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Sarpatwari A, Lu Z, Russo M, Zakoul H, Lee SB, Toyserkani GA, Zhou EH, LaCivita C, Shaw KHH, Zendel L, Dal Pan GJ, Kesselheim AS. How Do Risk Evaluation and Mitigation Strategies Impact Clinical Practice? A National Survey of Physicians. Clin Pharmacol Ther 2024; 115:1293-1303. [PMID: 38375585 DOI: 10.1002/cpt.3189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
The US Food and Drug Administration can require risk evaluation and mitigation strategy (REMS) programs for prescription drugs to ensure the benefits of use outweigh the risks. We conducted a national survey of physicians' experiences prescribing eight REMS-covered drugs: (1) ambrisentan; (2) bosentan; (3) clozapine; (4) isotretinoin; (5-7) the multiple myeloma (MM) drugs lenalidomide, pomalidomide, thalidomide; and (8) sodium oxybate. Between May 2022 and January 2023, we surveyed 5,331 physician prescribers of these drugs, and 1,295 (24%) returned surveys (range: 149 for bosentan to 226 for MM drugs). Although 765 (68%) respondents thought the certification process provided useful drug information, 757 (67%) wanted materials to include benefit data and 944 (84%) non-REMS-related risk data. A majority (704, 63%) thought the safe use requirements facilitated discussion with patients, but a similar number (637, 57%) attributed delayed medication access to these requirements. In multivariable modeling, MM drug and isotretinoin respondents were less likely than sodium oxybate respondents to agree that the certification process provided useful drug information (MM drug: odds ratio (OR) = 0.37, 95% confidence interval (CI) = 0.25-0.55; isotretinoin: OR = 0.39, 95% CI = 0.25-0.61), and isotretinoin, clozapine, and bosetan respondents were more likely than sodium oxybate respondents to agree that the safe use requirements often delayed medication access (isotretinoin: OR = 5.83, 95% CI = 3.70-9.19; clozapine: OR = 1.65, 95% CI = 1.08-2.54; bosentan: OR = 1.78, 95% CI = 1.12-2.85). Most physicians believe REMS programs convey useful drug safety information and facilitate discussion with patients but also seek information on benefits and non-REMS-related risks and better integration of REMS processes into clinical workflows.
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Affiliation(s)
- Ameet Sarpatwari
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zhigang Lu
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Massimiliano Russo
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gita A Toyserkani
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Esther H Zhou
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Cynthia LaCivita
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Katherine Hyatt Hawkins Shaw
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Laura Zendel
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gerald J Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Mahesri M, Sarpatwari A, Huybrechts KF, Lii J, Lee SB, Toyserkani GA, LaCivita C, Zhou EH, Pan GJD, Kesselheim AS, Bykov K. Trends in Use and Evidence of Adherence to Risk Evaluation and Mitigation Strategy Pregnancy Testing Requirements for Thalidomide, Lenalidomide, and Pomalidomide in the USA, 2000-2020. Drug Saf 2024:10.1007/s40264-024-01443-3. [PMID: 38755509 DOI: 10.1007/s40264-024-01443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Lenalidomide, pomalidomide, and thalidomide are effective treatments for multiple myeloma but are teratogenic. To mitigate this risk, the US Food and Drug Administration (FDA) required risk evaluation and mitigation strategy (REMS) programs for these drugs, which include pregnancy testing among women of childbearing potential-twice before initiation, weekly in the first month on treatment, and every 2-4 weeks thereafter. OBJECTIVE We evaluated dispensing trends of lenalidomide, pomalidomide, and thalidomide and assessed adherence to REMS pregnancy testing requirements among at-risk patients taking these drugs. METHODS Using three US health insurance claims databases (Optum Clinformatics® [2004-2020], Merative Marketscan [2003-2019], and Medicaid [2000-2018]), we assessed monthly use of the drugs, patient characteristics and treatment persistence among drug initiators, and claims-based evidence for adherence to pregnancy testing requirements among initiators with child-bearing potential. RESULTS Lenalidomide was the most prescribed agent following its approval in 2006 and through the end of the study period. A total of 48,311 lenalidomide (mean age = 59 years [standard deviation (SD) = 16]), 17,550 thalidomide (mean age = 65 years [SD = 12]), and 6560 pomalidomide initiators (mean age = 65 years [SD = 11]) were identified; 45% of initiators of each drug were women. Among initiators under follow-up on day 90, 70% were still on therapy. Initiators of childbearing potential comprised 3% (N = 1,920) of all initiators; among this cohort, 12% had evidence in claims data of two pregnancy tests before initiation, and 9% with at least 33 days of follow-up of four tests during the first month of treatment. By contrast, 52% who received a refill had claims-based evidence of a pregnancy test within 7 days of dispensing. CONCLUSION Although most patients who initiated lenalidomide, pomalidomide, and thalidomide were not of child-bearing potential, further investigation into actual non-adherence to pregnancy testing is needed.
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Affiliation(s)
- Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA.
| | - Ameet Sarpatwari
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
- Program on Regulation, Therapeutics, and Law, Boston, MA, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
| | - Joyce Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
| | - Gita A Toyserkani
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Cynthia LaCivita
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Esther H Zhou
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Gerald J Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
- Program on Regulation, Therapeutics, and Law, Boston, MA, USA
| | - Katsiaryna Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street (Suite 3030), Boston, MA, 02120, USA
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Laurentiev J, Kim DH, Mahesri M, Wang KY, Bessette LG, York C, Zakoul H, Lee SB, Zhou L, Lin KJ. Identifying Functional Status Impairment in People Living With Dementia Through Natural Language Processing of Clinical Documents: Cross-Sectional Study. J Med Internet Res 2024; 26:e47739. [PMID: 38349732 PMCID: PMC10900085 DOI: 10.2196/47739] [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: 03/30/2023] [Revised: 06/30/2023] [Accepted: 10/31/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Assessment of activities of daily living (ADLs) and instrumental ADLs (iADLs) is key to determining the severity of dementia and care needs among older adults. However, such information is often only documented in free-text clinical notes within the electronic health record and can be challenging to find. OBJECTIVE This study aims to develop and validate machine learning models to determine the status of ADL and iADL impairments based on clinical notes. METHODS This cross-sectional study leveraged electronic health record clinical notes from Mass General Brigham's Research Patient Data Repository linked with Medicare fee-for-service claims data from 2007 to 2017 to identify individuals aged 65 years or older with at least 1 diagnosis of dementia. Notes for encounters both 180 days before and after the first date of dementia diagnosis were randomly sampled. Models were trained and validated using note sentences filtered by expert-curated keywords (filtered cohort) and further evaluated using unfiltered sentences (unfiltered cohort). The model's performance was compared using area under the receiver operating characteristic curve and area under the precision-recall curve (AUPRC). RESULTS The study included 10,000 key-term-filtered sentences representing 441 people (n=283, 64.2% women; mean age 82.7, SD 7.9 years) and 1000 unfiltered sentences representing 80 people (n=56, 70% women; mean age 82.8, SD 7.5 years). Area under the receiver operating characteristic curve was high for the best-performing ADL and iADL models on both cohorts (>0.97). For ADL impairment identification, the random forest model achieved the best AUPRC (0.89, 95% CI 0.86-0.91) on the filtered cohort; the support vector machine model achieved the highest AUPRC (0.82, 95% CI 0.75-0.89) for the unfiltered cohort. For iADL impairment, the Bio+Clinical bidirectional encoder representations from transformers (BERT) model had the highest AUPRC (filtered: 0.76, 95% CI 0.68-0.82; unfiltered: 0.58, 95% CI 0.001-1.0). Compared with a keyword-search approach on the unfiltered cohort, machine learning reduced false-positive rates from 4.5% to 0.2% for ADL and 1.8% to 0.1% for iADL. CONCLUSIONS In this study, we demonstrated the ability of machine learning models to accurately identify ADL and iADL impairment based on free-text clinical notes, which could be useful in determining the severity of dementia.
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Affiliation(s)
- John Laurentiev
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Dae Hyun Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - Mufaddal Mahesri
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Lily G Bessette
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Cassandra York
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Heidi Zakoul
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Su Been Lee
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Li Zhou
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kueiyu Joshua Lin
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
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Yoshida K, Cai T, Bessette LG, Kim E, Lee SB, Zabotka LE, Sun A, Mastrorilli JM, Oduol TA, Liu J, Solomon DH, Kim SC, Desai RJ, Liao KP. Improving the accuracy of automated gout flare ascertainment using natural language processing of electronic health records and linked Medicare claims data. Pharmacoepidemiol Drug Saf 2024; 33:e5684. [PMID: 37654015 PMCID: PMC10873073 DOI: 10.1002/pds.5684] [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: 09/07/2022] [Revised: 06/20/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND We aimed to determine whether integrating concepts from the notes from the electronic health record (EHR) data using natural language processing (NLP) could improve the identification of gout flares. METHODS Using Medicare claims linked with EHR, we selected gout patients who initiated the urate-lowering therapy (ULT). Patients' 12-month baseline period and on-treatment follow-up were segmented into 1-month units. We retrieved EHR notes for months with gout diagnosis codes and processed notes for NLP concepts. We selected a random sample of 500 patients and reviewed each of their notes for the presence of a physician-documented gout flare. Months containing at least 1 note mentioning gout flares were considered months with events. We used 60% of patients to train predictive models with LASSO. We evaluated the models by the area under the curve (AUC) in the validation data and examined positive/negative predictive values (P/NPV). RESULTS We extracted and labeled 839 months of follow-up (280 with gout flares). The claims-only model selected 20 variables (AUC = 0.69). The NLP concept-only model selected 15 (AUC = 0.69). The combined model selected 32 claims variables and 13 NLP concepts (AUC = 0.73). The claims-only model had a PPV of 0.64 [0.50, 0.77] and an NPV of 0.71 [0.65, 0.76], whereas the combined model had a PPV of 0.76 [0.61, 0.88] and an NPV of 0.71 [0.65, 0.76]. CONCLUSION Adding NLP concept variables to claims variables resulted in a small improvement in the identification of gout flares. Our data-driven claims-only model and our combined claims/NLP-concept model outperformed existing rule-based claims algorithms reliant on medication use, diagnosis, and procedure codes.
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Affiliation(s)
- Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- OM1, Inc, Boston, MA, USA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Erin Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Luke E. Zabotka
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alec Sun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julianna M. Mastrorilli
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Theresa A. Oduol
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rishi J. Desai
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Katherine P. Liao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Kim DH, Lee H, Pawar A, Lee SB, Park CM, Levin R, Metzger E, Bateman BT, Ely EW, Pandharipande PP, Pisani MA, Hohmann SF, Marcantonio ER, Inouye SK. Trends in use of antipsychotics and psychoactive drugs in older patients after major surgery. J Am Geriatr Soc 2023; 71:3755-3767. [PMID: 37676699 PMCID: PMC10841351 DOI: 10.1111/jgs.18580] [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: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Professional society guidelines recommend limiting the use of antipsychotics in older patients with postoperative delirium. How these recommendations affected the use of antipsychotics and other psychoactive drugs in the postoperative period has not been studied. METHODS This retrospective cohort study included patients 65 years or older without psychiatric diagnoses who underwent major surgery in community hospitals (CHs) and academic medical centers (AMCs) in the United States. The outcome was the rate of hospital days exposed to antipsychotics, antidepressants, antiepileptics, benzodiazepines, hypnotics, and selective alpha-2 receptor agonist dexmedetomidine in the postoperative period by hospital type. RESULTS The study included 4,098,431 surgical admissions from CHs (mean age 75.0 [standard deviation, 7.1] years; 50.8% female) during 2008-2018 and 2,310,529 surgical admissions from AMCs (75.0 [7.4] years; 49.4% female) during 2009-2018. In the intensive care unit (ICU) setting, the number of exposed days per 1000 hospital-days declined for haloperidol (CHs: 33-21 days [p < 0.01]; AMCs: 24-15 days [p < 0.01]) and benzodiazepines (CHs: 261-136 days [p < 0.01]; AMCs: 150-77 days [p < 0.01]). The use of atypical antipsychotics, antidepressants, antiepileptics, and dexmedetomidine increased, while hypnotic use varied by the hospital type. In the non-ICU setting, the rate declined for haloperidol in CHs but not in AMCs (CHs: 10-6 days [p < 0.01]; AMCs: 4-3 days [p = 0.52]) and for benzodiazepines in both settings (CHs: 126-56 days [p < 0.01]; AMCs: 30-27 days [p < 0.01]). The use of antiepileptics and antidepressants increased, while the use of atypical antipsychotics and hypnotics varied by the hospital type. CONCLUSIONS The use of haloperidol and benzodiazepines in the postoperative period declined at both CHs and AMCs. These trends coincided with the increasing use of other psychoactive drugs.
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Affiliation(s)
- Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - E. Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Pratik P. Pandharipande
- Departments of Anesthesiology and Surgery, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Samuel F. Hohmann
- Vizient, Inc. and Department of Health Systems Management, Rush University, Chicago, IL
| | - Edward R. Marcantonio
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sharon K. Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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Ko D, Pande A, Lin KJ, Cervone A, Bessette LG, Lee SB, Cheng S, Glynn RJ, Kim DH. Utilization of P2Y 12 Inhibitors in Older Adults With ST-Elevation Myocardial Infarction and Frailty. Am J Cardiol 2023; 207:245-252. [PMID: 37757521 PMCID: PMC10840744 DOI: 10.1016/j.amjcard.2023.08.059] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
Choosing optimal P2Y12 inhibitor in frail older adults is challenging because they are at increased risk of both ischemic and bleeding events. We conducted a retrospective cohort study of Medicare Advantage Plan beneficiaries who were prescribed clopidogrel, prasugrel, or ticagrelor after percutaneous coronary intervention-treated ST-elevation myocardial infarction from January 1, 2010 to December 31, 2020. Frailty was defined using claims-based frailty index ≥0.25. We conducted multivariable logistic regression to identify factors associated with using potent P2Y12 inhibitors and multivariable-adjusted competing risk analyses to compare the rate of discontinuation of potent P2Y12 inhibitors in frail versus non-frail patients. There were 11,239 patients (mean age 74 years, 39% women). The prevalence of cardiovascular and geriatric co-morbidities was as follows: 32% chronic kidney disease, 28% heart failure, 10% previous myocardial infarction, 6% dementia, 20% anemia, and 12% frailty. The proportion of patients receiving clopidogrel decreased from 78.3% in 2010 to 2013 to 42.1% in 2018 to 2020, with a concurrent increase in those receiving potent P2Y12 inhibitors (mostly ticagrelor) from 21.7% to 57.9%. Frailty was independently associated with reduced odds of initiation (odds ratio 0.78, 95% confidence interval 0.67 to 0.90) but not with discontinuation of potent P2Y12 inhibitors (subdistribution hazard ratio 1.09, 95% confidence interval 0.98 to 1.22). In conclusion, frail older adults are less likely to receive potent P2Y12 inhibitors after percutaneous coronary intervention-treated ST-elevation myocardial infarction, but they are as likely as non-frail patients to continue with the prescribed P2Y12 inhibitor.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Ashvin Pande
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lily G Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Lauffenburger JC, Tesfaye H, Solomon DH, Antman EM, Glynn RJ, Lee SB, Tong A, Choudhry NK. Investigating the ability to adhere to cardiometabolic medications with different properties: a retrospective cohort study of >500 000 patients in the USA. BMJ Open 2023; 13:e075840. [PMID: 37949625 PMCID: PMC10649612 DOI: 10.1136/bmjopen-2023-075840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Poor medication adherence remains highly prevalent and adversely affects health outcomes. Patients frequently describe properties of the pills themselves, like size and shape, as barriers, but this has not been evaluated objectively. We sought to determine the extent to which oral medication properties thought to be influential translate into lower objectively-measured adherence. DESIGN Retrospective cohort study. SETTING US nationwide commercial claims database, 2016-2019. PARTICIPANTS Among patients initiating first-line hypertension, diabetes or hyperlipidaemia treatment based on clinical guidelines, we measured pill size, shape, colour and flavouring, number of pills/day and fixed-dose combination status as properties. OUTCOME MEASURES Outcomes included discontinuation after the first fill (ie, never filling again over a minimum of 1-year follow-up) and long-term non-adherence (1-year proportion of days covered <0.80). We estimated associations between each property and outcomes, by therapeutic class (eg, statins), with multivariable logistic regression. RESULTS Across 604 323 patients, 14.6% discontinued after filling once (ie, were non-persistent), and 54.0% were non-adherent over 1-year follow-up. Large pill size was associated with non-adherence, except for thiazides (eg, metformin adjusted OR (aOR): 1.12, 95% CI: 1.06 to 1.18). Greater pill burden was associated with a higher risk of non-adherence across all classes (eg, metformin aOR: 1.58, 95% CI: 1.53 to 1.64 for two pills/day). Taking less than one pill/day was also associated with higher risk of non-adherence and non-persistence (eg, non-persistence statin aOR: 1.29, 95% CI: 1.20 to 1.38). Pill shape, colour, flavouring and combination status were associated with mixed effects across classes. CONCLUSIONS Pill burden and pill size are key properties affecting adherence for almost all classes; others, like size and combination, could modestly affect medication adherence. Clinical interventions could screen patients for potential intolerance to medication and potentially implement more convenient dosing schedules.
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Affiliation(s)
- Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott M Antman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA
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8
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Lin KJ, Singer DE, Ko D, Glynn R, Najafzadeh M, Lee SB, Bessette LG, Cervone A, DiCesare E, Kim DH. Frailty, Home Time, and Health Care Costs in Older Adults With Atrial Fibrillation Receiving Oral Anticoagulants. JAMA Netw Open 2023; 6:e2342264. [PMID: 37943558 PMCID: PMC10636636 DOI: 10.1001/jamanetworkopen.2023.42264] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Importance There are no data on patient-centered outcomes and health care costs by frailty in patients with atrial fibrillation (AF) taking oral anticoagulants (OACs). Objective To compare home time, clinical events, and health care costs associated with OACs by frailty levels in older adults with AF. Design, Setting, and Participants This community-based cohort study assessed Medicare fee-for-service beneficiaries 65 years or older with AF from January 1, 2013, to December 31, 2019. Data analysis was performed from January to December 2022. Exposures Apixaban, rivaroxaban, and warfarin use were measured from prescription claims. Frailty was measured using a validated claims-based frailty index. Main outcomes and measures Outcome measures were (1) home time (days alive out of the hospital and skilled nursing facility) loss greater than 14 days; (2) a composite end point of ischemic stroke, systemic embolism, major bleeding, or death; and (3) total cost per member per year after propensity score overlap weighting. Results The weighted population comprised 136 551 beneficiaries, including 45 950 taking apixaban (mean [SD] age, 77.6 [7.3] years; 51.3% female), 45 320 taking rivaroxaban (mean [SD] age, 77.6 [7.3] years; 51.9% female), and 45 281 taking warfarin (mean [SD] age, 77.6 [7.3] years; 52.0% female). Compared with apixaban, rivaroxaban was associated with increased risk of home time lost greater than 14 days (risk difference per 100 persons, 1.8 [95% CI, 1.5-2.1]), composite end point (rate difference per 1000 person-years, 21.3 [95% CI, 16.4-26.2]), and total cost (mean difference, $890 [95% CI, $652-$1127]), with greater differences among the beneficiaries with frailty. Use of warfarin relative to apixaban was associated with increased home time lost (risk difference per 100 persons, 3.2 [95% CI, 2.9-3.5]) and composite end point (rate difference per 1000 person-years, 29.4 [95% CI, 24.5-34.3]), with greater differences among the beneficiaries with frailty. Compared with apixaban, warfarin was associated with lower total cost (mean difference, -$1166 [95% CI, -$1396 to -$937]) but higher cost when excluding OAC cost (mean difference, $1409 [95% CI, $1177 to $1642]) regardless of frailty levels. Conclusions and Relevance In older adults with AF, apixaban was associated with increased home time and lower rates of clinical events than rivaroxaban and warfarin, especially for those with frailty. Apixaban was associated with lower total cost compared with rivaroxaban but higher cost compared with warfarin due to higher OAC cost. These findings suggest that apixaban may be preferred for older adults with AF, particularly those with frailty.
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Affiliation(s)
- Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Daniel E. Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Darae Ko
- Section of Cardiovascular Medicine, Boston Medical Center, Boston, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Robert Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lily Gui Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elyse DiCesare
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Savage TJ, Kronman MP, Sreedhara SK, Lee SB, Oduol T, Huybrechts KF. Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis. JAMA 2023; 330:1064-1073. [PMID: 37721610 PMCID: PMC10509725 DOI: 10.1001/jama.2023.15503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023]
Abstract
Importance Acute sinusitis is one of the most common indications for antibiotic prescribing in children, with an estimated 4.9 million such prescriptions in the US annually. Consensus does not exist regarding the optimal empirical antibiotic. Objective To compare amoxicillin-clavulanate vs amoxicillin for the treatment of acute sinusitis in outpatient children. Design, Setting, and Participants Cohort study of children and adolescents aged 17 years or younger with a new outpatient diagnosis of acute sinusitis and a same-day new prescription dispensation of amoxicillin-clavulanate or amoxicillin in a nationwide health care utilization database. Propensity score matching was used to mitigate confounding. Exposure A new prescription dispensation of amoxicillin-clavulanate or amoxicillin. Main Outcomes and Measures Treatment failure, defined as an aggregate of a new antibiotic dispensation, emergency department or inpatient encounter for acute sinusitis, or inpatient encounter for a sinusitis complication, was assessed 1 to 14 days after cohort enrollment. Adverse events were evaluated, including gastrointestinal symptoms, hypersensitivity and skin reactions, acute kidney injury, and secondary infections. Results The cohort included 320 141 patients. After propensity score matching, there were 198 942 patients (99 471 patients per group), including 100 340 (50.4%) who were female, 101 726 (51.1%) adolescents aged 12 to 17 years, 52 149 (26.2%) children aged 6 to 11 years, and 45 067 (22.7%) children aged 0 to 5 years. Treatment failure occurred in 1.7% overall; 0.01% had serious failure (an emergency department or inpatient encounter). There was no difference in the risk of treatment failure between the amoxicillin-clavulanate and amoxicillin groups (relative risk [RR], 0.98 [95% CI, 0.92-1.05]). The risk of gastrointestinal symptoms (RR, 1.15 [95% CI, 1.05-1.25]) and yeast infections (RR, 1.33 [95% CI, 1.16-1.54]) was higher with amoxicillin-clavulanate. After patients were stratified by age, the risk of treatment failure after amoxicillin-clavulanate was an RR of 0.98 (95% CI, 0.86-1.12) for ages 0 to 5 years; RR was 1.06 (95% CI, 0.92-1.21) for 6 to 11 years; and RR was 0.87 (95% CI, 0.79-0.95) for 12 to 17 years. The age-stratified risk of adverse events after amoxicillin-clavulanate was an RR of 1.23 (95% CI, 1.10-1.37) for ages 0 to 5 years; RR was 1.19 (95% CI, 1.04-1.35) for 6 to 11 years; and RR was 1.04 (95% CI, 0.95-1.14) for 12 to 17 years. Conclusions and Relevance In children with acute sinusitis who were treated as outpatients, there was no difference in the risk of treatment failure between those who received amoxicillin-clavulanate compared with amoxicillin, but amoxicillin-clavulanate was associated with a higher risk of gastrointestinal symptoms and yeast infections. These findings may help inform decisions for empirical antibiotic selection in acute sinusitis.
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Affiliation(s)
- Timothy J. Savage
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Matthew P. Kronman
- Division of Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Theresa Oduol
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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10
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Kim DH, Lee SB, Park CM, Levin R, Metzger E, Bateman BT, Ely EW, Pandharipande PP, Pisani MA, Jones RN, Marcantonio ER, Inouye SK. Comparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery : A Nationwide Cohort Study. Ann Intern Med 2023; 176:1153-1162. [PMID: 37665998 PMCID: PMC10625498 DOI: 10.7326/m22-3021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Antipsychotics are commonly used to manage postoperative delirium. Recent studies reported that haloperidol use has declined, and atypical antipsychotic use has increased over time. OBJECTIVE To compare the risk for in-hospital adverse events associated with oral haloperidol, olanzapine, quetiapine, and risperidone in older patients after major surgery. DESIGN Retrospective cohort study. SETTING U.S. hospitals in the Premier Healthcare Database. PATIENTS 17 115 patients aged 65 years and older without psychiatric disorders who were prescribed an oral antipsychotic drug after major surgery from 2009 to 2018. INTERVENTIONS Haloperidol (≤4 mg on the day of initiation), olanzapine (≤10 mg), quetiapine (≤150 mg), and risperidone (≤4 mg). MEASUREMENTS The risk ratios (RRs) for in-hospital death, cardiac arrhythmia events, pneumonia, and stroke or transient ischemic attack (TIA) were estimated after propensity score overlap weighting. RESULTS The weighted population had a mean age of 79.6 years, was 60.5% female, and had in-hospital death of 3.1%. Among the 4 antipsychotics, quetiapine was the most prescribed (53.0% of total exposure). There was no statistically significant difference in the risk for in-hospital death among patients treated with haloperidol (3.7%, reference group), olanzapine (2.8%; RR, 0.74 [95% CI, 0.42 to 1.27]), quetiapine (2.6%; RR, 0.70 [CI, 0.47 to 1.04]), and risperidone (3.3%; RR, 0.90 [CI, 0.53 to 1.41]). The risk for nonfatal clinical events ranged from 2.0% to 2.6% for a cardiac arrhythmia event, 4.2% to 4.6% for pneumonia, and 0.6% to 1.2% for stroke or TIA, with no statistically significant differences by treatment group. LIMITATION Residual confounding by delirium severity; lack of untreated group; restriction to oral low-to-moderate dose treatment. CONCLUSION These results suggest that atypical antipsychotics and haloperidol have similar rates of in-hospital adverse clinical events in older patients with postoperative delirium who receive an oral low-to-moderate dose antipsychotic drug. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - E. Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Pratik P. Pandharipande
- Departments of Anesthesiology and Surgery, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Edward R. Marcantonio
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sharon K. Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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11
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Lee SB, Kwon LM, Song KS, Do YS, Park JH, Kim BJ. Comparison of complications after closure of totally implantable venous access devices with non-absorbable suture and n-butyl-2-cyanoacrylate (NBCA) skin adhesive: Propensity score matching analysis. J Vasc Access 2023:11297298231193525. [PMID: 37615157 DOI: 10.1177/11297298231193525] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
PURPOSE This study aimed to compare the complication rates of non-absorbable suture (NAS) and n-butyl-2-cyanoacrylate (NBCA) skin adhesive for skin closure during totally implantable venous access devices (TIVADs) implantation. METHODS Between March 2020 and February 2021, 586 consecutive patients who underwent TIVAD implantation were retrospectively analyzed. Two groups of patients suture with NAS (n = 299) or NBCA (n = 287) were followed up for 18 months to compare the occurrence of infection, thrombosis, and non-thrombotic malfunction. A total of 364 cases were extracted using propensity score matching in a 1:1 ratio. Mean TIVADs maintenance days were analyzed using Kaplan-Meier survival analysis. RESULTS Nineteen cases of complications occurred (0.294/1000 catheter-days) in the NAS group and 17 cases (0.210/1000 catheter-days) in the NBCA group. The difference in the complication rates between the two groups was not statistically significant (p = 0.725) after propensity score matching. Mean TIVADs maintenance days were 627.3 days in NAS group and 697.6 days in NBCA group. There was no statistically significant difference in the number of TIVADs maintenance days between the two groups (p = 0.081). CONCLUSION In TIVADs implantation, skin closure using NBCA showed no difference in the occurrence of infectious complications compared with conventional non-absorbable skin suture.
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Affiliation(s)
- Su Been Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Kyung Sup Song
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Young Soo Do
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Jung Ho Park
- Division of Breast and Endocrine Surgery, Department of General Surgery, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
| | - Bum Jun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea
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Thi My Nhung T, Phuoc Long N, Diem Nghi T, Suh Y, Hoang Anh N, Jung CW, Minh Triet H, Jung M, Woo Y, Yoo J, Noh S, Kim SJ, Lee SB, Park S, Thomas G, Simmen T, Mun J, Rhee HW, Kwon SW, Park SK. Genome-wide kinase-MAM interactome screening reveals the role of CK2A1 in MAM Ca 2+ dynamics linked to DEE66. Proc Natl Acad Sci U S A 2023; 120:e2303402120. [PMID: 37523531 PMCID: PMC10410754 DOI: 10.1073/pnas.2303402120] [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: 02/28/2023] [Accepted: 06/15/2023] [Indexed: 08/02/2023] Open
Abstract
The endoplasmic reticulum (ER) and mitochondria form a unique subcellular compartment called mitochondria-associated ER membranes (MAMs). Disruption of MAMs impairs Ca2+ homeostasis, triggering pleiotropic effects in the neuronal system. Genome-wide kinase-MAM interactome screening identifies casein kinase 2 alpha 1 (CK2A1) as a regulator of composition and Ca2+ transport of MAMs. CK2A1-mediated phosphorylation of PACS2 at Ser207/208/213 facilitates MAM localization of the CK2A1-PACS2-PKD2 complex, regulating PKD2-dependent mitochondrial Ca2+ influx. We further reveal that mutations of PACS2 (E209K and E211K) associated with developmental and epileptic encephalopathy-66 (DEE66) impair MAM integrity through the disturbance of PACS2 phosphorylation at Ser207/208/213. This, in turn, causes the reduction of mitochondrial Ca2+ uptake and the dramatic increase of the cytosolic Ca2+ level, thereby, inducing neurotransmitter release at the axon boutons of glutamatergic neurons. In conclusion, our findings suggest a molecular mechanism that MAM alterations induced by pathological PACS2 mutations modulate Ca2+-dependent neurotransmitter release.
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Affiliation(s)
- Truong Thi My Nhung
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Nguyen Phuoc Long
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan47392, Republic of Korea
| | - Tran Diem Nghi
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Yeongjun Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Nguyen Hoang Anh
- College of Pharmacy, Seoul National University, Seoul08826, Republic of Korea
| | - Cheol Woon Jung
- College of Pharmacy, Seoul National University, Seoul08826, Republic of Korea
| | - Hong Minh Triet
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Minkyo Jung
- Neural Circuit Research Group, Korea Brain Research Institute, Daegu41062, Republic of Korea
| | - Youngsik Woo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Jinyeong Yoo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Sujin Noh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Soo Jeong Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Su Been Lee
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
| | - Seongoh Park
- School of Mathematics, Statistics and Data Science, Sungshin Women’s University, Seoul02844, Republic of Korea
| | - Gary Thomas
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, PA15219
| | - Thomas Simmen
- Department of Cell Biology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, ABT6G 2H7, Canada
| | - Jiyoung Mun
- Neural Circuit Research Group, Korea Brain Research Institute, Daegu41062, Republic of Korea
| | - Hyun-Woo Rhee
- Department of Chemistry, Seoul National University, Seoul08826, Korea
| | - Sung Won Kwon
- College of Pharmacy, Seoul National University, Seoul08826, Republic of Korea
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang37673, Republic of Korea
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Bhatt AS, Vaduganathan M, Lee SB, Desai RJ. Examination of Initiation Patterns for Sacubitril/Valsartan Among Older Adults With HFrEF in the United States. JACC Heart Fail 2023; 11:1021-1023. [PMID: 37227387 DOI: 10.1016/j.jchf.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
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14
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Lee SB, D'Andrea E, Desai RJ. Initiation Patterns of Disease-Modifying Antirheumatic Drugs That Have Potential to Exacerbate Heart Failure. J Am Heart Assoc 2023:e029589. [PMID: 37449570 PMCID: PMC10382115 DOI: 10.1161/jaha.123.029589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital & Harvard Medical School Boston MA USA
| | - Elvira D'Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital & Harvard Medical School Boston MA USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital & Harvard Medical School Boston MA USA
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Ko B, Yoo JY, Yoo T, Choi W, Dogan R, Sung K, Um D, Lee SB, Kim HJ, Lee S, Beak ST, Park SK, Paik SB, Kim TK, Kim JH. Npas4-mediated dopaminergic regulation of safety memory consolidation. Cell Rep 2023; 42:112678. [PMID: 37379214 DOI: 10.1016/j.celrep.2023.112678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Amygdala circuitry encodes associations between conditioned stimuli and aversive unconditioned stimuli and also controls fear expression. However, whether and how non-threatening information for unpaired conditioned stimuli (CS-) is discretely processed remains unknown. The fear expression toward CS- is robust immediately after fear conditioning but then becomes negligible after memory consolidation. The synaptic plasticity of the neural pathway from the lateral to the anterior basal amygdala gates the fear expression of CS-, depending upon neuronal PAS domain protein 4 (Npas4)-mediated dopamine receptor D4 (Drd4) synthesis, which is precluded by stress exposure or corticosterone injection. Herein, we show cellular and molecular mechanisms that regulate the non-threatening (safety) memory consolidation, supporting the fear discrimination.
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Affiliation(s)
- BumJin Ko
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Jong-Yeon Yoo
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Taesik Yoo
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Woochul Choi
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Rumeysa Dogan
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Kibong Sung
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Dahun Um
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Su Been Lee
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Hyun Jin Kim
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Sangjun Lee
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea
| | - Seung Tae Beak
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Se-Bum Paik
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Tae-Kyung Kim
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Joung-Hun Kim
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Nam-gu, Pohang, Gyeongbuk 37673, Republic of Korea; Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea.
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16
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Cho E, Woo Y, Suh Y, Suh BK, Kim SJ, Nhung TTM, Yoo JY, Nghi TD, Lee SB, Mun DJ, Park SK. Ratiometric measurement of MAM Ca 2+ dynamics using a modified CalfluxVTN. Nat Commun 2023; 14:3586. [PMID: 37328454 PMCID: PMC10276021 DOI: 10.1038/s41467-023-39343-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/27/2022] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
Mitochondria-associated ER membrane (MAM) is a structure where these calcium-regulating organelles form close physical contact sites for efficient Ca2+ crosstalk. Despite the central importance of MAM Ca2+ dynamics in diverse biological processes, directly and specifically measuring Ca2+ concentrations inside MAM is technically challenging. Here, we develop MAM-Calflux, a MAM-specific BRET-based Ca2+ indicator. The successful application of the bimolecular fluorescence complementation (BiFC) concept highlights Ca2+-responsive BRET signals in MAM. The BiFC strategy imparts dual functionality as a Ca2+ indicator and quantitative structural marker specific for MAM. As a ratiometric Ca2+ indicator, MAM-Calflux estimates steady-state MAM Ca2+ levels. Finally, it enables the visualization of uneven intracellular distribution of MAM Ca2+ and the elucidation of abnormally accumulated MAM Ca2+ from the neurons of Parkinson's disease mouse model in both steady-state and stimulated conditions. Therefore, we propose that MAM-Calflux can be a versatile tool for ratiometrically measuring dynamic inter-organellar Ca2+ communication.
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Affiliation(s)
- Eunbyul Cho
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Youngsik Woo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
| | - Yeongjun Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Bo Kyoung Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Soo Jeong Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Truong Thi My Nhung
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jin Yeong Yoo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Tran Diem Nghi
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Su Been Lee
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Dong Jin Mun
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
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17
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Lee SB, Kim MJ, Lee IJ. Assessment of diagnostic accuracy and complication rates of CT-guided percutaneous core-needle biopsy for lung lesion: difference between solid and sub-solid nodules based on propensity score matching analysis. Clin Radiol 2023:S0009-9260(23)00177-0. [PMID: 37407369 DOI: 10.1016/j.crad.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 07/07/2023]
Abstract
AIM To compare the success and complication rates of computed tomography (CT)-guided percutaneous core-needle biopsy (PCNB) based on the density of lung nodules, using propensity score matching (PSM). MATERIALS AND METHODS This single-centre retrospective study included 1,312 PCNB cases of lung lesions, including solid (n=1,120), part-solid (n=115), and non-solid nodules (n=77), that were detected between March 2013 and March 2021. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were analysed before PSM. To perform PSM, part-solid and non-solid nodules were combined and newly defined as sub-solid nodules. The diagnostic accuracy and complication rates of pneumothorax and pulmonary haemorrhage were then compared between solid and sub-solid nodules after PSM. RESULTS Among the 1,312 included cases, the success rate and incidence of pneumothorax after CT-guided PCNB for solid, part-solid, and non-solid nodules were not statistically different (p=0.080 and 0.410). However, the rates of overall pulmonary haemorrhage showed statistical differences (p<0.001), particularly between solid and part-solid nodules (p<0.001) and between solid and non-solid nodules (p<0.001). After PSM, the incidence rates of overall pulmonary haemorrhage in solid and sub-solid nodules were 8.9% (17/192) and 29.7% (44/182), respectively, showing a statistically significant difference (p<0.001). CONCLUSION There is increased risk of haemorrhage in CT-guided needle biopsy of sub-solid nodules compared to solid nodules. Increased emphasis should be placed on the risk of pulmonary haemorrhage when consenting these patients.
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Affiliation(s)
- S B Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - M J Kim
- Department of Radiology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea.
| | - I J Lee
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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18
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Lee H, Sparks JA, Lee SB, Yoshida K, Landon JE, Kim SC. Validation of serostatus of rheumatoid arthritis using ICD-10 codes in administrative claims data. Pharmacoepidemiol Drug Saf 2023; 32:586-591. [PMID: 36728737 PMCID: PMC10073326 DOI: 10.1002/pds.5597] [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: 03/31/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the accuracy of International Classification of Diseases- Tenth Revision (ICD-10) diagnosis codes for rheumatoid arthritis (RA) serostatus using a U.S. claims database (Optum Clinformatics Data Mart, Optum) and to compare the results to a previous validation study performed in IBM Marketscan Research Database (sensitivity 73%, positive predictive value, PPV, 84%). METHODS In Optum (01/01/2016-03/31/2020) linked with laboratory results, we selected RA patients based on ≥2 ICD-10 diagnosis codes for RA (M05 or M06) and at least one dispensing of RA treatments. We included individuals with at least one laboratory result for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP) performed 365 days prior to and including the cohort entry date. An individual was "seropositive" if at least one of the 2 diagnosis codes used to define RA status was M05. "Seronegative" patients were required to have only M06. Secondary analyses were performed using subsets of M05 and M06 diagnosis codes. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa of M05 and M06 against the prespecified reference standard laboratory data. RESULTS We identified 14 490 adult RA patients who had at least 1 RF or anti-CCP result. The number of patients identified for each reference standard definition ranged from 3315 (reference standard definition: high + anti-CCP) to 13 636 (any + RF). PPV for seropositive RA, M05, was 77.1%. The PPV of M06 for seronegative RA was 61.6%. When we applied more restricted definitions of M05 and M06, the PPV for seropositive RA increased to 79.2%. The PPV for seronegative RA also notably increased to 89.5%. CONCLUSION ICD-10 codes (M05 and M06) can help identify RA serostatus in claims data, but their limitations should be acknowledged. The PPVs for seropositive and seronegative RA found in the Optum database were lower than those found in MarketScan, perhaps related to database variability or differing patient characteristics and clinical practice. When more restricted definitions of M05 and M06 were used, the PPVs for seropositive and seronegative RA improved to 79.2% and 89.5%, respectively.
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Affiliation(s)
- Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Joan E. Landon
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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19
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Wang SV, Schneeweiss S, Franklin JM, Desai RJ, Feldman W, Garry EM, Glynn RJ, Lin KJ, Paik J, Patorno E, Suissa S, D'Andrea E, Jawaid D, Lee H, Pawar A, Sreedhara SK, Tesfaye H, Bessette LG, Zabotka L, Lee SB, Gautam N, York C, Zakoul H, Concato J, Martin D, Paraoan D, Quinto K. Emulation of Randomized Clinical Trials With Nonrandomized Database Analyses: Results of 32 Clinical Trials. JAMA 2023; 329:1376-1385. [PMID: 37097356 PMCID: PMC10130954 DOI: 10.1001/jama.2023.4221] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/04/2023] [Indexed: 04/26/2023]
Abstract
Importance Nonrandomized studies using insurance claims databases can be analyzed to produce real-world evidence on the effectiveness of medical products. Given the lack of baseline randomization and measurement issues, concerns exist about whether such studies produce unbiased treatment effect estimates. Objective To emulate the design of 30 completed and 2 ongoing randomized clinical trials (RCTs) of medications with database studies using observational analogues of the RCT design parameters (population, intervention, comparator, outcome, time [PICOT]) and to quantify agreement in RCT-database study pairs. Design, Setting, and Participants New-user cohort studies with propensity score matching using 3 US claims databases (Optum Clinformatics, MarketScan, and Medicare). Inclusion-exclusion criteria for each database study were prespecified to emulate the corresponding RCT. RCTs were explicitly selected based on feasibility, including power, key confounders, and end points more likely to be emulated with real-world data. All 32 protocols were registered on ClinicalTrials.gov before conducting analyses. Emulations were conducted from 2017 through 2022. Exposures Therapies for multiple clinical conditions were included. Main Outcomes and Measures Database study emulations focused on the primary outcome of the corresponding RCT. Findings of database studies were compared with RCTs using predefined metrics, including Pearson correlation coefficients and binary metrics based on statistical significance agreement, estimate agreement, and standardized difference. Results In these highly selected RCTs, the overall observed agreement between the RCT and the database emulation results was a Pearson correlation of 0.82 (95% CI, 0.64-0.91), with 75% meeting statistical significance, 66% estimate agreement, and 75% standardized difference agreement. In a post hoc analysis limited to 16 RCTs with closer emulation of trial design and measurements, concordance was higher (Pearson r, 0.93; 95% CI, 0.79-0.97; 94% meeting statistical significance, 88% estimate agreement, 88% standardized difference agreement). Weaker concordance occurred among 16 RCTs for which close emulation of certain design elements that define the research question (PICOT) with data from insurance claims was not possible (Pearson r, 0.53; 95% CI, 0.00-0.83; 56% meeting statistical significance, 50% estimate agreement, 69% standardized difference agreement). Conclusions and Relevance Real-world evidence studies can reach similar conclusions as RCTs when design and measurements can be closely emulated, but this may be difficult to achieve. Concordance in results varied depending on the agreement metric. Emulation differences, chance, and residual confounding can contribute to divergence in results and are difficult to disentangle.
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Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Now with Optum, Boston, Massachusetts
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William Feldman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julie Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Elvira D'Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Now with AbbVie Inc, Washington, DC
| | - Dureshahwar Jawaid
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ajinkya Pawar
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lily G Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luke Zabotka
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nileesa Gautam
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cassie York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Concato
- Office of Medical Policy, US Food and Drug Administration, Silver Springs, Maryland
| | - David Martin
- Office of Medical Policy, US Food and Drug Administration, Silver Springs, Maryland
- Now with Moderna, Cambridge, Massachusetts
| | - Dianne Paraoan
- Office of Medical Policy, US Food and Drug Administration, Silver Springs, Maryland
| | - Kenneth Quinto
- Office of Medical Policy, US Food and Drug Administration, Silver Springs, Maryland
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20
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Savage TJ, Kronman MP, Sreedhara SK, Russo M, Lee SB, Oduol T, Huybrechts KF. Trends in the Antibiotic Treatment of Acute Sinusitis: 2003-2020. Pediatrics 2023; 151:e2022060685. [PMID: 36880204 PMCID: PMC10071422 DOI: 10.1542/peds.2022-060685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 12/22/2022] [Indexed: 03/08/2023] Open
Affiliation(s)
- Timothy J. Savage
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew P. Kronman
- Division of Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Massimiliano Russo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Theresa Oduol
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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21
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Song TJ, Shin JI, Yon DK, Lee SW, Hwang SY, Hwang J, Park SH, Lee SB, Lee MH, Kim MS, Koyanagi A, Tizaoui K, Kim JH, Smith L. Cerebral venous thrombosis after ChAdOx1 nCoV-19 vaccination: a systematic review. Eur Rev Med Pharmacol Sci 2023; 27:404-410. [PMID: 36647889 DOI: 10.26355/eurrev_202301_30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT. SUBJECTS AND METHODS We included 64 TTS patients from 19 articles, 6 case series and 13 case reports, in which thrombosis occurred after the first dose of ChAdOx1 nCoV-19 vaccination published up to 30 June 2021 in Embase, ePubs, Medline/PubMed, Scopus, and Web of Science databases. RESULTS Of the 64 TTS patients, 38 (59.3%) had CVT. Patients with CVT were younger (median 36.5 vs. 52.5 years, p<0.001), had lower fibrinogen levels (130 vs. 245 mg/dL, p=0.008), had more frequent history of intracerebral hemorrhage (ICH), and had higher mortality rate (48.6% vs. 19.2%, p=0.020) than that of patients without CVT. In multivariable analysis, the possibility of presence of CVT was higher in younger age groups [odd ratio (OR): 0.91, 95% confidence interval (CI): (0.86-0.97, p<0.001)] and those with accompanying intracerebral hemorrhage (ICH) (OR: 13.60, 95% CI (1.28-144.12, p=0.045). CONCLUSIONS Our study demonstrated that CVT related to ChAdOx1 nCoV-19 vaccination was associated with younger age, low levels of fibrinogen, presence of ICH and more frequent mortality compared to those of non-CVT. If TTS occurs after ChAdOx1 nCoV-19 vaccination, the presence of CVT in patients with young age or ICH should be considered.
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Affiliation(s)
- T-J Song
- Department of Neurology, Seoul Hospital, Ewha University College of Medicine, Seoul, Republic of Korea.
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22
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Goo BS, Mun DJ, Kim S, Nhung TTM, Lee SB, Woo Y, Kim SJ, Suh BK, Park SJ, Lee HE, Park K, Jang H, Rah JC, Yoon KJ, Baek ST, Park SY, Park SK. Schizophrenia-associated Mitotic Arrest Deficient-1 (MAD1) regulates the polarity of migrating neurons in the developing neocortex. Mol Psychiatry 2023; 28:856-870. [PMID: 36357673 PMCID: PMC9908555 DOI: 10.1038/s41380-022-01856-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Although large-scale genome-wide association studies (GWAS) have identified an association between MAD1L1 (Mitotic Arrest Deficient-1 Like 1) and the pathology of schizophrenia, the molecular mechanisms underlying this association remain unclear. In the present study, we aimed to address these mechanisms by examining the role of MAD1 (the gene product of MAD1L1) in key neurodevelopmental processes in mice and human organoids. Our findings indicated that MAD1 is highly expressed during active cortical development and that MAD1 deficiency leads to impairments in neuronal migration and neurite outgrowth. We also observed that MAD1 is localized to the Golgi apparatus and regulates vesicular trafficking from the Golgi apparatus to the plasma membrane, which is required for the growth and polarity of migrating neurons. In this process, MAD1 physically interacts and collaborates with the kinesin-like protein KIFC3 (kinesin family member C3) to regulate the morphology of the Golgi apparatus and neuronal polarity, thereby ensuring proper neuronal migration and differentiation. Consequently, our findings indicate that MAD1 is an essential regulator of neuronal development and that alterations in MAD1 may underlie schizophrenia pathobiology.
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Affiliation(s)
- Bon Seong Goo
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Dong Jin Mun
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Seunghyun Kim
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Truong Thi My Nhung
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Su Been Lee
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Youngsik Woo
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Soo Jeong Kim
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Bo Kyoung Suh
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Sung Jin Park
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea ,grid.168645.80000 0001 0742 0364Present Address: Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Hee-Eun Lee
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Kunyou Park
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Hyunsoo Jang
- grid.37172.300000 0001 2292 0500Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141 Republic of Korea
| | - Jong-Cheol Rah
- grid.452628.f0000 0004 5905 0571Korea Brain Research Institute, Daegu, 41062 Republic of Korea
| | - Ki-Jun Yoon
- grid.37172.300000 0001 2292 0500Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141 Republic of Korea
| | - Seung Tae Baek
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673 Republic of Korea
| | - Seung-Yeol Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
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Savage TJ, Kronman M, Lee SB, Oduol T, Huybrechts KF. 563. Nationwide Trends in Antibiotic Selection for the Treatment of Pediatrics Acute Sinusitis, 2003-2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Acute sinusitis is a common diagnosis associated with outpatient antibiotic prescribing for children. Infectious Diseases Society of America guidelines (published in 2012) and American Academy of Pediatrics guidelines (published in 2013) for the management of acute sinusitis recommend amoxicillin with or without clavulanate as empiric therapy. Nationwide trends in antibiotic treatment of sinusitis have not been described since guideline publication.
Methods
We evaluated trends in antibiotic prescriptions for new acute sinusitis diagnoses among commercially insured patients < 18 years old between January 1, 2003 and December 31, 2020 using the MarketScan Research Database. Subjects were identified via an outpatient encounter with an ICD code for acute sinusitis along with an oral antibiotic prescription dispensed on the day of the visit. New diagnoses were defined as having no sinusitis diagnosis in the preceding 180 days. Patients were excluded if they had a diagnosis code for chronic sinusitis or cystic fibrosis in the 6 months prior to the acute sinusitis diagnosis or had a same-day ICD code for another infection that would influence antibiotic selection (acute otitis media, cellulitis/abscess, community acquired pneumonia, Group A Streptococcal pharyngitis/tonsillitis, or urinary tract infection).
Results
3.3 million patients met the inclusion and exclusion criteria (Table 1). From 2003-2012, about 50% of patients received amoxicillin with or without clavulanate (Figure 1). Since 2013, the proportion of patients receiving first line antibiotics increased by 13%. The proportion receiving two or more antibiotics was unchanged. Approximately 80% of patients were prescribed 10-13 days of antibiotics (Figure 2). The proportion of patients receiving 14 or more days decreased by 67% over the study period.
Conclusion
In a nationwide cohort of commercially insured children with acute sinusitis, prescriptions for amoxicillin with or without clavulanate increased after publication of society guidelines. About 40% of patients are prescribed a non-first line antibiotic or multiple antibiotics and nearly 90% of patients are prescribed 10 or more days of antibiotics, presenting important opportunities for antimicrobial stewardship interventions.
Disclosures
Timothy J. Savage, MD, MPH, MSc, UCB: Contract to Brigham and Women's Hospital.
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Affiliation(s)
- Timothy J Savage
- Boston Children's Hospital / Brigham and Women's Hospital , Boston, Massachusetts
| | - Matthew Kronman
- Seattle Children's Hospital / University of Washington , Seattle, Washington
| | - Su Been Lee
- Brigham and Women's Hospital , Boston, Massachusetts
| | - Theresa Oduol
- Brigham and Women's Hospital , Boston, Massachusetts
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Ko D, Lin KJ, Bessette LG, Lee SB, Walkey AJ, Cheng S, Kim E, Glynn RJ, Kim DH. Trends in Use of Oral Anticoagulants in Older Adults With Newly Diagnosed Atrial Fibrillation, 2010-2020. JAMA Netw Open 2022; 5:e2242964. [PMID: 36399339 PMCID: PMC9675002 DOI: 10.1001/jamanetworkopen.2022.42964] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Undertreatment of older adults with atrial fibrillation with anticoagulation therapy is an important practice gap. It has been posited that the availability of direct oral anticoagulants (DOACs) would improve oral anticoagulant (OAC) initiation in older adults with atrial fibrillation given their superior safety profile compared with warfarin. OBJECTIVES To systematically examine trends in OAC initiation and nonadherence in older adults with atrial fibrillation and coexisting geriatric conditions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study uses administrative claims data from Optum's Clinformatics Data Mart from January 1, 2010, to December 31, 2020. Participants included beneficiaries of Medicare Advantage plans aged 65 years and older with atrial fibrillation and elevated risk of ischemic stroke. Data analysis was performed from October 2021 to October 2022. EXPOSURES Coexisting dementia, frailty, and anemia. MAIN OUTCOMES AND MEASURES The primary outcomes were OAC initiation within 12 months after the first diagnosis of atrial fibrillation per year and nonadherence with OAC per year (defined as <80% of proportion of days covered among patients newly started on OAC in each year). RESULTS There were 21 603 to 51 236 patients per year (total for 2010-2020, 381 488 patients) in the OAC-eligible incident AF cohort (mean [SD] age, 77.2 [6.1] to 77.4 [6.8] years; 13 871 [51.8%] to 22 901 [49.8%] women). OAC initiation within 12 months after incident AF increased from 20.2% (5405 of 26 782 patients) in 2010 to 32.9% (7111 of 21 603 patients) in 2020. DOAC uptake increased from 1.1% (291 of 26 782 patients) to 30.9% (6678 of 21 603 patients), and warfarin initiation decreased from 19.1% (5114 of 26 782 patients) to 2.0% (436 of 21 603 patients). Older age (odds ratio [OR], 0.98; 95% CI, 0.98-0.98), dementia (OR, 0.57; 95% CI, 0.55-0.58), frailty (OR, 0.74; 95% CI, 0.72-0.76), and anemia (OR, 0.75; 95% CI, 0.74-0.77) were associated with lower odds of OAC initiation. During the study period, the median (IQR) proportion of days covered increased from 77.6% (41.0%-96.4%) to 90.2% (57.4%-98.6%), and OAC nonadherence decreased from 52.2% (2290 of 4389 patients) to 39.0% (3434 of 8798 patients). CONCLUSIONS AND RELEVANCE Since the introduction of DOACs, OAC initiation in older adults with has improved but remained suboptimal in 2020. Additional strategies are needed to improve stroke prophylaxis in all older adults with atrial fibrillation including those with coexisting dementia, frailty, and anemia.
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Affiliation(s)
- Darae Ko
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lily G. Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Allan J. Walkey
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erin Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Dae Hyun Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
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Park CM, Inouye SK, Marcantonio ER, Metzger E, Bateman BT, Lie JJ, Lee SB, Levin R, Kim DH. Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery. JAMA Intern Med 2022; 182:1117-1127. [PMID: 36121671 PMCID: PMC9486639 DOI: 10.1001/jamainternmed.2022.3680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
Importance Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. However, the safety of perioperative gabapentin use among older patients remains uncertain. Objective To examine in-hospital adverse clinical events associated with perioperative gabapentin use among older patients undergoing major surgery. Design, Setting, and Participants This retrospective cohort study using data from the Premier Healthcare Database included patients aged 65 years or older who underwent major surgery at US hospitals within 7 days of hospital admission from January 1, 2009, to March 31, 2018, and did not use gabapentin before surgery. Data were analyzed from June 14, 2021, to May 23, 2022. Exposures Gabapentin use within 2 days after surgery. Main Outcomes and Measures The primary outcome was delirium, identified using diagnosis codes, and secondary outcomes were new antipsychotic use, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. To reduce confounding, 1:1 propensity score matching was performed. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were estimated. Results Among 967 547 patients before propensity score matching (mean [SD] age, 76.2 [7.4] years; 59.6% female), the rate of perioperative gabapentin use was 12.3% (119 087 patients). After propensity score matching, 237 872 (118 936 pairs) gabapentin users and nonusers (mean [SD] age, 74.5 [6.7] years; 62.7% female) were identified. Compared with nonusers, gabapentin users had increased risk of delirium (4040 [3.4%] vs 3148 [2.6%]; RR, 1.28 [95% CI, 1.23-1.34]; RD, 0.75 [95% CI, 0.75 [0.61-0.89] per 100 persons), new antipsychotic use (944 [0.8%] vs 805 [0.7%]; RR, 1.17 [95% CI, 1.07-1.29]; RD, 0.12 [95% CI, 0.05-0.19] per 100 persons), and pneumonia (1521 [1.3%] vs 1368 [1.2%]; RR, 1.11 [95% CI, 1.03-1.20]; RD, 0.13 [95% CI, 0.04-0.22] per 100 persons), but there was no difference in in-hospital death (362 [0.3%] vs 354 [0.2%]; RR, 1.02 [95% CI, 0.88-1.18]; RD, 0.00 [95% CI, -0.04 to 0.05] per 100 persons). Risk of delirium among gabapentin users was greater in subgroups with high comorbidity burden than in those with low comorbidity burden (combined comorbidity index <4 vs ≥4: RR, 1.20 [95% CI, 1.13-1.27] vs 1.40 [95% CI, 1.30-1.51]; RD, 0.41 [95% CI, 0.28-0.53] vs 2.66 [95% CI, 2.08-3.24] per 100 persons) and chronic kidney disease (absence vs presence: RR, 1.26 [95% CI, 1.19-1.33] vs 1.38 [95% CI, 1.27-1.49]; RD, 0.56 [95% CI, 0.42-0.69] vs 1.97 [95% CI, 1.49-2.46] per 100 persons). Conclusion and Relevance In this cohort study, perioperative gabapentin use was associated with increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. These results suggest careful risk-benefit assessment before prescribing gabapentin for perioperative pain management.
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Affiliation(s)
- Chan Mi Park
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Sharon K. Inouye
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward R. Marcantonio
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jessica J. Lie
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Desai RJ, Mahesri M, Lee SB, Varma VR, Loeffler T, Schilcher I, Gerhard T, Segal JB, Ritchey ME, Horton DB, Kim SC, Schneeweiss S, Thambisetty M. No association between initiation of phosphodiesterase-5 inhibitors and risk of incident Alzheimer's disease and related dementia: results from the Drug Repurposing for Effective Alzheimer's Medicines study. Brain Commun 2022; 4:fcac247. [PMID: 36330433 PMCID: PMC9598543 DOI: 10.1093/braincomms/fcac247] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/11/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
We evaluated the hypothesis that phosphodiesterase-5 inhibitors, including sildenafil and tadalafil, may be associated with reduced incidence of Alzheimer's disease and related dementia using a patient-level cohort study of Medicare claims and cell culture-based phenotypic assays. We compared incidence of Alzheimer's disease and related dementia after phosphodiesterase-5 inhibitor initiation versus endothelin receptor antagonist initiation among patients with pulmonary hypertension after controlling for 76 confounding variables through propensity score matching. Across four separate analytic approaches designed to address specific types of biases including informative censoring, reverse causality, and outcome misclassification, we observed no evidence for a reduced risk of Alzheimer's disease and related dementia with phosphodiesterase-5 inhibitors;hazard ratio (95% confidence interval): 0.99 (0.69-1.43), 1.00 (0.71-1.42), 0.67 (0.43-1.06), and 1.15 (0.57-2.34). We also did not observe evidence that sildenafil ameliorated molecular abnormalities relevant to Alzheimer's disease in most cell culture-based phenotypic assays. These results do not provide support to the hypothesis that phosphodiesterase-5 inhibitors are promising repurposing candidates for Alzheimer's disease and related dementia.
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Affiliation(s)
- Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Vijay R Varma
- Clinical & Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA
| | - Tina Loeffler
- QPS Austria GmbH, Parkring 12, 8074 Grambach, Austria
| | | | - Tobias Gerhard
- Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ 08901, USA
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
| | - Jodi B Segal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Mary E Ritchey
- Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ 08901, USA
| | - Daniel B Horton
- Rutgers Center for Pharmacoepidemiology and Treatment Science, New Brunswick, NJ 08901, USA
- Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08901, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Madhav Thambisetty
- Clinical & Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA
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Khosrow-Khavar F, Desai RJ, Lee H, Lee SB, Kim SC. Tofacitinib and Risk of Malignancy: Results From the Safety of Tofacitinib in Routine Care Patients With Rheumatoid Arthritis (STAR-RA) Study. Arthritis Rheumatol 2022; 74:1648-1659. [PMID: 35643956 PMCID: PMC9529806 DOI: 10.1002/art.42250] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 08/30/2021] [Revised: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Results of the ORAL Surveillance safety trial have indicated that there is an increased risk for the development of malignancies with tofacitinib therapy when compared to treatment with tumor necrosis factor inhibitors (TNFi). This study was undertaken to further examine this safety concern in rheumatoid arthritis (RA) patients in a real-world setting. METHODS Using US insurance claims data from Optum Clinformatics (2012-2020), IBM MarketScan Research Databases (2012-2018), and Medicare (parts A, B, and D, 2012-2017), we created 2 cohorts of RA patients who had initiated treatment with tofacitinib or TNFi. The first cohort, designated the real-world evidence (RWE) cohort, included RA patients from routine care. For the second cohort, designated the randomized controlled trial (RCT)-duplicate cohort, we emulated the inclusion and exclusion criteria that were applied in the ORAL Surveillance trial of tofacitinib, which allowed us to assess the comparability of our results with the results of that trial. Cox proportional hazards models with propensity score fine-stratification weighting were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of any malignancy (excluding nonmelanoma skin cancer). Database-specific estimates were meta-analyzed using fixed-effects models with inverse-variance weighting. RESULTS The RWE cohort consisted of 83,295 patients, including 10,504 patients (12.6%) who received treatment with tofacitinib. The pooled weighted HR for the primary outcome of any malignancy associated with tofacitinib treatment compared to any malignancy associated with TNFi therapy was 1.01 (95% CI 0.83, 1.22) in the RWE cohort and 1.17 (95% CI 0.85, 1.62) in the RCT-duplicate cohort (compared to the ORAL Surveillance trial HR of 1.48 [95% CI 1.04, 2.09]). CONCLUSION We did not find evidence of an increased risk of malignancy development with tofacitinib therapy, in comparison with TNFi therapy, in RA patients treated in a real-world setting. However, our results cannot rule out the possibility of an increase in risk that may accrue with a longer duration of treatment with tofacitinib.
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Affiliation(s)
- Farzin Khosrow-Khavar
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
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Won SM, Oh KK, Gupta H, Ganesan R, Sharma SP, Jeong JJ, Yoon SJ, Jeong MK, Min BH, Hyun JY, Park HJ, Eom JA, Lee SB, Cha MG, Kwon GH, Choi MR, Kim DJ, Suk KT. The Link between Gut Microbiota and Hepatic Encephalopathy. Int J Mol Sci 2022; 23:ijms23168999. [PMID: 36012266 PMCID: PMC9408988 DOI: 10.3390/ijms23168999] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatic encephalopathy (HE) is a serious complication of cirrhosis that causes neuropsychiatric problems, such as cognitive dysfunction and movement disorders. The link between the microbiota and the host plays a key role in the pathogenesis of HE. The link between the gut microbiome and disease can be positively utilized not only in the diagnosis area of HE but also in the treatment area. Probiotics and prebiotics aim to resolve gut dysbiosis and increase beneficial microbial taxa, while fecal microbiota transplantation aims to address gut dysbiosis through transplantation (FMT) of the gut microbiome from healthy donors. Antibiotics, such as rifaximin, aim to improve cognitive function and hyperammonemia by targeting harmful taxa. Current treatment regimens for HE have achieved some success in treatment by targeting the gut microbiota, however, are still accompanied by limitations and problems. A focused approach should be placed on the establishment of personalized trial designs and therapies for the improvement of future care. This narrative review identifies factors negatively influencing the gut–hepatic–brain axis leading to HE in cirrhosis and explores their relationship with the gut microbiome. We also focused on the evaluation of reported clinical studies on the management and improvement of HE patients with a particular focus on microbiome-targeted therapy.
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Jeong JJ, Park HJ, Cha MG, Park E, Won SM, Ganesan R, Gupta H, Gebru YA, Sharma SP, Lee SB, Kwon GH, Jeong MK, Min BH, Hyun JY, Eom JA, Yoon SJ, Choi MR, Kim DJ, Suk KT. The Lactobacillus as a Probiotic: Focusing on Liver Diseases. Microorganisms 2022; 10:microorganisms10020288. [PMID: 35208742 PMCID: PMC8879051 DOI: 10.3390/microorganisms10020288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/04/2022] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, scientific evidence for the properties, functions, and beneficial effects of probiotics for humans has continued to accumulate. Interest in the use of probiotics for humans has increased tremendously. Among various microorganisms, probiotics using bacteria have been widely studied and commercialized, and, among them, Lactobacillus is representative. This genus contains about 300 species of bacteria (recently differentiated into 23 genera) and countless strains have been reported. They improved a wide range of diseases including liver disease, gastrointestinal diseases, respiratory diseases, and autoimmune diseases. Here, we intend to discuss in depth the genus Lactobacillus as a representative probiotic for chronic liver diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ki Tae Suk
- Correspondence: ; Tel.: +82-10-5365-5700; Fax: +82-033-248-3481
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Khosrow-Khavar F, Kim SC, Lee H, Lee SB, Desai RJ. Tofacitinib and risk of cardiovascular outcomes: results from the Safety of TofAcitinib in Routine care patients with Rheumatoid Arthritis (STAR-RA) study. Ann Rheum Dis 2022; 81:798-804. [PMID: 35027405 DOI: 10.1136/annrheumdis-2021-221915] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Recent results from 'ORAL Surveillance' trial have raised concerns regarding the cardiovascular safety of tofacitinib in patients with rheumatoid arthritis (RA). We further examined this safety concern in the real-world setting. METHODS We created two cohorts of patients with RA initiating treatment with tofacitinib or tumour necrosis factor inhibitors (TNFI) using deidentified data from Optum Clinformatics (2012-2020), IBM MarketScan (2012-2018) and Medicare (parts A, B and D, 2012-2017) claims databases: (1) A 'real-world evidence (RWE) cohort' consisting of routine care patients and (2) A 'randomised controlled trial (RCT)-duplicate cohort' mimicking inclusion and exclusion criteria of the ORAL surveillance trial to calibrate results against the trial findings. Cox proportional hazards models with propensity score fine stratification weighting were used to estimate HR and 95% CIs for composite outcome of myocardial infarction and stroke and accounting for 76 potential confounders. Database-specific effect estimates were pooled using fixed effects models with inverse-variance weighting. RESULTS In the RWE cohort, 102 263 patients were identified of whom 12 852 (12.6%) initiated tofacitinib. The pooled weighted HR (95% CI) comparing tofacitinib with TNFI was 1.01 (0.83 to 1.23) in RWE cohort and 1.24 (0.90 to 1.69) in RCT-duplicate cohort which aligned closely with ORAL-surveillance results (HR: 1.33, 95% CI 0.91 to 1.94). CONCLUSIONS We did not find evidence for an increased risk of cardiovascular outcomes with tofacitinib in patients with RA treated in the real-world setting; however, tofacitinib was associated with an increased risk of cardiovascular outcomes, although statistically non-significant, in patients with RA with cardiovascular risk factors. TRIAL REGISTRATION NUMBER NCT04772248.
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Affiliation(s)
- Farzin Khosrow-Khavar
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hemin Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lee SB, Park J, Kwak Y, Park YU, Nhung TTM, Suh BK, Woo Y, Suh Y, Cho E, Cho S, Park SK. Disrupted-in-schizophrenia 1 enhances the quality of circadian rhythm by stabilizing BMAL1. Transl Psychiatry 2021; 11:110. [PMID: 33542182 PMCID: PMC7862247 DOI: 10.1038/s41398-021-01212-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022] Open
Abstract
Disrupted-in-schizophrenia 1 (DISC1) is a scaffold protein that has been implicated in multiple mental disorders. DISC1 is known to regulate neuronal proliferation, signaling, and intracellular calcium homeostasis, as well as neurodevelopment. Although DISC1 was linked to sleep-associated behaviors, whether DISC1 functions in the circadian rhythm has not been determined yet. In this work, we revealed that Disc1 expression exhibits daily oscillating pattern and is regulated by binding of circadian locomotor output cycles kaput (CLOCK) and Brain and muscle Arnt-like protein-1 (BMAL1) heterodimer to E-box sequences in its promoter. Interestingly, Disc1 deficiency increases the ubiquitination of BMAL1 and de-stabilizes it, thereby reducing its protein levels. DISC1 inhibits the activity of GSK3β, which promotes BMAL1 ubiquitination, suggesting that DISC1 regulates BMAL1 stability by inhibiting its ubiquitination. Moreover, Disc1-deficient cells and mice show reduced expression of other circadian genes. Finally, Disc1-LI (Disc1 knockout) mice exhibit damped circadian physiology and behaviors. Collectively, these findings demonstrate that the oscillation of DISC1 expression is under the control of CLOCK and BMAL1, and that DISC1 contributes to the core circadian system by regulating BMAL1 stability.
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Affiliation(s)
- Su Been Lee
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Jihyun Park
- grid.289247.20000 0001 2171 7818Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yongdo Kwak
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea ,grid.507563.2Present Address: SK biopharmaceuticals Ltd, Seongnam-Si, Republic of Korea
| | - Young-Un Park
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea ,grid.49606.3d0000 0001 1364 9317Present Address: Department of Pathology, College of Medicine, Hanyang University, Seoul, Korea
| | - Truong Thi My Nhung
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Bo Kyoung Suh
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Youngsik Woo
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Yeongjun Suh
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Eunbyul Cho
- grid.49100.3c0000 0001 0742 4007Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Sehyung Cho
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea.
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Suh BK, Lee SA, Park C, Suh Y, Kim SJ, Woo Y, Nhung TTM, Lee SB, Mun DJ, Goo BS, Choi HS, Kim SJ, Park SK. Schizophrenia-associated dysbindin modulates axonal mitochondrial movement in cooperation with p150 glued. Mol Brain 2021; 14:14. [PMID: 33461576 PMCID: PMC7814725 DOI: 10.1186/s13041-020-00720-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/14/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Mitochondrial movement in neurons is finely regulated to meet the local demand for energy and calcium buffering. Elaborate transport machinery including motor complexes is required to deliver and localize mitochondria to appropriate positions. Defects in mitochondrial transport are associated with various neurological disorders without a detailed mechanistic information. In this study, we present evidence that dystrobrevin-binding protein 1 (dysbindin), a schizophrenia-associated factor, plays a critical role in axonal mitochondrial movement. We observed that mitochondrial movement was impaired in dysbindin knockout mouse neurons. Reduced mitochondrial motility caused by dysbindin deficiency decreased the density of mitochondria in the distal part of axons. Moreover, the transport and distribution of mitochondria were regulated by the association between dysbindin and p150glued. Furthermore, altered mitochondrial distribution in axons led to disrupted calcium dynamics, showing abnormal calcium influx in presynaptic terminals. These data collectively suggest that dysbindin forms a functional complex with p150glued that regulates axonal mitochondrial transport, thereby affecting presynaptic calcium homeostasis.
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Affiliation(s)
- Bo Kyoung Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Seol-Ae Lee
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Cana Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
- Weill Institute of Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Yeongjun Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Soo Jeong Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Youngsik Woo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Truong Thi My Nhung
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Su Been Lee
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Dong Jin Mun
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Bon Seong Goo
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Hyun Sun Choi
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
- Department of Chemical Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - So Jung Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea.
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Oh J, Lee RW, Lee HR, Lee SB, Ju HJ, Park J, Park HR, Park JH, Hann SK, Almurayshid A, Shin J, Kang HY, Bae JM, Oh SH. Classification of facial and truncal segmental vitiligo and its clinical courses including recurrence rate and patterns: a retrospective review of 956 patients. Br J Dermatol 2020; 184:750-753. [PMID: 33131051 DOI: 10.1111/bjd.19661] [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] [Received: 10/05/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - R W Lee
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H R Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - S B Lee
- Department of Dermatology, Inha University, School of Medicine, Incheon, Republic of Korea
| | - H J Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J Park
- Department of Education and Training, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - H R Park
- Department of Education and Training, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J H Park
- Drs Woo and Hann's Skin Center, Seoul, Korea
| | - S-K Hann
- Drs Woo and Hann's Skin Center, Seoul, Korea
| | - A Almurayshid
- Department of Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - J Shin
- Department of Dermatology, Inha University, School of Medicine, Incheon, Republic of Korea
| | - H Y Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - J M Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S H Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Lee KD, Lee SB, Lim JK, Kang YM, Kim IB, Moon HJ, Lee WJ. Providing essential clinical care for non-COVID-19 patients in a Seoul metropolitan acute care hospital amidst ongoing treatment of COVID-19 patients. J Hosp Infect 2020; 106:673-677. [PMID: 33011308 PMCID: PMC7528870 DOI: 10.1016/j.jhin.2020.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
We assessed infection control efforts by comparing data collected over 20 weeks during a pandemic under a dual-track healthcare system. A decline in non-COVID-19 patients visiting the emergency department by 37.6% (P<0.01) was observed since admitting COVID-19 cases. However, patients with acute myocardial infarction (AMI), stroke, severe trauma and acute appendicitis presenting for emergency care did not decrease. Door-to-balloon time (34.3 (± 11.3) min vs 22.7 (± 8.3) min) for AMI improved significantly (P<0.01) while door-to-needle time (55.7 (± 23.9) min vs 54.0 (± 18.0) min) in stroke management remained steady (P=0.80). Simultaneously, time-sensitive care involving other clinical services, including patients requiring chemotherapy, radiation therapy and haemodialysis did not change.
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Affiliation(s)
- K D Lee
- Department of Infectious Diseases, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - S B Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - J K Lim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Y M Kang
- Department of Infectious Diseases, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - I B Kim
- Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - H J Moon
- New Horizon Cancer Institute, Myongji Hospital, Goyang, Republic of Korea
| | - W J Lee
- Department of General Surgery, Myongji Hospital, Goyang, Republic of Korea.
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Lee SH, Lee SB, Heo JH, Yoon HS, Byun JW, Choi GS, Shin J. Sebaceous glands participate in the inflammation of rosacea. J Eur Acad Dermatol Venereol 2020; 34:e144-e146. [PMID: 31709649 DOI: 10.1111/jdv.16055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S H Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - S B Lee
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - J H Heo
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - H S Yoon
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - J W Byun
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - G S Choi
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
| | - J Shin
- Department of Dermatology, Inha University School of Medicine, Incheon, Korea
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Suh Y, Noh SJ, Lee S, Suh BK, Lee SB, Choi J, Jeong J, Kim S, Park SK, Park SK. Dopamine D1 receptor (D1R) expression is controlled by a transcriptional repressor complex containing DISC1. IBRO Rep 2019. [DOI: 10.1016/j.ibror.2019.07.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Roh HG, Kim EY, Kim IS, Lee HJ, Park JJ, Lee SB, Choi JW, Jeon YS, Park M, Kim SU, Kim HJ. A Novel Collateral Imaging Method Derived from Time-Resolved Dynamic Contrast-Enhanced MR Angiography in Acute Ischemic Stroke: A Pilot Study. AJNR Am J Neuroradiol 2019; 40:946-953. [PMID: 31097431 DOI: 10.3174/ajnr.a6068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/12/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Assessment of the collateral status has been emphasized for appropriate treatment decisions in patients with acute ischemic stroke. The purpose of this study was to introduce a multiphase MRA collateral imaging method (collateral map) derived from time-resolved dynamic contrast-enhanced MRA and to verify the value of the multiphase MRA collateral map in acute ischemic stroke by comparing it with the multiphase collateral imaging method (MRP collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion. MATERIALS AND METHODS From a prospectively maintained registry of acute ischemic stroke, MR imaging data of patients with acute ischemic stroke caused by steno-occlusive lesions of the unilateral ICA and/or the M1 segment of the MCA were analyzed. We generated collateral maps using dynamic signals from dynamic contrast-enhanced MRA and DSC-MRP using a Matlab-based in-house program and graded the collateral scores of the multiphase MRA collateral map and the MRP collateral map independently. Interobserver reliabilities and intermethod agreement between both collateral maps for collateral grading were tested. RESULTS Seventy-one paired multiphase MRA and MRP collateral maps from 67 patients were analyzed. The interobserver reliabilities for collateral grading using multiphase MRA or MRP collateral maps were excellent (weighted κ = 0.964 and 0.956, respectively). The agreement between both collateral maps was also excellent (weighted κ = 0.884; 95% confidence interval, 0.819-0.949). CONCLUSIONS We demonstrated that the dynamic signals of dynamic contrast-enhanced MRA could be used to generate multiphase collateral images and showed the possibility of the multiphase MRA collateral map as a useful collateral imaging method in acute ischemic stroke.
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Affiliation(s)
- H G Roh
- From the Departments of Radiology (H.G.R., J.W.C.)
| | - E Y Kim
- Department of Radiology (E.Y.K.), Gachon University Gil Medical Center, Incheon, Korea
| | - I S Kim
- Siemens Healthineers Ltd (I.S.K.), Seoul, Korea
| | - H J Lee
- Departments of Neurosurgery (H.J.L., S.U.K.)
| | | | | | - J W Choi
- From the Departments of Radiology (H.G.R., J.W.C.)
| | - Y S Jeon
- Neurosurgery (Y.S.J.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - M Park
- Department of Radiology (M.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - S U Kim
- Departments of Neurosurgery (H.J.L., S.U.K.)
| | - H J Kim
- Radiology (H.J.K.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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Suh Y, Noh SJ, Lee S, Suh BK, Lee SB, Choi J, Jeong J, Kim S, Park SK. Dopamine D1 Receptor (D1R) Expression Is Controlled by a Transcriptional Repressor Complex Containing DISC1. Mol Neurobiol 2019; 56:6725-6735. [PMID: 30915712 PMCID: PMC6728282 DOI: 10.1007/s12035-019-1566-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/28/2018] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
Abstract
Disrupted-in-Schizophrenia 1 (DISC1) is a scaffold protein implicated in various psychiatric diseases. Dysregulation of the dopamine system has been associated with DISC1 deficiency, while the molecular mechanism is unclear. In this study, we propose a novel molecular mechanism underlying the transcriptional regulation of the dopamine D1 receptor (D1R) in the striatum via DISC1. We verified the increase in D1R at the transcriptional level in the striatum of DISC1-deficient mouse models and altered histone acetylation status at the D1r locus. We identified a functional interaction between DISC1 and Krüppel-like factor 16 (KLF16). KLF16 translocates DISC1 into the nucleus and forms a regulatory complex by recruiting SIN3A corepressor complexes to the D1r locus. Moreover, DISC1-deficient mice have altered D1R-mediated signaling in the striatum and exhibit hyperlocomotion in response to cocaine; the blockade of D1R suppresses these effects. Taken together, our results suggest that nuclear DISC1 plays a critical role in the transcriptional regulation of D1R in the striatal neuron, providing a mechanistic link between DISC1 and dopamine-related psychiatric symptoms.
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Affiliation(s)
- Yeongjun Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Su-Jin Noh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Saebom Lee
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University of School of Medicine, Baltimore, MD, USA
- The Center for Nanomedicine at Wilmer Eye Institute, The Johns Hopkins University of School of Medicine, Baltimore, MD, USA
| | - Bo Kyoung Suh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Su Been Lee
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jinhyuk Choi
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea
| | - Jaehoon Jeong
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sangjune Kim
- Neurodegeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University of School of Medicine, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sang Ki Park
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, 37673, Republic of Korea.
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Gwark SC, Kim J, Kim YH, Kim MS, Park JY, Lee SB, Sohn G, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH. Abstract P6-09-09: Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-09-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We aimed to evaluate the clinical implication of circulating tumor cell (CTC) counts in correlation with prognosis and radiologic/pathologic response to therapy in locally advanced breast cancer patients undergoing preoperative systemic therapy.
Methods: From Feb 2014 to May 2017, 207 patients without distant metastasis were prospectively enrolled from AMC. CTC counts were analyzed before-during-after the therapy. CTC isolation was performed using a SMART BIOPSY™ SYSTEM Isolation kit (Cytogen, Inc., Seoul, Korea). Recurrence-free and overall survival was analyzed according to CTC counts.
Result: The mean follow-up period was 22.46 months and mean age was 46.48 years. One or more CTC was identified in 132 of 203 patients(65.0%) before NST, in 135 of 186 patients(72.0%) during NST and 103 of 171 patients(60.2%) after NST. Initial tumor burden at diagnosis -tumor size, lymph node metastasis- was not correlated with CTC positivity. Overall, CTC count ((≥1 CTC, ≥2 CTCs, and ≥5 CTCs) was not correlated with response to therapy. Using RECIST criteria, 86.5% (179/204) were responders (complete, partial response, CR/PR) and 12.1% (25/204) were non-responders (stable, progressive disease, SD/PD). 14.5% (30/207) showed a pathologic complete response (pCR), yet no association was found between CTC count/changes and radiologic/pathologic response to therapy. Also, CTC count was not correlated with prognosis among the whole population. However, HR+ tumors, CTC detection before NST was significantly associated with treatment response by RECIST criteria (responder vs. non-responder) (p=0.003, p=0.017 and p=0.023, respectively).
Conclusions: Our findings support limited value of CTC count for locally advanced breast cancers undergoing neoadjuvant systemic therapy.
Citation Format: Gwark S-C, Kim J, Kim YH, Kim MS, Park JY, Lee SB, Sohn G, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH. Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-09-09.
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Affiliation(s)
- S-C Gwark
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - J Kim
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - YH Kim
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - MS Kim
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - JY Park
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - G Sohn
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - IY Chung
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - BS Ko
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - HJ Kim
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - JW Lee
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea; Cytogen Inc., Seoul, Republic of Korea
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Lee Y, Lee HS, Ahn SH, Son BH, Kim J, Lee SB. Abstract P1-02-04: Is asymptomatic surveillance after standard treatment beneficial? : A 10yr-survival analysis of recurrent breast cancer patients by detection method of recurrence. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Surveillance of recurrence after standard treatment of breast cancer (BC) for early detection and it's impact on overall survival are known to differ depending on recurrent site. Current guideline recommends asymptomatic surveillance to only detect loco-regional recurrences. As the evidences depend on historical randomized clinical trials we aimed to address questions whether earlier detection might have impact on survival now that plenty of new treatment strategies can be offered. Also to give answers to heterogeneous surveillance strategy in real-world practice we performed a retrospective 10yr-survival analysis of a large cohort of recurrent BC patients according to their detection method.
From 4188 operable breast cancer patients who completed standard treatment Asan Medical Center from 2006 to 2008 469 patients with recurrent BC were analyzed. Median disease free interval was 35.3 months (range 2.8-97.6) and overall survival (OS) was analyzed as time from initial diagnosis/surgery to death. Among 469 patients who developed recurrence 23.7% were local (ipsilateral breast skin chest wall) 22.6% were regional (ipsilateral axillary internal mammary lymph nodes) and 53.7% developed distant metastasis. 10yr-overall survival was analyzed according to recurrent site and it's detection method.
Detection of recurrence were categorized as 'asymptomatic surveillance (N=162, 34.5%)' and 'symptom-guided (N=307, 65.5%)'. Asymptomatic screening method included mammography breast-ultrasound serum tumor marker (CA15-3) and systemic images (eg. chest X-ray bone scan PET scans). Symptom-guided detection rate for local regional and distant metastasis was 14.9%, 5.5% and 15.1% respectively. Overall asymptomatic vs symptomatic 10yr-OS did not differ (81.3 vs 78.8 months, p=0.778). Among patients with distant metastasis 10ys-OS was not significantly different (70.3 vs 66.7 months p=0.846) and was similar according to stage/subtype. Among patients with local recurrence only 10yr-OS was 95.1 months ('symptomatic' vs 'aymptomatic 94.4 vs 94.5, p=0.809) which may be insufficient number of events to show significant difference. Among regional recurrent BCs, longer OS was observed in asymptomatically detected patients than symptom-guided group (86.1 vs 63.4, p=0.004). In Cox regression analyses asymptomatic detection showed significant better survival (HR=3.9, 95%CI:1.6-9.5) and this observation was more evident in patients with hormone receptor(HR) negative primary BCs (69.9 vs 47.9, p=0.029). Intriguingly, only 8.6% (7/80) of regional recurrence were diagnosed by mammography.
We observed survival benefit with asymptomatic screening in detecting regional recurrence especially in HR-negative primary BC patients. And role of systemic radiology even in advanced high risk breast cancer patients were limited. Although with limitation that surveillance method varied widely we emphasize the role of aymptomatic surveillance of regional nodal evaluation including breast-ultrasound. These findings are to be validated from a prospective clinical study along with using cutting edge modalities other than radiology which enable detection of micro-metastasis.
Citation Format: Lee Y, Lee HS, Ahn SH, Son BH, Kim J, Lee SB. Is asymptomatic surveillance after standard treatment beneficial? : A 10yr-survival analysis of recurrent breast cancer patients by detection method of recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-04.
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Affiliation(s)
- Y Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - HS Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea
| | - J Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea
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Gwark SC, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Ko BS, Kim HJ, Son BH, Ahn SH. Abstract P2-08-22: Clinical implication of HER2/neu status in hormone receptor positive pure mucinous breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Mucinous carcinoma of the breast is a rare type of breast cancer with favorable outcome compared with other types of breast cancer. The current guideline does not recommend chemotherapy/anti-HER2 therapy for mucinous breast cancer with hormone receptor-positive subtype regardless of HER2/neu status. In this study, we evaluated the survival of pure mucinous breast cancer according to tumor stage and subtype.
Methods: Between 1989 and 2014, in Asan Medical Center, Korea, total 473 pure mucinous carcinomas (stage I-III) undergone curative surgery were reviewed retrospectively. 5yr disease-free and overall survival were analyzed according to size, lymph node metastasis, hormone receptor/HER2 status and given therapy.
Result: Total of 473 patients with pure mucinous breast cancer were analyzed and median follow-up duration was 78.00 months. 439 patients were hormone receptor-positive, 374 were node negative, 55 were HER2/neu positive. Among 374 patients with hormone receptor-positive and node-negative, tumor size was <1cm in 46 patients, 1-2.9cm in 259 patients, ≥3cm in 69 patients. In HR-positive/Node-positive BCs, 90.8%(59/65)were given chemotherapy and 35.3%(6/17) were also given trastuzumab. Sixteen patients given trastuzumab were only included in the analysis to assess the benefit of trastuzumab among HER2 positive BCs.
Overall, 5-year disease-free survival (DFS) rate was 94.1% and the 5-year overall survival (OS) rate was 95.9%. Using Cox regression analysis, lymph node metastasis was the only significant prognostic factor for both DFS (HR4.0, 95%CI:1.8-9.0, p=0.001) and OS (HR3.5, 95%CI:1.3-8.9, p=0.008). Among HR-positive/node-negative with tumor size ≥3cm, HER2/neu positivity was only significantly associated with 5yr-DFS (71.4% in HER2/neu+ vs. 96.4% in HER2/neu-, HR9.5, 95%CI:1.3-67.5, p=0.024). This observation was consistently combining both 'HR-positive/node-negative/>3cm' and 'HR-positive/node positive' BCs (N=127) that HER2 positive tumors showed worse survival (HR 3.7, 95%CI:1.2-10.8, p=0.015). Intriguingly, within this subgroup of HR-positive/node-negative/>3cm' and 'HR-positive/node positive' BCs, among HER2 positive tumors, while 5yr-DFS was 63.7% in patients who didn't receive trastuzumab, 100% were disease free in patients who were given trastuzumab.
Conclusions: Overall, nodal status was the most significant prognostic factor for pure mucinous breast cancer. In hormone receptor-positive, lymph node negative mucinous breast cancer with tumor of ≥3cm, HER2 positive BCs showed worse survival, suggesting a potential role of anti-HER2 strategy in this subgroup.
Citation Format: Gwark S-C, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Ko BS, Kim HJ, Son BH, Ahn SH. Clinical implication of HER2/neu status in hormone receptor positive pure mucinous breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-22.
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Affiliation(s)
- S-C Gwark
- Asan Medical Center, Seoul, Republic of Korea
| | - JW Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - G Sohn
- Asan Medical Center, Seoul, Republic of Korea
| | - J Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - IY Chung
- Asan Medical Center, Seoul, Republic of Korea
| | - BS Ko
- Asan Medical Center, Seoul, Republic of Korea
| | - HJ Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea
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Lee HB, Kim KE, Ju YW, Jung JG, Ryu HS, Lee SB, Lee JW, Lee HJ, Kim MS, Kwon S, Kim J, Kim C, Moon HG, Noh DY, Ahn SH, Park IA, Kim S, Yoon S, Kim A, Han W. Abstract P2-07-10: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the conference.
Citation Format: Lee H-B, Kim KE, Ju YW, Jung J-G, Ryu H-S, Lee SB, Lee JW, Lee HJ, Kim M-S, Kwon S, Kim J, Kim C, Moon H-G, Noh D-Y, Ahn S-H, Park I-A, Kim S, Yoon S, Kim A, Han W. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-10.
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Affiliation(s)
- H-B Lee
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - KE Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - YW Ju
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - J-G Jung
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - H-S Ryu
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - SB Lee
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - JW Lee
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - HJ Lee
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - M-S Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - S Kwon
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - J Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - C Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - H-G Moon
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - D-Y Noh
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - S-H Ahn
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - I-A Park
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - S Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - S Yoon
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - A Kim
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
| | - W Han
- Seoul National University Hospital, Seoul, Korea; Asan Medican Center, Seoul, Korea; Seoul National University College of Engineering, Seoul, Korea; Korea University Guro Hospital, Seoul, Korea
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Kim J, Jo WK, Kim KY, Kim BJ, Lee SB, Lee HJ, Yu JH, Kim HJ, Chung IY, Ko BS, Kim SB, Jung KH, Ahn JH, Chang S, Lee JW, Son BH, Ahn SH. Abstract P4-01-11: Genomic alterations of cell-free DNA in early breast cancer patients with recurrence. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cell-free DNA (cfDNA), as a non-invasive strategy, provides substantial benefit to overcome tumor heterogeneity. Surveillance of recurrence after standard treatment in early breast cancer (BC) using cfDNA, enables to detect minimal residual disease (MRD), also to identify genomic alterations driving recurrences. We aimed to assess the role of cfDNA in detecting MRD by investigating genomic alterations of 1)primary, recurred tumor and 2)cfDNA at time of recurrence using deep targeted sequencing. Fifty-four early BC patients were enrolled prospectively between 2014 and 2017 at time of recurrence. Median disease free interval was 28.5 months (rage 6.2-49.8). 62.7% (32/51) were hormone receptor (HR) positive (28 HRpos/HER2neg, 4 HRpos/HER2pos), 11.8% (6/51) were HRneg/HER2pos and 25.5% (13/51) were triple negative BCs. 59.3% (32/54) patients developed loco-regional recurrence (15 local recurrence only, 13 regional only, 4 with both) and distant metastasis was observed among 40.7% (22/54) patients. Cell-free DNA was extracted from 5cc blood at time of recurrence. Deep targeted sequencing was performed using customized NGS panel –encompassing 426 cancer-related target coding region, 242 fusion and amplification-related region- of cfDNA and FFPE(formalin fixed paraffin embedded) tumor samples archived from surgical resection or biopsy. Deep targeted sequencing data was successfully performed in 72.1% (31/43) plasma samples and sequencing yield was significantly lower when stored for more than 2yrs (46.2% vs 83.3%).
Mutations of cfDNA and tumor (primary, recurred) were analyzed. Mean sequencing depth of cfDNA and FFPE were x425.7 and x777.6 respectively. Median number of pathogenic mutations found in primary tumor, cfDNA and recurred tumor were 27(range 12-99), 25(range 8-85) and 9(range 0-23). Among mutations found in primary tumor, 27.4% were shared mutations (range 8.1%-72.7%) with recurred tumor and 26.1% were shared mutations (range 4.7%-69.2%) observed in cfDNA sample. Among mutations found in recurred tumor, 40.9% were observed in cfDNA (range 17.7-87.5%). In primary tumor, median number of mutations with allelic fraction (MAF)>10% were 12 (range 4-21) and at least one mutation was found in cfDNA at time of recurrence. Among mutations with MAF>10%, 59.4% and 69.1% were found in cfDNA and recurred tumor. Known oncogenic mutations of PIK3CA, TP53, GATA3, AKT1, ESR1, RELN, ERBB2, ERBB3, BRCA1 mutation were found. PIK3CA gene (p.H1047R) was found in two cases both in primary tumor and cfDNA at recurrence (MAF 11.4% vs 5.3% and 12.3% vs 15.4%) suggesting de novo driver mutation. One patient developed regional recurrence during adjuvant aromatase inhibitor with ESR1 V392I mutation in both cfDNA and recurred tumor (MAF 48.1 and 54.5%), while another patient's recurred tumor during aromatase inhibitor harbored ESR1 D538G mutation exclusively in recurred tumor with MAF <1%. Both patients had no ESR1 hotpot mutation in primary tumor.
Our data showed sequencing yield of 83.3% in plasma samples within 2yr. Pathogenic mutations in primary tumor, especially when MAF>10%, half of them was observed in cfDNA at time of recurrence. ESR1 mutation should be included in cfDNA surveillance for patients undergoing endocrine therapy even absent in primary tumor.
Citation Format: Kim J, Jo WK, Kim KY, Kim BJ, Lee SB, Lee HJ, Yu JH, Kim HJ, Chung IY, Ko BS, Kim S-B, Jung KH, Ahn JH, Chang S, Lee JW, Son BH, Ahn SH. Genomic alterations of cell-free DNA in early breast cancer patients with recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-11.
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Affiliation(s)
- J Kim
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - WK Jo
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - KY Kim
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BJ Kim
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - HJ Lee
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - JH Yu
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - HJ Kim
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - IY Chung
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BS Ko
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-B Kim
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - KH Jung
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - JH Ahn
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Chang
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - JW Lee
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea; Macrogen Inc, Seoul, Republic of Korea; Samsung Medical Center, Seoul, Republic of Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Birch GF, Lee SB. Baseline physio-chemical characteristics of Sydney estuary water under quiescent conditions. Mar Pollut Bull 2018; 137:370-381. [PMID: 30503446 DOI: 10.1016/j.marpolbul.2018.10.041] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 05/14/2023]
Abstract
The current study establishes baseline water quality properties for Sydney estuary, Australia for long periods of quiescence, which characterize the region. The study was undertaken in response to numerous requests for such data by researchers, government agencies and contractors. During quiescent periods, the range in Secchi depth transparency, turbidity, salinity and total suspended solid (TSS) values was 0.3-5.3 m, 18.6-0.1 NTU, 26.4-35.3 PSU and 8.3-1.0 mg/L in the upper and lower estuary, respectively. Baseline particulate metal concentrations were high, however TSS metal mass was greater during high rainfall. Tables and GIS-based maps allow baseline physio-chemical values to be extracted from the database for any location in Sydney estuary for quiescent conditions. Strong inter-parameter baseline relationships enable interpolation between water quality data. Baseline physio-chemical values were used to assess the impact of a high-precipitation event to demonstrate the utility of the new database.
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Affiliation(s)
- G F Birch
- School of Geosciences, The University of Sydney, NSW, Australia.
| | - S B Lee
- School of Geosciences, The University of Sydney, NSW, Australia
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Lee SB, Kim DH, Kim T, Lee SH, Jeong JH, Kim SC, Park YJ, Lim D, Kang C. Anion gap and base deficit are predictors of mortality in acute pesticide poisoning. Hum Exp Toxicol 2018; 38:185-192. [PMID: 30001645 DOI: 10.1177/0960327118788146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors. METHODS: A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated. RESULTS: Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively. CONCLUSIONS: Initial high AG and BD values could predict mortality and require precise intensive care.
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Affiliation(s)
- S B Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Y J Park
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Lim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - C Kang
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Incerti S, Kyriakou I, Bernal MA, Bordage MC, Francis Z, Guatelli S, Ivanchenko V, Karamitros M, Lampe N, Lee SB, Meylan S, Min CH, Shin WG, Nieminen P, Sakata D, Tang N, Villagrasa C, Tran HN, Brown JMC. Geant4-DNA example applications for track structure simulations in liquid water: A report from the Geant4-DNA Project. Med Phys 2018; 45. [PMID: 29901835 DOI: 10.1002/mp.13048] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/03/2018] [Accepted: 06/04/2018] [Indexed: 01/11/2023] Open
Abstract
This Special Report presents a description of Geant4-DNA user applications dedicated to the simulation of track structures (TS) in liquid water and associated physical quantities (e.g., range, stopping power, mean free path…). These example applications are included in the Geant4 Monte Carlo toolkit and are available in open access. Each application is described and comparisons to recent international recommendations are shown (e.g., ICRU, MIRD), when available. The influence of physics models available in Geant4-DNA for the simulation of electron interactions in liquid water is discussed. Thanks to these applications, the authors show that the most recent sets of physics models available in Geant4-DNA (the so-called "option4" and "option 6" sets) enable more accurate simulation of stopping powers, dose point kernels, and W-values in liquid water, than the default set of models ("option 2") initially provided in Geant4-DNA. They also serve as reference applications for Geant4-DNA users interested in TS simulations.
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Affiliation(s)
- S Incerti
- University of Bordeaux, CENBG, UMR 5797, F-33170, Gradignan, France
- CNRS, IN2P3, CENBG, UMR 5797, F-33170, Gradignan, France
| | - I Kyriakou
- Medical Physics Laboratory, University of Ioannina Medical School, 45110, Ioannina, Greece
| | - M A Bernal
- Instituto de Física Gleb Wataghin, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - M C Bordage
- Université Toulouse III-Paul Sabatier, UMR1037 CRCT, Toulouse, France
- Inserm, UMR1037 CRCT, Toulouse, France
| | - Z Francis
- Department of Physics, Faculty of Sciences, Université Saint Joseph, Beirut, Lebanon
| | - S Guatelli
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - V Ivanchenko
- Geant4 Associates International Ltd., Hebden Bridge, UK
- Tomsk State University, Tomsk, Russia
| | - M Karamitros
- Radiation Laboratory, University of Notre Dame, Notre Dame, IN 46556, USA
| | - N Lampe
- Vicinity Centres, Data Science & Insights, Office Tower One, 1341 Dandenong Rd, Chadstone, Victoria, 3148, Australia
| | - S B Lee
- Proton Therapy Center, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - S Meylan
- SymAlgo Technologies, 75 rue Léon Frot, 75011, Paris, France
| | - C H Min
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, Korea
| | - W G Shin
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, Korea
| | | | - D Sakata
- University of Bordeaux, CENBG, UMR 5797, F-33170, Gradignan, France
- CNRS, IN2P3, CENBG, UMR 5797, F-33170, Gradignan, France
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - N Tang
- IRSN, Institut de Radioprotection et de Sureté Nucléaire, 92262, Fontenay-aux-Roses, France
| | - C Villagrasa
- IRSN, Institut de Radioprotection et de Sureté Nucléaire, 92262, Fontenay-aux-Roses, France
| | - H N Tran
- Division of Nuclear Physics, Advanced Institute of Materials Science, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - J M C Brown
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
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Gwark SC, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Kim HJ, Ko BS, Son BH, Ahn SH. Abstract P1-07-29: Clinicopathologic characteristics and prognostic factors of pure mucinous breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Mucinous carcinoma of the breast is a uncommon particular type of breast cancer and comprises approximately 4% of all invasive breast cancers. It is charactarized by abundant extracellular mucin production and present a more favorable prognosis than IDC-NOS. Pathologically, mucinous carcinoma is divided into two subtypes : pure and mixed. In this study, we reviewed the clinicopathologic characteristics and prognostic factors of pure mucinous carcinoma.
Methods: We reviewed the 23 years cumulative data of pure mucinous breast cancer patients from database of the Breast Cancer Center at ASAN medical center, Korea, between 1989-2011, retrospectively. Total 386 pure mucinous carcinoma cases were reviewed to analyze clinicopathologic characteristics and prognosis.
Result: Total of 386 patients with pure mucinous breast cancer were identified. Mean age was 46.7. 149 patients underwent modified radical mastectomy and 236 underwent breast-conserving therapy. The T-stage was T1 in 187 patients, T2 in 178 patients, T3 in 17 patient and T4 in 4 patients. Node negative was 325 and node positive was 61. Estrogen receptor was positive in 342 and negative in 29. Progesterone receptor was positive in 276 and negative in 95. HER-2 was positive in 47 and negative in 273. 152 patients received adjuvant chemotherapy and 240 patients received adjuvant radiotherapy. 351 patients received hormone therapy and among these patients, 231 patients were treated with Tamoxifen alone, 81 were Tamoxifen with ovarian function suppression, 37 were AI only and one patient was ovarian function suppression only. The 5 year disease free survival rate was 93.3%, 5 year cancer specific survival rate was 98.2% and 5 year overall survival rate was 96.6%. Univariate analysis showed that ER status, nodal status and Her2 status were appear to be prognostic factor of Disease free survival rate. Using Cox regression, result of multivariate analysis revealed that only nodal status is the most significant prognostic factor for survival rate.
Conclusions: Pure mucinous carcinoma of the breast is a rare subtype with a favorable prognosis. Nodal status rather than ER status, Her2 status are considered to be the most significant prognostic factor of pure mucinos breast cancer.
Citation Format: Gwark SC, Lee JW, Lee SB, Sohn G, Kim J, Chung IY, Kim HJ, Ko BS, Son BH, Ahn SH. Clinicopathologic characteristics and prognostic factors of pure mucinous breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-29.
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Affiliation(s)
- SC Gwark
- Asan Medical Center, Seoul, Republic of Korea
| | - JW Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - G Sohn
- Asan Medical Center, Seoul, Republic of Korea
| | - J Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - IY Chung
- Asan Medical Center, Seoul, Republic of Korea
| | - HJ Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - BS Ko
- Asan Medical Center, Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea
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Lee SB, Kang C, Kim DH, Kim T, Lee SH, Jeong JH, Kim SC, Rhee DY, Lim D. Base deficit is a predictor of mortality in organophosphate insecticide poisoning. Hum Exp Toxicol 2017; 37:118-124. [PMID: 29233034 DOI: 10.1177/0960327117694073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Organophosphate insecticide (OPI) self-poisoning is a major medical problem in many countries. Several studies have demonstrated that the base deficit (BD) is a prognostic tool that is correlated with the severity of injury and predicted mortality, particularly in trauma patients. Here, we aimed to investigate the prognostic significance of BD in OPI poisoning. METHODS This retrospective observational study was conducted between January 1, 2006, and January 31, 2015, at a single emergency department (ED). The BD values were divided into quartiles according to the number of patients: 3 mEq/L or less, 3-5.9 mEq/L, 6-9.9 mEq/L, and 10 mEq/L or greater. Survival at 30 days from ED admission was estimated using the Kaplan-Meier survival analysis. RESULTS Among 154 patients, 31 died, yielding a mortality of 20.1%. The highest BD quartile (≥ 10 mEq/L) and the 6-9.9 mEq/L group were associated with an increased risk of 30-day mortality. Patients with a BD of 10 mEq/L or greater had a 5.85-fold higher risk of 30-day mortality and patients with a BD of 6-9.9 mEq/L had a 5.40-fold higher risk of 30-day mortality compared to patients with a BD of 3 mEq/L or less. The area under the curves of the BD and the Acute Physiology and Chronic Health Evaluation II score for mortality were 0.748 (95% confidence interval (CI), 0.660-0.835) and 0.852 (95% CI, 0.789-0.915), respectively. CONCLUSIONS This study showed that the BD is a predictor of 30-day mortality in patients with OPI poisoning.
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Affiliation(s)
- S B Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - C Kang
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- 2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Y Rhee
- 3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Lim
- 3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Chung IY, Lee JW, Lee JS, Park YR, Lee Y, Lee SB, Kim HJ, Ko BS, Son BH, Ahn SH. Abstract P6-09-38: Interaction between body mass index and hormone receptor status as a prognostic factor in node-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The aim of this study was to investigate the interaction between BMI at breast cancer diagnosis and the various factors including hormone-receptor, menopausal and nodal status, and to find a specific subgroup where BMI has an effect on breast cancer prognosis.
Methods: We retrospectively analyzed the data of 8,763 non-metastatic invasive breast cancer patients from the Asan Medical Center's research database. Overall survival (OS) and breast cancer-specific survival (BCSS) among BMI groups were compared using the Kaplan-Meier method and Cox proportional hazard model with interaction term.
Results: Only in node-positive breast cancer, there was a significant interaction between obesity (BMI ≥ 30.0 kg/m2) at diagnosis and positive hormone receptor which showed worse overall survival (OS) and breast cancer specific survival (BCSS) than normal weight patients (adjusted hazard ratio [HR] = 1.65, 95% confidence interval [CI] = 1.01 to 2.69 and HR = 1.90, 95% CI = 1.15 to 3.15, respectively). Underweight (BMI<18.50 kg/m2) which interacted with negative hormone receptor status in node-positive breast cancer was associated with decreased OS (HR = 2.01, 95% CI = 1.02 to 3.98) and BCSS (HR = 2.15, 95% CI = 1.08 to 4.26). There was no significant interaction between BMI and hormone receptor status in node-negative setting and BMI did not interact with menopausal status in any population.
Conclusions: BMI interacts with hormone receptor status in node positive setting, thereby playing a role in the breast cancer prognosis.
Citation Format: Chung IY, Lee JW, Lee JS, Park YR, Lee Y, Lee SB, Kim HJ, Ko BS, Son BH, Ahn SH. Interaction between body mass index and hormone receptor status as a prognostic factor in node-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-38.
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Affiliation(s)
- IY Chung
- Asan Medical Center, Seoul, Republic of Korea
| | - JW Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - JS Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - YR Park
- Asan Medical Center, Seoul, Republic of Korea
| | - Y Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - SB Lee
- Asan Medical Center, Seoul, Republic of Korea
| | - HJ Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - BS Ko
- Asan Medical Center, Seoul, Republic of Korea
| | - BH Son
- Asan Medical Center, Seoul, Republic of Korea
| | - SH Ahn
- Asan Medical Center, Seoul, Republic of Korea
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Lee JS, Kim MJ, Park SH, Lee SB, Wang T, Jung US, Im J, Kim EJ, Lee KW, Lee HG. Effects of dietary mixture of garlic (Allium sativum), coriander (Coriandrum sativum) and probiotics on immune responses and caecal counts in young laying hens. J Anim Physiol Anim Nutr (Berl) 2016; 101:e122-e132. [PMID: 27678135 DOI: 10.1111/jpn.12573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/16/2016] [Indexed: 11/27/2022]
Abstract
This study was conducted to evaluate the effects of a combined mixture of phytogenic extracts (garlic and coriander) and probiotics on growth performance and immune responses in laying hens based on the results of in vitro studies to screen for immunomodulatory potency of each ingredient. Several parameters of immunomodulatory potency were estimated using lamina propria leucocytes (LPLs) isolated from rat intestinal mucosa tissue. Results show that the combined mixture enhanced LPLs proliferation, increased LPL-mediated cytotoxicity against YAC-1 tumour cells, and decreased lipopolysaccharide (LPS)-induced cytokine production including tumour necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in LPLs. For in vivo study, laying hens (n = 50/each diet group) were fed with control diet, a diet containing antibiotics (0.01% per kg feed) or the combined mixture (0.02% per kg feed) for 21 days. The dietary combined mixture improved egg production (p < 0.05) but not growth performance and carcass traits. Interestingly, the patterns of suppressing plasma IFN-γ productions during inflammation by LPS injection and decreasing caecal E. coli counts in the combined mixture group were comparable to those in the antibiotics group. Taken together, our results suggested that the 0.02% of combined mixture of phytogenic extracts and probiotics as ingredients has potential immunomodulatory effects in laying hens.
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Affiliation(s)
- J S Lee
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea.,Team of An Educational Program for Specialists in Global Animal Science, Brain Korea 21 Plus Project, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - M J Kim
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - S H Park
- Department of Animal Science, College of Natural Resources and Life Science, Pusan National University, Gyeongnam, Korea
| | - S B Lee
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - T Wang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - U S Jung
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - J Im
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - E J Kim
- Division of Animal Husbandry, College of Chonan Yonam, Cheonan-si, Chungnam, Korea
| | - K W Lee
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea.,Team of An Educational Program for Specialists in Global Animal Science, Brain Korea 21 Plus Project, Konkuk University, Gwangjin-gu, Seoul, Korea
| | - H G Lee
- Department of Animal Science and Technology, College of Animal Bioscience & Technology, Konkuk University, Gwangjin-gu, Seoul, Korea.,Team of An Educational Program for Specialists in Global Animal Science, Brain Korea 21 Plus Project, Konkuk University, Gwangjin-gu, Seoul, Korea
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