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Jabbour E, Stelljes M, Advani A, DeAngelo D, Wang T, Neuhof A, Vandendries E, Kantarjian H. PS954 TIME FROM RANDOMIZATION TO FIRST SUBSEQUENT INDUCTION/SALVAGE THERAPY IN PATIENTS WITH RELAPSED/REFRACTORY ACUTE LYMPHOBLASTIC LEUKEMIA TREATED WITH INOTUZUMAB OZOGAMICIN IN THE PHASE 3 INO-VATE TRIAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000562088.92701.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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2
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Nazha A, Al-Issa K, Hamilton BK, Radivoyevitch T, Gerds AT, Mukherjee S, Adema V, Zarzour A, Abuhadra N, Patel BJ, Hirsch CM, Advani A, Przychodzen B, Carraway HE, Maciejewski JP, Sekeres MA. Adding molecular data to prognostic models can improve predictive power in treated patients with myelodysplastic syndromes. Leukemia 2017; 31:2848-2850. [DOI: 10.1038/leu.2017.266] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3
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Nazha A, Al-Issa K, Zarzour A, Radivoyevitch T, Hamilton B, Gerds A, Mukherjee S, Adema V, Clemente M, Patel B, Hirsch C, Advani A, Bartlomiej P, Carraway H, Maciejewski J, Sekeres M. Adding Molecular Data to Prognostic Models can Improve their Predictive Power in Treated Patients with Myelodysplastic Syndromes (MDS). Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Stock W, Diouf B, Crews KR, Pei D, Cheng C, Laumann K, Mandrekar SJ, Luger S, Advani A, Stone RM, Larson RA, Evans WE. An Inherited Genetic Variant in CEP72 Promoter Predisposes to Vincristine-Induced Peripheral Neuropathy in Adults With Acute Lymphoblastic Leukemia. Clin Pharmacol Ther 2016; 101:391-395. [PMID: 27618250 DOI: 10.1002/cpt.506] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 01/28/2023]
Abstract
Peripheral neuropathy is a major toxicity of vincristine, yet no strategies exist for identifying adult patients at high-risk. We used a case-control design of 48 adults receiving protocol therapy for acute lymphoblastic leukemia (ALL) who developed vincristine-induced neuropathy (NCI grade 2-4) during treatment, and 48 matched controls who did not develop grade 2-4 neuropathy. Peripheral neuropathy was prospectively graded by National Cancer Institute (NCI) criteria. CEP72 promoter genotype (rs924607) was determined using polymerase chain reaction (PCR)-based single nucleotide polymorphism (SNP) genotyping. Frequency of the CEP72 T/T genotype was higher in cases (31% vs. 10%, P = 0.0221) and the incidence of vincristine-induced neuropathy (grades 2-4) was significantly higher in patients homozygous for the CEP72 T/T genotype. 75% of the 20 patients homozygous for the CEP72 T allele developed grade 2-4 neuropathy, compared to 44% of patients with CEP72 CC or CT genotype (P = 0.0221). The CEP72 polymorphism can identify adults at increased risk of vincristine-induced peripheral neuropathy.
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Affiliation(s)
- W Stock
- Section of Hematology Oncology, University of Chicago Medicine and Comprehensive Cancer Center, Chicago, Illinois, USA.,Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - B Diouf
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - K R Crews
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - D Pei
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - C Cheng
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - K Laumann
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA.,Alliance Statistics and Data Center; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - S J Mandrekar
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA.,Alliance Statistics and Data Center; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - S Luger
- University of Pennsylvania, ECOG-ACRIN Cancer Research Group, Philadelphia, Pennsylvania, USA
| | - A Advani
- Cleveland Clinic, Southwest Oncology Cooperative Group, Cleveland, Ohio, USA
| | - R M Stone
- Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - R A Larson
- Section of Hematology Oncology, University of Chicago Medicine and Comprehensive Cancer Center, Chicago, Illinois, USA.,Alliance for Clinical Trials in Oncology, Chicago, Illinois, USA
| | - W E Evans
- Hematological Malignancies Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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5
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Nazha A, Narkhede M, Radivoyevitch T, Seastone DJ, Patel BJ, Gerds AT, Mukherjee S, Kalaycio M, Advani A, Przychodzen B, Carraway HE, Maciejewski JP, Sekeres MA. Incorporation of molecular data into the Revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes. Leukemia 2016; 30:2214-2220. [DOI: 10.1038/leu.2016.138] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
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6
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Mahmud F, Noordin K, DeMelo E, Marcon M, Assor E, Cutz E, Davies-Shaw J, Sahota K, Advani A, Bax K, Beaton M, Cino M, Gallego P, Gilbert J, Kirsch S, Koltin D, Lawson M, Mack D, McDonald C, Mukerji G, Perkins B, Saibil F, Szentgyorgi E. 149: Type and Frequency of Reported Gastrointestinal Symptoms in Pediatric & Adult Type 1 Diabetes Patients Evaluated as Part of the CD-Diet Study. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e88a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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van Gent M, Heuvelman CJ, van der Heide HG, Hallander HO, Advani A, Guiso N, Wirsing von Kőnig CH, Vestrheim DF, Dalby T, Fry NK, Pierard D, Detemmerman L, Zavadilova J, Fabianova K, Logan C, Habington A, Byrne M, Lutyńska A, Mosiej E, Pelaz C, Gröndahl-Yli-Hannuksela K, Barkoff AM, Mertsola J, Economopoulou A, He Q, Mooi FR. Analysis of Bordetella pertussis clinical isolates circulating in European countries during the period 1998-2012. Eur J Clin Microbiol Infect Dis 2014; 34:821-30. [PMID: 25527446 PMCID: PMC4365279 DOI: 10.1007/s10096-014-2297-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/07/2014] [Indexed: 12/31/2022]
Abstract
Despite more than 50 years of vaccination, pertussis is still an endemic disease, with regular epidemic outbreaks. With the exception of Poland, European countries have replaced whole-cell vaccines (WCVs) by acellular vaccines (ACVs) in the 1990s. Worldwide, antigenic divergence in vaccine antigens has been found between vaccine strains and circulating strains. In this work, 466 Bordetella pertussis isolates collected in the period 1998–2012 from 13 European countries were characterised by multi-locus antigen sequence typing (MAST) of the pertussis toxin promoter (ptxP) and of the genes coding for proteins used in the ACVs: pertussis toxin (Ptx), pertactin (Prn), type 2 fimbriae (Fim2) and type 3 fimbriae (Fim3). Isolates were further characterised by fimbrial serotyping, multi-locus variable-number tandem repeat analysis (MLVA) and pulsed-field gel electrophoresis (PFGE). The results showed a very similar B. pertussis population for 12 countries using ACVs, while Poland, which uses a WCV, was quite distinct, suggesting that ACVs and WCVs select for different B. pertussis populations. This study forms a baseline for future studies on the effect of vaccination programmes on B. pertussis populations.
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Affiliation(s)
- M van Gent
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands,
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8
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Zeddeman A, van Gent M, Heuvelman CJ, van der Heide HG, Bart MJ, Advani A, Hallander HO, Wirsing von Konig CH, Riffelman M, Storsaeter J, Vestrheim DF, Dalby T, Krogfelt KA, Fry NK, Barkoff AM, Mertsola J, He Q, Mooi F. Investigations into the emergence of pertactin-deficient Bordetella pertussis isolates in six European countries, 1996 to 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 25166348 DOI: 10.2807/1560-7917.es2014.19.33.20881] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathogen adaptation has been proposed to contribute to the resurgence of pertussis. A striking recent example is the emergence of isolates deficient in the vaccine component pertactin (Prn). This study explores the emergence of such Prn-deficient isolates in six European countries. During 2007 to 2009, 0/83 isolates from the Netherlands, 0/18 from the United Kingdom, 0/17 Finland, 0/23 Denmark, 4/99 Sweden and 5/20 from Norway of the isolates collected were Prn-deficient. In the Netherlands and Sweden, respectively 4/146 and 1/8 were observed in a later period (2010–12). The Prn-deficient isolates were genetically diverse and different mutations were found to inactivate the prn gene. These are indications that Prn-deficiency is subject to positive selective pressure. We hypothesise that the switch from whole cell to acellular pertussis vaccines has affected the balance between ‘costs and benefits’ of Prn production by Bordetella pertussis to the extent that isolates that do not produce Prn are able to expand. The absence of Prn-deficient isolates in some countries may point to ways to prevent or delay the spread of Prn-deficient strains. In order to substantiate this hypothesis, trends in the European B. pertussis population should be monitored continuously.
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Affiliation(s)
- A Zeddeman
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), Centre for Infectious Diseases Control (CIb), National Institute of Public Health and the Environment (RIVM), the Netherlands
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9
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Bugyei-Twum A, Kosanam H, Mitchell M, Shen V, Advani A, Leong-Poi H, Gilbert R, Diamandis E, Connelly K. Proteomic Analysis of a Rodent Model of Heart Failure With Preserved Ejection Fraction - the Goto Kakizaki Rat. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Connelly K, Zhang Y, Mitchell M, Advani S, Thai K, Desjardins J, Azabeh A, Kabir G, Advani A, Gilbert R. Saxagliptin Improves Cardiac Function in the Post MI Diabetes Setting: Potential Role of Non GLP1 Mediated Cardioprotection Via Stromal Derived Factor 1 α. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Connelly K, Desjardins J, Advani A, Kabir G, Zhang Y, Advani S, Yuen D, Thai K, Gilbert R. 723 Dpp-4 Inhibition attenuates cardiac dysfunction and adverse remodelling following myocardial infarction in experimental diabetes. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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12
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Connelly KA, Advani A, Advani S, Zhang Y, Thai K, Thomas S, Krum H, Kelly DJ, Gilbert RE. Combination angiotensin converting enzyme and direct renin inhibition in heart failure following experimental myocardial infarction. Cardiovasc Ther 2011; 31:84-91. [PMID: 21884026 DOI: 10.1111/j.1755-5922.2011.00292.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS Diminishing the activity of the renin-angiotensin system (RAS) plays a pivotal role in the treatment of heart failure. In addition to angiotensin converting enzyme (ACE) inhibitors and angiotensin-receptor blockers, direct renin inhibition has emerged as a potential adjunctive treatment to conventional RAS blockade. We sought to determine the effectiveness of this strategy after myocardial infarction (MI) in the setting of preexisting hypertension, a common premorbid condition in patients with ischemic heart disease. METHODS AND RESULTS Ten-week-old female heterozygous hypertensive (mRen-2)27 transgenic rats (Ren-2), were randomized to one of five groups (n = 8 per group); sham, MI, MI + aliskiren, MI + lisinopril and MI + combination lisinopril and aliskiren. Cardiac function was assessed by echocardiography and in vivo cardiac catheterization. Untreated MI animals developed heart failure with hypotension, dilation, reduced ejection fraction (EF), and raised left ventricular end-diastolic pressure (LVEDP). Treatment with single agent treatment had only modest effect on cardiac function though combination therapy was associated with significant improvements in EF and LVEDP when compared to untreated MI animals (P < 0.05). Histologic analysis demonstrated increase extracellular matrix deposition and cardiomyocyte hypertrophy in the noninfarct region of all MI groups when compared with sham operated animals (P < 0.05) that was reduced by ACE inhibitor monotherapy and combination treatment but not by aliskiren alone. CONCLUSION In a hypertensive rat model that underwent experimental MI, EF, and LVEDP, key functional indices of heart failure, were improved by treatment with combination ACE and direct renin inhibition when compared with either agent used alone.
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Affiliation(s)
- K A Connelly
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
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13
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Michelson AP, Kopecky KJ, Koegle ER, Anderson JE, Godwin JE, Petersdorf SH, List AF, Willman CL, Appelbaum FR, Radich JP, Ganapathi MK, Ganapathi RN, Advani A. Expression of topoisomerase (topo) II in adult acute myeloid leukemia (AML): Relationships to immunophenotype and treatment outcomes. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Smith SD, Bolwell BJ, Rybicki LA, Kang T, Dean R, Advani A, Thakkar S, Sobecks R, Kalaycio M, Pohlman B, Sweetenham JW. Comparison of outcomes after auto-SCT for patients with relapsed diffuse large B-cell lymphoma according to previous therapy with rituximab. Bone Marrow Transplant 2010; 46:262-6. [DOI: 10.1038/bmt.2010.95] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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Advani A, Vaikkakara S, Gill MS, Arun CS, Pearce SH, Ball SG, James RA, Lennard TWJ, Bliss RD, Quinton R, Johnson SJ. Impact of standardised reporting in adrenocortical carcinoma: a single centre clinicopathological review. J Clin Pathol 2008; 61:939-44. [DOI: 10.1136/jcp.2008.057067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Kang TY, Rybicki LA, Bolwell BJ, Thakkar SG, Brown S, Dean R, Sekeres MA, Advani A, Sobecks R, Kalaycio M, Pohlman B, Sweetenham JW. Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma. Bone Marrow Transplant 2007; 40:973-8. [PMID: 17873917 DOI: 10.1038/sj.bmt.1705849] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autologous stem-cell transplantation (ASCT) has been used in follicular lymphoma (FL) to achieve durable responses in first remission or in the relapsed or refractory settings. Addition of rituximab to chemotherapy for FL has been shown to improve survival. The impact of prior therapy with rituximab upon the effectiveness of high-dose therapy (HDT) and ASCT in patients with FL is unknown. We retrospectively reviewed consecutive patients with FL who underwent HDT and ASCT. Patients were categorized according to prior therapy with rituximab. Outcomes were compared between groups in all patients and in a well-matched subset. In all 35 patients received prior rituximab and 71 rituximab-naive patients were analyzed. The rituximab-naive group had a median overall survival (OS) that was not reached during follow-up, with a median relapse-free (RFS) survival of 49.9 months. The prior rituximab group also did not reach median OS and had a median RFS of 24.6 months. Survivals were not significantly different in this group or in the well-matched subset. In conclusion, these results suggest that the use of rituximab-based regimens for the treatment of FL does not compromise the effectiveness of HDT and ASCT as a salvage strategy in patients with FL.
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Affiliation(s)
- T Y Kang
- Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
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17
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Kalaycio M, Rybicki L, Pohlman B, Dean R, Sweetenham J, Andresen S, Sobecks R, Sekeres MA, Advani A, Brown S, Bolwell B. Elevated lactate dehydrogenase is an adverse predictor of outcome in HLA-matched sibling bone marrow transplant for acute myelogenous leukemia. Bone Marrow Transplant 2007; 40:753-8. [PMID: 17700600 DOI: 10.1038/sj.bmt.1705811] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prognostic factors for survival following allogeneic BMT for AML include age, disease status and cytogenetic risk classification. Lactate dehydrogenase (LDH) levels have not been studied as a potential risk factor. We reviewed our experience with BMT for AML and included LDH at the time of admission in an analysis of prognostic factors for survival. We found that LDH >330 U/l (1.5 times the upper limit of normal at our institution), older age, active disease, peripheral stem cell graft and male-to-male transplant were significant adverse predictors of survival. After accounting for LDH, other factors such as disease status and cytogenetics were not significantly associated with the outcome of BMT. All but one patient with an LDH >330 U/l had active disease. However, when patients in CR were excluded, LDH >330 U/l remained a significant adverse predictor of overall survival (hazard ratio 2.70, 95% confidence interval 1.41-5.16, P=0.003). We conclude that LDH is an important adverse risk factor for survival and should be included in future studies of risk performed on larger patient cohorts.
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Affiliation(s)
- M Kalaycio
- Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Taussig Cancer Center, Cleveland, OH 44195, USA.
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Sekeres M, Kalaycio M, Erba H, Sobecks R, Advani A, Chan J, Maciejewski J. P155 Arsenic trioxide (ATO) and gemtuzumab ozogamicin (GO) in high-risk MDS or AML arising from MDS. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70225-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kalaycio M, Rybicki L, Pohlman B, Dean R, Sweetenham J, Andresen S, Sobecks R, Sekeres M, Advani A, Brown S, Bolwell B. 60: A high lactate dehydrogenase (LDH) level predicts for shorter survival following HLA-matched sibling bone marrow transplant (BMT) for patients with acute myelogenous leukemia (AML). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Thomas TH, Advani A. Inflammation in cardiovascular disease and regulation of the actin cytoskeleton in inflammatory cells: the actin cytoskeleton as a target. Cardiovasc Hematol Agents Med Chem 2006; 4:165-82. [PMID: 16611050 DOI: 10.2174/187152506776369926] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Cardiovascular disease is prevalent in developed countries causing very large burdens to health services. The underlying pathology is atheromatous plaque in the sub-endothelial region of the vascular wall. High levels of low density lipoprotein cholesterol and high blood pressure cause endothelial damage. Atheroma develop from a response to this injury that is perpetuated to chronic inflammation. The invasion of inflammatory leukocytes into atheroma during its development and in the precipitation of acute thrombotic events is mediated by adhesion molecules on the cell surface. These are regulated by the actin filament cytoskeleton which also mediates intracellular signalling from them. The actin cytoskeleton is central to NADPH oxidase activation that produces superoxide which is an intracellular signalling molecule for the hypertensive and inflammatory actions of angiotensin II. There are polymorphisms in actin filament proteins such as adducin and caldesmon and in the promoter regions of tropomyosins that may cause individual variation in these processes. Many signalling molecules in the actin filament response to inflammatory stimuli and in signalling downstream from actin filaments are small G-proteins that require post-transcriptional modification by isoprenoids from the cholesterol synthetic pathway. Statins deplete the isoprenoids and so down regulate G-proteins that mediate the inflammatory response. Angiotensin converting enzyme inhibitors and angiotensin II receptor type 1 antagonists decrease angiotensin II stimulated superoxide production thus decreasing not only blood pressure but also inflammation. The anti-inflammatory effects of these drugs, involving altered actin filament function, are a major contributor to their benefits in the treatment of cardiovascular disease. The feasibility of modifying the behaviour of actin filament proteins as a therapeutic approach for cardiovascular disease is considered.
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Affiliation(s)
- T H Thomas
- UWCM Academic Unit, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK.
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21
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Abstract
BACKGROUND Low-carbohydrate diets are popular and fashionable for weight loss despite lack of evidence about long-term effects. Many individuals attempting to lose weight have hypertension, especially those with diabetes, and the prevalence of hyperaldosteronism among hypertensive patients is higher than previously recognized. We present a patient with Type 2 diabetes and previously undiagnosed hyperaldosteronism who developed life-threatening hypokalaemia while following a low-carbohydrate diet. CASE REPORT A 60-year-old man with diet-treated Type 2 diabetes and hypertension presented with generalized muscle weakness and serum potassium of 1.9 mmol/l. He had succeeded in losing three and a half stones during the previous 4 months by adhering strictly to a low-carbohydrate diet. HbA(1c) was 4.8% and plasma aldosterone:renin ratios were elevated suggestive of increased aldosterone secretion. On a low-calorie mixed diet serum potassium levels were maintained in the low-normal range over the following 165 days. The adrenals were normal on CT scanning and blood pressure responded dramatically to the addition of spironolactone on day 212 (125/83 mmHg). CONCLUSIONS The prevalence of primary hyperaldosteronism in the hypertensive population, based on elevation of plasma renin:aldosterone ratio, is approximately 6%. The majority of these people are normokalaemic and remain undiagnosed. However, when carbohydrate intake is restricted such individuals are at increased risk of potentially life-threatening metabolic derangements.
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Affiliation(s)
- A Advani
- Department of Diabetes and Metabolism, Medical School, William Leech Building, 1 Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
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22
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van Amersfoorth SCM, Schouls LM, van der Heide HGJ, Advani A, Hallander HO, Bondeson K, von König CHW, Riffelmann M, Vahrenholz C, Guiso N, Caro V, Njamkepo E, He Q, Mertsola J, Mooi FR. Analysis of Bordetella pertussis populations in European countries with different vaccination policies. J Clin Microbiol 2005; 43:2837-43. [PMID: 15956406 PMCID: PMC1151907 DOI: 10.1128/jcm.43.6.2837-2843.2005] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the widespread use of pertussis vaccines during the last decades, pertussis has remained an endemic disease with frequent epidemic outbreaks. Currently two types of vaccines are used: whole-cell vaccines (WCVs) and recently developed acellular vaccines (ACVs). The long-term aim of our studies is to assess the effect of different vaccination policies on the population structure of Bordetella pertussis and ultimately on the disease burden in Europe. In the present study, a total of 102 B. pertussis isolates from the period 1998 to 2001 from five European countries (Finland, Sweden, Germany, The Netherlands, and France) were characterized. The isolates were analyzed by typing based on variable number of tandem repeats (VNTR); by sequencing of polymorphic genes encoding the surface proteins pertussis toxin S1 and S3 subunits (ptxA and ptxC), pertactin (prn), and tracheal colonization factor (tcfA); and by fimbrial serotyping. The results reveal a relationship between geographic location and VNTR types, the frequency of the ptxC alleles, and serotypes. We have not observed a relationship between the strain characteristics we studied and vaccination programs. Our results provide a baseline which can be used to reveal changes in the B. pertussis population in Europe in the coming years.
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Affiliation(s)
- S C M van Amersfoorth
- Laboratory for Vaccine Preventable Diseases. National Institute of Public Health and the Environment, Anthonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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23
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Sekeres MA, Jin T, Maciejewski J, Kalaycio ME, Brown S, Advani A, Golshayan AR, Sobecks R, Kattan MW. Characterization, resource use, and the economic impact of low-risk myelodysplastic syndrome (MDS) at an MDS specialty center. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - T. Jin
- Cleveland Clinic Fdn, Cleveland, OH
| | | | | | - S. Brown
- Cleveland Clinic Fdn, Cleveland, OH
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24
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Tiu RV, Kalmadi SR, Lowe C, Sobecks R, Bolwell B, Lichtin A, Kalaycio M, Maciejewski J, Advani A, Sekeres M, Pohlman B. Epsilon aminocaproic acid (EACA) is effective in controlling thrombocytopenic hemorrhage in patients with hematologic malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. V. Tiu
- The Cleveland Clinic Fdn, Cleveland, OH
| | | | - C. Lowe
- The Cleveland Clinic Fdn, Cleveland, OH
| | | | | | | | | | | | - A. Advani
- The Cleveland Clinic Fdn, Cleveland, OH
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25
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Abstract
BACKGROUND Leukocyte dysfunction contributes to the pathogenesis of diabetic vascular complications. Neutrophils adhere to the endothelium through the beta(2)integrin CD11b/CD18. In Type 2 diabetes, neutrophil surface CD11b expression is increased and is associated with impaired actin polymerization. This study aimed to determine whether increasing neutrophil actin polymerization could correct the defect in CD11b exposure. DESIGN Neutrophil actin polymerization was stimulated with the tyrosine phosphatase inhibitor phenylarsine oxide (PAO), and cytoskeletal phosphotyrosine was monitored by immunoblotting Triton X-100 insoluble fractions of cells. Neutrophil F-actin was measured with phalloidin-FITC staining, and surface CD11b expression was determined with anti-CD11b-PE before analysis with flow cytometry. RESULTS Phenylarsine oxide caused an increase in phosphotyrosine in neutrophils from both patients with Type 2 diabetes (DM) and controls (NC) (-fold increase: NC, 1.43 +/- 0.16; DM, 1.46 +/- 0.10). The response to PAO in terms of phalloidin-binding was impaired in neutrophils from patients [phalloidin-FITC MFI area under the curve, NC 200 +/- 5 (x 10(3)), DM 124 +/- 9 (x 10(3)), P < 0.0001]. Phenylarsine oxide at concentrations < 10 micro mol L(-1) also caused loss of CD11b from neutrophil surfaces that was impaired in samples from patients [CD11b sites area under the curve NC 90 +/- 6 (x 10(3)), DM 121 +/- 9 (x 10(3)), P < 0.002]. However, in neutrophils from patients, incubation with PAO at a concentration of > 10 micro mol L(-1) caused a significant increase in intracellular F-actin and CD11b down-regulation equivalent to that observed in controls. CONCLUSION In Type 2 diabetes, impaired neutrophil actin polymerization even in response to increasing cytoskeletal phophotyrosine suggests a downstream defect. Furthermore, increasing actin polymerization, above a minimum threshold level, corrects the defect in integrin exposure. Correction of the actin polymerization defect in Type 2 diabetes could improve the prognosis of diabetic vascular complications.
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Affiliation(s)
- A Advani
- Department of Medicine, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK.
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26
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Rawling LD, Advani A, Marshall SM, Thomas TH. Neutrophil antigen exposure is altered with age in relatives of patients with Type 2 diabetes. Diabetologia 2004; 47:353-5. [PMID: 14666369 DOI: 10.1007/s00125-003-1290-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Revised: 10/20/2003] [Indexed: 12/01/2022]
MESH Headings
- Actins/analysis
- Actins/metabolism
- Adult
- Age Factors
- Antigens, CD/analysis
- Antigens, CD/metabolism
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Differentiation, T-Lymphocyte/metabolism
- CD11b Antigen/analysis
- CD11b Antigen/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/physiopathology
- Family
- Family Health
- Flow Cytometry
- Humans
- Lectins, C-Type
- Leukocyte Common Antigens/analysis
- Leukocyte Common Antigens/metabolism
- Neutrophils/chemistry
- Neutrophils/drug effects
- Neutrophils/immunology
- Patient Selection
- Phalloidine/chemistry
- Tetradecanoylphorbol Acetate/pharmacology
- Vascular Diseases/blood
- Vascular Diseases/complications
- Vascular Diseases/etiology
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27
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Chan AS, Coleman RW, Martins SB, Advani A, Musen MA, Bosworth HB, Oddone EZ, Shlipak MG, Hoffman BB, Goldstein MK. Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension. Stud Health Technol Inform 2004; 107:125-9. [PMID: 15360788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intention of the guideline and different ways providers attempt to satisfy the guideline. During our work with a guideline-based decision support system for hypertension, ATHENA DSS, we document a number of subtle deviations from the strict hypertension guideline recommendations that ultimately demonstrate provider adherence. We believe that understanding these complexities is crucial to any valid evaluation of provider adherence. We also describe the development of an advisory evaluation engine that automates the interpretation of clinician adherence with the DSS on multiple levels, facilitating the high volume of complex data analysis that is created in a clinical trial of a guideline-based DSS.
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Affiliation(s)
- A S Chan
- Stanford Medical Informatics, Stanford University School of Medicine, MSOB X-215, Stanford, CA 94305, USA
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28
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Abstract
BACKGROUND In Type 2 diabetes impaired neutrophil function leads to increased bacterial infection and cardiovascular disease. Many neutrophil functions depend on calcium signalling, which involves release of calcium from intracellular stores and subsequently translocation of stores via the cytoskeleton to the plasma membrane, causing store-mediated calcium entry (SMCE) into the cell. We hypothesized that in Type 2 diabetes there would be a defect in SMCE. MATERIALS AND METHODS Neutrophils were prepared from patients with Type 2 diabetes (DM, n=15) and controls (NC, n=15). Free cytosolic calcium [Ca2+]i was measured with Fura-2 in resting cells and after stimulation of calcium release with fMLP and thapsigargin. RESULTS Baseline [Ca2+]i was higher in neutrophils from the patients than the controls (NC 65 +/- 5 nm, DM 80 +/- 4 nm, P<0.05). However, after fMLP-treatment [Ca2+]i was significantly lower in the patients (NC 301 +/- 28 nm, DM 210 +/- 20 nm, P<0.01). The greater increase in controls was not observed when cells were treated with fMLP in the absence of extracellular calcium (-fold increase NC 2.9 +/- 0.5, DM 2.7 +/- 0.3). Treatment of cells with thapsigargin caused a similar greater increase in [Ca2+]i in the controls than in the patients that was not seen in the absence of extracellular calcium (-fold increase with Ca2+ NC 5.2 +/- 1.0, DM 3.0 +/- 0.4, P<0.05; fold increase without Ca2+ NC 2.5 +/- 0.4, DM 2.2 +/- 0.2). CONCLUSIONS In Type 2 diabetes there is a defect in neutrophil calcium signalling which results in a lesser increase in free cytosolic calcium owing to impaired influx across the plasma membrane. Abnormal calcium signalling is likely to be important in the pathogenesis of diabetic complications.
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Affiliation(s)
- A Advani
- Department of Medicine, University of Newcastle Upon Tyne, Newcastle upon Tyne, UK.
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29
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Goldstein MK, Hoffman BB, Coleman RW, Tu SW, Shankar RD, O'Connor M, Martins S, Martins S, Advani A, Musen MA. Patient safety in guideline-based decision support for hypertension management: ATHENA DSS. Proc AMIA Symp 2002:214-8. [PMID: 11825183 PMCID: PMC2243380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
The Institute of Medicine recently issued a landmark report on medical error.1 In the penumbra of this report, every aspect of health care is subject to new scrutiny regarding patient safety. Informatics technology can support patient safety by correcting problems inherent in older technology; however, new information technology can also contribute to new sources of error. We report here a categorization of possible errors that may arise in deploying a system designed to give guideline-based advice on prescribing drugs, an approach to anticipating these errors in an automated guideline system, and design features to minimize errors and thereby maximize patient safety. Our guideline implementation system, based on the EON architecture, provides a framework for a knowledge base that is sufficiently comprehensive to incorporate safety information, and that is easily reviewed and updated by clinician-experts.
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31
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Advani A, Marshall SM, Thomas TH. Impaired neutrophil actin assembly causes persistent CD11b expression and reduced primary granule exocytosis in Type II diabetes. Diabetologia 2002; 45:719-27. [PMID: 12107753 DOI: 10.1007/s00125-002-0802-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2001] [Revised: 01/11/2002] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS Neutrophil dysfunction has a role in the pathogenesis of complications in Type II (non-insulin-dependent) diabetes mellitus. Neutrophils adhere through expression of the beta(2)integrin CD11b/CD18 which closely associates with the actin cytoskeleton. The aim of this study was to investigate the effect of actin polymerisation on CD11b expression and exocytosis of the primary granule marker CD69 in neutrophils from patients with Type II diabetes. METHODS Neutrophils were activated with fMLP or PMA, actin polymerisation was inhibited with cytochalasin D. Cells were stained for CD11b and CD69 expression and intracellular F-actin was measured with phalloidin-FITC. Cellular fluorescence was measured by flow cytometry. Actin content of Triton X-100 fractions of cells was measured by SDS-PAGE and Coomassie blue staining. RESULTS PMA caused an increase in neutrophil F-actin that was greater in control subjects than in patients with Type II diabetes (50.8% vs 33.4%, p<0.001) and correlated with actin integrated optical density (IOD) by SDS-PAGE ( r=0.74, p=0.01). Loss of CD11b from cell surfaces only occurred in neutrophils with high F-actin. The proportion of cells losing CD11b was lower in patients than in control subjects (23.1% vs 37.5%, p<0.001) and lowest in patients with additional cardiovascular risk markers (20.1% vs 27.7%; p<0.05). Cytochalasin D prevented loss of CD11b ( p<0.001). CD69 expression was reduced in patients with Type II diabetes (22.6% vs 36.4%, p<0.001) and correlated with F-actin content ( r=0.78, p<0.0001). CONCLUSION/INTERPRETATION In Type II diabetes impaired neutrophil actin polymerisation leads to persistent expression of CD11b and reduced exocytosis of primary granules and could contribute to the pathogenesis of diabetic complications.
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Affiliation(s)
- A Advani
- Department of Medicine, Medical School, University of Newcastle Upon Tyne, UK
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32
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Advani A, Shahar Y, Musen MA. Medical quality assessment by scoring adherence to guideline intentions. Proc AMIA Symp 2001:2-6. [PMID: 11825146 PMCID: PMC2243332] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe an approach for evaluating and consistently scoring clinician adherence to medical guidelines using the intentions of guideline authors. We present the Quality Indicator Language (QUIL) that may be used to formally specify quality constraints on physician behavior and patient outcomes derived from medical guidelines. We present a modeling and scoring methodology for consistently evaluating multi-step and multi-choice guideline plans based on guideline intentions and their revisions.
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Affiliation(s)
- A Advani
- Section on Medical Informatics, Stanford School of Medicine, Stanford, CA, USA
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Goldstein MK, Hoffman BB, Coleman RW, Musen MA, Tu SW, Advani A, Shankar R, O'Connor M. Implementing clinical practice guidelines while taking account of changing evidence: ATHENA DSS, an easily modifiable decision-support system for managing hypertension in primary care. Proc AMIA Symp 2000:300-4. [PMID: 11079893 PMCID: PMC2243943] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
This paper describes the ATHENA Decision Support System (DSS), which operationalizes guidelines for hypertension using the EON architecture. ATHENA DSS encourages blood pressure control and recommends guideline-concordant choice of drug therapy in relation to comorbid diseases. ATHENA DSS has an easily modifiable knowledge base that specifies eligibility criteria, risk stratification, blood pressure targets, relevant comorbid diseases, guideline-recommended drug classes for patients with comorbid disease, preferred drugs within each drug class, and clinical messages. Because evidence for best management of hypertension evolves continually, ATHENA DSS is designed to allow clinical experts to customize the knowledge base to incorporate new evidence or to reflect local interpretations of guideline ambiguities. Together with its database mediator Athenaeum, ATHENA DSS has physical and logical data independence from the legacy Computerized Patient Record System (CPRS) supplying the patient data, so it can be integrated into a variety of electronic medical record systems.
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Affiliation(s)
- M K Goldstein
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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34
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Folkesson A, Advani A, Sukupolvi S, Pfeifer JD, Normark S, Löfdahl S. Multiple insertions of fimbrial operons correlate with the evolution of Salmonella serovars responsible for human disease. Mol Microbiol 1999; 33:612-22. [PMID: 10417651 DOI: 10.1046/j.1365-2958.1999.01508.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
On centisome 7, Salmonella spp. contain a large region not present in the corresponding region of Escherichia coli. This region is flanked by sequences with significant homology to the E. coli tRNA gene aspV and the hypothetical E. coli open reading frame yafV. The locus consists of a mosaic of differentially acquired inserts forming a dynamic cs7 region of horizontally transferred inserts. Salmonella enterica subspecies I, responsible for most Salmonella infections in warm-blooded animals, carries a fimbrial gene cluster (saf) in this region as well as a regulatory gene (sinR). These genes are flanked by inverted repeats and are inserted in another laterally transferred region present in most members of Salmonella spp. encoding a putative invasin (pagN ). S. enterica subspecies I serovar Typhi, the Salmonella serovar that causes the most severe form of human salmonellosis, contains an additional insert of at least 8 kb in the sinR-pagN intergenic region harbouring a novel fimbrial operon (tcf ) similar to the coo operon encoding the CS1 fimbrial adhesin expressed by human-specific enterotoxigenic E. coli. It is suggested that the multiple insertions of fimbrial genes that have occurred in the cs7 region have contributed to phylogenetic diversity and host adaptation of Salmonella spp.
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Affiliation(s)
- A Folkesson
- Mikrobiologiskt och Tumörbiologiskt Centrum, Karolinska Institutet, Box 280, Tomtebodavagen 34, S-17177 Stockholm, Sweden.
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35
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Advani A, Tu S, O'Connor M, Coleman R, Goldstein MK, Musen M. Integrating a modern knowledge-based system architecture with a legacy VA database: the ATHENA and EON projects at Stanford. Proc AMIA Symp 1999:653-7. [PMID: 10566440 PMCID: PMC2232584] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
We present a methodology and database mediator tool for integrating modern knowledge-based systems, such as the Stanford EON architecture for automated guideline-based decision-support, with legacy databases, such as the Veterans Health Information Systems & Technology Architecture (VISTA) systems, which are used nation-wide. Specifically, we discuss designs for database integration in ATHENA, a system for hypertension care based on EON, at the VA Palo Alto Health Care System. We describe a new database mediator that affords the EON system both physical and logical data independence from the legacy VA database. We found that to achieve our design goals, the mediator requires two separate mapping levels and must itself involve a knowledge-based component.
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Affiliation(s)
- A Advani
- Stanford Medical Informatics, Stanford University, CA 94305-5479, USA
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36
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Advani A, Lo K, Shahar Y. Intention-based critiquing of guideline-oriented medical care. Proc AMIA Symp 1998:483-7. [PMID: 9929266 PMCID: PMC2232388] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
We present a methodology and tool for providing retrospective review and critiquing of guideline-based medical care given to patients. We show how our guideline representation language, Asbru, which supports the use of physicians intentions in addition to physician's actions, allows us to compare the care given to a patient at the level of the intention to treat in addition to the more detailed plan carried out. We have developed an algorithm based on this representation for retrospective quality assessment of guideline-based care. Our method takes the physician's and institution's preferences and policies into account in explaining or justifying physician deviations from the recommendations of a guideline.
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Affiliation(s)
- A Advani
- Section on Medical Informatics, Stanford University School of Medicine, CA 94305-5479, USA
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Schneiderman JH, Arnold D, Advani A. Different changes in spontaneous field potential oscillations precede epileptiform bursting in hippocampal slices perfused with penicillin or reduced magnesium. Brain Res 1990; 533:275-85. [PMID: 2289144 DOI: 10.1016/0006-8993(90)91350-p] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Power spectra were used to analyse spontaneous field potentials (SFPs) recorded in the CA3 distal apical dendritic region of guinea pig hippocampal slices perfused with either penicillin or reduced Mg2+. High concentrations of penicillin (2000 IU/ml) progressively converted the low amplitude, irregular oscillations observed in control medium to higher amplitude, low frequency, rhythmic oscillations at approximately 2-3 Hz just prior to the onset of spontaneous, synchronized bursting. Low concentrations (50-300 IU/ml) increased the power of frequencies below 10 Hz and suppressed higher frequencies in a dose-dependent fashion. Although Mg2(+)-free medium also increased the magnitude of the SFPs prior to the onset of synchronous bursting, the changes were smaller than with penicillin and the frequency distribution was completely different. Low concentrations of Mg2+ (0.0-0.5 mM) increased the power across all frequencies, however, the maximal effect was on frequencies between 5 and 25 Hz. The transition from normal to epileptiform activity may proceed through at least 2 distinct intermediate states. When recurrent inhibition is blocked (penicillin), synchronous synaptic activity precedes the onset of bursting, whereas non-specific increases in excitability and activation of NMDA receptors (reduced Mg2+) produce an asynchronous transition state.
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Abstract
Electrical or magnetic stimulation of the human motor cortex causes a strong, short latency facilitation of tibialis anterior (TA) motoneurons but only weak, longer latency changes in the excitability of soleus (SOL) motoneurons. The facilitation of TA motoneurons has been attributed to the monosynaptic action of the "fast" corticospinal pathway. The present study further investigates the cortical control of soleus motoneurons in man. In tests of reaction time to auditory stimuli, normal subjects took significantly longer to activate soleus motoneurons than tibialis anterior motoneurons. Thus we could not demonstrate the existence of a "fast" pathway from the brain to SOL motoneurons that, for some reason, is not activated by magnetic stimulation. The hypothesis that the cortex might control soleus motoneurons indirectly by modulation of the Ia input from muscle spindles was tested. Magnetic stimulation of the cortex was used to condition the facilitation of soleus motoneurons resulting from the stimulation of group I fibres in the tibial nerve. There were no consistent changes in Ia facilitation. We conclude (i) that there is no evidence so far that SOL motoneurons are excited by a direct pathway from the cortex (similar to that projecting to TA motoneurons) and (ii) that the observed changes in firing probability of soleus motoneurons produced by magnetic stimulation over the motor cortex do not result from modulation of presynaptic inhibition of Ia afferents.
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Affiliation(s)
- A Advani
- Playfair Neuroscience Unit, University of Toronto, Toronto Western Hospital, Ont., Canada
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39
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Abstract
Spontaneous field potential oscillations were recorded from the CA3 distal apical dendritic region of guinea pig hippocampal slices maintained in 'normal' artificial cerebrospinal fluid in vitro. Power spectral analysis revealed a mixture of frequencies mainly under 20 Hz without distinct peaks. High concentrations of extracellular Mg2+ blocked the activity. These findings suggest that the intrinsic spontaneous activity of the hippocampus is produced by partially synchronized synaptic potentials. This in vitro system may provide a suitable model for studying the mechanisms underlying the generation of EEG rhythms.
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