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Olah C, Hahnen C, Nagy N, Musial J, Varadi M, Nyiro G, Gyorffy B, Hadaschik B, Rawitzer J, Ting S, Sjödahl G, Hoffmann MJ, Reis H, Szarvas T. A quantitative polymerase chain reaction based method for molecular subtype classification of urinary bladder cancer-Stromal gene expressions show higher prognostic values than intrinsic tumor genes. Int J Cancer 2021; 150:856-867. [PMID: 34536301 DOI: 10.1002/ijc.33809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Abstract
Transcriptome-based molecular subtypes of muscle-invasive bladder cancer (MIBC) have been shown to be both prognostic and predictive, but are not used in routine clinical practice. We aimed to develop a feasible, reverse transcription quantitative polymerase chain reaction (RT-qPCR)-based method for molecular subtyping. First, we defined a 68-gene set covering tumor intrinsic (luminal, basal, squamous, neuronal, epithelial-to-mesenchymal, in situ carcinoma) and stromal (immune, extracellular matrix, p53-like) signatures. Then, classifier methods with this 68-gene panel were developed in silico and validated on public data sets with available subtype class information (MD Anderson [MDA], The Cancer Genome Atlas [TCGA], Lund, Consensus). Finally, expression of the selected 68 genes was determined in 104 frozen tissue samples of our MIBC cohort by RT-qPCR using the TaqMan Array Card platform and samples were classified by our newly developed classifiers. The prognostic value of each subtype classification system and molecular signature scores were assessed. We found that the reduced marker set combined with the developed classifiers were able to reproduce the TCGA II, MDA, Lund and Consensus subtype classification systems with an overlap of 79%, 76%, 69% and 64%, respectively. Importantly, we could successfully classify 96% (100/104) of our MIBC samples by using RT-qPCR. Neuronal and luminal subtypes and low stromal gene expressions were associated with poor survival. In conclusion, we developed a robust and feasible method for the molecular subtyping according to the TCGA II, MDA, Lund and Consensus classifications. Our results suggest that stromal signatures have a superior prognostic value compared to tumor intrinsic signatures and therefore underline the importance of tumor-stroma interaction during the progression of MIBC.
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Affiliation(s)
- Csilla Olah
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | - Christina Hahnen
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | - Nikolett Nagy
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Joanna Musial
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | - Melinda Varadi
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Gabor Nyiro
- MTA-SE Molecular Medicine Research Group, Semmelweis University, Budapest, Hungary
| | - Balazs Gyorffy
- 2nd Department of Pediatrics and Department of Bioinformatics, Semmelweis University, Budapest, Hungary.,Research Centre for Natural Sciences, Cancer Biomarker Research Group, Institute of Enzymology, Budapest, Hungary
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen, Essen, Germany
| | - Josefine Rawitzer
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Saskia Ting
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Gottfrid Sjödahl
- Department of Oncology, Clinical Sciences, Lund University Hospital, Lund University, Lund, Sweden
| | - Michéle J Hoffmann
- Department of Urology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Henning Reis
- Department of Oncology, Clinical Sciences, Lund University Hospital, Lund University, Lund, Sweden
| | - Tibor Szarvas
- Department of Urology, University of Duisburg-Essen, Essen, Germany.,Department of Urology, Semmelweis University, Budapest, Hungary
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Hahnen C, Freeman CG, Haldar N, Hamati JN, Bard DM, Murali V, Merli GJ, Joseph JI, van Helmond N. Accuracy of Vital Signs Measurements by a Smartwatch and a Portable Health Device: Validation Study. JMIR Mhealth Uhealth 2020; 8:e16811. [PMID: 32049066 PMCID: PMC7055753 DOI: 10.2196/16811] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/18/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background New consumer health devices are being developed to easily monitor multiple physiological parameters on a regular basis. Many of these vital sign measurement devices have yet to be formally studied in a clinical setting but have already spread widely throughout the consumer market. Objective The aim of this study was to investigate the accuracy and precision of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO2) measurements of 2 novel all-in-one monitoring devices, the BodiMetrics Performance Monitor and the Everlast smartwatch. Methods We enrolled 127 patients (>18 years) from the Thomas Jefferson University Hospital Preadmission Testing Center. SBP and HR were measured by both investigational devices. In addition, the Everlast watch was utilized to measure DBP, and the BodiMetrics Performance Monitor was utilized to measure SpO2. After 5 min of quiet sitting, four hospital-grade standard and three investigational vital sign measurements were taken, with 60 seconds in between each measurement. The reference vital sign measurements were calculated by determining the average of the two standard measurements that bounded each investigational measurement. Using this method, we determined three comparison pairs for each investigational device in each subject. After excluding data from 42 individuals because of excessive variation in sequential standard measurements per prespecified dropping rules, data from 85 subjects were used for final analysis. Results Of 85 participants, 36 (42%) were women, and the mean age was 53 (SD 21) years. The accuracy guidelines were only met for the HR measurements in both devices. SBP measurements deviated 16.9 (SD 13.5) mm Hg and 5.3 (SD 4.7) mm Hg from the reference values for the Everlast and BodiMetrics devices, respectively. The mean absolute difference in DBP measurements for the Everlast smartwatch was 8.3 (SD 6.1) mm Hg. The mean absolute difference between BodiMetrics and reference SpO2 measurements was 3.02%. Conclusions Both devices we investigated met accuracy guidelines for HR measurements, but they failed to meet the predefined accuracy guidelines for other vital sign measurements. Continued sale of consumer physiological monitors without prior validation and approval procedures is a public health concern.
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Affiliation(s)
- Christina Hahnen
- College of Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Cecilia G Freeman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nilanjan Haldar
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jacquelyn N Hamati
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Dylan M Bard
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Vignesh Murali
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Geno J Merli
- Department of Surgery and Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jeffrey I Joseph
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, United States
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van Helmond N, Freeman CG, Hahnen C, Haldar N, Hamati JN, Bard DM, Murali V, Merli GJ, Joseph JI. The accuracy of blood pressure measurement by a smartwatch and a portable health device. Hosp Pract (1995) 2019; 47:211-215. [PMID: 31423912 DOI: 10.1080/21548331.2019.1656991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/14/2019] [Indexed: 06/10/2023]
Abstract
Objectives: Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor.Methods: We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP.Results: Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP.Conclusions: The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.
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Affiliation(s)
- Noud van Helmond
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| | - Cecilia G Freeman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina Hahnen
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- College of Biomedical Sciences, Radboud University, Nijmegen, the Netherlands
| | - Nilanjan Haldar
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jacquelyn N Hamati
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dylan M Bard
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vignesh Murali
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Geno J Merli
- Department of Surgery and Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey I Joseph
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Bard DM, Hahnen C, Joseph JI, Helmond N. Validation of Two Pulse Transit Time‐Based Blood Pressure Measurement Devices. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.835.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dylan M Bard
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPA
| | - Christina Hahnen
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPA
| | - Jeffrey I Joseph
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPA
| | - Noud Helmond
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPA
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Hahnen C, van Helmond N. [Blood pressure measurement using pulse transit time]. Ned Tijdschr Geneeskd 2019; 163:D3408. [PMID: 30719885] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Blood pressure has been measured with a cuff for over a 100 years. Recently, various devices and smart phone applications that measure blood pressure without a cuff using pulse transit time (PTT) have become available. These measurements are based on the inverse relationship between blood pressure and PTT. PTT constitutes the time delay between the QRS complex on ECG and the onset of a photoplethysmography pulse wave, for example in the finger. Since these measurements are relatively more user-friendly than conventional cuff-based measurements, they may aid in more frequent blood pressure monitoring by patients themselves. Initial validation studies, however, seem to suggest that blood pressure measurement using PTT is not accurate. Given the current pace of development in PTT-based blood pressure monitors it seems likely that physicians will be increasingly confronted with measurements from these devices. For the time being, it seems wise to not recommend these types of monitors to patients and to avoid using any of their measurements when making diagnostic or therapeutic decisions.
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Affiliation(s)
- Christina Hahnen
- Thomas Jefferson University, afd. Anesthesiologie, Philadelphia, Verenigde Staten
| | - Noud van Helmond
- Cooper University Hospital, afd. Anesthesiologie, Camden, Verenigde Staten
- Contact: N. van Helmond
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Krombach GA, Hahnen C, Lodemann KP, Neitzel M, Boehringer J, Kühl H, Krämer N, Schoth F, Günther RW. Potenzial von Gd-BOPTA zur Darstellung der myokardialen Vitalität: T1-Werte und Kontrastmittelspätanreicherung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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