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Zuniga-Moya JC, Papadopoulos B, Mansoor AER, Mazi PB, Rauseo AM, Spec A. Incidence and Mortality of COVID-19-Associated Invasive Fungal Infections Among Critically Ill Intubated Patients: A Multicenter Retrospective Cohort Analysis. Open Forum Infect Dis 2024; 11:ofae108. [PMID: 38567199 PMCID: PMC10986750 DOI: 10.1093/ofid/ofae108] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background An association between coronavirus disease 2019 (COVID-19)-associated invasive fungal infections (CAIFIs) and high mortality among intubated patients has been suggested in previous research. However, some of the current evidence was derived from small case series and multicenter studies conducted during different waves of the COVID-19 pandemic. We examined the incidence of CAIFIs and their associated mortality using a large, multicenter COVID-19 database built throughout the pandemic. Methods We conducted a retrospective analysis of the National COVID Cohort Collaborative (N3C) database collected from 76 medical centers in the United States between January 2020 and August 2022. Patients were 18 years or older and intubated after severe acute respiratory syndrome coronavirus 2 infection. The primary outcomes were incidence and all-cause mortality at 90 days. To assess all-cause mortality, we fitted Cox proportional hazard models after adjusting for confounders via inverse probability weighting. Results Out of the 4 916 229 patients with COVID-19 diagnosed during the study period, 68 383 (1.4%) met our cohort definition. The overall incidence of CAIFI was 2.80% (n = 1934/68 383). Aspergillus (48.2%; n = 933/1934) and Candida (41.0%; n = 793/1934) were the most common causative organisms. The incidence of CAIFIs associated with Aspergillus among patients who underwent BAL was 6.2% (n = 83/1328). Following inverse probability weighting, CAIFIs caused by Aspergillus (hazard ratio [HR], 2.0; 95% CI, 1.8-2.2) and Candida (HR, 1.7; 95% CI, 1.5-1.9) were associated with increased all-cause mortality. Systemic antifungals reduced mortality in 17% of patients with CAIFI with Aspergillus and 24% of patients with CAIFI with Candida. Conclusions The incidence of CAIFI was modest but associated with higher 90-day all-cause mortality among intubated patients. Systemic antifungals modified mortality.
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Affiliation(s)
| | | | | | - Patrick B Mazi
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Adriana M Rauseo
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Andrej Spec
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
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Hamad Y, Nickel KB, Olsen MA, George IA. Outcomes of Ceftriaxone Compared With Cefazolin or Nafcillin/Oxacillin for Outpatient Therapy for Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections: Results From a Large United States Claims Database. Open Forum Infect Dis 2024; 11:ofad662. [PMID: 38352150 PMCID: PMC10863560 DOI: 10.1093/ofid/ofad662] [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: 08/28/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
Background Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking. Methods In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models. Results Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61-64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01-2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81-3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18-2.23]), central line-associated BSI (aOR, 1.72 [95% CI, 1.33-2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18-2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI, .67-1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI, .66-1.10]) when compared with oxacillin/nafcillin/cefazolin. Conclusions In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin.
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Affiliation(s)
- Yasir Hamad
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ige A George
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Tiwari A, Hashemiaghdam A, Laramie MA, Maschi D, Haddad T, Stunault MI, Bergom C, Javaheri A, Klyachko V, Ashrafi G. Sirtuin3 ensures the metabolic plasticity of neurotransmission during glucose deprivation. J Cell Biol 2024; 223:e202305048. [PMID: 37988067 PMCID: PMC10660140 DOI: 10.1083/jcb.202305048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/18/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Neurotransmission is an energetically expensive process that underlies cognition. During intense electrical activity or dietary restrictions, the glucose level in the brain plummets, forcing neurons to utilize alternative fuels. However, the molecular mechanisms of neuronal metabolic plasticity remain poorly understood. Here, we demonstrate that glucose-deprived neurons activate the CREB and PGC1α transcriptional program, which induces expression of the mitochondrial deacetylase Sirtuin 3 (Sirt3) both in vitro and in vivo. We show that Sirt3 localizes to axonal mitochondria and stimulates mitochondrial oxidative capacity in hippocampal nerve terminals. Sirt3 plays an essential role in sustaining synaptic transmission in the absence of glucose by providing metabolic support for the retrieval of synaptic vesicles after release. These results demonstrate that the transcriptional induction of Sirt3 facilitates the metabolic plasticity of synaptic transmission.
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Affiliation(s)
- Anupama Tiwari
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Arsalan Hashemiaghdam
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Marissa A. Laramie
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dario Maschi
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tristaan Haddad
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Marion I. Stunault
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ali Javaheri
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John Cochran VA Hospital, St. Louis, MO, USA
| | - Vitaly Klyachko
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ghazaleh Ashrafi
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
- Needleman Center for Neurometabolism and Axonal Therapeutics, Washington University School of Medicine, St. Louis, MO, USA
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Fritz CDL, Otegbeye EE, Zong X, Demb J, Nickel KB, Olsen MA, Mutch M, Davidson NO, Gupta S, Cao Y. Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst 2023; 115:909-916. [PMID: 37138415 PMCID: PMC10407716 DOI: 10.1093/jnci/djad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise. METHODS We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis. RESULTS Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (Ptrend < .001), respectively, with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month). CONCLUSIONS Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
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Affiliation(s)
- Cassandra D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ebunoluwa E Otegbeye
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Xiaoyu Zong
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Demb
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret A Olsen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Mutch
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas O Davidson
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Samir Gupta
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Internal Medicine, University of California San Diego, San Diego, CA, USA
- Veteran Affairs San Diego Healthcare System, Department of Medicine, Division of Gastroenterology, San Diego, CA, USA
| | - Yin Cao
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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Tardelli V, Xu KY, Bisaga A, Levin FR, Fidalgo TM, Grucza RA. Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk. BMJ Ment Health 2023; 26:e300728. [PMID: 37500184 PMCID: PMC10387656 DOI: 10.1136/bmjment-2023-300728] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (OUD) treatment with buprenorphine. OBJECTIVES To assess the effect of PAs on OUD buprenorphine treatment retention and/or SUD-related emergency admission or drug-related poisonings. METHODS We used a retrospective cohort design with a secondary analysis of data from Merative MarketScan Commercial and Multi-State Medicaid Databases from 1 January 2006 to 31 December 2016. Individuals included were aged 12-64 years, had an OUD diagnosis and were prescribed buprenorphine. Our analysis used multivariable Cox regression to evaluate the relationship between PA receipt and time to buprenorphine discontinuation. The second part focused on subsamples of buprenorphine initiators who had either (1) any SUD-related emergency admissions or (2) drug-related poisoning. These outcomes were modelled as a function of PA exposure using conditional logistic regression models as part of a within-person, case-crossover design. FINDINGS Our sample had 90 269 patients with OUD (mean age 34.2 years (SD=11.3)) who initiated buprenorphine. Being prescribed a PA was associated with improved buprenorphine retention among individuals both with (adjusted HR (aHR) 0.91 (95% CI 0.86 to 0.97)) and without a concurrent psychostimulant use disorder (PSUD) (aHR 0.92 (95% CI 0.90 to 0.93)). CONCLUSIONS PA use was associated with improved buprenorphine retention in people with OUD with and without co-occurring PSUD. The risks of acute SUD-related events and drug-related poisonings associated with PA use did not differ when comparing PA-using days with days without PA use. CLINICAL IMPLICATIONS Patients with OUD on buprenorphine should receive treatment with a PA when indicated.
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Affiliation(s)
- Vitor Tardelli
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Translational Addictions Research Lab, Centre for Addiction and Mental Health, Department of Psychiatr, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adam Bisaga
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York City, New York, USA
| | - Frances R Levin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA
| | - Thiago M Fidalgo
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Richard A Grucza
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
- Department of Health and Outcomes Research, Saint Louis University, St. Louis, Missouri, USA
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Shen H, Lane RA. Extracellular Vesicles From Primed Adipose-Derived Stem Cells Enhance Achilles Tendon Repair by Reducing Inflammation and Promoting Intrinsic Healing. Stem Cells 2023; 41:617-627. [PMID: 37085269 PMCID: PMC10267691 DOI: 10.1093/stmcls/sxad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
Achilles tendon rupture is a common sports-related injury. Even with advanced clinical treatments, many patients suffer from long-term pain and functional deficits. These unsatisfactory outcomes result primarily from an imbalanced injury response with excessive inflammation and inadequate tendon regeneration. Prior studies showed that extracellular vesicles from inflammation-primed adipose-derived stem cells (iEVs) can attenuate early tendon inflammatory response to injury. It remains to be determined if iEVs can both reduce inflammation and promote regeneration in the later phases of tendon healing and the underlying mechanism. Therefore, this study investigated the mechanistic roles of iEVs in regulating tendon injury response using a mouse Achilles tendon injury and repair model in vivo and iEV-macrophage and iEV-tendon cell coculture models in vitro. Results showed that iEVs promoted tendon anti-inflammatory gene expression and reduced mononuclear cell accumulation to the injury site in the remodeling phase of healing. iEVs also increased collagen deposition in the injury center and promoted tendon structural recovery. Accordingly, mice treated with iEVs showed less peritendinous scar formation, much lower incidence of postoperative tendon gap or rupture, and faster functional recovery compared to untreated mice. Further in vitro studies revealed that iEVs both inhibited macrophage M1 polarization and increased tendon cell proliferation and collagen production. The iEV effects were partially mediated by miR-147-3p, which blocked the toll-like receptor 4/NF-κB signaling pathway that activated the M1 phenotype of macrophages. The combined results demonstrate that iEVs are a promising therapeutic agent that can enhance tendon repair by attenuating inflammation and promoting intrinsic healing.
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Affiliation(s)
- Hua Shen
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan A Lane
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Smith GD, Thomas SL, Orscheln RC, Reyes SM, Reyes SA, Rosen DA, Terrill CM, Dodd S, Plax K, Newland JG. Listserv to Support Community Pediatric Clinicians During the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2023; 12:254-255. [PMID: 36915192 PMCID: PMC10146920 DOI: 10.1093/jpids/piad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Gabrielle D Smith
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sheridan L Thomas
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Summer M Reyes
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sydney A Reyes
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Rosen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cindy M Terrill
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sherry Dodd
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katie Plax
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Division of Adolescent Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
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Mazi PB, Sahrmann JM, Olsen MA, Coler-Reilly A, Rauseo AM, Pullen M, Zuniga-Moya JC, Powderly WG, Spec A. The Geographic Distribution of Dimorphic Mycoses in the United States for the Modern Era. Clin Infect Dis 2023; 76:1295-1301. [PMID: 36366776 PMCID: PMC10319749 DOI: 10.1093/cid/ciac882] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The dimorphic mycoses (DMs) of the United States-Histoplasma, Coccidioides, and Blastomyces-commonly known as endemic mycoses of North America (in addition to Paracoccidioides) are increasingly being diagnosed outside their historical areas of endemicity. Despite this trend, the maps outlining their geographic distributions have not been updated in more than half a century using a large, nationwide database containing individual-patient-level data. METHODS This was a retrospective analysis of >45 million Medicare fee-for-service beneficiaries from 1 January 2007 through 31 December 2016. Diagnoses of histoplasmosis, coccidioidomycosis, and blastomycosis were defined by International Classification of Diseases, Ninth/10th Revision, codes. The primary outcome was the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis for each US county. Clinically meaningful thresholds for incidence were defined as 100 cases/100 000 person-years for histoplasmosis and coccidioidomycosis and 50 cases/100 000 person-years for blastomycosis. RESULTS There were 79 749 histoplasmosis, 37 726 coccidioidomycosis, and 6109 blastomycosis diagnoses in unique persons from 2007-2016 across 3143 US counties. Considering all US states plus Washington, DC, 94% (48/51) had ≥1 county above the clinically relevant threshold for histoplasmosis, 69% (35/51) for coccidioidomycosis, and 78% (40/51) for blastomycosis. CONCLUSIONS Persons with histoplasmosis, coccidioidomycosis, and blastomycosis are diagnosed in significant numbers outside their historical geographic distributions established >50 years ago. Clinicians should consider DM diagnoses based on compatible clinical syndromes with less emphasis placed on patients' geographic exposure. Increased clinical suspicion leading to a subsequent increase in DM diagnostic testing would likely result in fewer missed diagnoses, fewer diagnostic delays, and improved patient outcomes.
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Affiliation(s)
- Patrick B Mazi
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - John M Sahrmann
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ariella Coler-Reilly
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Matthew Pullen
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julio C Zuniga-Moya
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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McGrath LJ, Frost HM, Newland JG, O’Neil CA, Sahrmann JM, Ma Y, Butler AM. Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States. Pharmacoepidemiol Drug Saf 2023; 32:256-265. [PMID: 36269007 PMCID: PMC9877117 DOI: 10.1002/pds.5554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration. METHODS Using national administrative claims data (2016-2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within-person antibiotic utilization for AOM, by agent and duration. RESULTS We identified 789 424 eligible commercially-insured and 502 239 medicaid-insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin-clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2-5 years and ≥6 years, respectively. Patterns were similar for medicaid-insured children. CONCLUSIONS Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad-spectrum agents and longer-than-recommended antibiotic durations.
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Affiliation(s)
| | - Holly M. Frost
- Department of Pediatrics, Denver Health Medical Center, Denver, Colorado
- Office of Research, Denver Health Medical Center, Denver, Colorado
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jason G. Newland
- Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO, USA
| | - Caroline A. O’Neil
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - John M. Sahrmann
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - Yinjiao Ma
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - Anne M. Butler
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
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Krysiak K, Danos A, Saliba J, McMichael J, Coffman A, Kiwala S, Barnell E, Sheta L, Grisdale C, Kujan L, Pema S, Lever J, Ridd S, Spies N, Andric V, Chiorean A, Rieke D, Clark K, Reisle C, Venigalla A, Evans M, Jani P, Takahashi H, Suda A, Horak P, Ritter D, Zhou X, Ainscough B, Delong S, Kesserwan C, Lamping M, Shen H, Marr A, Hoang M, Singhal K, Khanfar M, Li B, Lin WH, Terraf P, Corson L, Salama Y, Campbell K, Farncombe K, Ji J, Zhao X, Xu X, Kanagal-Shamanna R, King I, Cotto K, Skidmore Z, Walker J, Zhang J, Milosavljevic A, Patel R, Giles R, Kim R, Schriml L, Mardis E, Jones SJM, Raca G, Rao S, Madhavan S, Wagner A, Griffith M, Griffith O. CIViCdb 2022: evolution of an open-access cancer variant interpretation knowledgebase. Nucleic Acids Res 2023; 51:D1230-D1241. [PMID: 36373660 PMCID: PMC9825608 DOI: 10.1093/nar/gkac979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
CIViC (Clinical Interpretation of Variants in Cancer; civicdb.org) is a crowd-sourced, public domain knowledgebase composed of literature-derived evidence characterizing the clinical utility of cancer variants. As clinical sequencing becomes more prevalent in cancer management, the need for cancer variant interpretation has grown beyond the capability of any single institution. CIViC contains peer-reviewed, published literature curated and expertly-moderated into structured data units (Evidence Items) that can be accessed globally and in real time, reducing barriers to clinical variant knowledge sharing. We have extended CIViC's functionality to support emergent variant interpretation guidelines, increase interoperability with other variant resources, and promote widespread dissemination of structured curated data. To support the full breadth of variant interpretation from basic to translational, including integration of somatic and germline variant knowledge and inference of drug response, we have enabled curation of three new Evidence Types (Predisposing, Oncogenic and Functional). The growing CIViC knowledgebase has over 300 contributors and distributes clinically-relevant cancer variant data currently representing >3200 variants in >470 genes from >3100 publications.
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Affiliation(s)
- Kilannin Krysiak
- To whom correspondence should be addressed. Tel: +1 314 273 4218;
| | | | | | - Joshua F McMichael
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Adam C Coffman
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Susanna Kiwala
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Erica K Barnell
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Lana Sheta
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | | | - Lynzey Kujan
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Shahil Pema
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Jake Lever
- School of Computer Science, University of Glasgow, Glasgow, UK
| | - Sarah Ridd
- Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Nicholas C Spies
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Veronica Andric
- Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Andreea Chiorean
- Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Damian T Rieke
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kaitlin A Clark
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Caralyn Reisle
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
- Bioinformatics Graduate Program, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Ajay C Venigalla
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | | | - Payal Jani
- Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Hideaki Takahashi
- Department of Experimental Therapeutics/Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Avila Suda
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Peter Horak
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Deborah I Ritter
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX, USA
| | - Xin Zhou
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Benjamin J Ainscough
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Sean Delong
- Lassonde School of Engineering, York University, Toronto, Ontario, Canada
| | - Chimene Kesserwan
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA and Genetics Branch, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Mario Lamping
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Haolin Shen
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Alex R Marr
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - My H Hoang
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Kartik Singhal
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Mariam Khanfar
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Brian V Li
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | | | - Panieh Terraf
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura B Corson
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Yasser Salama
- Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Katie M Campbell
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Kirsten M Farncombe
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jianling Ji
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Xiaonan Zhao
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Xinjie Xu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology and Molecular Diagnostics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ian King
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network (UHN), Toronto, ON, Canada
| | - Kelsy C Cotto
- Department of Medicine, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Zachary L Skidmore
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Jason R Walker
- McDonnell Genome Institute, Washington University in St Louis School of Medicine, St. Louis, MO, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Ronak Y Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Rachel H Giles
- International Kidney Cancer Coalition, Duivendrecht-Amsterdam, the Netherlands
| | - Raymond H Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Sinai Health System, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario Institute for Cancer Research, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lynn M Schriml
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Gordana Raca
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Shruti Rao
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, WA DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, WA DC, USA
| | - Alex H Wagner
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Malachi Griffith
- Correspondence may also be addressed to Malachi Griffith. Tel: +1 314 286 1274;
| | - Obi L Griffith
- Correspondence may also be addressed to Obi L. Griffith. Tel: +1 314 747 9248;
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O’Halloran JA, Sahrmann J, Parra-Rodriguez L, Vo DT, Butler AM, Olsen MA, Powderly WG. Integrase Strand Transfer Inhibitors Are Associated With Incident Diabetes Mellitus in People With Human Immunodeficiency Virus. Clin Infect Dis 2022; 75:2060-2065. [PMID: 35521785 PMCID: PMC10200297 DOI: 10.1093/cid/ciac355] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 02/01/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are associated with weight gain in people with HIV (PWH). Less is known about the risk of other metabolic outcomes such as diabetes mellitus and hyperglycemia. METHODS IBM® MarketScan® databases for commercially and Medicaid-insured adults were used to identify PWH newly initiating antiretroviral therapy (ART). The primary outcome was a composite of new-onset diabetes mellitus/hyperglycemia in the 6 months following ART initiation and was identified using International Classification of Disease, Ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis and procedure codes and Current Procedural Terminology, 4th Edition (CPT-4) codes. To examine the relationship between INSTI use and the composite outcome, we estimated the risk using Cox proportional hazards models with calendar time-specific standardized mortality ratio weights. RESULTS Of 42 382 PWH who initiated ART between 1 July 2007 and 30 June 2018, 22 762 (54%) were treated with INSTI-based regimens. Mean age was 38 years, 74% were male, and 19% were Medicaid insured. PWH on INSTIs were 31% more likely to develop new-onset diabetes mellitus/hyperglycemia (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.15-1.48]) compared with those who initiated non-INSTI-based regimens. When examined individually, the highest risk was associated with elvitegravir (HR, 1.54; 95% CI, 1.32-1.97; P < .001) and the lowest risk with raltegravir (HR, 1.19; 95% CI, 1.03-1.37; P = .02). CONCLUSIONS INSTI use was associated with increased risk of new-onset diabetes mellitus/hyperglycemia in the 6 months following ART initiation.
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Affiliation(s)
- Jane A O’Halloran
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John Sahrmann
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Luis Parra-Rodriguez
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel T Vo
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anne M Butler
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Margaret A Olsen
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - William G Powderly
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Rauseo AM, Olsen MA, Stwalley D, Mazi PB, Larson L, Powderly WG, Spec A. Creation and Internal Validation of a Clinical Predictive Model for Fluconazole Resistance in Patients With Candida Bloodstream Infection. Open Forum Infect Dis 2022; 9:ofac447. [PMID: 36119958 PMCID: PMC9472663 DOI: 10.1093/ofid/ofac447] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Fluconazole is recommended as first-line therapy for candidemia when risk of fluconazole resistance (fluc-R) is low. Lack of methods to estimate resistance risk results in extended use of echinocandins and prolonged hospitalization. This study aimed to develop a clinical predictive model to identify patients at low risk for fluc-R where initial or early step-down fluconazole would be appropriate. Methods Retrospective analysis of hospitalized adult patients with positive blood culture for Candida spp from 2013 to 2019. Multivariable logistic regression model was performed to identify factors associated with fluc-R. Stepwise regression was performed on bootstrapped samples to test individual variable stability and estimate confidence intervals (CIs). We used receiver operating characteristic curves to assess performance across the probability spectrum. Results We identified 539 adults with candidemia and 72 Candida isolates (13.4%) were fluc-R. Increased risk of fluc-R was associated with older age, prior bacterial bloodstream infection (odds ratio [OR], 2.02 [95% CI, 1.13-3.63]), myelodysplastic syndrome (OR, 3.09 [95% CI, 1.13-8.44]), receipt of azole therapy (OR, 5.42 [95% CI, 2.90-10.1]) within 1 year of index blood culture, and history of bone marrow or stem cell transplant (OR, 2.81 [95% CI, 1.41-5.63]). The model had good discrimination (optimism-corrected c-statistic 0.771), and all of the selected variables were stable. The prediction model had a negative predictive value of 95.7% for the selected sensitivity cutoff of 90.3%. Conclusions This model is a potential tool for identifying patients at low risk for fluc-R candidemia to receive first-line or early step-down fluconazole.
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Affiliation(s)
- Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Dustin Stwalley
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Patrick B Mazi
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lindsey Larson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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Cederberg KLJ, Hanif U, Peris Sempere V, Hédou J, Leary EB, Schneider LD, Lin L, Zhang J, Morse AM, Blackman A, Schweitzer PK, Kotagal S, Bogan R, Kushida CA, Ju YES, Petousi N, Turnbull CD, Mignot E. Proteomic Biomarkers of the Apnea Hypopnea Index and Obstructive Sleep Apnea: Insights into the Pathophysiology of Presence, Severity, and Treatment Response. Int J Mol Sci 2022; 23:7983. [PMID: 35887329 PMCID: PMC9317550 DOI: 10.3390/ijms23147983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA), a disease associated with excessive sleepiness and increased cardiovascular risk, affects an estimated 1 billion people worldwide. The present study examined proteomic biomarkers indicative of presence, severity, and treatment response in OSA. Participants (n = 1391) of the Stanford Technology Analytics and Genomics in Sleep study had blood collected and completed an overnight polysomnography for scoring the apnea−hypopnea index (AHI). A highly multiplexed aptamer-based array (SomaScan) was used to quantify 5000 proteins in all plasma samples. Two separate intervention-based cohorts with sleep apnea (n = 41) provided samples pre- and post-continuous/positive airway pressure (CPAP/PAP). Multivariate analyses identified 84 proteins (47 positively, 37 negatively) associated with AHI after correction for multiple testing. Of the top 15 features from a machine learning classifier for AHI ≥ 15 vs. AHI < 15 (Area Under the Curve (AUC) = 0.74), 8 were significant markers of both AHI and OSA from multivariate analyses. Exploration of pre- and post-intervention analysis identified 5 of the 84 proteins to be significantly decreased following CPAP/PAP treatment, with pathways involving endothelial function, blood coagulation, and inflammatory response. The present study identified PAI-1, tPA, and sE-Selectin as key biomarkers and suggests that endothelial dysfunction and increased coagulopathy are important consequences of OSA, which may explain the association with cardiovascular disease and stroke.
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Affiliation(s)
- Katie L. J. Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Umaer Hanif
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, 2600 Glostrup, Denmark
| | - Vicente Peris Sempere
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Julien Hédou
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Eileen B. Leary
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Jazz Pharmaceuticals, 3170 Porter Drive, Palo Alto, CA 94304, USA
| | - Logan D. Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
- Alphabet, Inc., 1600 Amphitheater Parkway Mountain View, Palo Alto, CA 94043, USA
- Stanford/VA Alzheimer’s Research Center, 3801 Miranda Ave, Building 4, C-141, Mail Code 116F-PAD, Palo Alto, CA 94304, USA
| | - Ling Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Jing Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Anne M. Morse
- Division of Child Neurology and Pediatric Sleep Medicine, Geisinger, Janet Weis Children’s Hospital, 100 N Academy Ave, Danville, PA 17822, USA;
| | - Adam Blackman
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1L5, Canada;
| | - Paula K. Schweitzer
- Sleep Medicine & Research Center, St. Lukes Hospital, 232 S. Woods Mill Road, Chesterfield, MO 63017, USA;
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, 200 First St., Rochester, MN 55905, USA;
| | - Richard Bogan
- College of Medicine, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA;
| | - Clete A. Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
| | - Yo-El S. Ju
- Department of Neurology, Washington University, St. Louis, MO 63110, USA;
- Hope Center for Neurological Disorders, Washington University, St. Louis, MO 63110, USA
- Center on Biological Rhythms and Sleep (COBRAS), Washington University, 1600 S. Brentwood Blvd, St. Louis, MO 63144, USA
| | - Nayia Petousi
- Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Chris D. Turnbull
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK;
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, 3165 Porter Drive, Stanford, CA 94304, USA; (K.L.J.C.); (U.H.); (V.P.S.); (J.H.); (E.B.L.); (L.D.S.); (L.L.); (J.Z.); (C.A.K.)
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14
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Menssen AJ, Khanna A, Miller CA, Nonavinkere Srivatsan S, Chang GS, Shao J, Robinson J, O'Laughlin M, Fronick CC, Fulton RS, Brendel K, Heath SE, Saba R, Welch JS, Spencer DH, Payton JE, Westervelt P, DiPersio JF, Link DC, Schuelke MJ, Jacoby MA, Duncavage EJ, Ley TJ, Walter MJ. Convergent Clonal Evolution of Signaling Gene Mutations Is a Hallmark of Myelodysplastic Syndrome Progression. Blood Cancer Discov 2022; 3:330-345. [PMID: 35709710 PMCID: PMC9338759 DOI: 10.1158/2643-3230.bcd-21-0155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Progression from myelodysplastic syndromes (MDS) to secondary acute myeloid leukemia (AML) is associated with the acquisition and expansion of subclones. Our understanding of subclone evolution during progression, including the frequency and preferred order of gene mutation acquisition, remains incomplete. Sequencing of 43 paired MDS and secondary AML samples identified at least one signaling gene mutation in 44% of MDS and 60% of secondary AML samples, often below the level of standard sequencing detection. In addition, 19% of MDS and 47% of secondary AML patients harbored more than one signaling gene mutation, almost always in separate, coexisting subclones. Signaling gene mutations demonstrated diverse patterns of clonal evolution during disease progression, including acquisition, expansion, persistence, and loss of mutations, with multiple patterns often coexisting in the same patient. Multivariate analysis revealed that MDS patients who had a signaling gene mutation had a higher risk of AML progression, potentially providing a biomarker for progression. SIGNIFICANCE Subclone expansion is a hallmark of progression from MDS to secondary AML. Subclonal signaling gene mutations are common at MDS (often at low levels), show complex and convergent patterns of clonal evolution, and are associated with future progression to secondary AML. See related article by Guess et al., p. 316 (33). See related commentary by Romine and van Galen, p. 270. This article is highlighted in the In This Issue feature, p. 265.
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Affiliation(s)
- Andrew J. Menssen
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ajay Khanna
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher A. Miller
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Sridhar Nonavinkere Srivatsan
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Gue Su Chang
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Jin Shao
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua Robinson
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michele O'Laughlin
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Catrina C. Fronick
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S. Fulton
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly Brendel
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Sharon E. Heath
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Raya Saba
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John S. Welch
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - David H. Spencer
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jacqueline E. Payton
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Westervelt
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - John F. DiPersio
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel C. Link
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew J. Schuelke
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Meagan A. Jacoby
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Eric J. Duncavage
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy J. Ley
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew J. Walter
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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15
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Mazi PB, Arnold SR, Baddley JW, Bahr NC, Beekmann SE, McCarty TP, Polgreen PM, Rauseo AM, Spec A. Management of Histoplasmosis by Infectious Disease Physicians. Open Forum Infect Dis 2022; 9:ofac313. [PMID: 35899286 PMCID: PMC9310261 DOI: 10.1093/ofid/ofac313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were last revised 15 years ago. Since those guidelines were compiled, new antifungal treatment options have been developed. Furthermore, the ongoing development of immunomodulatory therapies has increased the population at increased risk to develop histoplasmosis. Methods An electronic survey about the management practices of histoplasmosis was distributed to the adult infectious disease (ID) physician members of the IDSA's Emerging Infections Network. Results The survey response rate was 37% (551/1477). Only 46% (253/551) of respondents reported seeing patients with histoplasmosis. Regions considered endemic had 82% (158/193) of physicians report seeing patients with histoplasmosis compared to 27% (95/358) of physicians in regions not classically considered endemic (P < 0.001). Most ID physicians follow IDSA treatment guidelines recommending itraconazole for acute pulmonary (189/253 [75%]), mild-moderate disseminated (189/253 [75%]), and as step-down therapy for severe disseminated histoplasmosis with (232/253 [92%]) and without (145/253 [57%]) central nervous system involvement. There were no consensus recommendations observed for survey questions regarding immunocompromised patients. Conclusions Though there are increased reports of histoplasmosis diagnoses outside regions classically considered endemic, a majority of ID physicians reported not seeing patients with histoplasmosis. Most respondents reported adherence to IDSA guidelines recommending itraconazole in each clinical situation. New histoplasmosis guidelines need to reflect the growing need for updated general guidance, particularly for immunocompromised populations.
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Affiliation(s)
- Patrick B Mazi
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Sandra R Arnold
- Division of Pediatric Infectious Diseases, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - John W Baddley
- Division of Infectious Diseases, University of Maryland, Baltimore, Maryland, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, University of Kansas, Kansas City, Kansas, USA
| | - Susan E Beekmann
- Division of Infectious Diseases, University of Iowa, Iowa City, Iowa, USA
- Emerging Infections Network, University of Iowa, Iowa City, Iowa, USA
| | - Todd P McCarty
- Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, USA
| | - Philip M Polgreen
- Division of Infectious Diseases, University of Iowa, Iowa City, Iowa, USA
- Emerging Infections Network, University of Iowa, Iowa City, Iowa, USA
| | - Adriana M Rauseo
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
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16
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Olsen MA, Greenberg JK, Peacock K, Nickel KB, Fraser VJ, Warren DK. Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion. J Antimicrob Chemother 2022; 77:1178-1184. [PMID: 35040936 PMCID: PMC9126069 DOI: 10.1093/jac/dkab475] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/24/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). METHODS Persons aged 10-64 years undergoing spinal fusion between 1 January 2010 and 30 June 2015 were identified in the MarketScan Commercial Database. Complicated patients and those coded for infection from 30 days before to 2 days after the surgical admission were excluded. Outpatient oral antibiotics were identified within 2 days of surgical discharge. SSI was defined using ICD-9-CM diagnosis codes within 90 days of surgery. Generalized linear models were used to determine factors associated with post-discharge prophylactic antibiotic use and with SSI. RESULTS The cohort included 156 446 fusion procedures, with post-discharge prophylactic antibiotics used in 9223 (5.9%) surgeries. SSIs occurred after 2557 (1.6%) procedures. Factors significantly associated with post-discharge prophylactic antibiotics included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. In multivariable analysis, post-discharge prophylactic antibiotic use was not associated with SSI risk after spinal fusion (relative risk 0.98; 95% CI 0.84-1.14). CONCLUSIONS Post-discharge prophylactic oral antibiotics after spinal fusion were used more commonly in patients with major medical comorbidities, more complex surgeries and those with postoperative complications during the surgical admission. After adjusting for surgical complexity and infection risk factors, post-discharge prophylactic antibiotic use was not associated with decreased SSI risk. These results suggest that prolonged prophylactic antibiotic use should be avoided after spine surgery, given the lack of benefit and potential for harm.
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Affiliation(s)
- Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kate Peacock
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Katelin B. Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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17
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Bray MJ, Chen LS, Fox L, Ma Y, Grucza RA, Hartz SM, Culverhouse RC, Saccone NL, Hancock DB, Johnson EO, McKay JD, Baker TB, Bierut LJ. Studying the Utility of Using Genetics to Predict Smoking-Related Outcomes in a Population-Based Study and a Selected Cohort. Nicotine Tob Res 2021; 23:2110-2116. [PMID: 33991188 PMCID: PMC8570670 DOI: 10.1093/ntr/ntab100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/10/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The purpose of this study is to examine the predictive utility of polygenic risk scores (PRSs) for smoking behaviors. AIMS AND METHODS Using summary statistics from the Sequencing Consortium of Alcohol and Nicotine use consortium, we generated PRSs of ever smoking, age of smoking initiation, cigarettes smoked per day, and smoking cessation for participants in the population-based Atherosclerosis Risk in Communities (ARIC) study (N = 8638), and the Collaborative Genetic Study of Nicotine Dependence (COGEND) (N = 1935). The outcomes were ever smoking, age of smoking initiation, heaviness of smoking, and smoking cessation. RESULTS In the European ancestry cohorts, each PRS was significantly associated with the corresponding smoking behavior outcome. In the ARIC cohort, the PRS z-score for ever smoking predicted smoking (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.31, 1.43); the PRS z-score for age of smoking initiation was associated with age of smoking initiation (OR: 0.87; 95% CI: 0.82, 0.92); the PRS z-score for cigarettes per day was associated with heavier smoking (OR: 1.17; 95% CI: 1.11, 1.25); and the PRS z-score for smoking cessation predicted successful cessation (OR: 1.24; 95% CI: 1.17, 1.32). In the African ancestry cohort, the PRSs did not predict smoking behaviors. CONCLUSIONS Smoking-related PRSs were associated with smoking-related behaviors in European ancestry populations. This improvement in prediction is greatest in the lowest and highest genetic risk categories. The lack of prediction in African ancestry populations highlights the urgent need to increase diversity in research so that scientific advances can be applied to populations other than those of European ancestry. IMPLICATIONS This study shows that including both genetic ancestry and PRSs in a single model increases the ability to predict smoking behaviors compared with the model including only demographic characteristics. This finding is observed for every smoking-related outcome. Even though adding genetics is more predictive, the demographics alone confer substantial and meaningful predictive power. However, with increasing work in PRSs, the predictive ability will continue to improve.
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Affiliation(s)
- Michael J Bray
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Louis Fox
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Yinjiao Ma
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah M Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert C Culverhouse
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Nancy L Saccone
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Dana B Hancock
- GenOmics, Bioinformatics, and Translational Research Center, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, USA
| | - Eric O Johnson
- GenOmics, Bioinformatics, and Translational Research Center, Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, USA
- Fellow Program, RTI International, Research Triangle Park, NC, USA
| | - James D McKay
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Timothy B Baker
- Department of Medicine, Center for Tobacco Research and Intervention, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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18
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Choreño-Parra JA, Jiménez-Álvarez LA, Ramírez-Martínez G, Cruz-Lagunas A, Thapa M, Fernández-López LA, Carnalla-Cortés M, Choreño-Parra EM, Mena-Hernández L, Sandoval-Vega M, Hernández-Montiel EM, Hernández-García DL, Ramírez-Noyola JA, Reyes-López CE, Domínguez-Faure A, Zamudio-López GY, Márquez-García E, Moncada-Morales A, Mendoza-Milla C, Cervántes-Rosete D, Muñoz-Torrico M, Luna-Rivero C, García-Latorre EA, Guadarrama-Ortíz P, Ávila-Moreno F, Domínguez-Cherit G, Rodríguez-Reyna TS, Mudd PA, Hernández-Cárdenas CM, Khader SA, Zúñiga J. Expression of Surfactant Protein D Distinguishes Severe Pandemic Influenza A(H1N1) from Coronavirus Disease 2019. J Infect Dis 2021; 224:21-30. [PMID: 33668070 PMCID: PMC7989215 DOI: 10.1093/infdis/jiab113] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/11/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
The differentiation between influenza and coronavirus disease 2019 (COVID-19) could constitute a diagnostic challenge during the ongoing winter owing to their clinical similitude. Thus, novel biomarkers are required to enable making this distinction. Here, we evaluated whether the surfactant protein D (SP-D), a collectin produced at the alveolar epithelium with known immune properties, was useful to differentiate pandemic influenza A(H1N1) from COVID-19 in critically ill patients. Our results revealed high serum SP-D levels in patients with severe pandemic influenza but not those with COVID-19. This finding was validated in a separate cohort of mechanically ventilated patients with COVID-19 who also showed low plasma SP-D levels. However, plasma SP-D levels did not distinguish seasonal influenza from COVID-19 in mild-to-moderate disease. Finally, we found that high serum SP-D levels were associated with death and renal failure among severe pandemic influenza cases. Thus, our studies have identified SP-D as a unique biomarker expressed during severe pandemic influenza but not COVID-19.
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Affiliation(s)
- José Alberto Choreño-Parra
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Luis Armando Jiménez-Álvarez
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Ramírez-Martínez
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alfredo Cruz-Lagunas
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Mahima Thapa
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Luis Alejandro Fernández-López
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Martha Carnalla-Cortés
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Eduardo M Choreño-Parra
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Lourdes Mena-Hernández
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Montserrat Sandoval-Vega
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla de Baz, Mexico
| | - Erika Mariana Hernández-Montiel
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Diana Lizzeth Hernández-García
- Respiratory Critical Care Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Jazmín Ariadna Ramírez-Noyola
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla de Baz, Mexico
| | - Cynthia Estefania Reyes-López
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Andrea Domínguez-Faure
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Guillermo Yamil Zamudio-López
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Eduardo Márquez-García
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Angélica Moncada-Morales
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Criselda Mendoza-Milla
- Departamento de Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Isamel Cosío Villegas, Mexico City, Mexico
| | - Diana Cervántes-Rosete
- Deparment of Immunology and Reumathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Cesar Luna-Rivero
- Department of Pathology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ethel A García-Latorre
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Federico Ávila-Moreno
- Biomedicine Research Unit, Lung Diseases and Cancer Epigenomics Laboratory, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla de Baz, Mexico
| | - Guillermo Domínguez-Cherit
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Intensive Care Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Tatiana Sofía Rodríguez-Reyna
- Deparment of Immunology and Reumathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Philip A Mudd
- Department of Emergency Medicine, Washington University School of Medicine in St Louis, Missouri, USA
| | | | - Shabaana A Khader
- Department of Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
| | - Joaquín Zúñiga
- Laboratorio de Inmunobiología y Genética, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
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Choi MH, Blanco A, Stealey S, Duan X, Case N, Sell SA, Rai MF, Zustiak SP. Micro-Clotting of Platelet-Rich Plasma Upon Loading in Hydrogel Microspheres Leads to Prolonged Protein Release and Slower Microsphere Degradation. Polymers (Basel) 2020; 12:E1712. [PMID: 32751604 PMCID: PMC7464943 DOI: 10.3390/polym12081712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/30/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022] Open
Abstract
Platelet-rich plasma (PRP) is an autologous blood product that contains a variety of growth factors (GFs) that are released upon platelet activation. Despite some therapeutic potential of PRP in vitro, in vivo data are not convincing. Bolus injection of PRP is cleared rapidly from the body diminishing its therapeutic efficacy. This highlights a need for a delivery vehicle for a sustained release of PRP to improve its therapeutic effect. In this study, we used microfluidics to fabricate biodegradable PRP-loaded polyethylene glycol (PEG) microspheres. PRP was incorporated into the microspheres as a lyophilized PRP powder either as is (powder PRP) or first solubilized and pre-clotted to remove clots (liquid PRP). A high PRP loading of 10% w/v was achieved for both PRP preparations. We characterized the properties of the resulting PRP-loaded PEG microspheres including swelling, modulus, degradation, and protein release as a function of PRP loading and preparation. Overall, loading powder PRP into the PEG microspheres significantly affected the properties of microspheres, with the most pronounced effect noted in degradation. We further determined that microsphere degradation in the presence of powder PRP was affected by platelet aggregation and clotting. Platelet aggregation did not prevent but prolonged sustained PRP release from the microspheres. The delivery system developed and characterized herein could be useful for the loading and releasing of PRP to promote tissue regeneration and wound healing or to suppress tissue degeneration in osteoarthritis, and intervertebral disc degeneration.
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Affiliation(s)
- Miran Hannah Choi
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Alexandra Blanco
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Samuel Stealey
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Xin Duan
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA; (X.D.); (M.F.R.)
| | - Natasha Case
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Scott Allen Sell
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Muhammad Farooq Rai
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA; (X.D.); (M.F.R.)
- Department of Cell Biology & Physiology, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA
| | - Silviya Petrova Zustiak
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
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20
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Wang MH, Mousa OY, Friton JJ, Raffals LE, Leighton JA, Pasha SF, Picco MF, Cushing KC, Monroe K, Nix BD, Newberry RD, Faubion WA. Unique Phenotypic Characteristics and Clinical Course in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis: A Multicenter US Experience. Inflamm Bowel Dis 2020; 26:774-779. [PMID: 31626701 PMCID: PMC7534392 DOI: 10.1093/ibd/izz209] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC) is a rare phenotype. We aimed to assess patients with UC-PSC or UC alone and describe differences in clinical and phenotypic characteristics, antitumor necrosis factor (TNF) therapy, and long-term clinical outcomes. METHODS This retrospective multicenter cohort study included patients who received a diagnosis of UC from 1962 through 2015. We evaluated clinical factors associated with UC-PSC vs UC alone and assessed associations by using multivariable logistic regression models. RESULTS Among 522 patients with UC, 56 (10.7%) had PSC. Compared with UC alone, patients with UC-PSC were younger (younger than 20 years) at diagnosis (odds ratios [OR], 2.35; adjusted P = 0.02) and had milder UC severity (adjusted P = 0.05), despite having pancolonic involvement (OR, 7.01; adjusted P < 0.001). In the biologics era (calendar year 2005 to 2015), patients with UC-PSC less commonly received anti-TNF therapy compared with patients with UC (OR, 0.38; adjusted P = 0.009), but their response rates were similar. Fewer patients with UC-PSC received corticosteroids (OR, 0.24; adjusted P = 0.005) or rectal 5-aminosalicyte acid (OR, 0.26; adjusted P < 0.001). Other differences were identified that were not statistically significant in a multivariable model: patients with UC-PSC more commonly were male, had lower rates of smoking, and had higher rates of colorectal cancer and colectomy. DISCUSSION This study identified a unique phenotype of UC with concurrent PSC, which had different clinical behavior compared with UC only. These phenotypic characteristics can help identify high-risk patients with UC before PSC is diagnosed and guide different management and monitoring strategies.
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Affiliation(s)
- Ming-Hsi Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Gastroenterology, Mayo Clinic Health System in Mankato, Mankato, Minnesota, USA
| | - Omar Y Mousa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica J Friton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan A Leighton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shabana F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Michael F Picco
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kelly C Cushing
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly Monroe
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Billy D Nix
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rodney D Newberry
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Carter EB, Stockburger J, Tuuli MG, Macones GA, Odibo AO, Trudell AS. Large-for-gestational age and stillbirth: is there a role for antenatal testing? Ultrasound Obstet Gynecol 2019; 54:334-337. [PMID: 30353961 PMCID: PMC7543666 DOI: 10.1002/uog.20162] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the association between large-for-gestational-age (LGA) pregnancy and stillbirth to determine if the LGA fetus may benefit from antenatal testing with non-stress test or biophysical profile. METHODS This was a retrospective cohort study of singleton pregnancies that were ongoing at 24 weeks' gestation and that had undergone routine second-trimester anatomy ultrasound examination, during the period 1990 to 2009. Pregnancies complicated by fetal anomaly or aneuploidy, those with missing birth weight information and those that were small-for-gestational age were excluded. Appropriate-for-gestational age (AGA) and LGA were defined as birth weight between the 10th and 90th percentiles and > 90th percentile, respectively, according to the Alexander growth standard. The incidence of stillbirth was calculated as the number of stillbirths per 10 000 ongoing pregnancies. Adjusted odds ratios (aOR) with 95% CI for stillbirth in LGA compared with AGA pregnancies were estimated using logistic regression analysis, controlling for pre-existing and gestational diabetes. The incidence and aOR for stillbirth were estimated at 4-week intervals from ≥ 24 to ≥ 40 weeks' gestation. RESULTS Of 52 749 pregnancies ongoing at 24 weeks, 46 205 (87.6%) were AGA and 6544 (12.4%) were LGA at delivery. The incidence of stillbirth in LGA pregnancies was significantly higher than that in AGA pregnancies from 36 weeks' gestation (26/10 000 vs 7/10 000; aOR, 3.10; 95% CI, 1.68-5.70). When women with diabetes were excluded in stratified analysis, pregnancies complicated by LGA continued to be at increased risk for stillbirth ≥ 36 weeks (18/10 000 vs 7/10 000; OR, 2.63; 95% CI, 1.27-5.43). CONCLUSION Pregnancies complicated by LGA are at significantly increased risk for stillbirth at or beyond 36 weeks, independent of maternal diabetes status, and may benefit from antenatal testing. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E B Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - J Stockburger
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - M G Tuuli
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - G A Macones
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - A O Odibo
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Moorsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - A S Trudell
- Barnes Jewish Christian Medical Group, Maternal Fetal Medicine, St Louis, MO, USA
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Trudell AS, Tuuli MG, Colditz GA, Macones GA, Odibo AO. A stillbirth calculator: Development and internal validation of a clinical prediction model to quantify stillbirth risk. PLoS One 2017; 12:e0173461. [PMID: 28267756 PMCID: PMC5340400 DOI: 10.1371/journal.pone.0173461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/22/2017] [Indexed: 01/06/2023] Open
Abstract
Objective To generate a clinical prediction tool for stillbirth that combines maternal risk factors to provide an evidence based approach for the identification of women who will benefit most from antenatal testing for stillbirth prevention. Design Retrospective cohort study Setting Midwestern United States quaternary referral center Population Singleton pregnancies undergoing second trimester anatomic survey from 1999–2009. Pregnancies with incomplete follow-up were excluded. Methods Candidate predictors were identified from the literature and univariate analysis. Backward stepwise logistic regression with statistical comparison of model discrimination, calibration and clinical performance was used to generate final models for the prediction of stillbirth. Internal validation was performed using bootstrapping with 1,000 repetitions. A stillbirth risk calculator and stillbirth risk score were developed for the prediction of stillbirth at or beyond 32 weeks excluding fetal anomalies and aneuploidy. Statistical and clinical cut-points were identified and the tools compared using the Integrated Discrimination Improvement. Main outcome measures Antepartum stillbirth Results 64,173 women met inclusion criteria. The final stillbirth risk calculator and score included maternal age, black race, nulliparity, body mass index, smoking, chronic hypertension and pre-gestational diabetes. The stillbirth calculator and simple risk score demonstrated modest discrimination but clinically significant performance with no difference in overall performance between the tools [(AUC 0.66 95% CI 0.60–0.72) and (AUC 0.64 95% CI 0.58–0.70), (p = 0.25)]. Conclusion A stillbirth risk score was developed incorporating maternal risk factors easily ascertained during prenatal care to determine an individual woman’s risk for stillbirth and provide an evidenced based approach to the initiation of antenatal testing for the prediction and prevention of stillbirth.
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Affiliation(s)
- Amanda S. Trudell
- Mercy Hospital St. Louis Department of Obstetrics and Gynecology, Midwest Maternal Fetal Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Methodius G. Tuuli
- Washington University School of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, St. Louis, Missouri, United States of America
| | - Graham A. Colditz
- Washington University School of Medicine Department of Surgery Division of Public Health, St. Louis, Missouri, United States of America
| | - George A. Macones
- Washington University School of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, St. Louis, Missouri, United States of America
| | - Anthony O. Odibo
- University of South Florida, Moorsani College of Medicine Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, Tampa, Florida, United States of America
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George IA, Santos CAQ, Olsen MA, Powderly WG. Epidemiology of Cryptococcosis and Cryptococcal Meningitis in a Large Retrospective Cohort of Patients After Solid Organ Transplantation. Open Forum Infect Dis 2017; 4:ofx004. [PMID: 28480277 PMCID: PMC5414000 DOI: 10.1093/ofid/ofx004] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients. There are no nationally representative data describing the incidence, risk factors, and outcomes of cryptococcosis after SOT. METHODS We assembled a large cohort of adult SOT recipients using Classification of Diseases, Ninth Revision, Clinical Modification billing data from Healthcare Cost and Utilization Project State Inpatient Databases of Florida (2006-2012), New York (2006-2011), and California (2004-2010). Demographics, comorbidities, death, and cryptococcal infections coded during hospitalization were identified. RESULTS A total of 42634 adults with SOT were identified during the study period. Cryptococcal disease was identified in 0.37% (n = 158), 44% of which had meningitis (n = 69). Median time to diagnosis of cryptococcosis was 464 days (range, 4-2393). The median time to onset of cryptococcosis was earlier for lung (191 days; range, 7.5-1816), heart (195 days; range, 4-1061), and liver (200 days; range, 4-1581) compared with kidney transplant recipients (616 days; range, 12-2393; P < .001, log rank test). Very early-onset disease (<30 days after transplantation) more frequently occurred in liver and lung transplant recipients. Lung transplant recipients had the highest risk of cryptococcosis (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.21-3.60). Cryptococcosis was associated with death (HR, 2.29; 95% CI, 1.68-3.11), after adjusting for age, type of SOT, and other comorbidities. CONCLUSIONS Cryptococcosis is rare after SOT, but it is associated with significantly increased risk of death. Lung transplant recipients are at highest risk for cryptococcosis among SOTs. Nonkidney transplants have earlier onset of cryptococcosis and higher risk of death compared with kidney transplant recipients.
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Affiliation(s)
| | | | - Margaret A Olsen
- Divisions of Infectious Diseases and
- Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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