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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Adachi I, Adamczyk K, Aggarwal L, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becherer F, Becker J, Behera PK, Bennett JV, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bobrov A, Bodrov D, Bolz A, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heidelbach A, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Horak P, Hsu CL, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Junkerkalefeld H, Kaliyar AB, Kandra J, Kang KH, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kinoshita K, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li Y, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natkaniec Z, Natochii A, Nayak L, Nazaryan G, Nisar NK, Nishida S, Ogawa S, Ono H, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schnepf M, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Veronesi M, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Wach B, Waheed E, Wakai M, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Zani L, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhukova VI, Žlebčík R. Tests of Light-Lepton Universality in Angular Asymmetries of B^{0}→D^{*-}ℓν Decays. Phys Rev Lett 2023; 131:181801. [PMID: 37977641 DOI: 10.1103/physrevlett.131.181801] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
We present the first comprehensive tests of the universality of the light leptons in the angular distributions of semileptonic B^{0}-meson decays to charged spin-1 charmed mesons. We measure five angular-asymmetry observables as functions of the decay recoil that are sensitive to lepton-universality-violating contributions. We use events where one neutral B is fully reconstructed in ϒ(4S)→BB[over ¯] decays in data corresponding to 189 fb^{-1} integrated luminosity from electron-positron collisions collected with the Belle II detector. We find no significant deviation from the standard model expectations.
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Adachi I, Aggarwal L, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bodrov D, Bondar A, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheema P, Chekelian V, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Choi SK, Choudhury S, Cochran J, Corona L, Das S, Dattola F, De La Motte SA, de Marino G, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dreyer S, Dubey S, Dujany G, Ecker P, Epifanov D, Feichtinger P, Ferlewicz D, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Han Y, Hayasaka K, Hayashii H, Hazra S, Hearty C, Heredia de la Cruz I, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jaffe DE, Jang EJ, Ji QP, Jia S, Jin Y, Junkerkalefeld H, Kaliyar AB, Kandra J, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kinoshita K, Kodyš P, Koga T, Kohani S, Kojima K, Korobov A, Korpar S, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li LK, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Manfredi R, Manoni E, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natkaniec Z, Natochii A, Nayak L, Nazaryan G, Nisar NK, Nishida S, Ono H, Otani F, Oxford ER, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Roney JM, Rostomyan A, Rout N, Russo G, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schwanda C, Schwartz AJ, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Shi XD, Shillington T, Shiu JG, Shtol D, Sibidanov A, Simon F, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stottler ZS, Stroili R, Sumihama M, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanida K, Tenchini F, Tittel O, Tonelli D, Torassa E, Trabelsi K, Tsaklidis I, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varvell KE, Veronesi M, Vismaya VS, Vitale L, Volpe R, Wach B, Wallner S, Wang E, Wang MZ, Wang XL, Wang Z, Warburton A, Watanabe M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yoshihara K, Yuan CZ, Yusa Y, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhukova VI, Žlebčík R. Precise Measurement of the D_{s}^{+} Lifetime at Belle II. Phys Rev Lett 2023; 131:171803. [PMID: 37955504 DOI: 10.1103/physrevlett.131.171803] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023]
Abstract
We measure the lifetime of the D_{s}^{+} meson using a data sample of 207 fb^{-1} collected by the Belle II experiment running at the SuperKEKB asymmetric-energy e^{+}e^{-} collider. The lifetime is determined by fitting the decay-time distribution of a sample of 116×10^{3} D_{s}^{+}→ϕπ^{+} decays. Our result is τ_{D_{s}^{+}}=(499.5±1.7±0.9) fs, where the first uncertainty is statistical and the second is systematic. This result is significantly more precise than previous measurements.
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Bansal S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bernieri E, Bernlochner FU, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhardwaj V, Bhuyan B, Bianchi F, Bilka T, Bilokin S, Biswas D, Bobrov A, Bodrov D, Bolz A, Borah J, Bozek A, Bračko M, Branchini P, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang MC, Chang P, Cheaib R, Cheema P, Chekelian V, Chen YQ, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cinabro D, Cochran J, Corona L, Cremaldi LM, Cunliffe S, Czank T, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dossett D, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Epifanov D, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Frey A, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghevondyan G, Ghosh D, Ghumaryan H, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Gogota O, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Guilliams J, Halder S, Han Y, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hirata H, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Inguglia G, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jaffe DE, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kakuno H, Kaleta M, Kalita D, Kaliyar AB, Kandra J, Kang KH, Kang S, Karl R, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Konno T, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lanceri L, Lange JS, Laurenza M, Lautenbach K, Leboucher R, Le Diberder FR, Leitl P, Levit D, Lewis PM, Li C, Li LK, Li YB, Libby J, Lieret K, Liu QY, Liu ZQ, Liventsev D, Longo S, Lozar A, Lueck T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Manfredi R, Manoni E, Manthei AC, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martini A, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Miyake H, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakamura KR, Nakao M, Nakayama H, Nakazawa H, Nakazawa Y, Narimani Charan A, Naruki M, Narwal D, Natkaniec Z, Natochii A, Nayak L, Nayak M, Nazaryan G, Niebuhr C, Nisar NK, Nishida S, Ogawa S, Ono H, Onuki Y, Oskin P, Otani F, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Pardi S, Parham K, Park J, Park SH, Paschen B, Passeri A, Patra S, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Pinna Angioni G, Podesta-Lerma PLM, Podobnik T, Pokharel S, Polat L, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Ramirez Morales A, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Rizzuto LB, Robertson SH, Rodríguez Pérez D, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sanders DA, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schnepf M, Schueler J, Schwanda C, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shen CP, Shi XD, Shillington T, Shiu JG, Shtol D, Shwartz B, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Strube J, Sue Y, Sumihama M, Sumisawa K, Sutcliffe W, Suzuki SY, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tanigawa H, Tenchini F, Thaller A, Tiwary R, Tonelli D, Torassa E, Toutounji N, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uematsu Y, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Vobbilisetti V, Volpe R, Vossen A, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang XL, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Ye H, Yelton J, Yin JH, Yook YM, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhai Y, Zhang Y, Zhilich V, Zhou JS, Zhou QD, Zhou XY, Zhukova VI, Žlebčík R. Search for a τ^{+}τ^{-} Resonance in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} Events with the Belle II Experiment. Phys Rev Lett 2023; 131:121802. [PMID: 37802942 DOI: 10.1103/physrevlett.131.121802] [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] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/08/2023] [Indexed: 10/08/2023]
Abstract
We report the first search for a nonstandard-model resonance decaying into τ pairs in e^{+}e^{-}→μ^{+}μ^{-}τ^{+}τ^{-} events in the 3.6-10 GeV/c^{2} mass range. We use a 62.8 fb^{-1} sample of e^{+}e^{-} collisions collected at a center-of-mass energy of 10.58 GeV by the Belle II experiment at the SuperKEKB collider. The analysis probes three different models predicting a spin-1 particle coupling only to the heavier lepton families, a Higgs-like spin-0 particle that couples preferentially to charged leptons (leptophilic scalar), and an axionlike particle, respectively. We observe no evidence for a signal and set exclusion limits at 90% confidence level on the product of cross section and branching fraction into τ pairs, ranging from 0.7 to 24 fb, and on the couplings of these processes. We obtain world-leading constraints on the couplings for the leptophilic scalar model for masses above 6.5 GeV/c^{2} and for the axionlike particle model over the entire mass range.
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Adachi I, Adamczyk K, Aggarwal L, Ahmed H, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aversano M, Babu V, Bae H, Bahinipati S, Bambade P, Banerjee S, Barrett M, Baudot J, Bauer M, Baur A, Beaubien A, Becker J, Behera PK, Bennett JV, Bertacchi V, Bertemes M, Bertholet E, Bessner M, Bettarini S, Bhuyan B, Bianchi F, Bilka T, Biswas D, Bodrov D, Bondar A, Borah J, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Cerasoli J, Chang P, Cheaib R, Cheema P, Chekelian V, Chen C, Cheon BG, Chilikin K, Chirapatpimol K, Cho HE, Cho K, Cho SJ, Choi SK, Choudhury S, Cochran J, Corona L, Cremaldi LM, Das S, Dattola F, De La Cruz-Burelo E, De La Motte SA, de Marino G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, De Yta-Hernandez A, Dhamija R, Di Canto A, Di Capua F, Dingfelder J, Doležal Z, Domínguez Jiménez I, Dong TV, Dorigo M, Dort K, Dreyer S, Dubey S, Dujany G, Ecker P, Eliachevitch M, Feichtinger P, Ferber T, Ferlewicz D, Fillinger T, Finck C, Finocchiaro G, Fodor A, Forti F, Fulsom BG, Gabrielli A, Ganiev E, Garcia-Hernandez M, Garg R, Garmash A, Gaudino G, Gaur V, Gaz A, Gellrich A, Ghosh D, Giakoustidis G, Giordano R, Giri A, Glazov A, Gobbo B, Godang R, Goldenzweig P, Gradl W, Grammatico T, Granderath S, Graziani E, Greenwald D, Gruberová Z, Gu T, Guan Y, Gudkova K, Halder S, Han Y, Hara K, Hara T, Hayasaka K, Hayashii H, Hazra S, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hohmann M, Hsu CL, Humair T, Iijima T, Inami K, Ipsita N, Ishikawa A, Ito S, Itoh R, Iwasaki M, Jackson P, Jacobs WW, Jang EJ, Ji QP, Jia S, Jin Y, Johnson A, Joo KK, Junkerkalefeld H, Kaleta M, Kaliyar AB, Kandra J, Kang KH, Kang S, Kar S, Karyan G, Kawasaki T, Keil F, Ketter C, Kiesling C, Kim CH, Kim DY, Kim KH, Kim YK, Kindo H, Kodyš P, Koga T, Kohani S, Kojima K, Korobov A, Korpar S, Kovalenko E, Kowalewski R, Kraetzschmar TMG, Križan P, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumara K, Kunigo T, Kuzmin A, Kwon YJ, Lacaprara S, Lai YT, Lam T, Lange JS, Laurenza M, Leboucher R, Le Diberder FR, Leitl P, Levit D, Li C, Li LK, Libby J, Liu QY, Liu ZQ, Liventsev D, Longo S, Lueck T, Luo T, Lyu C, Ma Y, Maggiora M, Maharana SP, Maiti R, Maity S, Mancinelli G, Manfredi R, Manoni E, Mantovano M, Marcantonio D, Marcello S, Marinas C, Martel L, Martellini C, Martinov T, Massaccesi L, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Maurya SK, McKenna JA, Mehta R, Meier F, Merola M, Metzner F, Milesi M, Miller C, Mirra M, Miyabayashi K, Mizuk R, Mohanty GB, Molina-Gonzalez N, Mondal S, Moneta S, Moser HG, Mrvar M, Mussa R, Nakamura I, Nakazawa Y, Narimani Charan A, Naruki M, Natochii A, Nayak L, Nayak M, Nazaryan G, Nisar NK, Nishida S, Ono H, Onuki Y, Oskin P, Pakhlov P, Pakhlova G, Paladino A, Paoloni E, Pardi S, Parham K, Park H, Park SH, Passeri A, Patra S, Paul S, Pedlar TK, Peschke R, Pestotnik R, Pham F, Piccolo M, Piilonen LE, Podesta-Lerma PLM, Podobnik T, Pokharel S, Praz C, Prell S, Prencipe E, Prim MT, Purwar H, Rad N, Rados P, Raeuber G, Raiz S, Reif M, Reiter S, Remnev M, Ripp-Baudot I, Rizzo G, Robertson SH, Roehrken M, Roney JM, Rostomyan A, Rout N, Russo G, Sahoo D, Sandilya S, Sangal A, Santelj L, Sato Y, Savinov V, Scavino B, Schmitt C, Schwanda C, Schwartz AJ, Seino Y, Selce A, Senyo K, Serrano J, Sevior ME, Sfienti C, Shan W, Sharma C, Shi XD, Shillington T, Shiu JG, Shtol D, Sibidanov A, Simon F, Singh JB, Skorupa J, Sobie RJ, Sobotzik M, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stavroulakis P, Stefkova S, Stottler ZS, Stroili R, Sumihama M, Sumisawa K, Sutcliffe W, Svidras H, Takahashi M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Tenchini F, Thaller A, Tittel O, Tiwary R, Tonelli D, Torassa E, Trabelsi K, Tsaklidis I, Uchida M, Ueda I, Uglov T, Unger K, Unno Y, Uno K, Uno S, Urquijo P, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vismaya VS, Vitale L, Wach B, Wakai M, Wakeling HM, Wallner S, Wang E, Wang MZ, Wang Z, Warburton A, Watanabe M, Watanuki S, Welsch M, Wessel C, Won E, Xu XP, Yabsley BD, Yamada S, Yan W, Yang SB, Yin JH, Yoshihara K, Yuan CZ, Yusa Y, Zani L, Zhang Y, Zhilich V, Zhou QD, Zhukova VI. Measurement of CP Violation in B^{0}→K_{S}^{0}π^{0} Decays at Belle II. Phys Rev Lett 2023; 131:111803. [PMID: 37774261 DOI: 10.1103/physrevlett.131.111803] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 10/01/2023]
Abstract
We report a measurement of the CP-violating parameters C and S in B^{0}→K_{S}^{0}π^{0} decays at Belle II using a sample of 387×10^{6} BB[over ¯] events recorded in e^{+}e^{-} collisions at a center-of-mass energy corresponding to the ϒ(4S) resonance. These parameters are determined by fitting the proper decay-time distribution of a sample of 415 signal events. We obtain C=-0.04_{-0.15}^{+0.14}±0.05 and S=0.75_{-0.23}^{+0.20}±0.04, where the first uncertainties are statistical and the second are systematic.
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Okholm Kryger K, Wang A, Mehta R, Impellizzeri F, Massey A, Harrison M, Glendinning R, McCall A. Can we evidence-base injury prevention and management in women's football? A scoping review. Res Sports Med 2023; 31:687-702. [PMID: 35164617 DOI: 10.1080/15438627.2022.2038161] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
This review aimed, as part of a larger FIFA project aiming to steer women's football research, to scope literature on any level of competitive football for women, to understand the current quantity of research on women's football injuries. The study reviewed all injury-related papers scoped by a recent scoping review mapping all published women's football research with an updated search performed on 23 February 2021. Eligibility criteria assessment followed the recent scoping review with injury-specific research focus. A total of 497 studies were scoped. Most studies contained an epidemiological (N = 226; 45%) or risk factors assessment (N = 105; 21%). Less assessed areas included financial burden (N = 1; <1%) and injury awareness (N = 5; 1%). 159 studies (32%) assessed injuries of the whole body. The most common single location assessed in the literature was the knee (N = 134, 27%), followed by head/face (N =108, 22%). These numbers were, however, substantially lowered, when subdivided by playing level and age-group. The volume of research focuses especially on descriptive research and specific body locations (head/face and knee). Although information can be taken from studies in other sports, more football-specific studies to support management and prevention of injuries are warranted.
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Affiliation(s)
- K Okholm Kryger
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, London, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Wang
- College of Medicine and Veterinary Medicine, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R Mehta
- College of Medicine and Veterinary Medicine, The Football Association, London, UK
| | - Fm Impellizzeri
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - A Massey
- College of Medicine and Veterinary Medicine, Fédération Internationale de Football Association, Zurich, Switzerland
| | - M Harrison
- College of Medicine and Veterinary Medicine, St Helen's and Knowsley Teaching Hospitals Nhs Trust, Prescot, UK
| | - R Glendinning
- College of Medicine and Veterinary Medicine, Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - A McCall
- College of Medicine and Veterinary Medicine, Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- College of Medicine and Veterinary Medicine, School of Applied Sport & Exercise Sciences, Edinburgh Napier University, Edinburgh, UK
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Mehta R, Moalic M, Krawczyk M, Saha S. Tunability of spin-wave spectra in a 2D triangular shaped magnonic fractals. J Phys Condens Matter 2023; 35. [PMID: 37116510 DOI: 10.1088/1361-648x/acd15f] [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] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
Reprogramming the structure of the magnonic bands during their operation is important for controlling spin waves in magnonic devices. Here, we report the tunability of the spin-wave spectra for a triangular shaped deterministic magnonic fractal, which is known as Sierpinski triangle by solving the Landau-Lifshitz-Gilbert equation using a micromagnetic simulations. The spin-wave dynamics change significantly with the variation of iteration number. A wide frequency gap is observed for a structure with an iteration number exceeding some value and a plenty of mini-frequency bandgaps at structures with high iteration number. The frequency gap could be controlled by varying the strength of the magnetic field. A sixfold symmetry in the frequency gap is observed with the variation of the azimuthal angle of the external magnetic field. The spatial distributions of the spin-wave modes allow to identify the bands surrounding the gap. The observations are important for the application of magnetic fractals as a reconfigurable aperiodic magnonic crystals.
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Affiliation(s)
- R Mehta
- Department of Physics, Ashoka University, Sonipat, Haryana 131029, India
| | - M Moalic
- Institute of Spintronic and Quantum Information, Faculty of Physics, Adam Mickiewicz University, Poznan, Uniwersytetu Poznanskiego 2, Poznan PL-61-614, Poland
| | - M Krawczyk
- Institute of Spintronic and Quantum Information, Faculty of Physics, Adam Mickiewicz University, Poznan, Uniwersytetu Poznanskiego 2, Poznan PL-61-614, Poland
| | - S Saha
- Department of Physics, Ashoka University, Sonipat, Haryana 131029, India
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Kincaid B, Mehta R. A rare case of acute lymphocytic leukemia presenting with pediatric acute liver failure. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00405-6] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abbasi A, Liu M, Riley-Gillis B, Waring J, Jacob H, Brown SM, Cheng T, Mehta R, Smaoui N. 079 Applying human phenomics to electronic health records provides a framework for understanding skin-aging related phenotypes. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.089] [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: 11/19/2022]
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Moukthika KVN, Krishnappa D, Patloori Sirish Chandra S, Bhole C, Deshpande S, Roshan J, Barthur A, Parameshwaran S, Mehta R, Padmanabhan D. Inflammation begets isolated atrioventricular conduction disturbances in young an observation from indian registry data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.499] [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: 11/13/2022] Open
Abstract
Abstract
Background
High grade AV block is less commonly encountered in patients <60 years. The aetiological role of inflammatory conditions is not well studied in this group of patients.
Purpose
To determine the prevalence of myocardial inflammation in young patients presenting with High grade AV block and assess its response to immunosuppression.
Methodology
This is a prospective, registry based, observational study conducted at two centers from Jan 2020 to Dec 2021. Myocardial inflammation was detected using Cardiac PET, and/or histopathological examination. Those with evidence of inflammation were started on graded immunosuppression.
Results
318 patients were enrolled. Mean EF was 55.2±7.0%. Cardiac PET was performed in 87/318 (27.3%). Myocardial inflammation was seen in 57/87 (65%). LV basal septum was most commonly involved. 44/57 (77%) were started on immunosuppressive therapy after excluding indolent tuberculosis.8 patients died during follow-up with all deaths being sudden in nature. 5/44 (11.3%) had reversal of CHB with resolution of cPET findings.
Conclusion
Significant proportion of young patients with High grade AV block have segmental myocardial inflammation. Immunosuppression helps restore AV conduction in some of these patients. Long-term studies are required to assess adverse impact of inflammation on cardiac contractile function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K V N Moukthika
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Krishnappa
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | | | - C Bhole
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Deshpande
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - J Roshan
- Christian Medical College, electrophysiology , Vellore , India
| | - A Barthur
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - S Parameshwaran
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - R Mehta
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
| | - D Padmanabhan
- sri jayadeva institute of cardiovascular sciences and research, Bangalore , India , India
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De Michieli L, Knott J, Attia Z, Ola O, Akula A, Mehta R, Dworak M, Lobo R, Hodge D, Tak T, Cagin C, Friedman P, Gulati R, Jaffe A, Sandoval Y. Artificial intelligence-enabled electrocardiographic algorithm for the detection of left ventricular dysfunction in emergency department patients undergoing high-sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1330] [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: 11/14/2022] Open
Abstract
Abstract
Background
Artificial intelligence-augmented electrocardiogram (AI-ECG) algorithms have been developed from the standard 12-lead ECG and validated for the recognition of left ventricular systolic dysfunction (LVSD), defined as LV ejection fraction (LVEF)≤35%. Whether AI-ECG facilitates identification of LVSD and is associated with adverse outcomes in emergency department (ED) patients undergoing high-sensitivity cardiac troponin (hs-cTnT) testing is uncertain.
Purpose
To investigate the diagnostic and prognostic performance of AI-ECG in ED patients undergoing hs-cTnT measurement.
Methods
Observational US cohort study of ED patients undergoing hs-cTnT measurement. Cases with hs-cTnT increases >sex-specific 99th percentiles were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Post-discharge major adverse cardiac events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischemic attack, and new onset atrial fibrillation/flutter during 2-years follow-up. The AI-ECG network output, which is a continuous number between 0–1, that provides a probability of LVSD, was obtained for each patient from the first ECG during the index presentation. An AI-ECG threshold of ≥0.256 indicates a positive screen that correlates with a high probability of LVSD.
Results
Among 1977 patients, 1729 (87%) had a negative AI-ECG screen, while 248 (13%) had a positive AI-ECG screen. Patients with a positive AI-ECG screen were older and had more comorbidities. As compared to patients with hs-cTnT≤99th percentile in whom AI-ECG was positive in 5.8%, those with hs-cTnT>99th percentile had a positive AI-ECG in 22% of cases (p<0.0001). Based on adjudicated diagnoses, the frequency of a positive AI-ECG was 20% in myocardial injury, 38% in type 1 MI, and 20% in type 2 MI. At 2-years follow-up, as compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p<0.0001, adjusted HR 1.39, 95% CI 1.11–1.75) (Figure 1), mainly because of more deaths (43% vs. 30%, p=0.004) and HF hospitalizations (36% vs. 13%, p<0.0001). A positive AI-ECG was associated with a higher risk for MACE (60% vs. 41%, p<0.0001, adjusted HR 1.30, 95% CI 1.02–1.64) in those with hs-cTnT increases >99th percentile, but not in those without hs-cTnT increases. Among patients with an echocardiogram during index presentation or within 30-days (n=452), the diagnostic accuracy of AI-ECG for LVEF ≤35% was 81.4% (95% CI 77.5, 84.9) with a negative predictive value of 96.5% (95% CI 94.0, 98.2). A normal LVEF (>50%) was observed in 87% of those with a negative AI ECG, whereas in those with a positive AI-ECG LVEF was reduced (<50%) in 60%.
Conclusions
Among ED patients evaluated with hs-cTnT, a positive AI-ECG screen for LVSD identifies patients at high risk of MACE. These findings are largely because of more deaths and HF hospitalizations in those with hs-cTnT increases >sex-specific 99th percentiles.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Knott
- Mayo Clinic , Rochester , United States of America
| | - Z Attia
- Mayo Clinic , Rochester , United States of America
| | - O Ola
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - A Akula
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Mehta
- Mayo Clinic , Rochester , United States of America
| | - M Dworak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Lobo
- Mayo Clinic , Rochester , United States of America
| | - D Hodge
- Mayo Clinic , Jacksonville , United States of America
| | - T Tak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - C Cagin
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - P Friedman
- Mayo Clinic , Rochester , United States of America
| | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - A Jaffe
- Mayo Clinic , Rochester , United States of America
| | - Y Sandoval
- Mayo Clinic , Rochester , United States of America
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Pitters E, Puts M, Alqurini N, Strohschein F, Koneru R, Szumacher E, Mariano C, Monette J, Hsu T, Brennenstuhl S, McLean B, Wills A, Berger A, Amir E, Romanovsky L, Li A, Mehta R, Krzyzanowska M, Elser C, Jang R, Prica A, Wan-Chow-Wah D, Emmenegger U, Menjak I, Bergman S, Lemonde M, Krahn M, Beland F, Breunis H, Alibhai S. The impact of the COVID-19 pandemic on quality of life, health care use and mortality in older adults in the 5C study of geriatric assessment and management: secondary analysis. J Geriatr Oncol 2022. [PMCID: PMC9595410 DOI: 10.1016/s1879-4068(22)00376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Puts M, Alqurini N, Strohschein F, Berger A, Romanovsky L, Monette J, Mehta R, Li A, Wan-Chow-Wah D, Hsu T, Brennenstuhl S, Koneru R, Szumacher E, Mariano C, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Jang R, Prica A, Pitters E, Emmenegger U, Menjak I, Bergman S, Lemonde M, Breunis H, Beland F, Krahn M, Alibhai S. Recommendations and adherence to recommendations made based on a comprehensive geriatric assessment for Canadian older adults with cancer: Results of the 5C trial. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Nair VV, Sharma P, Rajendran N, Raja S, Rao PP, Mehta R. CASE REPORT ON RARE OUTCOME OF A RETROPERITONEAL MASS: MANAGEMENT CHALLENGES AND LESSONS LEARNT. IJMMR 2022. [DOI: 10.11603/ijmmr.2413-6077.2022.1.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background. Gastrointestinal stromal tumours (GIST) are non-epithelial mesenchymal solid neoplasm with varied presentation. The study reports the case of a retroperitoneal GIST in a 21‑year‑old male presented with an abdominal lump for six months. The lesion was initially thought to be a retroperitoneal sarcoma. Exploratory laparotomy revealed an abdominopelvic mass covering the entire right side of abdomen and pelvis. The tumour was adherent to the terminal ileum and ascending colon. There were dense adhesions between the retroperitoneum with involvement of the middle third of the right ureter. The tumour was resected with right hemicolectomy with ileotransverse anastomosis. Post-operative histopathology revealed it as high-grade spindle cell type GIST. The patient is presently on post-operative chemotherapy with Imatinib mesylate.
Objective. Atypical presentations of GIST are seldom discussed but frequently encountered in clinical practice. This article depicts different challenges the surgeon has to face while diagnosing such atypical entity.
Methods. Case report of atypical GIST presenting as retroperitoneal lump.
Results. The patient underwent surgical resection and is presently on post-operative chemotherapy with good overall outcome for a one year follow up.
Conclusions. GISTs presenting as retroperitoneal lumps are very rare, they should be considered in their differential diagnosis of an atypical retroperitoneal mass.
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Zhang Y, Mezzacappa C, Shen L, Ivatorov A, Petukhova-Greenstein A, Mehta R, Ciarleglio M, Deng Y, Levin W, Steinhardt S, Connery D, Pineau M, Onyiuke I, Taylor C, Rose MG, Taddei TH. Cancer tracking system improves timeliness of liver cancer care at a Veterans Hospital: A comparison of cohorts before and after implementation of an automated care coordination tool. PLOS Digit Health 2022; 1:e0000080. [PMID: 36812575 PMCID: PMC9931271 DOI: 10.1371/journal.pdig.0000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/26/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) requires complex care coordination. Patient safety may be compromised with untimely follow-up of abnormal liver imaging. This study evaluated whether an electronic case-finding and tracking system improved timeliness of HCC care. METHODS An electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. This system reviews all liver radiology reports, generates a queue of abnormal cases for review, and maintains a queue of cancer care events with due dates and automated reminders. This is a pre-/post-intervention cohort study to evaluate whether implementation of this tracking system reduced time between HCC diagnosis and treatment and time between first liver image suspicious for HCC, specialty care, diagnosis, and treatment at a Veterans Hospital. Patients diagnosed with HCC in the 37 months before tracking system implementation were compared to patients diagnosed with HCC in the 71 months after its implementation. Linear regression was used to calculate mean change in relevant intervals of care adjusted for age, race, ethnicity, BCLC stage, and indication for first suspicious image. RESULTS There were 60 patients pre-intervention and 127 post-intervention. In the post-intervention group, adjusted mean time from diagnosis to treatment was 36 days shorter (p = 0.007), time from imaging to diagnosis 51 days shorter (p = 0.21), and time from imaging to treatment 87 days shorter (p = 0.05). Patients whose imaging was performed for HCC screening had the greatest improvement in time from diagnosis to treatment (63 days, p = 0.02) and from first suspicious image to treatment (179 days, p = 0.03). The post-intervention group also had a greater proportion of HCC diagnosed at earlier BCLC stages (p<0.03). CONCLUSIONS The tracking system improved timeliness of HCC diagnosis and treatment and may be useful for improving HCC care delivery, including in health systems already implementing HCC screening.
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Affiliation(s)
- Yapei Zhang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Catherine Mezzacappa
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Lin Shen
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Amanda Ivatorov
- Yale University, New Haven, Connecticut, United States of America
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- Institute of Radiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Rajni Mehta
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Maria Ciarleglio
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Woody Levin
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Steve Steinhardt
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Donna Connery
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Michael Pineau
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Ifeyinwa Onyiuke
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Caroline Taylor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Michal G. Rose
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Tamar H. Taddei
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- * E-mail:
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Abrams RE, Pierre K, El-Murr N, Seung E, Wu L, Luna E, Mehta R, Li J, Larabi K, Ahmed M, Pelekanou V, Yang ZY, van de Velde H, Stamatelos SK. Quantitative systems pharmacology modeling sheds light into the dose response relationship of a trispecific T cell engager in multiple myeloma. Sci Rep 2022; 12:10976. [PMID: 35768621 PMCID: PMC9243109 DOI: 10.1038/s41598-022-14726-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/10/2022] [Indexed: 02/08/2023] Open
Abstract
In relapsed and refractory multiple myeloma (RRMM), there are few treatment options once patients progress from the established standard of care. Several bispecific T-cell engagers (TCE) are in clinical development for multiple myeloma (MM), designed to promote T-cell activation and tumor killing by binding a T-cell receptor and a myeloma target. In this study we employ both computational and experimental tools to investigate how a novel trispecific TCE improves activation, proliferation, and cytolytic activity of T-cells against MM cells. In addition to binding CD3 on T-cells and CD38 on tumor cells, the trispecific binds CD28, which serves as both co-stimulation for T-cell activation and an additional tumor target. We have established a robust rule-based quantitative systems pharmacology (QSP) model trained against T-cell activation, cytotoxicity, and cytokine data, and used it to gain insight into the complex dose response of this drug. We predict that CD3-CD28-CD38 killing capacity increases rapidly in low dose levels, and with higher doses, killing plateaus rather than following the bell-shaped curve typical of bispecific TCEs. We further predict that dose–response curves are driven by the ability of tumor cells to form synapses with activated T-cells. When competition between cells limits tumor engagement with active T-cells, response to therapy may be diminished. We finally suggest a metric related to drug efficacy in our analysis—“effective” receptor occupancy, or the proportion of receptors engaged in synapses. Overall, this study predicts that the CD28 arm on the trispecific antibody improves efficacy, and identifies metrics to inform potency of novel TCEs.
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Affiliation(s)
- R E Abrams
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA.,Daichi Sankyo, 211 Mt. Airy Rd., Basking Ridge, NJ, 07920, USA
| | - K Pierre
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA.
| | - N El-Murr
- Sanofi, 13 quai Jules Guesde 94403 Cedex, VITRY-SUR-SEINE, Vitry/Alfortville, France
| | - E Seung
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | - L Wu
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | | | | | - J Li
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA
| | - K Larabi
- Sanofi, 13 quai Jules Guesde 94403 Cedex, VITRY-SUR-SEINE, Vitry/Alfortville, France
| | - M Ahmed
- Sanofi, 50 Binney St., Cambridge, MA, 02142, USA
| | - V Pelekanou
- Sanofi, 50 Binney St., Cambridge, MA, 02142, USA.,Bayer Pharmaceuticals, Cambridge, MA, 02142, USA
| | - Z-Y Yang
- Sanofi, 270 Albany St., Cambridge, MA, 02139, USA.,Modex Therapeutics, 22 Strathmore Road, Natick, MA, 01760, USA
| | | | - S K Stamatelos
- Sanofi, 55 Corporate Dr, Bridgewater, NJ, 08807, USA. .,Bayer Pharmaceuticals, PH100 Bayer Boulevard, Whippany, NJ, 07981, USA.
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Mehta R, Shardell M, Ryan A, Dong Y, Beamer B, Gallo J, Stuart E, Schuler M, Hochberg M, Rathbun A. POS1138 PERSISTENCY OF DEPRESSIVE SYMPTOMS AND PHYSICAL PERFORMANCE IN KNEE OSTEOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundKnee osteoarthritis (OA) is the most prevalent arthritic disorder, characterized by joint paint, which is exacerbated by chronic depressive episodes. Depression in knee OA is also associated with declines in physical activity level and greater disability; however, the impact of persistent depressive symptoms on physical performance remains unclear.ObjectivesTo determine how the persistence of depressive symptoms affects functional capacity in knee OA.MethodsParticipants (n=2,212) were from the Osteoarthritis Initiative cohort and included individuals with radiographic disease (Kellgren-Lawrence grade ≥ 2) and complete data on study measures at baseline. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60) at baseline and the first three follow-up visits. Physical Performance was measured using 20-meter gait speed (meters per second) during follow-up at the first four annual visits. Persistency of depressive symptoms was operationalized as a cumulative exposure using average severity over time. Gait speed was standardized so that outcome estimates could be interpreted in standard deviations. Time-invariant confounders measured at study enrollment included demographic, socioeconomic, and lifestyle factors. Time-varying confounders assessed concurrent to CES-D scores were body mass index, analgesic medications, pain, and other knee OA signs and symptoms. Marginal structural models accounting for time-dependent confounding and selective attrition were the primary method of analysis. The outcome model included all potential statistical interactions between depressive symptoms and follow-up time indicators. Post-estimation linear combinations estimated time-specific effects of time-averaged CES-D scores on standardized gait speed and differences in physical performance between participants with (i.e., CES-D=16) and without (i.e., CES-D=0) depressive symptoms satisfying screening criteria for major depression.ResultsThe interaction between depressive symptoms and time was statistically significant (P=<0.001). Time-specific associations indicated that the largest negative impact of depressive symptoms on physical performance was from baseline through year one (β = -0.0077; 95% CI: -0.0125, 0.0030). However, the effect of persistent depressive symptoms decreased over time and reversed in magnitude and directionality, evidenced by the time-specific associations between time-averaged CES-D scores from baseline through year one and year two and gait speed at year two (β = -0.0033; 95% CI: -0.0084, 0.0019) and year three (β = 0.0014; 95% CI: -0.0046, 0.0074), respectively. Consequently, the strongest negative affect of depressive symptoms on gait speed (β = -0.1232; 95% CI: -0.1998, -0.0473) between participants with and without depressive symptoms satisfying screening criteria for major depression was when depressive symptoms were first measured closest to the initial gait speed assessment.ConclusionIn the contrast to the dose-dependent relationship between chronic depressive episodes and pain in knee OA, study findings imply that the negative effect of depressive symptoms on physical performance decreases over time with increasing depression persistency. These results may reflect diminishing marginal effects, where the largest impact on physical performance in knee OA is during the first depressive episode closest to initial gait speed assessment, especially when averaged against improvement in symptoms over the same duration.AcknowledgementsThe OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.Disclosure of InterestsRhea Mehta: None declared, Michelle Shardell: None declared, Alice Ryan: None declared, Yu Dong: None declared, Brock Beamer: None declared, Joseph Gallo: None declared, Elizabeth Stuart: None declared, Megan Schuler: None declared, Marc Hochberg Shareholder of: Dr. Marc C. Hochberg is the President of Rheumcon Corporation., Consultant of: Dr. Marc C. Hochberg receives consulting fees from Bioiberica SA, Bristol-Myers Squibb, Eli Lilly, EMD Serono, Galapagos, IBSA Biotechniq SA, Novartis Pharma AG, Pfizer, Plexxikon, Samumed LLC, Theralogix LLC, and TissueGene Inc., Alan Rathbun: None declared
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Mehta R, Petrova A. Urinary levels of energy metabolism hormones in association with the proportional intake of maternal milk and weight gain in very preterm neonates. J Neonatal Perinatal Med 2022; 15:599-607. [PMID: 35342054 DOI: 10.3233/npm-210936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study prospectively investigated the levels of energy metabolism hormones in very preterm neonates to identify their change over time, association with intake of maternal milk, and weight gain velocity. METHODS We measured and compared the leptin, adiponectin, ghrelin, and insulin-like growth factor I (IGF-1) levels in the urine of 70 very preterm neonates, before the initiation of any enteral feeding (baseline level) and twice within 14 days on full enteral feeding (FEF). Regression models identified the role of intake of maternal milk on the levels of the tested energy metabolism hormones in the enteral-fed infants. We also analyzed the adequacy of the weight gain velocity defined by the fetal-infant growth reference (FIGR). We also collected and analyzed the infants' clinical and feeding characteristics during the birth hospitalization. RESULTS The preterm infants' baseline levels of the energy metabolism hormones significantly predicted their increase at the end of two weeks of observation on FEF. The leptin level was associated with increased intake of maternal milk, whereas the feeding volume was associated with increased ghrelin and IGF-1, and decreased leptin and adiponectin. Infants with comparable FIGR had higher leptin levels than those with inadequate weight gain velocity. CONCLUSION Early postnatal levels of leptin, adiponectin, ghrelin, and IGF-1 predicted the increase of these hormones in the fully enteral fed very preterm neonates. Moreover, greater intake of maternal milk by the study infants contributed to an increased leptin-associated weight gain velocity.
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Affiliation(s)
- R Mehta
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - A Petrova
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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M S D, chikkanayakanahalli gurusiddaiah S, Aral K, shankar M, v L, Lingaraju U, Mehta R, muniannaiah K. POS-655 CLINICAL PROFILE AND OUTCOMES OF PATIENT ON MAINTENANCE HAEMODIALYSIS HOSPITALIZED WITH COVID 19 AT A TERTIARY CARE CENTRE. Kidney Int Rep 2022. [PMCID: PMC8854926 DOI: 10.1016/j.ekir.2022.01.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Puts M, Alqurini N, Strohschein F, Mariano C, Monette J, Wan-Chow-Wah D, Szumacher E, Koneru R, Mehta R, Li A, Hsu T, Brennenstuhl S, McLean B, Wills A, Amir E, Krzyzanowska M, Elser C, Pitters E, Breunis H, Berger A, Romanovsky L, Alibhai S. Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Ku G, Elimova E, Denlinger C, Mehta R, Lee KW, Iqbal S, Kang YK, Oh DY, Rha S, Kim Y, Seol Y, Mwatha T, Grim J, Ajani J. 1380P Phase (Ph) II study of zanidatamab + chemotherapy (chemo) in first-line (1L) HER2 expressing gastroesophageal adenocarcinoma (GEA). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kadoya K, Wheeler S, Kala R, Mehta R. LB811 Exosomes from human neonatal fibroblasts conditioned media play an important role in skin rejuvenation. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.126] [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: 11/28/2022]
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Lu Z, Clement JM, Pan Q, Swede H, Mehta R, Wang X. Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16531] [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
e16531 Background: Among the approaches to curative-intent therapy for MIBC, neoadjuvant cisplatin-based chemotherapy (NAC) is recognized as the gold standard. The combined modality approach of concurrent chemo-radiation is also considered a standard of care. Despite guidelines recommending multidisciplinary care, studies have shown a low adoption rate of multidisciplinary approaches for MIBC. This study aimed to describe the treatment patterns for MIBC pts using real world data. Methods: Following the appropriate IRB approvals, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center. Manual chart review was performed on MIBC pts diagnosed in Connecticut from 2004 –2015 and treated at investigator-affiliated hospitals. Information on medical history, comorbidity, and treatment types were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. The descriptive and logistic regression were used to analyze treatment patterns and predicators in each treatment lines: surgery alone, chemotherapy alone, radiation alone and standard care (NAC followed by surgery; surgery followed by adjuvant chemotherapy and concurrent chemo-radiation). Results: The number of adult MIBC pts in the cohort was 1,198. Among them, 290 (24.2%) received surgery as the only treatment; 117 (9.8%) received chemotherapy only; 100 (8.3%) received concurrent chemo-radiation; 96 (8.0%) received NAC followed by surgery. Besides age ( OR: 0.546, 95% CI: 0.289-0.986), when comparing female to male patients on the likelihood of receiving NAC to the alternative treatment types (radiation or surgery), female pts were less likely to receive NAC than males (OR: 0.421, 95% CI: 0.184-0.930). Conclusions: Regardless of demographics, the overall adoption rate of standard care was low, consisting of 236 pts (19.7%) of the population. From the logistic regression results, age was consistently shown as a predictor for receiving NAC over the alternative treatment types, and sex was identified as another strong predictor. Older and female patients were less likely to receive NAC than younger males.[Table: see text]
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Affiliation(s)
| | - Jessica M. Clement
- University of Connecticut Health Center Carole and Ray Neag Comprehensive Cancer Center, Farmington, CT
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Feagan BG, Loftus EV, Danese S, Vermeire S, Sandborn WJ, Ritter T, Mehta R, Seidler U, Seibold F, Beales I, Kim H, McNally J, Yun C, Zhao S, Liu X, Tasset C, Besuyen R, Watanabe M, Schreiber S, Rogler G, Hibi T, Peyrin-Biroulet L. A15 EFFICACY AND SAFETY OF FILGOTINIB AS INDUCTION THERAPY FOR PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS: RESULTS FROM THE PHASE 2B/3 SELECTION STUDY. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
The SELECTION (NCT02914522) Induction Studies evaluated the efficacy/safety of filgotinib (FIL), a preferential JAK1 inhibitor, as induction therapy for patients (pts) with moderately to severely active ulcerative colitis (UC) who were biologic-naïve but failed conventional therapy (Induction Study A) or failed prior biologics (Induction Study B).
Methods
Pts were randomized 2:2:1 to once–daily FIL 200mg, FIL 100mg or placebo (PBO). The primary (clinical remission), key secondary (Mayo Clinic Score [MCS] remission, endoscopic remission, and histologic remission), and exploratory endpoints (MCS response and endoscopic improvement) were assessed at Week 10.
Results
In both studies, baseline demographics and disease characteristics were similar across treatment groups. In Study A, 659 pts were randomized and treated. Baseline mean MCS was 8.6 and 56% had a Mayo endoscopic subscore (ES)=3. A significantly higher proportion of biologic-naïve pts on FIL 200mg achieved clinical remission vs PBO and all key secondary endpoints (Table). In Study B, 689 pts were randomized and treated. Baseline mean MCS was 9.3 and 78% had ES=3. Prior treatment failures were: anti-TNF (86%), vedolizumab (52%) and both (dual-refractory; 43%). A significantly higher proportion of biologic-experienced pts on FIL 200mg achieved clinical remission vs PBO. In Studies A and B, a greater proportion of pts on FIL 200 mg achieved an MCS response and endoscopic improvement vs PBO.
The rates of AEs, serious AEs and discontinuations due to AEs were similar across FIL and PBO groups during induction. In the PBO, FIL 100mg and FIL 200mg groups, serious infections occurred in 0.7%, 0.7% and 0.4% pts in Study A and 1.4%, 1.4% and 0.8% pts in Study B; H Zoster occurred in <1% in both groups for both cohorts.
Conclusions
SELECTION included a high proportion of dual-refractory pts, and pts with severe endoscopic disease. Both doses of FIL were well tolerated. Filgotinib 200mg was effective induction therapy for both biologic-naïve/-experienced pts with moderately to severely active UC.
Funding Agencies
None
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Affiliation(s)
| | - E V Loftus
- Mayo Clinic College of Medicine, Rochester, MN
| | - S Danese
- Humanitas University, Milan, Italy
| | - S Vermeire
- University Hospitals Leuven, Leuven, Belgium
| | - W J Sandborn
- University of California San Diego, La Jolla, CA
| | | | - R Mehta
- Surat Institute of Digestive Science (SIDS), Surat, India
| | - U Seidler
- Hannover Medical School, Hannover, Germany
| | - F Seibold
- Seibold & Partner Crohn’s Colitis Center, Gastroenterological Practice Balsiger, Bern, Switzerland
| | - I Beales
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - H Kim
- Kyung Hee University Hospital, Center for Crohn’s and Colitis, Seoul, Korea (the Republic of)
| | - J McNally
- Gilead Sciences, Inc., Foster City, CA
| | - C Yun
- Gilead Sciences, Inc., Foster City, CA
| | - S Zhao
- Gilead Sciences, Inc., Foster City, CA
| | - X Liu
- Gilead Sciences, Inc., Foster City, CA
| | | | | | - M Watanabe
- Tokyo Medical and Dental University, Tokyo, Japan
| | - S Schreiber
- University Hospital Schleswig-Holstein, Department of Medicine I and Institute for Clinical Molecular Biology, Kiel, Germany
| | - G Rogler
- University Hospital of Zurich, Zurich, Switzerland
| | - T Hibi
- Kitasato University Kitasato Institute Hospital, Center for Advanced IBD Research and Treatment, Tokyo, Japan
| | - L Peyrin-Biroulet
- Lorraine University, Nancy University Hospital and Inserm U1256 NGERE, Vandoeuvre-les-Nancy, France
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McDonald J, Hoffe S, Frakes J, Mehta R, Fontaine J, Pimiento J. Effect of Tumor Grade on Neoadjuvant Treatment Outcome in Esophageal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 1:1-7. [PMID: 33019948 DOI: 10.1097/ono.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 134:1-7. [PMID: 33019948 DOI: 10.1017/s0022215120001978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Antonio-Villa NE, Bello-Chavolla OY, Vargas-Vázquez A, Mehta R, Aguilar-Salinas CA. The combination of insulin resistance and visceral adipose tissue estimation improves the performance of metabolic syndrome as a predictor of type 2 diabetes. Diabet Med 2020; 37:1192-1201. [PMID: 32061103 DOI: 10.1111/dme.14274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
Abstract
AIMS To assess the performance of metabolic syndrome as a predictor of type 2 diabetes in a model that also includes both a measure of insulin resistance and a metabolic score for visceral fat, and to propose a novel metabolic syndrome definition. METHODS In a prospective Metabolic Syndrome Cohort (n=6143), we evaluated improvements in type 2 diabetes risk prediction using International Diabetes Federation-defined and Adult Treatment Panel III-defined metabolic syndrome, after inclusion in the model of updated homeostatic model assessment of insulin resistance and a metabolic score for visceral fat. We also developed a modified metabolic syndrome construct, 'MS-METS', which used the metabolic score for visceral fat instead of waist circumference to evaluate improved predictive performance for risk of developing type 2 diabetes. RESULTS Participants who had metabolic syndrome as defined by both the Adult Treatment Panel III and the International Diabetes Federation criteria had a higher risk of type 2 diabetes compared to participants who did not meet these criteria. Addition of updated homeostatic model assessment of insulin resistance and metabolic score for visceral fat to both metabolic syndrome definitions increased predictive performance for type 2 diabetes risk. Homeostatic model assessment of insulin resistance was the only additional predictor of type 2 diabetes in participants without metabolic syndrome. Conversely, in participants with metabolic syndrome, the use of the metabolic score for visceral fat was the stronger added predictor for type 2 diabetes. When evaluating participants using the MS-METS definition we observed the largest improvement in predictive ability for type 2 diabetes risk and a significant reduction in risk overestimation compared to evaluation using metabolic syndrome defined according to the International Diabetes Federation and Adult Treatment Panel III criteria alone. CONCLUSION Inclusion of updated homeostatic model assessment of insulin resistance and metabolic score for visceral fat increases performance of metabolic syndrome in prediction of type 2 diabetes. Assessment of insulin resistance could be more useful than conventional metabolic syndrome and assessment of visceral adipose tissue could be more useful in people with metabolic syndrome. Metabolic syndrome as defined using our modified MS-METS construct improved the accuracy of type 2 diabetes prediction.
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Affiliation(s)
- N E Antonio-Villa
- Unidad de Investigacion de Enfermedades Metabólicas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, Universidad Nacional Autonoma de México, Tlalpan, Mexico
| | - O Y Bello-Chavolla
- Unidad de Investigacion de Enfermedades Metabólicas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- Department of Physiology, Faculty of Medicine, Universidad Nacional Autonoma de México, Tlalpan, Mexico
- Research Division, Instituto Nacional de Geriatría, Tlalpan, Mexico
| | - A Vargas-Vázquez
- Unidad de Investigacion de Enfermedades Metabólicas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- MD/PhD (PECEM) Program, Faculty of Medicine, Universidad Nacional Autonoma de México, Tlalpan, Mexico
| | - R Mehta
- Unidad de Investigacion de Enfermedades Metabólicas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- Department of Endocrinolgy and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
| | - C A Aguilar-Salinas
- Unidad de Investigacion de Enfermedades Metabólicas, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- Department of Endocrinolgy and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Tlalpan, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Tlalpan, Mexico
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Park H, Sanjeevaiah A, Suresh R, Mehta R, Trikalinos N, Bagegni N, Aranha O, Pedersen K, Nixon A, Jin R, Mills J, Fields R, Amin M, Lim K, Tan B, Grierson P, Jiang S, Rosario MD, Wang-Gillam A, Lockhart A. P-131 Ramucirumab and irinotecan in patients with previously treated gastroesophageal adenocarcinoma: Interim analysis of a phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alfini AJ, Wanigatunga AA, Schrack JA, Wanigatunga S, Li J, Rojo-Wissar DM, Mehta R, Okoye S, Zipunnikov V, Simonsick EM, Spira AP. 0139 Associations of Actigraphic Sleep Parameters with Maximal Oxygen Consumption and Resting Metabolism in Well-Functioning Older Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.137] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Both poor sleep and poor cardiorespiratory fitness are common in older age and associated with negative health outcomes. Additionally, among older adults, higher resting metabolic rate (RMR) has been associated with increased morbidity and mortality risk. To evaluate whether, and in what ways, sleep may affect these relationships, we investigated the association of actigraphic sleep indices with cardiorespiratory fitness and RMR in older adults.
Methods
We studied 393 community-dwelling participants in the Baltimore Longitudinal Study of Aging (mean age 73.5±10.3 years, 52% women) who completed 6.7±0.9 nights of wrist actigraphy, RMR testing, and a maximal graded exercise test. Primary predictors included mean actigraphic total sleep time (TST, minutes), sleep efficiency (SE, %), wake after sleep onset (WASO, minutes), and average wake bout length (WBL, minutes). Cardiorespiratory fitness, as measured by maximal oxygen consumption (V O2MAX; ml/kg/min), and RMR (kcal/day) were the primary outcomes.
Results
After adjustment for age, sex, race, body mass index, comorbidity index, and depressive symptoms, longer WBL was associated with lower V O2MAX (β=-0.12, 95% confidence interval (CI)=-0.20, -0.04), greater WASO was associated with lower V O2MAX (β=-0.09, 95% CI=-0.17, -0.01), and greater SE was associated with higher V O2MAX (β=0.12, 95% CI=0.03, 0.20). In addition, longer TST was associated with lower RMR (β=-0.10, 95% CI=-0.19, -0.01) and longer WBL was linked to higher RMR (β=0.12, 95% CI=0.04, 0.21).
Conclusion
In well-functioning older adults, indices of greater wakefulness after sleep onset are linked with poorer cardiorespiratory fitness and higher resting metabolism, while longer and more efficient sleep are associated with better fitness and lower resting metabolic rate. Our findings suggest that sleep disturbance may be linked to disrupted energy homeostasis, evidenced by excessive energy expenditure at rest and inefficient energy utilization in response to maximal demands. Prospective analyses are necessary to determine the nature of these associations.
Support
This study was supported in part by National Institute on Aging (NIA) grants R01AG050507 and T32-AG027668, the NIA Intramural Research Program (IRP), and Research and Development Contract HHSN-260-2004-00012C.
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Affiliation(s)
- A J Alfini
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A A Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - S Wanigatunga
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J Li
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - D M Rojo-Wissar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - R Mehta
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - S Okoye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - V Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - E M Simonsick
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - A P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Clement JM, Lu Z, Pan Q, Swede H, Mehta R, Wang X. Patterns and predictors of referral among patients with muscle-invasive bladder cancer: A real-world study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17051] [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
e17051 Background: The multidisciplinary treatment of muscle-invasive bladder cancer (MIBC) has demonstrated considerable challenges in widespread clinical adoption. Despite guidelines recommending multidisciplinary, utilization of neoadjuvant chemotherapy for bladder cancer treatment remains low in the real-world settings. This study aims to examine the real-world referral patterns from urology to medical oncology and/or radiation oncology and the factors that associated with the referral following a diagnosis of MIBC. Methods: Following approval of involved IRBs, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center and performed manual chart review of MIBC patients diagnosed in the state of Connecticut from 2004 – 2015 and treated at investigator-affiliated hospitals. Information on medical history, radical or partial cystectomy, chemotherapy, radiation therapy, initial treating physician, and referrals to additional providers were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. Logistic regression analysis adjusted with demographics (i.e. gender, race) and medical histories (i.e. prior cancers) was conducted to identify factors associated with referral. Results: Of the 665 patients whose initial treating physician was urologist, only 291 (43.8%) were referred to a medical oncologist and/or a radiation oncologist. Independent factors associated with lack of referral included: older age (OR = 0.994 for every incremental year, P-value: 0.0055), and greater Charlson comorbidity score (OR = 1.064. P-value: 0.015). Patients with kidney diseases and diabetes were less likely to be referred. Conclusions: Lack of referral to medical oncology and/or radiation oncology is a critical barrier to the use of optimal multidisciplinary therapy. Referral decision made by urologists is impacted by a patient’s age and overall health condition. [Table: see text]
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Affiliation(s)
- Jessica Mary Clement
- University of Connecticut Health Center Carole and Ray Neag Comprehensive Cancer Center, Farmington, CT
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Shah I, Dani S, Shetty NS, Mehta R, Nene A. Profile of osteoarticular tuberculosis in children. Indian J Tuberc 2020; 67:43-45. [PMID: 32192616 DOI: 10.1016/j.ijtb.2019.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine clinical profile of osteoarticular tuberculosis (TB) in children. METHODS Cross-sectional analysis from 2007 to 2013. All patients diagnosed with bone TB, spinal TB or TB abscesses were included. RESULTS Out of 1318 children with TB, 39 (2.96%) had osteoarticular TB, of which 16 (42%) had osteomyelitis, 8 (20.5%) had spinal involvement, 7 (17.9%) had TB synovitis, 2 (5.1%) had psoas abscess and 6 (15.4%) had abscesses. The mean age of presentation was 7.1 ± 3.5 years (range 2-14 years). Of the 33 cases in which a culture was done, 25 (64%) showed a positive culture. Drug sensitivity tests were done in 21 patients of which 10 (47.6%) tested were drug resistant, of which 4 (36.4%) were multidrug resistant (MDR), 2 (18.2%) were extensively drug resistant (XDR), 3 were pre-XDR (27.3%) and 1 was polyresistant (9.1%). Nine (23.1%) patients had TB in the past with a treatment duration of 8.3 ± 5.3 months. Contact with a TB patient had occurred in 10 (25.6%) cases. Associated pulmonary TB were seen in 6 (15.39%) and TB meningitis were seen in 1 (2.6%) patients. Surgical intervention was needed in 11 (28.2%) patients of which 5 (45.5%) underwent curettage, drainage was done in 1 (9.1%), arthrotomy in 4 (36.4%) and spinal surgery in 1 (9.1%) patient. CONCLUSION Drug resistant osteoarticular TB is an emerging problem in children.
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Affiliation(s)
- I Shah
- Pediatric TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India.
| | - S Dani
- Pediatric TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India
| | - N S Shetty
- Pediatric TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India
| | - R Mehta
- Department of Pediatric Orthopedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - A Nene
- Department of Pediatric Orthopedics, B.J. Wadia Hospital for Children, Mumbai, India
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Tsilimigras DI, Moris D, Hyer JM, Bagante F, Sahara K, Moro A, Paredes AZ, Mehta R, Ratti F, Marques HP, Silva S, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Sasaki K, Rodarte AI, Aucejo FN, Pawlik TM. Hepatocellular carcinoma tumour burden score to stratify prognosis after resection. Br J Surg 2020; 107:854-864. [PMID: 32057105 DOI: 10.1002/bjs.11464] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 11/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. METHODS Patients who underwent hepatectomy with curative intent for BCLC-0, -A or -B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi-institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. RESULTS Among 1053 patients, 63 (6·0 per cent) had BCLC-0, 826 (78·4 per cent) BCLC-A and 164 (15·6 per cent) had BCLC-B HCC. OS worsened incrementally with higher TBS (5-year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC-A/medium TBS versus BCLC-B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC-A/high TBS versus BCLC-B/high TBS, P = 0·175). Patients with BCLC-B HCC and a medium TBS had better OS than those with BCLC-A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC-A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC-B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5-year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). CONCLUSION The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.
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Affiliation(s)
- D I Tsilimigras
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - D Moris
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - J M Hyer
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - F Bagante
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA.,Department of Surgery, University of Verona, Verona, Italy
| | - K Sahara
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - A Moro
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - A Z Paredes
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - R Mehta
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - H P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - S Silva
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - O Soubrane
- Department of Hepatobiliopancreatic Surgery, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - V Lam
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - G A Poultsides
- Department of Digestive Disease Institute, Stanford University, Stanford, California, USA
| | - I Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - S Alexandrescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - G Martel
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - A Workneh
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - A Guglielmi
- Department of Surgery, University of Verona, Verona, Italy
| | - T Hugh
- Department of Surgery, University of Sydney, School of Medicine, Sydney, New South Wales, Australia
| | - L Aldrighetti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - I Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - K Sasaki
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - A I Rodarte
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - F N Aucejo
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - T M Pawlik
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
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Puts M, Strohschein F, Mclean B, Alqurini N, Syed A, Amir E, Béland F, Berger A, Bergman S, Vanderbyl B, Breunis H, Elser C, Emmenegger U, Fung S, Hsu T, Jang R, Krahn M, Koneru R, Kozlowski N, Krzyzanowska M, Lemonde M, Li A, Mariano C, Mehta R, Monette J, Papadakos J, Pitters E, Prica A, Ray J, Romanofsky L, Szumacher E, Wan-Chow-Wah D, Langleben A, Alibhai S. CLINICAL AND COST-EFFECTIVENESS OF COMPREHENSIVE GERIATRIC ASSESSMENT AND MANAGEMENT FOR CANADIAN ELDERS WITH CANCER: THE 5C STUDY – INITIAL RECRUITMENT AND IMPLEMENTATION RESULTS. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torgersen J, Taddei TH, Park LS, Carbonari DM, Kallan MJ, Mitchell Richards K, Zhang X, Jhala D, Bräu N, Homer R, D'Addeo K, Mehta R, Skanderson M, Kidwai-Khan F, Justice AC, Lo Re V. Differences in Pathology, Staging, and Treatment between HIV + and Uninfected Patients with Microscopically Confirmed Hepatocellular Carcinoma. Cancer Epidemiol Biomarkers Prev 2019; 29:71-78. [PMID: 31575557 DOI: 10.1158/1055-9965.epi-19-0503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/21/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) is substantially higher among HIV-infected (HIV+) than uninfected persons. It remains unclear if HCC in the setting of HIV infection is morphologically distinct or more aggressive. METHODS We evaluated differences in tumor pathology in a cohort of HIV+ and uninfected patients with microscopically confirmed HCC in the Veterans Aging Cohort Study from 2000 to 2015. We reviewed pathology reports and medical records to determine Barcelona Clinic Liver Cancer stage (BCLC), HCC treatment, and survival by HIV status. Multivariable Cox regression was used to determine the hazard ratio [HR; 95% confidence interval (CI)] of death associated with HIV infection after microscopic confirmation. RESULTS Among 873 patients with HCC (399 HIV+), 140 HIV+ and 178 uninfected persons underwent liver tissue sampling and had microscopically confirmed HCC. There were no differences in histologic features of the tumor between HIV+ and uninfected patients, including tumor differentiation (well differentiated, 19% vs. 28%, P = 0.16) and lymphovascular invasion (6% vs. 7%, P = 0.17) or presence of advanced hepatic fibrosis (40% vs. 39%, P = 0.90). There were no differences in BCLC stage (P = 0.06) or treatment (P = 0.29) by HIV status. After adjustment for risk factors, risk of death was higher among HIV-infected than uninfected patients (HR = 1.37; 95% CI, 1.02-1.85). CONCLUSIONS We found no differences in HCC tumor characteristics or background hepatic parenchyma by HIV status, yet HIV was associated with poorer survival. Of note, pathology reports often omitted these characteristics. IMPACT Systematic evaluation of HCC pathology by HIV status is needed to understand tumor characteristics associated with improved survival.
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Affiliation(s)
- Jessie Torgersen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. .,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tamar H Taddei
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lesley S Park
- Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Dena M Carbonari
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Kallan
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Darshana Jhala
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Norbert Bräu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,James J. Peters VA Medical Center, Bronx, New York
| | - Robert Homer
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn D'Addeo
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Rajni Mehta
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Melissa Skanderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Farah Kidwai-Khan
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Amy C Justice
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Vincent Lo Re
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Eapen A, Lyou Y, Eisenbud L, Mehta R, Lane K, Lama T, Daroui P, Lin E, Ziogas A, Parajuli R. Correlation of clinical and pathological features with the tumour microenvironment in DCIS: An institutional experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.100] [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: 11/13/2022] Open
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Hong S, Nguye A, Mehta R, Kadoya K. LB1083 Development of functional assay using 3D skin in vitro model to evaluate barrier function of the skin. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Evans R, Hemmila U, Mzinganjira H, Raimann J, Calice-Silva V, Dreyer G, Levin N, Pecoits-Filho R, Mehta R, Macedo E. SAT-162 THE PERFORMANCE OF A POINT-OF-CARE SALIVARY UREA NITROGEN DIPSTICK TO DETECT KIDNEY DISEASE IN DISTRICT AND COMMUNITY SETTINGS IN MALAWI. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kaplan DE, Serper MA, Mehta R, Fox R, John B, Aytaman A, Baytarian M, Hunt K, Albrecht J, Njei B, Taddei TH. Effects of Hypercholesterolemia and Statin Exposure on Survival in a Large National Cohort of Patients With Cirrhosis. Gastroenterology 2019; 156:1693-1706.e12. [PMID: 30660733 DOI: 10.1053/j.gastro.2019.01.026] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [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: 08/14/2018] [Revised: 12/17/2018] [Accepted: 01/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Concerns related to hepatotoxicity frequently lead to discontinuation or non-initiation of 3-hydroxy-3-methylglutaryl-coenzyme A reductase therapy in patients with cirrhosis despite data supporting statin use. We investigated the independent effects of hyperlipidemia and statin exposure on mortality, hepatic decompensation, and hepatocellular carcinoma development in a large national cohort of patients with cirrhosis. METHODS We performed a retrospective cohort study of patients with newly diagnosed cirrhosis from January 1, 2008 through June 30, 2016 in the Veterans Health Administration. Subjects were divided into 2 cohorts: 21,921 patients with prior statin exposure (existing users) and 51,023 statin-naïve individuals, of whom 8794 subsequently initiated statin therapy (new initiators) and 44,269 did not (non-initiators). Multivariable Cox proportional hazard models with inverse probability weighting were constructed to assess the effects of time-updating lipid profiles and cumulative exposure to statins on survival and hepatic decompensation. Statin-naïve new initiators were propensity matched with non-initiators to simulate a randomized controlled trial of statin use in cirrhosis. RESULTS In statin-naïve subjects, every 10-mg/dL increase in baseline total cholesterol was associated with a 3.6% decrease in mortality. In existing users, each year of continued statin exposure was associated with a hazard ratio of 0.920 (95% confidence interval 0.0.897-0.943) for mortality. After risk-set matching, each year of statin exposure among new initiators was associated with a hazard ratio of 0.913 (95% confidence interval 0.890-0.937) for mortality. CONCLUSIONS In a retrospective cohort study of veterans with a new diagnosis of cirrhosis, we associated hypercholesterolemia with well-preserved hepatic function and decreased mortality. Nonetheless, each cumulative year of statin exposure was associated with an independent 8.0%-8.7% decrease of mortality of patients with cirrhosis of Child-Turcotte-Pugh classes A and B.
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Affiliation(s)
- David E Kaplan
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Marina A Serper
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajni Mehta
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Rena Fox
- San Francisco VA Medical Center, San Francisco, California
| | - Binu John
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Ayse Aytaman
- VA New York Harbor Health Care System, Brooklyn, New York
| | | | - Kristel Hunt
- James J. Peters VA Medical Center, Bronx, New York
| | | | - Basile Njei
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Tamar H Taddei
- VA Connecticut Healthcare System, West Haven, Connecticut
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Parajuli R, Ly R, Ziogas A, Eapen A, Lane K, Chen J, Lin E, Mehta R, Tsai A. Abstract P3-01-16: Micro-cavity array system for size-based enrichment of circulating tumor cells and circulating cancer associated fibroblasts from blood of patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-01-16] [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:Circulating Tumor Cells(CTCs) have prognostic implications in patients with metastatic breast cancer(MBC).During the Epithelial Mesenchymal Transition(EMT), CTCs acquire a more mesenchymal phenotype. Hence, methodologies such as the Cell search that rely on the expression of an epithelial marker EpCAM in CTCs fail to capture a subset of CTCs undergoing the process of EMT and therefore do not adequately represent the true circulatory metastatic load. Hitachi chemicals has invented a size based micro cavity array (MCA) system that allows for the isolation of tumor cells based on the differences in size and deformability between tumor and blood cells. Photolithography and the metal plating can precisely control the filter pore size of our system. Our platform is more sensitive than the Cell Search method in detecting CTCs in Lung Cancer. Cancer Associated Fibroblasts (CAFs) are a major component of the breast tumor microenvironment. Using a micro filter capture technique, our co-authors have demonstrated that CAFs can be enumerated as circulating CAFs (cCAFs). Hitachi's Micro cavity Array System has not been evaluated in the detection of CTCs and cCAFs in patients with Breast Cancer. The purpose of this study is to demonstrate that CTCs and cCAFs can be enumerated using our platform and the cCAFs can serve as biomarkers of metastasis simultaneously with CTCs.
Method:We undertook a Pilot study of 20 patients each with breast cancer across Stage I, Stage II, Stage III and Stage IV. A total of 10ml of peripheral blood was obtained from each patient. Enumeration of CTCs and cCAFs was carried out by the size based mircocavity array system invented by Hitachi Chemicals. Identification of these cells was done by a triple Immunofluorescence staining for pan-CK (cytokeratin), FAP (Fibroblast Activated Protein) and CD45. CTCs were identified as CK+, CD45-, FAP- cells and cCAFs were identified as FAP+, CK- and CD 45 negative cells.
Result:Our method had a high cell recovery rate (90%or higher) and efficient white blood cells depletion rate (99.99%). We present the data from a total of 13 patients in this abstract, (two with stage III and eleven with stage IV breast cancer) . Data from rest of the subjects will be presented at the actual meeting. We detected the presence of CTCs in 11/11(100%) in patients with stage IV(mean of 44) and in 2 out of 2 (100%) patients with Stage III Breast Cancer. We detected the presence of cCAFs in 1 out of 2 patients( 50%) with stage III and in 8 of 11(81.8%) (mean of 9)patients with stage IV breast cancer( Fisher's exact test p-value= 0.42). The number of CTCs and cCAFs was significantly elevated in patients with MBC and the number was clinically associated with a high metastatic burden.
Conclusions:CTCs and cCAFs can be enumerated using a size based size based micro cavity array invented by Hitachi Chemicals that does not rely on the expression of epithelial markers in CTCs. CTCs and cCAFs can be detected in patients with stage III and stage IV breast cancer. CTCs and cCAFs were associated with high metastatic burden and their numbers were significantly elevated in patients with MBC. cCAFs could serve as biomarkers alongside of CTCs in MBC.
Citation Format: Parajuli R, Ly R, Ziogas A, Eapen A, Lane K, Chen J, Lin E, Mehta R, Tsai A. Micro-cavity array system for size-based enrichment of circulating tumor cells and circulating cancer associated fibroblasts from blood of patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-01-16.
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Affiliation(s)
- R Parajuli
- University of California, Irvine, Irvine, CA
| | - R Ly
- University of California, Irvine, Irvine, CA
| | - A Ziogas
- University of California, Irvine, Irvine, CA
| | - A Eapen
- University of California, Irvine, Irvine, CA
| | - K Lane
- University of California, Irvine, Irvine, CA
| | - J Chen
- University of California, Irvine, Irvine, CA
| | - E Lin
- University of California, Irvine, Irvine, CA
| | - R Mehta
- University of California, Irvine, Irvine, CA
| | - A Tsai
- University of California, Irvine, Irvine, CA
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Rhodes D, Hunt K, Conners A, Zingula S, Whaley D, Ellis R, Gasal Spilde J, Mehta R, Polley MY, O'Connor M, Hruska C. Abstract PD4-05: Molecular breast imaging and tomosynthesis to eliminate the reservoir of undetected cancer in dense breasts: The Density MATTERS trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd4-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
High mammographic breast density is the primary reason for missed cancers or delayed detection on mammography, and is associated with a higher rate of advanced and interval cancers which increase breast cancer mortality. Digital breast tomosynthesis (DBT) has been shown to reduce false positive findings relative to 2D mammography but does not eliminate the potential for tumor masking in dense breasts due to the similar x-ray attenuation characteristics of tumors and normal fibroglandular tissue. Molecular Breast Imaging (MBI) performed with a dedicated gamma camera to detect functional uptake of a radiotracer, Tc-99m sestamibi, has been shown to reveal breast cancers obscured by density on mammography. In single-institution studies, adding MBI to 2D mammography in women with dense breasts detected an additional 5 to10 invasive cancers per 1000 screened, with modest increases in recall rate (6 to 8%) at a lower cost-per-cancer detected than mammography alone. Despite this promising evidence, the lack of multicenter trial data has limited wider acceptance. Also, MBI has yet to be compared to DBT, which in some centers has replaced 2D mammography screening. We present interim results from a multicenter trial comparing cancer detection rate of DBT and MBI in screening of women with mammographically dense breasts.
Methods
In this ongoing, prospective, multicenter clinical trial, asymptomatic women aged 40-75 years with dense breasts on prior mammogram and no prior history of supplemental screening are invited to undergo two annual rounds of concurrent DBT and MBI. MBI is performed with injection of 300 MBq Tc-99m sestamibi with a dual-head semiconductor-based gamma camera. Screening tests are interpreted independently. Here, preliminary cancer detection rates (cancers per 1000 women screened), recall rates, and biopsy rates of DBT and MBI for initial screening are reported.
Results
In 537 women out of a planned 3000 who have completed the first round of screening, 7 cancers were detected: one by DBT only and 6 by MBI only, giving cancer detection rates of 1.9 for DBT vs. 11.2 for MBI and incremental cancer detection rate of 9.3 for MBI. The one DBT-only cancer was a node-negative 0.8 cm invasive lobular carcinoma. All 6 cancers detected by MBI were invasive; 5 of 6 were node negative (median size 1.0 cm; range 0.6 to 2.6 cm). Recall rate was 11% (60/537) for DBT alone; 16% (84/537) for MBI alone, and 21% (115/537) for the combination. Biopsy was prompted by DBT in 13 patients (PPV 8% [1/13]); by MBI in 23 patients (PPV 26% [6/23]); and by the combination of modalities in 33 (PPV 21% [7/33]).
Conclusion
These preliminary results demonstrate that MBI detects invasive breast cancers occult on DBT in dense breasts. Data from a second screening round will allow calculation of sensitivity and specificity, and determination of the impact of screening MBI in reducing advanced (> 2 cm) and interval cancers. Additional planned analyses will evaluate a denoising algorithm for further reduction in MBI radiation dose to match that of DBT.
Citation Format: Rhodes D, Hunt K, Conners A, Zingula S, Whaley D, Ellis R, Gasal Spilde J, Mehta R, Polley M-Y, O'Connor M, Hruska C. Molecular breast imaging and tomosynthesis to eliminate the reservoir of undetected cancer in dense breasts: The Density MATTERS trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-05.
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Affiliation(s)
- D Rhodes
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - K Hunt
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - A Conners
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - S Zingula
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - D Whaley
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - R Ellis
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - J Gasal Spilde
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - R Mehta
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - M-Y Polley
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - M O'Connor
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
| | - C Hruska
- Mayo Clinic, Rochester, MN; Franciscan Skemp Mayo Clinic Health System, Lacrosse, WI
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Abstract
Interest has been focused on differentiating anatomical, molecular, and physiological characteristics of the types of mammalian adipose tissues. White adipose tissue (WAT) and brown adipose tissue (BAT) are the two main forms of adipose tissue in humans. WAT functions as an endocrine organ and serves as a reservoir of energy in the form of triglycerides. The hormones released by WAT are called adipokines. BAT consists of a group of specialized cells with abundant uncoupling protein 1 (UCP1) in the inner mitochondrial membrane and also fulfills endocrine functions. Following the identification of functional (BAT) in human adults, there has been a great deal of interest in finding out how it is induced, its localization, and the mechanisms by which it regulates thermogenesis. Fibroblast growth factor 21 (FGF21) is a key regulator of the differentiation to brown adipocytes. The main mechanisms occur through enhancing UCP1 expression. In addition, following exposure to cold or exercise, FGF21 induces upregulation of local peroxisome proliferator-activated receptor gamma co-activator (PGC)-1-alfa and thus promotes thermogenesis in adipose tissue and skeletal muscle. FGF21 integrates several pathways allowing the regulation of human energy balance, glucose levels, and lipid metabolism. Such mechanisms and their clinical relevance are summarized in this review.
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Affiliation(s)
- Daniel Cuevas-Ramos
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - R Mehta
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Monterrey, Mexico
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Koul P, Chaudhari S, Chokhani R, Christopher D, Dhar R, Doshi K, Ghoshal A, Luhadiya SK, Mahashur A, Mehta R, Nene A, Rahman M, Swarnakar R. Pneumococcal disease burden from an Indian perspective : Need for its prevention in pulmonology practice. Lung India 2019. [DOI: 10.4103/0970-2113.257714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mehta R, Bhandari R, Kuhad A, Kuhad A. Zuranolone. GABA-A receptor positive allosteric modulator, Treatment of major depressive disorder, Treatment of postpartum depression. DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.6.2958473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Trivedi R, Pukhraj A, Mehta R, Risbud R. IMPROVING HEART FAILURE MANAGEMENT THROUGH THE UTILIZATION OF CAREMAPS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Petrova A, Karatas M, Mehta R. Features of serial cranial ultrasound detected neuropathology in very preterm infants. J Neonatal Perinatal Med 2018; 12:65-71. [PMID: 30149481 DOI: 10.3233/npm-1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to identify the pattern and factors associated with changes in cranial ultrasound (CUS) -detected findings in infants born at or less than 28 weeks of gestation. METHODS We compared readings of CUS performed at the end of the first week of life and at 4-5 weeks of age. Alteration of CUS findings was classified as: (i) unchanged, if no deviation was detected (Group 1); (ii) worsening, if there were new findings (Group 2); and (iii) improvement, if there was normalization or reduction in severity (Group 3). Descriptive statistics, multivariate controlled logistic regression, and kappa (k) statistics with 95% Confidence Interval (95% CI) were reported. RESULTS Among 510 studied infants, 82.3% (95% CI 78.8-85.4) were in Group 1, 10.0% (95% CI 7.7-12.9) in Group 2, and 7.7% (95% CI 5.7-10.3) in Group 3. Overall agreement between the two scans was moderate (k 0.62; 95% CI 0.55-0.69). Worsening of CUS findings was associated with neonatal morbidities independently from gestational age and birth weight. The probability for worsening of CUS findings was higher in infants with an initial diagnosis of intraventricular hemorrhage (IVH) grade 2, than in those reported as no pathology/IVH grade 1 (Odds Ratio 5.79; 95% CI 2.42-13.91) or IVH grade 3-4 (Odds Ratio 3.81; 95% CI 1.10-13.21). CONCLUSIONS In very preterm born infants, the initial CUS findings in combination with neonatal morbidities can help predict the brain lesions that are seen at the end of the first month of life and could be useful in their clinical management.
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Affiliation(s)
- A Petrova
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - M Karatas
- Department of Pediatrics, Jersey Shore University Medical Center, NJ, USA
| | - R Mehta
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Kanwal F, Mapaskhi S, Smith D, Taddei T, Hussain K, Madu S, Duong N, White D, Cao Y, Mehta R, El-Serag H, Asch S, Midboe A. Implementation of a Population-Based Cirrhosis Identification and Management System. Clin Gastroenterol Hepatol 2018; 16:1182-1186.e2. [PMID: 29803805 PMCID: PMC7185902 DOI: 10.1016/j.cgh.2018.01.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; 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.
| | - Srikar Mapaskhi
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Donna Smith
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Tamar Taddei
- Section of Digestive Diseases, Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Khozema Hussain
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Stella Madu
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Ngoc Duong
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Donna White
- 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
| | - Yumei Cao
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Rajni Mehta
- Section of Digestive Diseases, Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Hashem El-Serag
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas;,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Steven Asch
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Medical Center, Palo Alto, California;,Division of Primary Care and Population Health, Stanford University, Palo Alto, California
| | - Amanda Midboe
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Medical Center, Palo Alto, California;,Division of Primary Care and Population Health, Stanford University, Palo Alto, California
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Ashby K, Navarro Almario EE, Tong W, Borlak J, Mehta R, Chen M. Review article: therapeutic bile acids and the risks for hepatotoxicity. Aliment Pharmacol Ther 2018; 47:1623-1638. [PMID: 29701277 DOI: 10.1111/apt.14678] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/17/2018] [Accepted: 03/31/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bile acids play important roles in cholesterol metabolism and signal through farnesoid X receptor and G protein-coupled receptors. Given their importance in liver biology, bile acid therapy enables therapeutic applications beyond the treatment of cholestatic liver disease. However, predicting hepatotoxicity of bile acids in humans is obscured due to inconsistent extrapolations of animal data to humans. AIM To review the evidence that could explain discordant bile acids hepatotoxicity observed in humans and animals. METHOD Literature search was conducted in PubMed using keywords "bile acid," "transporter," "hepatotoxicity," "clinical study," "animal study," "species difference," "mechanism," "genetic disorder." Relevant articles were selected for review. RESULTS Clinically significant hepatotoxicity was reported in response to certain bile acids, namely chenodeoxycholic acid, which was given a boxed warning for potential hepatotoxicity. The chemical structure, specifically the number and orientation of hydroxyl groups, significantly affects their hydrophobicity, an important factor in bile acid toxicity. Experimental studies show that hydrophobic bile acids can lead to liver injury through various mechanisms, such as death receptor signalling, mitochondrial dysfunction and inflammation. Although animal studies play a central role in investigating bile acid safety, there are considerable differences in bile acid composition, metabolism and hepatobiliary disposition across species. This does not allow appropriate safety inference, especially for predicting hepatotoxicity in humans. Exploring evidences stemming from inborn errors, genetic models of disease and toxicology studies further improves an understanding of bile acid hepatotoxicity. CONCLUSION Species differences should be considered in the development of bile acid related therapeutics. Although the mechanism of bile acid hepatotoxicity is still not fully understood, continued mechanistic studies will deepen our understanding.
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Affiliation(s)
- K Ashby
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - E E Navarro Almario
- Office of Computational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - W Tong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - J Borlak
- Hannover Medical School, Center of Pharmacology and Toxicology, Hannover, Germany
| | - R Mehta
- Division of Gastroenterology and Inborn Error Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - M Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
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Dumitriu IE, Kaur S, Dinkla S, Mehta R, Barkey G, Camm JA. P511Deregulations in CD4+ T lymphocytes subsets promote inflammation in atrial fibrillation. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I E Dumitriu
- St. George's University of London, London, United Kingdom
| | - S Kaur
- St. George's University of London, London, United Kingdom
| | - S Dinkla
- St. George's University of London, London, United Kingdom
| | - R Mehta
- St. George's University of London, London, United Kingdom
| | - G Barkey
- St. George's University of London, London, United Kingdom
| | - J A Camm
- St. George's University of London, London, United Kingdom
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