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Karmacharya P, Chakradhar R, Hulshizer CA, Gunderson TM, Ogdie A, Davis JM, Wright K, Tollefson MM, Duarte-García A, Bekele D, Maradit-Kremers H, Crowson CS. Multimorbidity in Psoriasis as a Risk Factor for Psoriatic Arthritis: A Population-Based Study. Rheumatology (Oxford) 2024:keae040. [PMID: 38291896 DOI: 10.1093/rheumatology/keae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES To examine multimorbidity in psoriasis and its association with the development of PsA. METHODS A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000-2009) and prevalence (Jan 1, 2010) cohorts of psoriasis were identified by manual chart review. A cohort of individuals without psoriasis (comparators) were identified (1:1 matched on age, sex, and county). Morbidities were defined using ≥2 Clinical Classification Software codes ≥30 days apart within prior five years. PsA was defined using ClASsification of Psoriatic ARthritis (CASPAR) criteria. χ2 and rank-sum tests were used to compare morbidities, and age-, sex-, and race-adjusted Cox models to examine the association of baseline morbidities in psoriasis with development of PsA. RESULTS Among 817 incident psoriasis patients, the mean age was 45.2 years with 52.0% females, and 82.0% moderate/severe psoriasis. No multimorbidity differences were found between incident psoriasis patients and comparators. However, in the 1,088 prevalent psoriasis patients, multimorbidity was significantly more common compared with 1,086 comparators (OR : 1.35 and OR : 1.48 for ≥2 and ≥5 morbidities, respectively). Over a median 13.3-year follow-up, 23 patients (cumulative incidence: 2.9% by 15 years) developed PsA. Multimorbidity (≥2 morbidities) was associated with a 3-fold higher risk of developing PsA. CONCLUSION Multimorbidity was more common in the prevalent but not incident cohort of psoriasis compared with the general population, suggesting patients with psoriasis may experience accelerated development of multimorbidity. Moreover, multimorbidity at psoriasis onset significantly increased the risk of developing PsA, highlighting the importance of monitoring multimorbid psoriasis patients for the development of PsA.
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Affiliation(s)
- Paras Karmacharya
- Division of Rheumatology & Immunology, Vanderbilt University Medical Center, Nashville, TN
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Rikesh Chakradhar
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Department of Psychiatry, MetroHealth Medical Center, Psychiatry, Cleveland, OH
| | | | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Kerry Wright
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | - Megha M Tollefson
- Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Delamo Bekele
- Division of Rheumatology, Mayo Clinic, Rochester, MN
| | | | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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Figueroa-Parra G, Meade-Aguilar JA, Hulshizer CA, Gunderson TM, Chamberlain AM, Thanarajasingam U, Greenlund KJ, Barbour KE, Crowson CS, Duarte-García A. Multimorbidity in systemic lupus erythematosus in a population-based cohort: the lupus Midwest network. Rheumatology (Oxford) 2023:kead617. [PMID: 38001025 DOI: 10.1093/rheumatology/kead617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES To assess the prevalence and incidence of multimorbidity and the association with the SLICC/ACR damage index (SDI) among patients with systemic lupus erythematosus (SLE). METHODS Using prevalent and incident population-based cohorts of patients with SLE and their matched comparators, we assessed 57 chronic conditions. Chronic conditions were categorized as SDI-related or SDI-unrelated. Multimorbidity was defined as the presence of 2+ chronic conditions. Multimorbidity at prevalence and incidence/index was compared between cohorts using logistic regression. Cox models were used to examine development of multimorbidity after SLE incidence. RESULTS The prevalent cohort included 449 patients with established SLE on January 1, 2015. They were three times more likely to have multimorbidity compared with non-SLE comparators (OR 2.98, 95% CI 2.18-4.11). The incident cohort included 270 patients with new-onset SLE. At SLE incidence, patients with SLE were more likely to have multimorbidity than comparators (OR 2.27, 95% CI 1.59-3.27). After incidence, the risk of developing multimorbidity was 2-fold higher among patients with SLE than comparators (hazard ratio (HR) 2.11, 95% CI 1.59-2.80). Development of multimorbidity was higher in patients with SLE based on SDI-related (HR 2.91, 95% CI 2.17-3.88) and SDI-unrelated conditions (HR 1.73, 95% CI, 1.32-2.26). CONCLUSION Patients with SLE have a higher burden of multimorbidity, even before the onset of the disease. The risk disparity continues after SLE classification and is also seen in a prevalent SLE cohort. Multimorbidity is driven both by SDI-related and unrelated conditions.
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Affiliation(s)
| | | | | | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Montenegro MM, Kissoon NR, Atkinson JLD, Benson JC, Brinjikji W, Carr CM, Cutsforth-Gregory JK, Garza I, Gunderson TM, Kim DK, Liebo GB, Whealy MA, Lanier WL, Verdoorn JT. Clinical and Imaging Outcomes of Surgically Repaired Cerebrospinal Fluid-Venous Fistulas Identified by Lateral Decubitus Digital Subtraction Myelography. World Neurosurg 2023:S1878-8750(23)00831-8. [PMID: 37355170 DOI: 10.1016/j.wneu.2023.06.062] [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] [Received: 04/19/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To describe the clinical and radiographic outcomes of surgical repair of cerebrospinal fluid-venous fistula (CVF), an increasingly recognized cause of spontaneous intracranial hypotension that is poorly responsive to epidural blood patching treatment. PATIENTS AND METHODS Through retrospective review, we identified adult patients who had lateral decubitus digital subtraction myelography indicative of cerebrospinal fluid leak at Mayo Clinic between November 2018 and February 2020, with clearly localized CVF, followed by surgical treatment. Patients without available imaging before and after surgery were excluded. History of epidural blood patching (EBP) and clinical response to EBP were evaluated along with surgical outcomes. RESULTS Twenty-five patients met protocol criteria and were included in the data analysis. Of these, 22/25 (88%) received EBP, but clinical benefit lasting ≥4 wk occurred in only 2/22 (9%). Of the 25 surgical patients, headache was the most prominent preoperative feature (24/25; 96%). Following surgery, 18/24 (75%) patients had complete headache improvement, 4/24 (17%) had partial improvement, and 2/24 (8%) had no improvement. Ten of 25 (40%) patients reported cognitive disturbance at baseline; at follow-up, 5/10 (50%) had complete improvement, 3/10 (30%) had partial improvement, and 2/10 (20%) had no improvement. On post-operative brain magnetic resonance imaging, 6/25 (24%) patients had complete resolution of findings by Bern score criteria, 18/25 (72%) showed partial improvement, and 1/25 (4%) did not change. Adverse events were minor and included surgical site pain and paresthesias. CONCLUSION Surgical repair of CVF resulted in improvements in headache and other symptoms, with few side effects.
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Affiliation(s)
| | - Narayan R Kissoon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - John C Benson
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Waleed Brinjikji
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Carrie M Carr
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Ivan Garza
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Tina M Gunderson
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Dong Kun Kim
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Greta B Liebo
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Whealy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - William L Lanier
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jared T Verdoorn
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Elfishawi M, Rakholiya J, Gunderson TM, Achenbach SJ, Crowson CS, Matteson EL, Turesson C, Wadström K, Weyand C, Koster MJ, Warrington KJ. Lower Frequency of Comorbidities Prior to Onset of Giant Cell Arteritis: A Population-Based Study. J Rheumatol 2023; 50:526-531. [PMID: 36521923 PMCID: PMC10066824 DOI: 10.3899/jrheum.220610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the frequency of comorbidities and metabolic risk factors at and prior to giant cell arteritis (GCA) diagnosis. METHODS This is a retrospective case control study of patients with incident GCA between January 1, 2000, and December 31, 2019, in Olmsted County, Minnesota. Two age- and sex-matched controls were identified, and each assigned an index date corresponding to an incidence date of GCA. Medical records were manually abstracted for comorbidities and laboratory data at incidence date, 5 years, and 10 years prior to incidence date. Twenty-five chronic conditions using International Classification of Diseases, 9th revision, diagnosis codes were also studied at incidence date and 5 years prior to incidence date. RESULTS One hundred and twenty-nine patients with GCA (74% female) and 253 controls were identified. At incidence date, the prevalence of diabetes mellitus (DM) was lower among patients with GCA (5% vs 17%; P = 0.001). At 5 years prior to incidence date, patients were less likely to have DM (2% vs 13%; P < 0.001) and hypertension (27% vs 45%; P = 0.002) and had a lower mean number (SD) of comorbidities (0.7 [1.0] vs 1.3 [1.4]; P < 0.001) compared to controls. Moreover, patients had significantly lower median fasting blood glucose (FBG; 96 mg/dL vs 104 mg/dL; P < 0.001) and BMI (25.8 vs 27.7; P = 0.02) compared to controls. Multivariable logistic regression analysis revealed negative associations for FBG with GCA at 5 and 10 years prior to diagnosis/index date. CONCLUSION DM prevalence and median FBG and BMI were lower in patients with GCA up to 5 years prior to diagnosis, suggesting that metabolic factors influence the risk of GCA.
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Affiliation(s)
- Mohanad Elfishawi
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Jigisha Rakholiya
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara J Achenbach
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Carl Turesson
- C. Turesson, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Karin Wadström
- K. Wadström, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, and Center for Rheumatology, Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Cornelia Weyand
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Koster
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth J Warrington
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Crowson CS, Gunderson TM, Davis JM, Myasoedova E, Kronzer VL, Coffey CM, Atkinson EJ. Using Unsupervised Machine Learning Methods to Cluster Comorbidities in a Population-Based Cohort of Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:210-219. [PMID: 35724274 PMCID: PMC9763549 DOI: 10.1002/acr.24973] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify clusters of comorbidities in patients with rheumatoid arthritis (RA) using 4 methods and to compare to patients without RA. METHODS In this retrospective, population-based study, residents of 8 Minnesota counties with prevalent RA as of January 1, 2015 were identified. Age-, sex-, and county-matched non-RA comparators were selected from the same underlying population. Diagnostic codes were retrieved for 5 years before January 1, 2015. Using 2 codes ≥30 days apart, 44 previously defined morbidities and 11 nonoverlapping chronic disease categories based on Clinical Classifications Software were defined. Unsupervised machine learning methods of interest included hierarchical clustering, factor analysis, K-means clustering, and network analysis. RESULTS Two groups of 1,643 patients with and without RA (72% female; mean age 63.1 years in both groups) were studied. Clustering of comorbidities revealed strong associations among mental/behavioral comorbidities and among cardiovascular risk factors and diseases. The clusters were associated with age and sex. Differences between the 4 clustering methods were driven by comorbidities that are rare and those that were weakly associated with other comorbidities. Common comorbidities tended to group together consistently across approaches. The instability of clusters when using different random seeds or bootstrap sampling impugns the usefulness and reliability of these methods. Clusters of common comorbidities between RA and non-RA cohorts were similar. CONCLUSION Despite the higher comorbidity burden in patients with RA compared to the general population, clustering comorbidities did not identify substantial differences in comorbidity patterns between the RA and non-RA cohorts. The instability of clustering methods suggests caution when interpreting clustering using 1 method.
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Chevet B, Figueroa-Parra G, Yang JX, Hulshizer CA, Gunderson TM, Duong SQ, Putman MS, Barbour KE, Crowson CS, Duarte-García A. COVID-19 Vaccine Uptake Among Patients With Systemic Lupus Erythematosus in the American Midwest: The Lupus Midwest Network (LUMEN). J Rheumatol 2022; 49:1276-1282. [PMID: 35777817 PMCID: PMC9633343 DOI: 10.3899/jrheum.220220] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) are at higher risk of poor outcomes from coronavirus disease 2019 (COVID-19). The vaccination rate among such patients is unknown. We aimed to assess COVID-19 vaccine uptake among patients with SLE. METHODS We included 342 patients with SLE from the Lupus Midwest Network (LUMEN) and 350 age-, sex-, race-, and county-matched comparators. Vaccination uptake for influenza, pneumococcal, and zoster vaccines before pandemic restrictions began (up to February 29, 2020) was assessed. First-dose COVID-19 vaccine uptake was electronically retrieved and manually ascertained (December 15, 2020, to July 31, 2021). Time to COVID-19 vaccination, demographics, SLE manifestations, medications, Charlson Comorbidity Index, Area Deprivation Index, and Rural-Urban Commuting Area codes were compared. RESULTS On July 31, 2021, 83.3% of patients with SLE and 85.5% of comparators were vaccinated against COVID-19. The COVID-19 vaccination rates were similar among SLE and comparators (hazard ratio 0.93, 95% CI 0.79-1.10). Unvaccinated patients with SLE were more likely than vaccinated patients to be men (27.3% vs 14.1%), younger (mean age 54.1 vs 58.8 yrs), have a shorter SLE duration (median 7.3 vs 10.7 yrs), and be less frequently vaccinated with influenza and pneumococcal vaccines. CONCLUSION Patients with SLE in the Lupus Midwest Network had similar COVID-19 vaccination uptake as matched comparators, most of whom were vaccinated early when the vaccine became available. One in 6 patients with SLE remain unvaccinated.
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Affiliation(s)
- Baptiste Chevet
- B. Chevet, MD, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA, and Division of Rheumatology, Brest Teaching Hospital, LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | | | - Jeffrey X Yang
- J.X. Yang, MD, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassondra A Hulshizer
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie Q Duong
- C.A. Hulshizer, BA, T.M. Gunderson, MS, S.Q. Duong, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael S Putman
- M.S. Putman, MD, MSci, Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kamil E Barbour
- K.E. Barbour, PhD, MPH, MS, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alí Duarte-García
- A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
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Chevet B, Figueroa-Parra G, Yang JX, Hocaoglu M, Osei-Onomah SA, Hulshizer CA, Gunderson TM, Cornec D, Barbour KE, Greenlund KJ, Crowson CS, Duarte-García A. Utilization of preventive services in a systemic lupus erythematosus population-based cohort: a Lupus Midwest Network (LUMEN) study. Arthritis Res Ther 2022; 24:211. [PMID: 36050780 PMCID: PMC9434086 DOI: 10.1186/s13075-022-02878-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a disease that can lead to damage of multiple organs and, along with certain treatments, increase the risk of developing cancer, cardiovascular disease, diabetes, osteoporosis, and infections. Preventive services are particularly important in patients with SLE to mitigate the aforementioned risks. We aimed to evaluate the trends of preventive services utilization in patients with systemic lupus erythematosus, compared with non-SLE population. METHODS All ≥19-year-old patients in the Lupus Midwest Network (LUMEN) registry, a population-based cohort, with SLE on January 1, 2015, were included and matched (1:1) by sex, age, race, and county to non-SLE comparators. Among both groups, we compared the rates of screenings for breast and cervical cancer, hypertension, hyperlipidemia, diabetes mellitus, and osteoporosis as well as immunizations. RESULTS We included 440 SLE patients and 430 non-SLE comparators. The probability of breast cancer screening among women with SLE was similar to comparators (hazard ratio [HR] 1.09, 95% CI 0.85-1.39), while cervical cancer screening was lower (HR 0.75, 95% CI 0.58-0.96). Hypertension screening was higher among patients with SLE (HR 1.35, 95% CI 1.13-1.62); however, hyperlipidemia screening was similar to comparators (HR 1.16, 95% CI 0.96-1.41). Diabetes and osteoporosis screenings were more likely to be performed for SLE patients than for comparators (HR 2.46, 95% CI 2.11-2.87; and HR 3.19, 95% CI 2.31-4.41; respectively). Influenza and pneumococcal immunizations were higher among SLE patients (HR 1.31, 95% CI 1.12-1.54; and HR 2.06, 95% CI 1.38-3.09; respectively), while zoster vaccination was similar (HR 1.17, 95% CI 0.81-1.69). CONCLUSIONS The trends of utilization of preventive services by SLE patients vary according to screening or vaccine compared with the general population. Considering these differences, we demonstrate an opportunity for improvement, particularly in cervical cancer, hyperlipidemia, and osteoporosis screenings and vaccinations.
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Affiliation(s)
- Baptiste Chevet
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | | | - Jeffrey X Yang
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
| | | | | | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Divi Cornec
- Division of Rheumatology, Brest Teaching Hospital; LBAI, UMR1227, Univ Brest, Inserm, CHU de Brest, Brest, France
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, 200 First Street SW, MN, 55905, USA.
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Gunderson TM, Myasoedova E, Davis JM, Crowson CS. Dr. Gunderson et al reply. J Rheumatol 2022; 49:964. [DOI: 10.3899/jrheum.211343] [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: 11/22/2022]
Abstract
We thank Drs. Liao, Liao, and Liaw for their interest in our article on multimorbidity burden in patients with rheumatoid arthritis (RA).1 We agree that not all morbidities were included in the assessment of multimorbidity in our article, and further research is warranted to more comprehensively assess multimorbidity in patients with RA.
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Carr CM, Lane JI, Eckel LJ, Diehn FE, Kallmes DF, Carlson ML, Shu Y, Bernstein MA, Gunderson TM, Poling GL. Evaluation of hearing loss in young adults after exposure to 3.0T MRI with standard hearing protection. J Acoust Soc Am 2022; 151:1913. [PMID: 35364910 DOI: 10.1121/10.0009824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Standard clinical protocols require hearing protection during magnetic resonance imaging (MRI) for patient safety. This investigation prospectively evaluated the auditory function impact of acoustic noise exposure during a 3.0T MRI in healthy adults. Twenty-nine participants with normal hearing underwent a comprehensive audiologic assessment before and immediately following a clinically indicated head MRI. Appropriate hearing protection with earplugs (and pads) was used per standard of practice. To characterize noise hazards, current sound monitoring tools were used to measure levels of pulse sequences measured. A third audiologic test was performed if a significant threshold shift (STS) was identified at the second test, within 30 days post MRI. Some sequences produced high levels (up to 114.5 dBA; 129 dB peak SPL) that required hearing protection but did not exceed 100% daily noise dose. One participant exhibited an STS in the frequency region most highly associated with noise-induced hearing loss. No participants experienced OSHA-defined STS in either ear. Overall, OAE measures did not show evidence of changes in cochlear function after MRI. In conclusion, hearing threshold shifts associated with hearing loss or OAE level shifts reflecting underlying cochlear damage were not detected in any of the 3.0T MRI study participants who used the current recommended hearing protection.
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Affiliation(s)
- Carrie M Carr
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - John I Lane
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Larry J Eckel
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Felix E Diehn
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Dave F Kallmes
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Matthew L Carlson
- Division of Audiology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Yunhong Shu
- Division of Medical Physics, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Matt A Bernstein
- Division of Medical Physics, Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Tina M Gunderson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
| | - Gayla L Poling
- Division of Audiology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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Crowson CS, Gunderson TM, Dykhoff HJ, Myasoedova E, Atkinson EJ, Kronzer VL, Coffey CM, Davis Iii JM. Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis. RMD Open 2022; 8:rmdopen-2021-002022. [PMID: 35042730 PMCID: PMC8768925 DOI: 10.1136/rmdopen-2021-002022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/19/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To comprehensively assess multimorbidity burden in patients with rheumatoid arthritis (RA) in order to unify the multimorbidity definition for RA research and clinical practice. Methods In this population-based study, residents of eight Minnesota counties with prevalent RA on 1 January 2015 were identified. Age, sex and county-matched non-RA comparators were selected from the same population. Diagnostic codes were retrieved for 5 years before 1 January 2015. Using two codes ≥30 days apart, 44 previously defined morbidities and 78 non-overlapping chronic disease categories based on Clinical Classification Software were defined. Prevalence of each morbidity in the RA versus non-RA cohorts was compared using false discovery rate to adjust for multiple comparisons. Morbidities more common in RA than non-RA and those with prevalence ≥5% were retained. Results 1643 patients with RA and 1643 non-RA subjects (72% women; mean age 63.1 years) were studied. Using the 44 morbidities, multimorbidity (defined as 2+ morbidities) was present in 1411 (86%) of RA and 1164 (71%) of non-RA subjects (p<0.001) with 5+ morbidities present in 907 (55%) of RA and 619 (38%) of non-RA (p<0.001). Patients with RA had significantly higher prevalence of 24 of the 44 morbidities compared with non-RA, especially interstitial lung disease, fibromyalgia, osteoarthritis and osteoporosis. Among the additional 78 categories, 7 were significantly higher in RA than non-RA, including organic sleep disorders, vitamin D deficiency and foot ulcers. Conclusion Patients with RA have a higher prevalence of multimorbidity compared with non-RA subjects. These results confirm the list of 44 morbidities and add several other morbidities of interest in RA.
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Affiliation(s)
- Cynthia S Crowson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA .,Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Hayley J Dykhoff
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Myasoedova
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth J Atkinson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Vanessa L Kronzer
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caitrin M Coffey
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John M Davis Iii
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Sas DJ, Enders FT, Gunderson TM, Mehta RA, Olson JB, Seide BM, Banks CJ, Dehmel B, Pellikka PA, Lieske JC, Milliner DS. Natural History of Clinical, Laboratory, and Echocardiographic Parameters of a Primary Hyperoxaluria Cohort on Long Term Hemodialysis. Front Med (Lausanne) 2021; 8:592357. [PMID: 33898474 PMCID: PMC8062902 DOI: 10.3389/fmed.2021.592357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/12/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Primary hyperoxaluria type 1 (PH1) is a rare monogenic disorder characterized by excessive hepatic production of oxalate leading to recurrent nephrolithiasis, nephrocalcinosis, and progressive kidney damage, often requiring renal replacement therapy (RRT). Though systemic oxalate deposition is well-known, the natural history of PH1 during RRT has not been systematically described. In this study, we describe the clinical, laboratory, and echocardiographic features of a cohort of PH1 patients on RRT. Methods: Patients with PH1 enrolled in the Rare Kidney Stone Consortium PH Registry who progressed to require RRT, had ≥2 plasma oxalate (pOx) measurements 3–36 months after start of RRT, and at least one pair of pOx measurements between 6 and 18 months apart were retrospectively analyzed. Clinical, echocardiographic, and laboratory results were obtained from the Registry. Results: The 17 PH1 patients in our cohort had a mean total HD hours/week of 17.4 (SD 7.9; range 7.5–36) and a range of age of RRT start of 0.2–75.9 years. The average change in plasma oxalate (pOx) over time on RRT was −0.74 [−2.9, 1.4] μmol/L/month with the mean pOx never declining below 50 μmol/L. Over time on RRT, oxalosis progressively developed in multiple organ systems. Echocardiography performed on 13 subjects showed worsening of left ventricular global longitudinal strain correlated with pOx (p < 0.05). Conclusions: Even when a cohort of PH1 patients were treated with intensified RRT, their predialysis pOx remained above target and they developed increasing evidence of oxalosis. Echocardiographic data suggest that cardiac dysfunction could be related to elevated pOx and may worsen over time.
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Affiliation(s)
- David J Sas
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Tina M Gunderson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Julie B Olson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Barbara M Seide
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Carly J Banks
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | | | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Dawn S Milliner
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
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12
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Gunderson TM, Myasoedova E, Davis JM, Crowson CS. Multimorbidity Burden in Rheumatoid Arthritis: A Population-based Cohort Study. J Rheumatol 2021; 48:1648-1654. [PMID: 33589552 DOI: 10.3899/jrheum.200971] [Citation(s) in RCA: 18] [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] [Accepted: 02/02/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To estimate the prevalence and incidence of multimorbidity (MM) in a population-based cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA. METHODS Between 1999-2013, residents of Olmsted County, Minnesota with incident RA who met the 1987 American College of Rheumatology criteria were compared to age- and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser, and Rheumatic Disease Comorbidity Indices were included, excluding rheumatic comorbidities. The Aalen-Johansen method was used to estimate the cumulative incidence of MM (MM2+; ≥ 2 chronic comorbidities) or substantial MM (MM5+; ≥ 5), adjusting for the competing risk of death. RESULTS The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% White, mean age 55.5 yrs). At incidence/index date, the prevalence of MM2+ was higher in RA than non-RA subjects (38% RA vs 32% non-RA, P = 0.02), whereas prevalence of MM5+ was similar (5% RA vs. 4% non-RA, P = 0.68). During follow-up (median 11.6 yrs RA, 11.3 yrs non-RA), more patients with RA developed MM2+ (214 RA vs 188 non-RA; adjusted HR 1.39, 95% CI 1.14-1.69). By 10 years after RA incidence/index, the cumulative incidence of MM2+ was 56.5% among the patients with RA (95% CI 56.5-62.3%) compared with 47.9% among the non-RA (95% CI 42.8-53.7%). Patients with RA showed no evidence of increase in incidence of MM5+ (adjusted HR 1.17, 95% CI 0.93-1.47). CONCLUSION Patients with RA have both a higher prevalence of MM at the time of RA incidence as well as increased incidence thereafter.
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Affiliation(s)
- Tina M Gunderson
- T.M. Gunderson, MS, Department of Health Sciences Research, Mayo Clinic, Rochester
| | - Elena Myasoedova
- E. Myasoedova, MD, PhD, C.S. Crowson, PhD, Department of Health Sciences Research, and Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester
| | - John M Davis
- J.M. Davis III, MD, MS, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- E. Myasoedova, MD, PhD, C.S. Crowson, PhD, Department of Health Sciences Research, and Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester;
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13
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Gong S, Dong Y, Gunderson TM, Andrijasevic NM, Kashani KB. Elastic Bandage vs Hypertonic Albumin for Diuretic-Resistant Volume-Overloaded Patients in Intensive Care Unit: A Propensity-Match Study. Mayo Clin Proc 2020; 95:1660-1670. [PMID: 32605782 DOI: 10.1016/j.mayocp.2020.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare elastic bandage (EB) vs hypertonic albumin solution administration to increase fluid removal by enhancing loop diuretic efficiency (DE) in patients with volume overload and diuretic resistance. PATIENTS AND METHODS In this historic cohort study with propensity matching, we included diuretic-resistant adult (≥18 years) patients with volume overload after fluid resuscitation admitted in the intensive care unit from January 1, 2006, through June 30, 2017. Regression models and propensity matching were used to assess the associations of these interventions with changes in DE and other clinical outcomes. RESULTS Of 1147 patients (median age, 66; interquartile range [IQR], 56-76 years; 51% [n=590] men), 384 (33%) received EB and 763 (67%) received hypertonic albumin solution. In adjusted models, EB was significantly associated with higher DE compared with hypertonic albumin solution (odds ratio, 1.37; 95% CI, 1.04 to 1.81; P=.004). After propensity matching of 345 pairs, DE remained significantly different between the 2 groups (median, 2111; IQR, 1092 to 4665 mL for EB vs median, 1829; IQR, 1032 to 3436 mL for hypertonic albumin solution; P=.02). EB, male sex, lower baseline serum urea nitrogen level, lower Charlson Comorbidity Index score, and higher baseline left ventricular ejection fraction were DE determinants. The lowest DE quartile (<1073 mL/40-mg furosemide equivalent) following adjustment for known predictors of mortality remained independently associated with higher 90-day death rate (odds ratio, 1.64; 95% CI, 1.13 to 2.36; P=.009). CONCLUSION EB use is associated with greater DE than hypertonic albumin solution during the deescalation phase of sepsis resuscitation. Prospective clinical trials would validate the findings of this hypothesis-generating study.
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Affiliation(s)
- Shurong Gong
- Department of Surgical Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Tina M Gunderson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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14
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Kim DK, Verdoorn JT, Gunderson TM, Huston III J, Brinjikji W, Lanzino G, Lehman VT. Comparison of non-contrast vessel wall imaging and 3-D time-of-flight MRA for atherosclerotic stenosis and plaque characterization within intracranial arteries. J Neuroradiol 2020; 47:266-271. [DOI: 10.1016/j.neurad.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
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15
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Bandak G, Sakhuja A, Andrijasevic NM, Gunderson TM, Gajic O, Kashani K. Use of diuretics in shock: Temporal trends and clinical impacts in a propensity-matched cohort study. PLoS One 2020; 15:e0228274. [PMID: 32053637 PMCID: PMC7018137 DOI: 10.1371/journal.pone.0228274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/12/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors. PATIENTS AND METHODS This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics. RESULTS There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however, was higher in the group that received diuretics. Ninety-day mortality was 191 (45.2%) in the exposed group VS 156 (36.9%) p = .009. CONCLUSIONS While the use of diuretic therapy in critically ill patients receiving vasopressor infusions augmented urine output, it was not associated with higher vasopressor requirements, AKI incidence, and need for renal replacement therapy.
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Affiliation(s)
- Ghassan Bandak
- Division of Pulmonary and Critical Care Medicine, Marshall Health, Huntington, WV, United States of America
| | - Ankit Sakhuja
- Division of Pulmonary and Critical Care Medicine, University of West Virginia, Morgantown, WV, United States of America
| | - Nicole M. Andrijasevic
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Tina M. Gunderson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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16
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Welch BT, Packard AT, Atwell TD, Johnson GB, Lowe VJ, Karnes RJ, Mynderse LA, Gunderson TM, Park SS, Stish BJ, Evans JD, Kwon ED, Davis BJ, Nathan MA. Percutaneous Image-Guided Nodal Biopsy After 11C-Choline PET/CT for Biochemically Recurrent Prostate Cancer: Imaging Predictors of Disease and Clinical Implications. Adv Radiat Oncol 2019; 4:79-89. [PMID: 30706014 PMCID: PMC6349661 DOI: 10.1016/j.adro.2018.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose Management of recurrent prostate cancer necessitates timely diagnosis and accurate localization of the sites of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after 11C-choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease to better inform clinical decision making regarding local therapy planning. Materials and Methods Retrospective review of patients undergoing CholPET followed by percutaneous core needle biopsy between January 1, 2010 and January 1, 2016. A total of 153 patients were identified who underwent 166 biopsy procedures. Patient, CholPET, procedural, and pathologic characteristics were recorded. Results A total of 157 biopsies were technically successful, and 110 (70.1%; 95% confidence interval, 62.2-77.1) yielded histologic results abnormal for metastatic prostate cancer. Lesion location, lesion maximum standardized uptake value (SUVmax), SUV ratio (calculated as the ratio of SUVmax to SUV mean in the right atrium), prostate-specific antigen, lesion short axis length, total Gleason score, and castration resistance were all associated with abnormal biopsy results (P values <.001, <.001, <.001, .02, .02, .02, and .015, respectively). External iliac, common iliac, and inguinal sites were associated with much lower rates of histologic positivity (mean [95% confidence interval], 51.2% [35.1-67.1], 46.2% [19.2-74.9], and 33.3% [7.5-70.1]), respectively. Conclusions In a cohort of patients in whom core needle biopsy was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion–to–blood pool SUV ratio, prostate-specific antigen, total Gleason score, and castration resistance were significantly associated with abnormal biopsy results for metastatic disease on CholPET. Relatively high false positive rates were found in common iliac, external iliac, and inguinal lymph node locations. Histologic confirmation of these sites should be strongly considered in the appropriate clinical scenario before designing additional local therapy plans.
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Affiliation(s)
- Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ann T Packard
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jaden D Evans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Nathan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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17
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Nehra AK, McDonald RJ, Bluhm AM, Gunderson TM, Murray DL, Jannetto PJ, Kallmes DF, Eckel LJ, McDonald JS. Accumulation of Gadolinium in Human Cerebrospinal Fluid after Gadobutrol-enhanced MR Imaging: A Prospective Observational Cohort Study. Radiology 2018; 288:416-423. [DOI: 10.1148/radiol.2018171105] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Avinash K. Nehra
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Robert J. McDonald
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Amy M. Bluhm
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Tina M. Gunderson
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David L. Murray
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Paul J. Jannetto
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David F. Kallmes
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J. Eckel
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jennifer S. McDonald
- From the Departments of Radiology (A.K.N., R.J.M., D.F.K., L.J.E., J.S.M.), Department of Laboratory Medicine and Pathology (A.M.B., D.L.M., P.J.J.), Department of Health Sciences Research (T.M.G.), and Department of Neurosurgery, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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18
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Jiang H, Schmit NR, Koenen AR, Bansal A, Pandey MK, Glynn RB, Kemp BJ, Delaney KL, Dispenzieri A, Bakkum-Gamez JN, Peng KW, Russell SJ, Gunderson TM, Lowe VJ, DeGrado TR. Safety, pharmacokinetics, metabolism and radiation dosimetry of 18F-tetrafluoroborate ( 18F-TFB) in healthy human subjects. EJNMMI Res 2017; 7:90. [PMID: 29080017 PMCID: PMC5660009 DOI: 10.1186/s13550-017-0337-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND 18F-Tetrafluoroborate (18F-TFB) is a promising iodide analog for PET imaging of thyroid cancer and sodium/iodide symporter (NIS) reporter activity in viral therapy applications. The aim of this study was to evaluate the safety, pharmacokinetics, biodistribution, and radiation dosimetry of high-specific activity 18F-TFB in healthy human subjects. METHODS 18F-TFB was synthesized with specific activity of 3.2 ± 1.3 GBq/μmol (at the end of synthesis). Dynamic and whole-body static PET/CT scans over 4 h were performed after intravenous administration of 18F-TFB (333-407 MBq) in four female and four male healthy volunteers (35 ± 11 years old). Samples of venous blood and urine were collected over the imaging period and analyzed by ion-chromatography HPLC to determine tracer stability. Vital signs and clinical laboratory safety assays were measured to evaluate safety. RESULTS 18F-TFB administration was well tolerated with no significant findings on vital signs and no clinically meaningful changes in clinical laboratory assays. Left-ventricular blood pool time-activity curves showed a multi-phasic blood clearance of 18F-radioactivity with the two rapid clearance phases over the first 20 min, followed by a slower clearance phase. HPLC analysis showed insignificant 18F-labeled metabolites in the blood and urine over the length of the study (4 h). High uptakes were seen in the thyroid, stomach, salivary glands, and bladder. Urinary clearance of 18F-TFB was prominent. Metabolic stability was evidenced by low accumulation of 18F-radioactivity in the bone. Effective doses were 0.036 mSv/MBq in males and 0.064 mSv/MBq in females (p = 0.08, not significant). CONCLUSIONS This initial study in healthy human subjects showed 18F-TFB was safe and distributed in the human body similar to other iodide analogs. These data support further translational studies with 18F-TFB as NIS gene reporter and imaging biomarker for thyroid cancer and other disease processes that import iodide.
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Affiliation(s)
- Huailei Jiang
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Nicholas R. Schmit
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Alex R. Koenen
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Aditya Bansal
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Mukesh K. Pandey
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Robert B. Glynn
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Bradley J. Kemp
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Kera L. Delaney
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | | | | | - Kah-Whye Peng
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN USA
| | | | | | - Val J. Lowe
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Timothy R. DeGrado
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
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19
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Baffour FI, Hickson LJ, Stegall MD, Dean PG, Gunderson TM, Atwell TD, Kurup AN, Schmitz JJ, Park WD, Schmit GD. Effects of Aspirin Therapy on Ultrasound-Guided Renal Allograft Biopsy Bleeding Complications. J Vasc Interv Radiol 2016; 28:188-194. [PMID: 27993506 DOI: 10.1016/j.jvir.2016.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To determine if patient aspirin exposure and timing affect bleeding risk after renal allograft biopsy. MATERIALS AND METHODS Review of 6,700 renal allograft biopsies (in 2,362 unique patients) was performed. Median patient age was 53.0 years [interquartile range 43.0, 62.0]; 56.2% of patients were male. Of biopsies, 4,706 (70.2%) were performed in patients with no aspirin exposure within 10 days of biopsy; 664 (9.9%), were performed within 8-10 days of aspirin exposure; 855 (12.8%), within 4-7 days; and 475 (7.1%), within 0-3 days. Follow-up to 3 months after the procedure was completed in all patients. Biopsies were categorized as protocol or indication; 19.7% were indication biopsies. Bleeding complications were graded based on SIR criteria. Logistic regression models examined the association between aspirin use and bleeding events. RESULTS Rate [95% confidence interval] of major bleeding complications was 0.24% [0.14, 0.39], and rate of any bleeding complication was 0.66% [0.46, 0.90]. Bleeding events were significantly associated with patients undergoing indication biopsies compared with protocol biopsies (odds ratio [OR] 2.27, P = .012). Patient factors associated with major bleeding complications in multivariate models included estimated glomerular filtration rate (OR 0.61, P = .016) and platelet count (OR 0.64, P = .033). Aspirin use was not significantly associated with increased risk of bleeding complication except for use of 325 mg of aspirin within 3 days of biopsy (any complication OR 3.87 [1.12, 13.4], P = .032; major complication OR 6.30 [1.27, 31.3], P = .024). CONCLUSIONS Renal allograft biopsy bleeding complications are very rare, particularly for protocol biopsies. Use of 325 mg of aspirin within 3 days of renal allograft biopsy was associated with increased bleeding complications.
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Affiliation(s)
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, 200 First Street SW, Rochester, MN 55905
| | - Mark D Stegall
- Department of Medicine, Division of Transplant Surgery, 200 First Street SW, Rochester, MN 55905
| | - Patrick G Dean
- Department of Medicine, Division of Transplant Surgery, 200 First Street SW, Rochester, MN 55905
| | - Tina M Gunderson
- Department of Surgery, Division of Biomedical Statistics and Informatics, 200 First Street SW, Rochester, MN 55905
| | - Thomas D Atwell
- Division of Ultrasound, 200 First Street SW, Rochester, MN 55905
| | - A Nicholas Kurup
- Division of Ultrasound, 200 First Street SW, Rochester, MN 55905
| | - John J Schmitz
- Division of Abdominal Imaging, 200 First Street SW, Rochester, MN 55905
| | - Walter D Park
- Division of Surgery Research Services, 200 First Street SW, Rochester, MN 55905; Department of Health Sciences Research, and William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Grant D Schmit
- Division of Abdominal Imaging, 200 First Street SW, Rochester, MN 55905
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Dou L, Lan H, Reynolds DJ, Gunderson TM, Kashyap R, Gajic O, Caples S, Li G, Kashani KB. Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study. Nephron Clin Pract 2016; 135:137-146. [PMID: 27951537 DOI: 10.1159/000453367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Obstructive sleep apnea (OSA) is a known risk factor for chronic kidney disease (CKD); however, its association with acute kidney injury (AKI) is not well documented. We aimed to study whether OSA is associated with the risk of AKI in the intensive care unit (ICU) setting. METHODS All consecutive adult Olmsted County, MN residents who were admitted in Mayo Clinic ICUs from January 1, 2010 to December 31, 2010 were screened. Chronic and acute risk factors were collected within the first 48 h of ICU admission. Logistic regression and propensity score matching were used to examine crude and adjusted associations of OSA with AKI. RESULTS Among 1,259 enrolled ICU patients, 183 patients had a diagnosis of OSA prior to the index ICU admission. Compared with non-OSA patients, the incidence of AKI in OSA patients was more frequent (41 vs. 57%, p < 0.001). In univariate analysis, it was found that CKD, age, gender, Caucasian race, congestive heart failure, cerebrovascular disease, diabetes mellitus, body mass index, and OSA were associated with AKI. In the multivariate model, following adjustment for age, gender, race, and chronic and acute risk factors, OSA was found to have an independent association with AKI (OR 1.53; 95% CI 1.04-2.24; p = 0.031). Among 176 propensity score matched pairs, there was a significant difference in the incidence of AKI between the OSA and non-OSA groups (OR 1.54; 95% CI 1.01-2.35; p = 0.04). CONCLUSIONS The history of OSA diagnosed by polysomnography is associated with higher risk of AKI in critically ill patients.
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Affiliation(s)
- Lin Dou
- Division of Critical Care Medicine, Tianjin First Center Hospital, Tianjin, China
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21
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DeGrado TR, Kemp BJ, Pandey MK, Jiang H, Gunderson TM, Linscheid LR, Woodwick AR, McConnell DM, Fletcher JG, Johnson GB, Petersen RC, Knopman DS, Lowe VJ. First PET Imaging Studies With 63Zn-Zinc Citrate in Healthy Human Participants and Patients With Alzheimer Disease. Mol Imaging 2016; 15:15/0/1536012116673793. [PMID: 27941122 PMCID: PMC5469518 DOI: 10.1177/1536012116673793] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/23/2016] [Accepted: 09/15/2016] [Indexed: 12/31/2022] Open
Abstract
Abnormalities in zinc homeostasis are indicated in many human diseases, including Alzheimer disease (AD). 63Zn-zinc citrate was developed as a positron emission tomography (PET) imaging probe of zinc transport and used in a first-in-human study in 6 healthy elderly individuals and 6 patients with clinically confirmed AD. Dynamic PET imaging of the brain was performed for 30 minutes following intravenous administration of 63Zn-zinc citrate (∼330 MBq). Subsequently, body PET images were acquired. Urine and venous blood were analyzed to give information on urinary excretion and pharmacokinetics. Regional cerebral 63Zn clearances were compared with 11C-Pittsburgh Compound B (11C-PiB) and 18F-fluorodeoxyglucose (18F-FDG) imaging data. 63Zn-zinc citrate was well tolerated in human participants with no adverse events monitored. Tissues of highest uptake were liver, pancreas, and kidney, with moderate uptake being seen in intestines, prostate (in males), thyroid, spleen, stomach, pituitary, and salivary glands. Moderate brain uptake was observed, and regional dependencies were observed in 63Zn clearance kinetics in relationship with regions of high amyloid-β plaque burden (11C-PiB) and 18F-FDG hypometabolism. In conclusion, zinc transport was successfully imaged in human participants using the PET probe 63Zn-zinc citrate. Primary sites of uptake in the digestive system accent the role of zinc in gastrointestinal function. Preliminary information on zinc kinetics in patients with AD evidenced regional differences in clearance rates in correspondence with regional amyloid-β pathology, warranting further imaging studies of zinc homeostasis in patients with AD.
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Affiliation(s)
| | - Bradley J Kemp
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Huailei Jiang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Tina M Gunderson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Potretzke TA, Gunderson TM, Aamodt D, Weisbrod AJ, Hesley GK, Welch TJ, Atwell TD. Incidence of bleeding complications after percutaneous core needle biopsy in hypertensive patients and comparison to normotensive patients. Abdom Radiol (NY) 2016; 41:637-42. [PMID: 26826087 DOI: 10.1007/s00261-016-0653-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To retrospectively determine the rate of major bleeding complications after solid organ or lung biopsy in patients with hypertension and compare to the rates of bleeding in normotensive patients. MATERIALS AND METHODS Following IRB approval, retrospective review of all solid organ and lung biopsies performed at our institution between June 1st, 2013 and October 31st, 2015 was performed. Hypertension was defined as a maximum observed systolic blood pressure of 160 mmHg or greater and/or diastolic blood pressure of 90 mmHg or greater at the time of the biopsy procedure. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) established by the National Cancer Institute. RESULTS 4756 total biopsies in 3876 unique patients (median age 60, 57% male) were included. 1488 (31.3%) of these biopsies were performed in hypertensive patients. Fifteen major hemorrhages (CTCAE grade 3 or higher) occurred (0.32%). There were no deaths. There was no significant association between hypertension and major bleeding. The incidence of bleeding in hypertensive patients was 0.40% (6/1488), which was not statistically different than the incidence in normotensive patients (9/3268, 0.28%, p = 0.496). For the subgroup of native renal parenchymal biopsies, the rate of bleeding was slightly higher in hypertensive patients (3/213, 1.4% vs. 1/355, 0.28% in normotensive patients) but remained low, and the difference was not statistically significant (p = 0.188). CONCLUSION The overall incidence of major bleeding after percutaneous biopsy is very low. Hypertension does not appear to significantly increase the risk of major bleeding complications.
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Affiliation(s)
- Theodora A Potretzke
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA.
| | - Tina M Gunderson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 55905, USA
| | - David Aamodt
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Adam J Weisbrod
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Gina K Hesley
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Timothy J Welch
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Ave SW, Rochester, MN, 55905, USA
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Thongprayoon C, Cheungpasitporn W, Srivali N, Harrison AM, Gunderson TM, Kittanamongkolchai W, Greason KL, Kashani KB. AKI after Transcatheter or Surgical Aortic Valve Replacement. J Am Soc Nephrol 2015; 27:1854-60. [PMID: 26487562 DOI: 10.1681/asn.2015050577] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P=0.21), major adverse kidney events (2.1% versus 1.5%; P=0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P=0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.
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Affiliation(s)
| | | | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | | | | | | | - Kevin L Greason
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,
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