance for HCC. The HES algorithm incorporates data on age, level of alanine aminotransferase, platelet count, and rate of AFP change to increase likelihood of earlier detection and thereby reduce HCC-related mortality. We updated the HES algorithm to include etiology of cirrhosis and validated it in a community-based cohort. METHODS We collected data from the Veterans Health Administration, from 2010 through 2015, on etiologies for HCC, including hepatitis C, hepatitis B, alcoholic liver disease, and non-alcoholic fatty liver disease. We used these data to update the HES algorithm and tested its accuracy using data from patients with cirrhosis in the Kaiser Permanente Northern California healthcare system (validation cohort). RESULTS Among the 7432 patients with cirrhosis in the validation cohort, 1102 were diagnosed with HCC during a median follow-up time of 3.21 years; 709 patients had early-stage HCC. The HES algorithm identified patients who would receive a diagnosis of early-stage HCC within the next 6 months with 51.20% sensitivity and 90.00% specificity, compared with 46.02% sensitivity for the AFP test alone (5.18% absolute improvement; P = .0015). In HCC screening, a positive result from HES or AFP test leads to follow-up evaluation with more sensitive imaging methods. The number of early-stage HCC cases detected per 1000 imaging analyses were 136.46 with the HES algorithm vs 118.01 with the AFP test alone (P < .0005). The HES algorithm identified 56.00% of patients with HCC in the 6 months before their diagnosis despite no detection of nodules by surveillance ultrasound; the AFP test identified only 50.00% of these patients. CONCLUSIONS We validated the HES algorithm using data from a diverse community-based cohort of patients with cirrhosis. The algorithm offers a modest but useful advantage over the AFP test alone in detection of early-stage HCC with virtually no added cost.
Collapse
Affiliation(s)
- Nabihah Tayob
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Douglas A. Corley
- Kaiser Permanente, Northern California, San Francisco Medical Center, San Francisco, California; Division of Research, Oakland, California
| | - Israel Christie
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lucy Almers
- Kaiser Permanente, Northern California, San Francisco Medical Center, San Francisco, California; Division of Research, Oakland, California
| | - Ahmed K Rahal
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter Richardson
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Donna L. White
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jessica Davila
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Fasiha Kanwal
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Houston VA Health Services Research and Development Service Center of Excellence, Houston, Texas; Section of Health Services Research, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
12
|
Lenz HJ, Richardson P, Stebbing J. The Emergence of Baricitinib: A Story of Tortoises Versus Hares. Clin Infect Dis 2021; 72:1251-1252. [PMID: 32901809 PMCID: PMC7499511 DOI: 10.1093/cid/ciaa940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Heinz-Josef Lenz
- Division of Oncology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | | | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| |
Collapse
|
13
|
Stebbing J, Sánchez Nievas G, Falcone M, Youhanna S, Richardson P, Ottaviani S, Shen JX, Sommerauer C, Tiseo G, Ghiadoni L, Virdis A, Monzani F, Rizos LR, Forfori F, Avendaño Céspedes A, De Marco S, Carrozzi L, Lena F, Sánchez-Jurado PM, Lacerenza LG, Cesira N, Caldevilla Bernardo D, Perrella A, Niccoli L, Méndez LS, Matarrese D, Goletti D, Tan YJ, Monteil V, Dranitsaris G, Cantini F, Farcomeni A, Dutta S, Burley SK, Zhang H, Pistello M, Li W, Romero MM, Andrés Pretel F, Simón-Talero RS, García-Molina R, Kutter C, Felce JH, Nizami ZF, Miklosi AG, Penninger JM, Menichetti F, Mirazimi A, Abizanda P, Lauschke VM. JAK inhibition reduces SARS-CoV-2 liver infectivity and modulates inflammatory responses to reduce morbidity and mortality. Sci Adv 2021; 7:eabe4724. [PMID: 33187978 PMCID: PMC7775747 DOI: 10.1126/sciadv.abe4724] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/28/2020] [Indexed: 05/16/2023]
Abstract
Using AI, we identified baricitinib as having antiviral and anticytokine efficacy. We now show a 71% (95% CI 0.15 to 0.58) mortality benefit in 83 patients with moderate-severe SARS-CoV-2 pneumonia with few drug-induced adverse events, including a large elderly cohort (median age, 81 years). An additional 48 cases with mild-moderate pneumonia recovered uneventfully. Using organotypic 3D cultures of primary human liver cells, we demonstrate that interferon-α2 increases ACE2 expression and SARS-CoV-2 infectivity in parenchymal cells by greater than fivefold. RNA-seq reveals gene response signatures associated with platelet activation, fully inhibited by baricitinib. Using viral load quantifications and superresolution microscopy, we found that baricitinib exerts activity rapidly through the inhibition of host proteins (numb-associated kinases), uniquely among antivirals. This reveals mechanistic actions of a Janus kinase-1/2 inhibitor targeting viral entry, replication, and the cytokine storm and is associated with beneficial outcomes including in severely ill elderly patients, data that incentivize further randomized controlled trials.
Collapse
Affiliation(s)
- Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK.
| | - Ginés Sánchez Nievas
- Department of Rheumatology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Youhanna
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Joanne X Shen
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Sommerauer
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luis Romero Rizos
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, University of Pisa, Italy
| | - Almudena Avendaño Céspedes
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Salvatore De Marco
- Department of Internal Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, University of Pisa, Italy
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Misericordia Hospital, Grosseto, Italy
| | - Pedro Manuel Sánchez-Jurado
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | | | - Nencioni Cesira
- Department of Medicine, Misericordia Hospital, Grosseto, Italy
| | | | | | - Laura Niccoli
- Department of Rheumatology, Hospital of Prato, Prato, Italy
| | - Lourdes Sáez Méndez
- Department of Internal Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Delia Goletti
- Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Yee-Joo Tan
- University of Singapore, Infectious Diseases Programme, Immunology Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore and Institute of Molecular and Cell Biology (IMCB), A*STAR (Agency for Science, Technology and Research), Singapore, Singapore
| | - Vanessa Monteil
- Karolinska Institutet, Department of Laboratory Medicine, Unit of Clinical Microbiology, and SE-17177, Stockholm, Sweden
| | - George Dranitsaris
- Department of Hematology, School of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome Tor Vergata, Rome Italy
| | - Shuchismita Dutta
- RCSB Protein Data Bank, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Stephen K Burley
- RCSB Protein Data Bank, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Haibo Zhang
- Departments of Anesthesia, Medicine, and Physiology, University of Toronto, Toronto, ON, Canada
| | - Mauro Pistello
- Virology Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - William Li
- The Angiogenesis Foundation, Cambridge, MA, USA
| | - Marta Mas Romero
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fernando Andrés Pretel
- Department of Statistics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Rafael García-Molina
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Claudia Kutter
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Science for Life Laboratory, Solna, Sweden
| | | | | | | | - Josef M Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Vienna, Austria
- Department of Medical Genetics, Life Science Institute, University of British Columbia, Vancouver, BC, Canada
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ali Mirazimi
- Karolinska Institutet, Department of Laboratory Medicine, Unit of Clinical Microbiology, and SE-17177, Stockholm, Sweden
- National Veterinary Institute, Uppsala, Sweden
| | - Pedro Abizanda
- Department of Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- CIBERFES, Ministerio de Economía y Competitividad, Madrid, Spain
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
14
|
Carvalho D, Richardson P, Olaciregui NG, Stankunaite R, Lavarino CE, Molinari V, Corley E, Ruddle R, Donovan A, Pal A, Raynaud FI, Overington JP, Phelan A, Sheppard D, Mackinnon A, Hubank M, Cruz O, Madrid AML, Mueller S, Carcaboso AM, Carceller F, Jones C. EXTH-46. ARTIFICIAL INTELLIGENCE-BASED IDENTIFICATION OF COMBINED VANDETANIB AND EVEROLIMUS IN THE TREATMENT OF ACVR1-MUTANT DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Somatic mutations in ACVR1, encoding the serine/threonine kinase ALK2 receptor, are found in a quarter of children with the currently incurable brain tumour diffuse intrinsic pontine glioma (DIPG). Treatment of ACVR1-mutant DIPG patient-derived models with multiple inhibitor chemotypes leads to a reduction in cell viability in vitro and extended survival in orthotopic xenografts in vivo, though there are currently no specific ACVR1 inhibitors licensed for DIPG. Using an Artificial Intelligence-based platform to search for approved compounds which could be used to treat ACVR1-mutant DIPG, the combination of vandetanib and everolimus was identified as a possible therapeutic approach. Vandetanib, an approved inhibitor of VEGFR/RET/EGFR, was found to target ACVR1 (Kd=150nM) and reduce DIPG cell viability in vitro, but has been trialed in DIPG patients with limited success, in part due to an inability to cross the blood-brain-barrier. In addition to mTOR, everolimus inhibits both ABCG2 (BCRP) and ABCB1 (P-gp) transporter, and was synergistic in DIPG cells when combined with vandetanib in vitro. This combination is well-tolerated in vivo, and significantly extended survival and reduced tumour burden in an orthotopic ACVR1-mutant patient-derived DIPG xenograft model. Based on these preclinical data, three patients with ACVR1-mutant DIPG were treated with vandetanib and everolimus. These cases may inform on the dosing and the toxicity profile of this combination for future clinical studies. This bench-to-bedside approach represents a rapidly translatable therapeutic strategy in children with ACVR1 mutant DIPG.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ruth Ruddle
- Institute of Cancer Research, London, United Kingdom
| | - Adam Donovan
- Institute of Cancer Research, London, United Kingdom
| | - Akos Pal
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Michael Hubank
- Royal Marsden Hospital NHS Trust, London, United Kingdom
| | | | | | - Sabine Mueller
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
15
|
Dimopoulos M, Weisel K, Moreau P, Jr L, White D, Miguel J, Sonneveld P, Engelhardt M, Jenner M, Corso A, Dürig J, Pavic M, Salomo M, Casal E, Jiang R, Nguyen T, Peluso T, Richardson P. POMALIDOMIDE, BORTEZOMIB, DEXAMETHASONE AFTER 1 PRIOR LINE OF THERAPY IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA: SUBANALYSIS OF OPTIMMISM BY AGE, PRIOR TRANSPLANT, AND HIGH-RISK CYTOGENETICS. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.454] [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: 10/23/2022] Open
|
16
|
Mazul AL, Hartman C, Kramer J, White DL, Royse K, Raychaudhury S, Sandulache V, Ahmed ST, Richardson P, Sikora AG, Chiao E. Incidence and survival for oropharynx and non-oropharynx head and neck cancers among veterans living with HIV. Cancer Med 2020; 9:9326-9335. [PMID: 33094910 PMCID: PMC7774719 DOI: 10.1002/cam4.3539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 01/06/2023] Open
Abstract
Background People living with HIV/AIDS (PLWH) have an excess risk for head and neck squamous cell carcinoma (HNSCC) compared to the general U.S. population, but little is known about HIV‐specific risk factors associated with the incidence and outcomes HNSCC. We aim to identify clinical and HIV‐specific risk factors associated with oropharyngeal and non‐oropharyngeal HNSCC incidence and outcomes separately. Methods We constructed a retrospective cohort study of 45,052 PLWH aged 18 or above from the national Veteran Affairs (VA) Corporate Data from 1999 to 2015. We extracted demographic data and risk factor information, including history of alcohol abuse, smoking, CD4 count (cells/μl), and percent of follow‐up time with undetectable HIV viral load as time‐updated variables. We calculated the age‐standardized incidence rates of oropharyngeal and non‐oropharyngeal HNSCC and estimated adjusted hazard ratios (HR). We also examined overall survival using Kaplan–Meier curves and adjusted HR. Results The standardized incidence rate of oropharyngeal and non‐oropharyngeal HNSCC in this veteran cohort of PLWH is 23.0 (95% confidence intervals (CIs): 17.1‐28.9) and 55.4 (95% CI: 46.5‐64.3) per 100,000 person‐years, respectively. Nadir CD4 count ≤200 was associated with an increased risk of non‐oropharyngeal HNSCC (HR: 1.78; 95% CI: 1.31‐2.30 vs >200). Five‐year overall survival of OPSCC (37.0%) was significantly lower than non‐oropharyngeal HNSCC (49.1%). Conclusions PLWH who receive care in the VA had higher age‐adjusted HNSCC incidence rates than reported in the general population, suggesting that HIV and immunosuppression play a role. Additional studies should be conducted to study the interaction between HPV and HIV.
Collapse
Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,Division of Public Health Science, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Christine Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jennifer Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Vlad Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sarah T Ahmed
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Andrew G Sikora
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Otolaryngology Section, Operative Care Line Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Elizabeth Chiao
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
17
|
Sada Y, Zafeiropoulou E, Richardson P, Kramer J, Christie I, Jiao L, Liu Y, Chiao E, White D. Trends in gender-based disparity in incidence, mortality and survival for major digestive disease cancers in the U.S. (2000-2016). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13621 Background: Males have excess risk of most digestive cancers; whether cancer mainly due to virus (stomach), lifestyle including obesity/alcohol (colon/esophagus), or both (liver). We evaluated for secular trends in gender-specific incidence, mortality and survival for these cancers in the U.S. Methods: We used official U.S. Cancer Statistics [USCS] data (2000-2016) to calculate annual age-adjusted incidence and mortality rates (IR/MR). It covers >98% population/all states (vs. SEER-10 statewide registries, covers <1/3rd African-Americans/Whites). We calculated mortality-to-incidence rate ratios (MIR), an established 5-year survival proxy. We used Joinpoint to assess trends in average annual percentage change (AAPC). Results: Table shows age-adjusted IRs and MRs for colon, esophagus and stomach cancer decreased for men and women (all AAPCs negative, all significant but stomach IR women), with both liver IR/MR significantly increasing in both genders. Gender differences in relative burden were seen (e.g., MRs in colon>esophagus>liver>stomach in men vs. colon>stomach>liver>esophagus in women), with greatest male excess in esophagus (e.g., 4.4-fold IR). MIRs suggested less favorable survival (higher=worse) for men for esophagus/colon. Conclusion: Substantial gender disparity persists in digestive cancers, with male excess gap decreasing for colon and increasing for liver. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | - Li Jiao
- Baylor College of Medicine, Houston, TX
| | | | | | - Donna White
- Michael E DeBakey VA Medical Center, Houston, TX
| |
Collapse
|
18
|
Bekker L, Li S, Pathak S, Tolley E, Marzinke M, Justman J, Mgodi N, Chirenje M, Swaminathan S, Adeyeye A, Farrior J, Hendrix C, Piwowar-Manning E, Richardson P, Eshelman S, Redinger H, Williams P, Sista N. Safety and tolerability of injectable Rilpivirine LA in HPTN 076: A phase 2 HIV pre-exposure prophylaxis study in women. EClinicalMedicine 2020; 21:100303. [PMID: 32280940 PMCID: PMC7139112 DOI: 10.1016/j.eclinm.2020.100303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Daily oral TDF/FTC is protective against HIV infection when used for pre-exposure prophylaxis (PrEP). However, daily adherence to oral PrEP is difficult for many; therefore, finding alternative PrEP strategies remains a priority. HPTN 076 evaluated the long-acting injectable form of rilpivirine (RPV), known as RPV LA for safety, pharmacokinetics and acceptability. METHODS HPTN 076 (NTC 02165202) was a phase 2, double-blind, 2:1 randomized trial comparing the safety of 1200mg RPV LA (LA) to placebo (P). The study included a 28-day oral run-in phase of daily, self- administered oral RPV (25 mg), with directly observed oral dosing about six times. Of 136 enrolled sexually active, HIV-uninfected, low HIV-risk African (100) and US (36) adult women, injectable product was administered in two gluteal, intramuscular (IM) injections once every eight weeks to 122 participants following the oral run-in phase. A maximum of six injection time points occurred over a 48-week period. Acceptability, safety, tolerability and pharmacokinetic (PK) data were collected throughout the study. This paper includes primary endpoint data collected up to the week 52 post enrollment. FINDINGS The median age of the enrolled population was 31 years (IQR: 25,38), median weight 75 kg (IQR: 64, 89), median body mass index (BMI) 30 (IQR: 27, 35), 46% married, 94% Black and 60% unemployed. A total of 122 (80 LA, 42 P) women received at least one injection and 98 (64 LA, 34 P) received all six injections. During the injection phase, three women withdrew from the study (2 LA, 1 P) and 16 women discontinued study product (10 LA, 6 P). Fourteen women (11 LA and 3 P) discontinued oral study product and did not enter the injection phase. Study product discontinuations were not significantly different between the two arms throughout. Of the product discontinuations in the injection phase, 8% in LA and 5% in P arm were due to adverse events (AEs), including one randomized to the P arm with prolonged QTc interval on EKG. The proportion of women who experienced Grade 2 or higher AEs during the injection phase as the primary outcome was not significantly different between the two arms [73.8%, 95% CI: (63.2%, 82.1%) for LA and 73.8%, 95% CI: (58.9%, 84.7%), p>0.99]. Transient Grade ≥2 liver abnormalities occurred in 14% of women in the LA arm compared with 12% in P arm. Three LA women (4%) developed Grade 3 injection site reactions compared with none in P arm. In participants who received at least 1 injection, the geometric mean of overall RPV trough concentrations (Ctrough) was 62.2 ng/mL. In participants who received all six injections, the geometric mean of CTrough through the injection phase and after the last injection were 72.8 ng/mL and 100.9 ng/mL, respectively. At week 52 (eight weeks after last injection), the geometric mean of RPV Ctrough was 75.0 ng/mL. At the last injection visit (Week 44), 80 % of women who answered acceptability questions strongly agreed that they would think about using- and 68% that they would definitely use a PrEP injectable in the future. INTERPRETATION RPV LA IM injections every eight weeks in African and US women were safe and acceptable. Overall, despite more injection site reactions and pain in the participants receiving RPV LA the injections were well tolerated. Data from this study support the further development of injectable PrEP agents.
Collapse
Affiliation(s)
- L.G. Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - S. Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S. Pathak
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - N.M. Mgodi
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - M. Chirenje
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | | | | | | | | | | | - H. Redinger
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - P. Williams
- Johnson and Johnson Global Public Health, Belgium
| | | | | |
Collapse
|
19
|
Fu Y, Richardson P, Li K, Yu H, Yu B, Donne S, Kisi E, Ma T. Transition Metal Aluminum Boride as a New Candidate for Ambient-Condition Electrochemical Ammonia Synthesis. Nanomicro Lett 2020; 12:65. [PMID: 34138306 PMCID: PMC7770662 DOI: 10.1007/s40820-020-0400-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/02/2020] [Indexed: 05/21/2023]
Abstract
Achieving more meaningful N2 conversion by reducing the energy input and carbon footprint is now being investigated through a method of N2 fixation instead of the Haber-Bosch process. Unfortunately, the electrochemical N2 reduction reaction (NRR) method as a rising approach currently still shows low selectivity (Faradaic efficiency < 10%) and high-energy consumption [applied potential at least - 0.2 V versus the reversible hydrogen electrode (RHE)]. Here, the role of molybdenum aluminum boride single crystals, belonging to a family of ternary transition metal aluminum borides known as MAB phases, is reported for the electrochemical NRR for the first time, at a low applied potential (- 0.05 V versus RHE) under ambient conditions and in alkaline media. Due to the unique nano-laminated crystal structure of the MAB phase, these inexpensive materials have been found to exhibit excellent electrocatalytic performances (NH3 yield: 9.2 µg h-1 cm-2 mg cat. -1 , Faradaic efficiency: 30.1%) at the low overpotential, and to display a high chemical stability and sustained catalytic performance. In conjunction, further mechanism studies indicate B and Al as main-group metals show a highly selective affinity to N2 due to the strong interaction between the B 2p/Al 3p band and the N 2p orbitals, while Mo exhibits specific catalytic activity toward the subsequent reduction reaction. Overall, the MAB-phase catalyst under the synergy of the elements within ternary compound can suppress the hydrogen evolution reaction and achieve enhanced NRR performance. The significance of this work is to provide a promising candidate in the future synthesis of ammonia.
Collapse
Affiliation(s)
- Yang Fu
- Discipline of Chemistry, School of Environmental and Life Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Peter Richardson
- School of Engineering, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kangkang Li
- CSIRO Energy, 10 Murray Dwyer Circuit, Mayfield West, NSW, 2304, Australia
| | - Hai Yu
- CSIRO Energy, 10 Murray Dwyer Circuit, Mayfield West, NSW, 2304, Australia
| | - Bing Yu
- School of Environmental Science and Engineering, Fujian Normal University, Fuzhou, 350007, Fujian, People's Republic of China
| | - Scott Donne
- Discipline of Chemistry, School of Environmental and Life Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Erich Kisi
- School of Engineering, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Tianyi Ma
- Discipline of Chemistry, School of Environmental and Life Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia.
| |
Collapse
|
20
|
Richardson P, Griffin I, Tucker C, Smith D, Oechsle O, Phelan A, Rawling M, Savory E, Stebbing J. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet 2020; 395:e30-e31. [PMID: 32032529 PMCID: PMC7137985 DOI: 10.1016/s0140-6736(20)30304-4] [Citation(s) in RCA: 925] [Impact Index Per Article: 231.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK.
| |
Collapse
|
21
|
Parr K, Johnson F, Langley N, Richardson P. Improving patient pathways in head and neck cancer at a UK Cancer Centre. Results of a dietetic pre-treatment project (DPP). Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.094] [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: 11/26/2022]
|
22
|
|
23
|
Kramer JR, Hartman C, White DL, Royse K, Richardson P, Thrift AP, Raychaudhury S, Desiderio R, Sanchez D, Chiao EY. Validation of HIV-infected cohort identification using automated clinical data in the Department of Veterans Affairs. HIV Med 2019; 20:567-570. [PMID: 31131549 DOI: 10.1111/hiv.12757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The US Department of Veterans Affairs (VA) is the largest integrated health care provider for HIV-infected patients in the USA. VA data for HIV-specific clinical and quality improvement research are an important resource. We sought to determine the accuracy of using the VA Corporate Data Warehouse (CDW), a fully automated medical records database for all VA users nationally, to identify HIV-infected patients compared with a gold-standard VA HIV Clinical Case Registry (CCR). METHODS We assessed the test performance characteristics of each of our CDW criteria-based algorithms (presence of one, two or all of the following: diagnostic codes for HIV, positive HIV laboratory tests, and prescription for HIV medication) by calculating their sensitivity (proportion of HIV-positive patients in the CCR accurately detected as HIV-positive by the CDW algorithm) and positive predictive value (PPV; the proportion of patients identified by the CDW algorithm who were classified as HIV-positive from the CCR). RESULTS We found that using a CDW algorithm requiring two of three HIV diagnostic criteria yielded the highest sensitivity (95.2%) with very little trade-off in PPV (93.5%). CONCLUSIONS A two diagnostic criteria-based algorithm can be utilized to accurately identify HIV-infected cohorts seen in the nationwide VA health care system.
Collapse
Affiliation(s)
- J R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - C Hartman
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - D L White
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research in Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - K Royse
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - P Richardson
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - A P Thrift
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - S Raychaudhury
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - R Desiderio
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - D Sanchez
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - E Y Chiao
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
24
|
Todorovic V, Su Z, Putman C, Kakavas S, Salte K, McDonald H, Wetter J, Paulsboe S, Sun Q, Medina L, Sielaff B, Gerstein C, Olson L, Stockmann H, Richardson P, Qiu W, Argiriadi M, Henry R, Herold M, McGaraughty S, Honore P, Shotwell J, Gopalakrishnan S, Sun C, Scott V. 677 Discovery and characterization of a small molecule IL-36γ antagonist as a novel approach to treat plaque psoriasis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.753] [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]
|
25
|
Garcia J, Dong Y, Richardson P, Kramer J, Hartman C, Royse K, Thrift A, White D, Chiao E. SAT-093 Effect of HIV Infection and Antiretroviral Therapy Use on Body Weight and Body Weight Changes over a 5-Year Period in US Veterans. J Endocr Soc 2019. [PMCID: PMC6552215 DOI: 10.1210/js.2019-sat-093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Obesity has reached epidemic proportions in the U.S. and is more prevalent in Veterans. Obesity and obesity-related comorbidities are also very common in HIV-infected individuals and HIV- and antiretroviral therapy (ART)-specific factors may contribute to obesity and to the excess morbidity and mortality seen in this population. Our objective was to evaluate the weight trajectory in a retrospective cohort of HIV-infected and HIV-uninfected veterans. We also sought to establish the role of ART in this setting. HIV-infected (n=31,015, 97% male, 36% Caucasian, 52% African American, age 48±11 years) and HIV-uninfected veterans (controls, n=105,801, 96% male, 63% Caucasian, 19% African American, age 48±12 years) were included in the analyses. Variables of interest including body weight, weight change at 1, 2 and 5 years after diagnosis (or corresponding baseline visit for controls), ART use and other covariates (age, race, gender). Data were extracted from the VA Corporate Data Warehouse using laboratory values, medications, vital signs and ICD codes. Body weight at baseline was lower in HIV-infected veterans compared to controls (80±17.7 vs. 92.2±19.9 Kg respectively, p<0.01), and the prevalence of overweight (BMI 25-29.9) and obesity (BMI≥30) was higher in controls (34% and 17% in HIV-infected, 38% and 41% in controls respectively). HIV-infected individuals with a BMI <25 gained more weight at 1, 2 and 5 years post-index date compared to controls with most of these gains taking place at year 1 (3.4±7.8 vs. 2.2±7.1 Kg, 3.9±8.6 vs. 3±8 Kg, 4.4±9.8 vs. 4±9.1 Kg change from baseline at 1, 2 and 5 years respectively, all p<0.01). Although this trend was reversed in overweight individuals at 5 years (1.1±7.1 vs. 0.9±5.6 Kg, p=0.06; 1.3±8.1 vs. 1.4±6.5 Kg, p=0.22; 1.7±9.7 vs. 2.3±8.4 Kg, p<0.01 respectively) and in obese individuals at 2 and 5 years (-0.15±9.7 vs. -0.14±8.2 Kg, p>0.9; -0.29±11.2 vs. 0.19±9.2 Kg, p<0.01; -0.03±13 vs. 1.06±11.6 Kg, p<0.01 respectively). Among HIV-infected individuals, those on ART (n=16,028) gained more weight compared to those not on ART (n=4,392) 1, 2 and 5 years after diagnosis (2.3±8.2 vs. 0.88±7.5 Kg, 2.5±9.1 vs. 1.03±8.9 Kg, 2.8±10.6 vs. 1.65±10.2 Kg, respectively, all p<0.01). The weight increase at 1 year was 2.3±8.2 Kg for those exposed to nucleoside reverse-transcriptase inhibitors (NRTI, n=15,853), 2.2±8 Kg for non-NRTI (n=9,237), 2.7±8.6 Kg for protease inhibitors (n=6,961), 2.8±8.2 Kg for integrase inhibitors (n=1895), 0.01±7.1 Kg for fusion inhibitors (n=50), 2.1±8.4 Kg for CCR5 antagonists (n=63) and 2.4±8.8 Kg for pharmacokinetic enhancers (n=499). HIV infection in veterans is associated with lower rates of obesity at diagnosis and significant weight gain for those with a BMI<25 post-diagnosis. Our data also suggest that exposure to ART (perhaps with the exception of fusion inhibitors) is likely to mediate the increase in body weight seen in this setting.
Collapse
Affiliation(s)
- Jose Garcia
- University of Washington/Puget Sound VA/SIBCR, Seattle, WA, United States
| | - Yongquan Dong
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Peter Richardson
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Jennifer Kramer
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Christine Hartman
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Kathryn Royse
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Aaron Thrift
- Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, United States
| | - Donna White
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| | - Elizabeth Chiao
- Clinical Epidemiology and Comparative Effectiveness Program, VA Health Services Research Center of Innovations (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
26
|
Skelton F, Martin LA, Evans CT, Kramer J, Grigoryan L, Richardson P, Kunik ME, Poon IO, Holmes SA, Trautner BW. Determining Best Practices for Management of Bacteriuria in Spinal Cord Injury: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e12272. [PMID: 30762584 PMCID: PMC6393777 DOI: 10.2196/12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/20/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 12/24/2022] Open
Abstract
Background Bacteriuria, either asymptomatic (ASB) or symptomatic, urinary tract infection (UTI), is common in persons with spinal cord injury (SCI). Current Veterans Health Administration (VHA) guidelines recommend a screening urinalysis and urine culture for every veteran with SCI during annual evaluation, even when asymptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use. Objective Through a series of innovative studies utilizing mixed methods, administrative databases, and focus groups, we will gain further knowledge about the attitudes driving current urine testing practices during the annual exam, as well as quantitative data on the clinical outcomes of these practices. Methods Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation through qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination and compare the clinical outcomes of those who received antibiotics with those who did not. Aim 3 will use the information gathered from the previous 2 aims to develop the Test Smart, Treat Smart intervention, a combination of patient and provider education and resources that will help stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site. Results This protocol received institutional review board and VHA Research and Development approval in July 2017, and Veterans Affairs Health Services Research and Development funding started on November 2017. As of submission of this manuscript, 10/15 (67%) of the target goal of provider interviews were complete, and 77/100 (77%) of the goal of surveys. With regard to patients, 5/15 (33%) of the target goal of interviews were complete, and 20/100 (20%) of the target goal of surveys had been completed. Preliminary analyses are ongoing; the study team plans to present these results in April 2019. Database analyses for aim 2 will begin in January 2019. Conclusions The negative consequences of antibiotic overuse and antibiotic resistance are well-documented and have national and even global implications. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI and guide antibiotic stewardship in this high-risk population. The next step will be to refine the intervention and test its feasibility and effectiveness at multiple sites as well as reform policy for management of this common but burdensome condition. International Registered Report Identifier (IRRID) DERR1-10.2196/12272
Collapse
Affiliation(s)
- Felicia Skelton
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Lindsey Ann Martin
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Charlesnika T Evans
- Center for Innovation for Complex Chronic HealthCare, Hines VA Hospital, Chicago, IL, United States.,Department of Preventive Medicine and Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States
| | - Mark E Kunik
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Ivy Oiyee Poon
- Department of Pharmacy Practice, Texas Southern University, Houston, TX, United States
| | - S Ann Holmes
- H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Infectious Disease Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
27
|
Wiles R, Patanwala I, Hankinson B, Healey P, Farrell C, Griffin C, Bonnett L, Richardson P. Corrigendum to: Can ARFI of the liver and spleen predict the presence of gastroesophageal varies? [Clin Radiol 73 (12) (2018) 1046–1051]. Clin Radiol 2019; 74:164. [DOI: 10.1016/j.crad.2018.11.006] [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: 10/27/2022]
|
28
|
Mapakshi S, Kramer JR, Richardson P, El-Serag HB, Kanwal F. Positive Predictive Value of International Classification of Diseases, 10th Revision, Codes for Cirrhosis and Its Related Complications. Clin Gastroenterol Hepatol 2018; 16:1677-1678. [PMID: 29410051 DOI: 10.1016/j.cgh.2018.01.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/29/2017] [Accepted: 01/27/2018] [Indexed: 12/12/2022]
Abstract
Large administrative databases using International Classification of Diseases (ICD) codes are useful for epidemiologic, health services, and outcomes research.1,2 However, coding accuracy of disease conditions could be a limiting factor. Cirrhosis prevalence is increasing because of an aging hepatitis C cohort and an increase in nonalcoholic steatohepatitis.3 We previously examined the validity of ICD, 9th revision (ICD-9), codes for cirrhosis in US Department of Veterans Affairs (VA) administrative databases.4,5 This work has formed the basis for many clinical, epidemiologic, and health services research studies. However, with transition from the ICD-9 to ICD, 10th revision (ICD-10), coding system, it is important to determine the validity of these new cirrhosis codes in administrative databases. Although the greater number of codes in the ICD-10 system may be associated with greater specificity and coding accuracy than with the ICD-9 system, this hypothesis remains untested.
Collapse
Affiliation(s)
- Srikar Mapakshi
- Houston Veterans Affairs Health Services Research & Development Center for Innovations, Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
| | - Jennifer R Kramer
- Houston Veterans Affairs Health Services Research & Development Center for Innovations, Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter Richardson
- Houston Veterans Affairs Health Services Research & Development Center for Innovations, Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Houston Veterans Affairs Health Services Research & Development Center for Innovations, Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Fasiha Kanwal
- Houston Veterans Affairs Health Services Research & Development Center for Innovations, Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
29
|
Wang Z, White D, Chen L, Richardson P, El-Serag HB, Jiao L. Abstract 4946: The association between antihypertensive medication, sRAGE, and risk of pancreatic cancer: Results from the Women's Health Initiative Study. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pancreatic cancer is the 4th leading cause of cancer-related death in the United States. With its anti-inflammatory property, soluble receptor for advanced glycation end-product (sRAGE) has been associated with lower risk of pancreatic cancer. Antihypertensive medications were shown to modulate sRAGE levels and AGE/RAGE signaling pathway. However, few large-scale population-based studies have evaluated the associations between antihypertensive medications and risk of pancreatic cancer.Methods: A total of 145,553 postmenopausal women aged 50 to 79 years with no prevalent cancer from Women's Health Initiative (WHI) were included in our prospective cohort study with a mean follow-up of 13.8 years. Medication data including product and generic name, duration of use, and dosage form were collected at baseline recruitment (1993-98). We interrogated four antihypertensive drugs including β-blockers, diuretics, angiotensin converting enzyme inhibitors (ACEi) and calcium channel blockers (CCBs). Serum levels of sRAGE were measured in a subset of 842 study participants using immunoassay. Cox proportional hazard regression model was performed to obtain hazard ratio (HR) and its 95% confidence interval (CI) for each antihypertensive medication use and its duration of use in association with risk of pancreatic cancer. We additionally used Fine and Grey method to account for competing risk of nonpancreatic cancer deaths.Results: By August 29, 2014, a total of 841 incident pancreatic cancer cases were ascertained through annual self-administered questionnaires and confirmed by central adjudication. A 33% increased risk of pancreatic cancer was found among ever users of CCBs compared with never users (HR=1.33, 95% CI: 1.06-1.67) after adjusting for age, ethnicity, BMI, smoking status, diabetes history, use of β-blockers, ACEi or diuretics. The association remained after accounting for competing risks (HR=1.36, 95% CI: 1.30-1.42). Compared with never users of CCBs, long-term users (>3 years) had a 48% higher risk of pancreatic cancer (HR=1.48, 95% CI: 1.13-1.95, P trend = 0.005) and the association slightly attenuated but remained significant in the competing risk model (HR=1.35, 95% CI: 1.28-1.42, P trend < 0.001). The average serum sRAGE level was lower in CCBs ever users than CCBs never users (1,284 pg/mL versus 1,457 pg/mL, P = 0.011). Other antihypertensive medication use including β-blockers, diuretics, and ACEi were not associated with risk of pancreatic cancer.Conclusions: We found a positive association between CCB use and risk of incident pancreatic cancer in postmenopausal women. The inverse association between sRAGE level and CCBs use may help explain this association. Future studies are warranted to confirm these findings and further elucidate potential mechanisms by which CCBs may influence development of pancreatic cancer.
Citation Format: Zhensheng Wang, Donna White, Liang Chen, Peter Richardson, Hashem B. El-Serag, Li Jiao. The association between antihypertensive medication, sRAGE, and risk of pancreatic cancer: Results from the Women's Health Initiative Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4946.
Collapse
Affiliation(s)
| | | | | | | | | | - Li Jiao
- Baylor College of Medicine, Houston, TX
| |
Collapse
|
30
|
Jeon S, Conley S, Yaggi K, Jacoby D, Hollenbeak C, O’Connell M, Linsky S, Gaiser E, Richardson P, Mathew B, Kelly-Hauser J, Redeker NS. 0381 Cognitive Impairment Mediates The Relationship between Insomnia and Emotional Wellbeing among Patients with Stable Heart Failure. Sleep 2018. [DOI: 10.1093/sleep/zsy061.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Jeon
- Yale School of Nursing, Orange, CT
| | - S Conley
- Yale School of Nursing, Orange, CT
| | - K Yaggi
- Yale School of Medicine, New Haven, CT
| | - D Jacoby
- Yale School of Medicine, New Haven, CT
| | - C Hollenbeak
- The Pennsylvania State University, University Park, PA
| | | | - S Linsky
- Yale School of Nursing, Orange, CT
| | - E Gaiser
- Yale School of Medicine, New Haven, CT
| | | | | | | | | |
Collapse
|
31
|
Conley S, Jeon S, Yaggi H, Jacoby D, Hollenbeak C, O’Connell M, Linsky S, Darden JW, Gaiser E, Kelly-Hauser J, Matthew B, Richardson P, Redeker NS. 0881 Insomnia Is Related To Self-care In People With Stable Heart Failure. Sleep 2018. [DOI: 10.1093/sleep/zsy061.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Conley
- Yale University School of Nursing, West Haven, CT
| | - S Jeon
- Yale University School of Nursing, West Haven, CT
| | - H Yaggi
- Yale University School of Medicine, New Haven, CT
| | - D Jacoby
- Yale University School of Medicine, New Haven, CT
| | - C Hollenbeak
- Pennsylvania State University College of Medicine, Hershey, PA
| | - M O’Connell
- Yale University School of Nursing, West Haven, CT
| | - S Linsky
- Yale University School of Nursing, West Haven, CT
| | - J W Darden
- Yale University School of Nursing, West Haven, CT
| | - E Gaiser
- Yale University School of Nursing, West Haven, CT
| | | | - B Matthew
- Yale University School of Nursing, West Haven, CT
| | - P Richardson
- Yale University School of Nursing, West Haven, CT
| | - N S Redeker
- Yale University School of Nursing, West Haven, CT
| |
Collapse
|
32
|
White DL, Hoogeveen RC, Chen L, Richardson P, Ravishankar M, Shah P, Tinker L, Rohan T, Whitsel EA, El-Serag HB, Jiao L. A prospective study of soluble receptor for advanced glycation end products and adipokines in association with pancreatic cancer in postmenopausal women. Cancer Med 2018; 7:2180-2191. [PMID: 29573228 PMCID: PMC5943487 DOI: 10.1002/cam4.1426] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/30/2018] [Accepted: 02/09/2018] [Indexed: 12/23/2022] Open
Abstract
Advanced glycation end products (AGEs) dysregulate adipokines and induce inflammation by binding to their adipocyte receptor (RAGE). Soluble RAGE (sRAGE) prevents AGEs/RAGE signaling. We performed a nested case–control study of the association between sRAGE, adipokines, and incident pancreatic cancer risk in the prospective Women's Health Initiative Study. We individually matched controls (n = 802) to cases (n = 472) on age, race, and blood draw date. We evaluated serum concentrations of sRAGE, adiponectin, leptin, monocyte chemotactic protein 1 (MCP1), and plasminogen activator inhibitor‐1 (PAI1) using immunoassay. We used conditional logistic regression model to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for pancreatic cancer over biomarker quartiles (Q1–Q4). We used principal component analysis to create two composite biomarkers and performed a confirmatory factor analysis to examine the association between composite biomarker scores (CBS) and pancreatic cancer risk. Baseline serum sRAGE concentrations were inversely associated with pancreatic cancer risk (aORQ4 vs. Q1 = 0.70, 95% CI: 0.50–0.99). High MCP1 (aOR Q4 vs. Q1 = 2.55, 95% CI: 1.41–4.61) and the higher CBS including MCP1, PAI1, and leptin (aORQ4 vs. Q1 = 1.82, 95% CI = 1.04–3.18) were also associated with increased pancreatic cancer risk among women with BMI <25 kg/m2 (P values for interaction <0.05). We found an inverse association between prediagnostic sRAGE concentrations and risk of incident pancreatic cancer in postmenopausal women. A proinflammatory CBS was associated with increased risk only in women with normal BMI. MCP1 was not modulated by sRAGE.
Collapse
Affiliation(s)
- Donna L White
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas.,Texas Medical Center Digestive Disease Center, Houston, Texas.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, Texas.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Liang Chen
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Peter Richardson
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
| | | | - Preksha Shah
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Thomas Rohan
- Albert Einstein College of Medicine, Bronx, New York
| | - Eric A Whitsel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hashem B El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas.,Texas Medical Center Digestive Disease Center, Houston, Texas.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, Texas
| | - Li Jiao
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas.,Texas Medical Center Digestive Disease Center, Houston, Texas.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, Texas.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
| |
Collapse
|
33
|
Shah R, Richardson P, Yu H, Kramer J, Hou JK. Gastric Acid Suppression Is Associated with an Increased Risk of Adverse Outcomes in Inflammatory Bowel Disease. Digestion 2018; 95:188-193. [PMID: 28288458 DOI: 10.1159/000455008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 10/13/2016] [Accepted: 12/06/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The intestinal microbiota may influence inflammatory bowel disease (IBD) activity. Histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) can alter the intestinal microbiota. The aim of this study was to assess the relationship between H2RAs, PPIs, and IBD-related outcomes. METHODS We conducted a case-control study of IBD patients using the Veterans Health Affairs databases. Cases were defined by their first instance of an IBD-related hospitalization or surgery and the exposure of interest was H2RA or PPI use 30 days prior to the outcome. Incidence density ratios were calculated using conditional logistic regression. RESULTS In a cohort of 58,459 patients with IBD, we found 4,887 cases and 9,761 controls with ulcerative colitis (UC) and 4,876 cases and 9,745 controls with Crohn disease (CD). Filled prescriptions for H2RAs were associated with an increased risk of IBD-related hospitalization or surgery in CD patients (adjusted incidence density ratio 1.18; 95% CI 1.03-1.34). A similar association was found for PPIs in UC patients (adjusted incidence density ratio 1.11; 95% CI 1.02-1.21) and CD patients (adjusted incidence density ratio 1.12; 95% CI 1.02-1.22). CONCLUSIONS H2RAs and PPIs were associated with a modestly increased risk of IBD-related hospitalization or surgery.
Collapse
Affiliation(s)
- Rajesh Shah
- Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | |
Collapse
|
34
|
Cilia M, Ruiz S, Richardson P, Salmonson T, Serracino-Inglott A, Wirth F, Borg JJ. Quality Issues Identified During the Evaluation of Biosimilars by the European Medicines Agency's Committee for Medicinal Products for Human Use. AAPS PharmSciTech 2018; 19:489-511. [PMID: 29027130 DOI: 10.1208/s12249-017-0892-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/24/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to identify trends in deficiencies raised during the EU evaluation of the quality part of dossiers for marketing authorisation applications of biosimilar medicinal products. All adopted day 120 list of questions on the quality module of 22 marketing authorisation applications for biosimilars submitted to the European Medicines Agency and concluded by the end of October 2015 was analysed. Frequencies of common deficiencies identified were calculated and summarised descriptions included. Frequencies and trends on quality deficiencies were recorded and presented for 22 biosimilar applications. Thirty-two 'major objections' for 9 products were identified from 14 marketing authorisation applications with 15 raised for drug substance and 17 for drug product. In addition, 547 'other concerns' for drug substance and 495 for drug product were also adopted. The frequencies and trends of the identified deficiencies together with their impact were discussed from a regulatory perspective and how these impact key manufacturing processes and key materials used in the production of biosimilars. This study provides an insight to the regulatory challenges prospective companies need to consider when developing biosimilars; it also helps elucidate common pitfalls in the development and production of biosimilars and in the submission of dossiers for their marketing authorisations. The results are expected to be of interest to pharmaceutical companies but also to regulators to obtain consistent information on medicinal products based on transparent rules safeguarding the necessary pharmaceutical quality of medicinal products.
Collapse
|
35
|
Rival P, Slade G, Al-Khalil M, Kandage D, Quinn P, Deacon-Elliott E, Richardson P, Hakim A, Squires O. Undergraduate Surgical Teaching: Reflections by a Student-Led Surgical Society. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.362] [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: 10/18/2022]
|
36
|
Jiao L, Chen L, White DL, Tinker L, Chlebowski RT, Van Horn LV, Richardson P, Lane D, Sangi-Haghpeykar H, El-Serag HB. Low-fat Dietary Pattern and Pancreatic Cancer Risk in the Women's Health Initiative Dietary Modification Randomized Controlled Trial. J Natl Cancer Inst 2017; 110:4085218. [PMID: 28922784 DOI: 10.1093/jnci/djx117] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 01/03/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Observational studies suggest that diet may influence pancreatic cancer risk. We investigated the effect of a low-fat dietary intervention on pancreatic cancer incidence. Methods The Women's Health Initiative Dietary Modification (WHI-DM) trial is a randomized controlled trial conducted in 48 835 postmenopausal women age 50 to 79 years in the United States between 1993 and 1998. Women were randomly assigned to the intervention group (n = 19 541), with the goal of reducing total fat intake and increasing intake of vegetables, fruits, and grains, or to the usual diet comparison group (n = 29 294). The intervention concluded in March 2005. We evaluated the effect of the intervention on pancreatic cancer incidence with the follow-up through 2014 using the log-rank test and multivariable Cox proportional hazards regression model. All statistical tests were two-sided. Results In intention-to-treat analyses including 46 200 women, 92 vs 165 pancreatic cancer cases were ascertained in the intervention vs the comparison group (P = .23). The multivariable hazard ratio (HR) of pancreatic cancer was 0.86 (95% confidence interval [CI] = 0.67 to 1.11). Risk was statistically significantly reduced among women with baseline body mass indexes (BMIs) of 25 kg/m2 or higher (HR = 0.71, 95% CI = 0.53 to 0.96), but not among women with BMIs of less than 25 kg/m2 (HR = 1.62, 95% CI = 0.97 to 2.71, Pinteraction = .01). Conclusions A low-fat dietary intervention was associated with reduced pancreatic cancer incidence in women who were overweight or obese in the WHI-DM trial. Caution needs to be taken in interpreting the findings based on subgroup analyses.
Collapse
Affiliation(s)
- Li Jiao
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Liang Chen
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Donna L White
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Lesley Tinker
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Rowan T Chlebowski
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Linda V Van Horn
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Peter Richardson
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Dorothy Lane
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Haleh Sangi-Haghpeykar
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Hashem B El-Serag
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| |
Collapse
|
37
|
Fonseca R, Abouzaid S, Bonafede M, Cai Q, Parikh K, Cosler L, Richardson P. Trends in overall survival and costs of multiple myeloma, 2000-2014. Leukemia 2017; 31:1915-1921. [PMID: 28008176 PMCID: PMC5596206 DOI: 10.1038/leu.2016.380] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022]
Abstract
Little real-world evidence is available to describe the recent trends in treatment costs and outcomes for patients with multiple myeloma (MM). Using the Truven Health MarketScan Research Databases linked with social security administration death records, this study found that the percentage of MM patients using novel therapy continuously increased from 8.7% in 2000 to 61.3% in 2014. Compared with MM patients diagnosed in earlier years, those diagnosed after 2010 had higher rates of novel therapy use and better survival outcomes; patients diagnosed in 2012 were 1.25 times more likely to survive 2 years than those diagnosed in 2006. MM patients showed improved survival over the study period, with the 2-year survival gap between MM patients and matched controls decreasing at a rate of 3% per year. Total costs among MM patients have increased in all healthcare services over the years; however, the relative contribution of drug costs has remained fairly stable since 2009 despite new novel therapies coming to market. Findings from this study corroborate clinical data, suggesting a paradigm shift in MM treatment over the past decade that is associated with substantial survival gains. Future studies should focus on the impact on specific novel agents on patients' outcomes.
Collapse
Affiliation(s)
| | | | - M Bonafede
- Health Economics and Outcomes Research, Truven Health Analytics Inc., an IBM company, Cambridge, MA, USA
| | - Q Cai
- Health Economics and Outcomes Research, Truven Health Analytics Inc., an IBM company, Cambridge, MA, USA
| | - K Parikh
- Celgene Corporation, Summit, NJ, USA
| | - L Cosler
- Binghamton University, Binghamton, NY, USA
| | | |
Collapse
|
38
|
Périquet S, Richardson P, Cameron EZ, Ganswindt A, Belton L, Loubser E, Dalerum F. Effects of lions on behaviour and endocrine stress in plains zebras. Ethology 2017. [DOI: 10.1111/eth.12638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Stéphanie Périquet
- Department of Zoology and Entomology; University of the Free State; Phuthaditjhaba South Africa
| | | | - Elissa Z. Cameron
- School of Zoology; University of Tasmania; Hobart TAS Australia
- Mammal Research Institute; Department of Zoology and Entomology; University of Pretoria; Pretoria South Africa
- School of Biological Sciences; University of Canterbury; Christchurch New Zealand
| | - André Ganswindt
- Mammal Research Institute; Department of Zoology and Entomology; University of Pretoria; Pretoria South Africa
- Endocrine Research Laboratory; Department of Anatomy and Physiology; University of Pretoria; Onderstepoort South Africa
| | - Lydia Belton
- Mammal Research Institute; Department of Zoology and Entomology; University of Pretoria; Pretoria South Africa
| | - Elize Loubser
- Mammal Research Institute; Department of Zoology and Entomology; University of Pretoria; Pretoria South Africa
| | - Fredrik Dalerum
- Mammal Research Institute; Department of Zoology and Entomology; University of Pretoria; Pretoria South Africa
- Research Unit of Biodiversity (UO-CSIC-PA); University of Oviedo; Mieres Spain
- Department of Zoology; Stockholm University; Stockholm Sweden
| |
Collapse
|
39
|
Jia G, Royse K, Tang H, Li D, Chen L, Tinker L, Petersen G, Klein A, Richardson P, White D, Sangi-Haghapeykar H, El-Serag HB, Jiao L. Abstract LB-160: Genetic variations in the AGEs/AGER pathway and risk of pancreatic cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-lb-160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Chronic inflammation is implicated in pancreatic cancer carcinogenesis. Advanced glycation end-products (AGEs), which are rich in cooked red meat and cigarette smoke, can perpetuate inflammation by binding to the receptor for advanced glycation end products (AGER, also known as RAGE). We hypothesized that genetic variation of the AGEs/AGER pathway affects pancreatic cancer risk by modulating chronic inflammation.
Methods: We conducted a two-stage case-control study to examine the association between 96 single nucleotide polymorphisms (SNPs) in 21 genes (GLO1, MSR1, PINK1, KIF17, AGPAT1, AKR1B1, DDOST, CD36, SCARB1, AGER, APP, HMGB1, S100A8, S100B, S100P, S100A12, MMP9, ADAM10, PPARG, NOTCH4, and PDGF) of the AGEs/AGER pathway and risk of pancreatic cancer. The discovery study was conducted in 672 pancreatic cancer cases and 1361 controls ascertained from the Women’s Health Initiative (WHI) Study matched on age, race/ethnicity and study arm. The validation study was conducted in a PANC4 pooled hospital-based case-control study of 1,034 women cases and 989 women controls. A pooled analysis of 1706 cases and 2350 controls was also performed. SNP data were obtained or imputed from the previously performed GWASs. Pancreatic cancer risk was calculated as odds ratios (ORs) and 95% confidence intervals (Cis) using logistic regression models adjusting for age, race/ethnicity, body mass index (BMI), type 2 diabetes, and smoking using an additive genetic model. The potential interaction between individual SNP and red meat intake and cigarette smoking was examined. A false discovery rate (FDR) adjusted q value < 0.20 was considered statistically significant in the pooled analyses. We also conducted logistic-Kernel machine (LKM) test to examine the association between sets of SNP and risk of pancreatic cancer in the pooled dataset.
Results: We identified 11 SNPs with raw P values < 0.10 in the discovery stage in the WHI study. However, none of the SNPs was validated in the validation and pooled dataset. The LKM test showed that sets of SNPs in CD36 (P = 9.3E-10), GLO1(P =2.0E-7), and DDOST (P = 2.5E-4) were significantly associated with pancreatic cancer risk. We found an interaction effect between the GLO1 SNP rs6932648 and smoking status (never versus ever) in the WHI study (P for interaction = 0.01) and the pooled dataset (P for interaction = 0.049). In the pooled dataset, the variant T allele of rs6932648 (MAF = 0.12) was associated with increased risk of pancreatic cancer among ever smokers (additive OR = 1.26, 95% CI: 1.02-1.55), but not among never smokers (additive OR = 0.94, 95% CI: 0.78-1.14), compared with the C allele.
Summary and Conclusion: We did not observe significant association between any of 96 single SNP and pancreatic cancer risk. However, we found combined set of SNPs in the GLO1, DDOST, and CD36 genes were associated with risk of pancreatic cancer. GLO SNP rs6932648 may modify the association between smoking and risk of pancreatic cancer. GLO1, DDOST, and CD36 are involved in detoxification or clearance of AGEs compounds. Further investigation of AGEs and receptors systems in pancreatic cancer is warranted.
Citation Format: Guochong Jia, Kathryn Royse, Hongwei Tang, Donghui Li, Liang Chen, Lesley Tinker, Gloria Petersen, Alison Klein, Peter Richardson, Donna White, Haleh Sangi-Haghapeykar, Hashem B. El-Serag, Li Jiao. Genetic variations in the AGEs/AGER pathway and risk of pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-160. doi:10.1158/1538-7445.AM2017-LB-160
Collapse
Affiliation(s)
| | | | | | - Donghui Li
- 3UT-MD Anderson Cancer Center, Houston, TX
| | - Liang Chen
- 2Baylor College of Medicine, Houston, TX
| | - Lesley Tinker
- 4Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alison Klein
- 6Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | | | | | - Li Jiao
- 2Baylor College of Medicine, Houston, TX
| |
Collapse
|
40
|
Affiliation(s)
- P Petros
- Professorial Department of Surgery, St Vincent's Hospital, University of NSW, Sydney, Sydney, Australia.
| | - P Richardson
- Department of Health, Medical and Applied Sciences, University of Central Queensland, Rockhampton, Australia
| |
Collapse
|
41
|
Affiliation(s)
- Richard Veselý
- Scientific and Regulatory Management Department, European Medicines Agency, London E14 5EU, UK.
| | - Peter Richardson
- Specialised Scientific Disciplines Department, European Medicines Agency, London E14 5EU, UK
| |
Collapse
|
42
|
|
43
|
Khan N, Hills RK, Virgo P, Couzens S, Clark N, Gilkes A, Richardson P, Knapper S, Grimwade D, Russell NH, Burnett AK, Freeman SD. Expression of CD33 is a predictive factor for effect of gemtuzumab ozogamicin at different doses in adult acute myeloid leukaemia. Leukemia 2017; 31:1059-1068. [PMID: 27795558 PMCID: PMC5419583 DOI: 10.1038/leu.2016.309] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 06/14/2016] [Revised: 08/05/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022]
Abstract
It remains unclear in adult acute myeloid leukaemia (AML) whether leukaemic expression of CD33, the target antigen for gemtuzumab ozogamicin (GO), adds prognostic information on GO effectiveness at different doses. CD33 expression quantified in 1583 patients recruited to UK-NCRI-AML17 (younger adults) and UK-NCRI-AML16 (older adults) trials was correlated with clinical outcomes and benefit from GO including a dose randomisation. CD33 expression associated with genetic subgroups, including lower levels in both adverse karyotype and core-binding factor (CBF)-AML, but was not independently prognostic. When comparing GO versus no GO (n=393, CBF-AMLs excluded) by stratified subgroup-adjusted analysis, patients with lowest quartile (Q1) %CD33-positivity had no benefit from GO (relapse risk, HR 2.41 (1.27-4.56), P=0.009 for trend; overall survival, HR 1.52 (0.92-2.52)). However, from the dose randomisation (NCRI-AML17, n=464, CBF-AMLs included), 6 mg/m2 GO only had a relapse benefit without increased early mortality in CD33-low (Q1) patients (relapse risk HR 0.64 (0.36-1.12) versus 1.70 (0.99-2.92) for CD33-high, P=0.007 for trend). Thus CD33 expression is a predictive factor for GO effect in adult AML; although GO does not appear to benefit the non-CBF AML patients with lowest CD33 expression a higher GO dose may be more effective for CD33-low but not CD33-high younger adults.
Collapse
MESH Headings
- Adolescent
- Adult
- Age Factors
- Aminoglycosides/administration & dosage
- Aminoglycosides/pharmacology
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Biomarkers/analysis
- Dose-Response Relationship, Drug
- Female
- Gemtuzumab
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Recurrence
- Sialic Acid Binding Ig-like Lectin 3/analysis
- Survival Rate
- Treatment Outcome
- Young Adult
Collapse
Affiliation(s)
- Naeem Khan
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Robert K Hills
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Paul Virgo
- Department of Immunology, North Bristol NHS Trust, UK
| | - Stephen Couzens
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Nithiya Clark
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Amanda Gilkes
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Peter Richardson
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| | - Steven Knapper
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - David Grimwade
- Department of Medical and Molecular Genetics, King’s College London School of Medicine, Guy’s & St. Thomas’ NHS Foundation Trust, London UK
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham
| | - Alan K Burnett
- Institute of Cancer and Genetics, Cardiff University School of Medicine, University Hospital Wales, Heath Park, Cardiff
| | - Sylvie D Freeman
- Department of Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston Birmingham B15 2TT UK
| |
Collapse
|
44
|
Owens L, Patterson K, King G, Richardson P. A multidisciplinary team (MDT) approach to managing alcohol-dependent patients with comorbid depression in an acute hospital setting. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.447] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionAlcohol-dependent patients have a significantly increased risk of depression, contributing a cycle of relapse and attendance at acute hospital services seeking help. Care is often focused on the alcohol dependence treatment with little consideration of concomitant psychiatric disorders.AimTo help bridge this gap in care planning and aim toward multidisciplinary long-term support.MethodWe collected data on all patients referred to our alcohol complex patient MDT. We investigated the range of disciplines involved in patient care. We spoke to our patients about why they had chosen to attend hospital. We then developed a referral system to our alcohol MDT where a bespoke pathways of care was developed with all current and future care providers.ResultsOur patients were often being cared for by multiple services, however much of this work was happening in isolation and was at times conflicting. Importantly, the patients were unclear where to go for what, and were utilizing the ED as a fail-safe when they were troubled.Of 15 patients referred to MDT, 7 (50%) had a diagnosis of depression (DSM-IV). These patients had an average of 5.1 hospital attendances and 2.2 hospital admissions in the 3 months prior to MDT. At 3 months post-MDT, we were able to demonstrate a reduction in hospital admissions and attendances (average 2.2 & 1.4, respectively).ConclusionsAn MDT for alcohol-dependent patients with depression facilitates effective and collaborative working for the benefit of patients and services.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
45
|
Liedl B, Inoue H, Sekiguchi Y, Haverfield M, Richardson P, Yassourides A, Wagenlehner F. Is overactive bladder in the female surgically curable by ligament repair? Cent European J Urol 2017; 70:53-59. [PMID: 28461989 PMCID: PMC5407336 DOI: 10.5173/ceju.2017.938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/23/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Overactive bladder (OAB) symptoms (urge, frequency, nocturia) are not generally considered surgically curable by learning institutions. The Integral Theory hypothesizes that OAB is a prematurely activated, but normal micturition reflex caused by loose suspensory ligaments and potentially curable surgically by repairing such ligaments. To test this hypothesis by surgical repair of loose cardinal and uterosacral ligaments in patients with 2nd degree or greater uterine/apical prolapse. MATERIAL AND METHODS Multicenter prospective case control audit. 611 females, mean age 70. Inclusions: symptomatic apical prolapse of 2nd or greater degree, (POPQ stages 2-4), and at least two pelvic symptoms. Exclusions: Comorbid medical problems known to cause chronic pelvic pain (e.g., infection), sphincter tears, neurological bladder conditions. Surgery: minimally invasive cardinal/uterosacral ligament repair using the TFS (Tissue Fixation System). Primary outcome: Uterine prolapse cure; Secondary outcomes; bladder, bowel, and pain symptoms improvement. RESULTS 90% prolapse cure in 611 patients. Symptom incidence (% Cure at 12 months in brackets) was: urge incontinence: n = 310 (85%); frequency: n = 317 (83%); nocturia: n = 254 (68%); chronic pelvic pain (CPP): n = 194 (77%); fecal incontinence: n = 93 (65%). Statistics: McNemar x2-tests to test for significant changes in the symptoms' incidence-frequency from baseline (preoperative) to the postoperative phase. For each symptom the null hypothesis H0: P(baseline) = P(12 months after surgery)versus H1: P(baseline) ≠ P(12 months after surgery) was tested, with P indicating prevalence or incidence rate. CONCLUSIONS Bladder & bowel incontinence and chronic pelvic pain occur in predictable groupings and are associated with apical prolapse. OAB symptom improvement with the TFS ligament repair provides a good alternative to anticholinergics, especially when considering their association with dementia causation. Application of the Integral Theory System has the potential to significantly improve clinical practice, QoL for ageing women, delaying entry into Nursing Homes and creating new scientific research directions. The take home message is that symptoms of chronic pelvic pain, bladder and bowel dysfunction occur in relatively predictable groups, caused by lax suspensory ligaments and can be cured or improved by TFS mini sling ligament repair.
Collapse
Affiliation(s)
- Bernhard Liedl
- Zentrum für Urogenital Chirurgie BBZ, Fachkliniken München AG, Germany
| | - Hiromi Inoue
- Urogynaecology Center, Shonan Kamakura General Hospital, Kamakura, Japan
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Yuki Sekiguchi
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Max Haverfield
- Department of Gynaecology, The Northern Hospital, Melbourne Victoria, Australia
| | - Peter Richardson
- Department of Health, Medical and Applied Sciences, University of Central Queensland, Australia University of Central Queensland, Australia
| | | | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology und Andrology, Justus-Liebig-University Giessen, Germany
| |
Collapse
|
46
|
Chayanupatkul M, Omino R, Mittal S, Kramer JR, Richardson P, Thrift AP, El-Serag HB, Kanwal F. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection. J Hepatol 2017; 66:355-362. [PMID: 27693539 DOI: 10.1016/j.jhep.2016.09.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [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: 08/13/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cirrhosis related to chronic hepatitis B (CHB) is a major risk factor for hepatocellular carcinoma (HCC). The extent to which HCC occurs in U.S. in the absence of cirrhosis in CHB remains unclear. METHODS We identified CHB patients who were diagnosed with HCC in the national Veterans Administration (VA) between 2001 and 2013. We defined presence and absence of cirrhosis at the time of HCC diagnosis using explicit histological, radiological, endoscopic, and laboratory criteria. We used multivariable regression analysis to identify demographic and clinical characteristics associated with CHB-related HCC in the absence of cirrhosis. We also examined liver transplant-free survival in CHB-HCC patients with and without cirrhosis. RESULTS Among 8539 CHB patients, 317 developed HCC of whom 30 (9.5%) did not have any evidence of cirrhosis at the time of HCC diagnosis. Compared to HCC patients with cirrhosis, HCC patients without cirrhosis were more likely to be non-white (African American, OR=6.78; 95% CI 2.05-22.4; Asian, OR 11.6, 95% CI 2.63-50.8), have a family history of HCC (OR 32.9, 95% CI 3.76-288), and hypertension (OR 3.15, 95% CI 1.02-9.75). There was no significant difference in the transplant-free survival between CHB-HCC patients with and without cirrhosis (hazard ratio 0.68, 95% CI 0.43-1.09). CONCLUSIONS Fewer than 10% of U.S. based CHB-related HCC patients did not have cirrhosis. Race and family history of HCC were the main risk factors for HCC in the absence of cirrhosis in CHB. These factors may help guide the decision to initiate HCC surveillance in CHB patients without cirrhosis. LAY SUMMARY Patients with chronic hepatitis B who are African American, or Asian, older than 40years of age with family members with liver cancer or high blood pressure are at a higher risk of developing liver cancer in the absence of cirrhosis. These patients should be included in the screening program for liver cancer.
Collapse
Affiliation(s)
- Maneerat Chayanupatkul
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - Ronald Omino
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sahil Mittal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Center of Innovation, Effectiveness and Quality, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States
| | - Jennifer R Kramer
- Center of Innovation, Effectiveness and Quality, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Section of Gastroenterology and Hepatology, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States
| | - Peter Richardson
- Center of Innovation, Effectiveness and Quality, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Section of Gastroenterology and Hepatology, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States
| | - Aaron P Thrift
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Center of Innovation, Effectiveness and Quality, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Section of Gastroenterology and Hepatology, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Center of Innovation, Effectiveness and Quality, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States; Section of Health Services Research, Section of Gastroenterology and Hepatology, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX, United States
| |
Collapse
|
47
|
Natarajan Y, White DL, El-Serag HB, Ramsey D, Richardson P, Kuzniarek J, Shukla R, Tansel A, Kanwal F. Role of Non-hepatic Medical Comorbidity and Functional Limitations in Predicting Mortality in Patients with HCV. Dig Dis Sci 2017; 62:76-83. [PMID: 27655101 DOI: 10.1007/s10620-016-4303-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/07/2016] [Accepted: 09/07/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Medical comorbidities and functional status limitations are determinants of mortality in many chronic diseases. The extent to which survival in the rapidly aging cohort of patients with HCV is affected by these competing causes of mortality remains unclear. AIM We sought to determine the effect of medical/functional comorbidities on survival after adjusting for liver disease severity in a cohort of patients with HCV infection. METHODS We prospectively recruited consecutive patients from an HCV clinic 2009-2014. We calculated an index of survival (Schonberg Index, SI) based on age, gender, medical comorbidities, and functional status variables. We defined cirrhosis with the FibroSure test (F3/4-F4). We used multivariable Cox modeling to assess association between functional/survival measure and survival after adjustment for severity of liver disease. RESULTS The cohort consisted of 1052 HCV patients. The average age was 56.8 years; 36 % had cirrhosis. The mean SI was 8.2 (SD = 2.7). During a mean follow-up of 5610 person-years, 102 (9.7 %) patients died. In unadjusted analysis, higher baseline SI predicted mortality (HR 1.17; 95 % CI 1.09-1.25). SI similarly predicted mortality in cirrhotic patients (HR 1.23, 95 % CI 1.13-1.34) and non-cirrhotic patients (HR 1.21, 95 % CI 1.08-1.36). This did not change after adjusting for age, drug use, or coronary artery disease. DISCUSSION Comorbidities and functional limitations predict higher mortality in patients with HCV; this relationship is independent of cirrhosis. Use of general prognostic indices may help identify HCV patients at high risk for mortality, which could further guide clinical care in a manner not achievable with assessment of liver disease alone.
Collapse
Affiliation(s)
- Yamini Natarajan
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
| | - Donna L White
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Texas Medical Center Digestive Disease Center, Houston, TX, USA.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Texas Medical Center Digestive Disease Center, Houston, TX, USA.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA
| | - David Ramsey
- Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Peter Richardson
- Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Jill Kuzniarek
- Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Richa Shukla
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Aylin Tansel
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.,Texas Medical Center Digestive Disease Center, Houston, TX, USA.,Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
48
|
Hwang C, Copeland A, Lucas S, Lapidus A, Barry K, Detter JC, Glavina Del Rio T, Hammon N, Israni S, Dalin E, Tice H, Pitluck S, Chertkov O, Brettin T, Bruce D, Han C, Schmutz J, Larimer F, Land ML, Hauser L, Kyrpides N, Mikhailova N, Ye Q, Zhou J, Richardson P, Fields MW. Complete Genome Sequence of Alkaliphilus metalliredigens Strain QYMF, an Alkaliphilic and Metal-Reducing Bacterium Isolated from Borax-Contaminated Leachate Ponds. Genome Announc 2016; 4:e01226-16. [PMID: 27811105 PMCID: PMC5095475 DOI: 10.1128/genomea.01226-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
Alkaliphilus metalliredigens strain QYMF is an anaerobic, alkaliphilic, and metal-reducing bacterium associated with phylum Firmicutes QYMF was isolated from alkaline borax leachate ponds. The genome sequence will help elucidate the role of metal-reducing microorganisms under alkaline environments, a capability that is not commonly observed in metal respiring-microorganisms.
Collapse
Affiliation(s)
- C Hwang
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, USA
| | - A Copeland
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - S Lucas
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - A Lapidus
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - K Barry
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - J C Detter
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | | | - N Hammon
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - S Israni
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - E Dalin
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - H Tice
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - S Pitluck
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - O Chertkov
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - T Brettin
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - D Bruce
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - C Han
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - J Schmutz
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - F Larimer
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - M L Land
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - L Hauser
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - N Kyrpides
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - N Mikhailova
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - Q Ye
- State Key Laboratory of Estuarine and Coastal Research, East China Normal University, Shanghai, China
| | - J Zhou
- University of Oklahoma, Department of Microbiology and Plant Biology, Norman, Oklahoma, USA
| | - P Richardson
- DOE Joint Genome Institute, Walnut Creek, California, USA
| | - M W Fields
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana, USA
| |
Collapse
|
49
|
El-Serag HB, Kanwal F, Richardson P, Kramer J. Risk of hepatocellular carcinoma after sustained virological response in Veterans with hepatitis C virus infection. Hepatology 2016; 64:130-7. [PMID: 26946190 PMCID: PMC4917456 DOI: 10.1002/hep.28535] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED The long-term prognosis in terms of risk or predictors of developing hepatocellular carcinoma (HCC) among patients with sustained virological response (SVR) remains unclear. We conducted a retrospective cohort study using data from the Veterans Affairs VA hepatitis C virus (HCV) Clinical Case Registry in patients with positive HCV RNA between October 1999 and August 2009 and follow-up through December 2010. HCV treatment (interferon with or without ribavirin) and SVR (RNA test negative at least 12 weeks after the end of treatment) were determined. We used Cox's proportional hazards models to calculate hazard ratios (HRs) for potential predictors (demographic, virological, and clinical) associated with HCC development post-SVR. We identified 33,005 HCV-infected individuals who received treatment, of whom 10,817 achieved SVR. Among these patients, 100 developed new HCC during a total follow-up of 30,562 person-years for an overall incidence rate of 0.33% per year. Annual risk of HCC remained considerably high among patients with cirrhosis (1.39%) and those cured after age 64 (0.95%). Patients with diabetes (adjusted HR = 1.88; 1.21-2.91) or genotype 3 infection (adjusted HR = 1.62; 0.96-2.734) were significantly more likely to develop HCC. CONCLUSIONS Risk of HCC after HCV cure, though considerably reduced, remains relatively high at 0.33% per year. Older age and/or presence of cirrhosis at the time of SVR are associated with a high enough risk to warrant surveillance. Diabetes is also a risk factor for post-SVR HCC. (Hepatology 2016;64:130-137).
Collapse
Affiliation(s)
- Hashem B. El-Serag
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jennifer Kramer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
50
|
Sada Y, Hou J, Richardson P, El-Serag H, Davila J. Validation of Case Finding Algorithms for Hepatocellular Cancer From Administrative Data and Electronic Health Records Using Natural Language Processing. Med Care 2016; 54:e9-14. [PMID: 23929403 DOI: 10.1097/mlr.0b013e3182a30373] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. METHODS We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. RESULTS A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. CONCLUSIONS A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.
Collapse
Affiliation(s)
- Yvonne Sada
- *Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine †Health Services Research and Development Section Departments of ‡Oncology §Gastroenterology, Baylor College of Medicine, Houston, TX
| | | | | | | | | |
Collapse
|