1
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Wu X, Jeong Y, de Frias SP, Easthausen I, Hoffman K, Oromendia C, Taheri S, Esposito AJ, Arias LQ, Ayaub EA, Maurer R, Gill RR, Hatabu H, Nishino M, Frits ML, Iannaccone CK, Weinblatt ME, Shadick NA, Dellaripa PF, Choi AM, Kim EY, Rosas IO, Martinez FJ, Doyle TJ. Serum proteomic profiling of rheumatoid arthritis-interstitial lung disease with a comparison to idiopathic pulmonary fibrosis. Thorax 2022; 77:1041-1044. [PMID: 35907639 PMCID: PMC9976796 DOI: 10.1136/thorax-2021-217822] [Citation(s) in RCA: 2] [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: 06/21/2021] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
Although interstitial lung disease (ILD) causes significant morbidity and mortality in rheumatoid arthritis (RA), it is difficult to predict the development or progression of ILD, emphasising the need for improved discovery through minimally invasive diagnostic tests. Aptamer-based proteomic profiling was used to assess 1321 proteins from 159 patients with rheumatoid arthritis with interstitial lung disease (RA-ILD), RA without ILD, idiopathic pulmonary fibrosis and healthy controls. Differential expression and gene set enrichment analyses revealed molecular signatures that are strongly associated with the presence and severity of RA-ILD and provided insight into unexplored pathways of disease. These warrant further study as non-invasive diagnostic tools and future therapeutic targets.
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Affiliation(s)
- Xiaoping Wu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Yunju Jeong
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Sergio Poli de Frias
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Imaani Easthausen
- Department of Population Health Science, Division of Biostatistics, Weill Cornell Medicine, New York, NY United States
| | - Katherine Hoffman
- Department of Population Health Science, Division of Biostatistics, Weill Cornell Medicine, New York, NY United States
| | - Clara Oromendia
- Department of Population Health Science, Division of Biostatistics, Weill Cornell Medicine, New York, NY United States
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Anthony J. Esposito
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Luisa Quesada Arias
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Ehab A. Ayaub
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ritu R. Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hiroto Hatabu
- Harvard Medical School, Boston, MA, United States,Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mizuki Nishino
- Harvard Medical School, Boston, MA, United States,Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Michelle L. Frits
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, United States
| | - Christine K. Iannaccone
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, United States
| | - Michael E. Weinblatt
- Harvard Medical School, Boston, MA, United States,Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, United States
| | - Nancy A. Shadick
- Harvard Medical School, Boston, MA, United States,Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, United States
| | - Paul F. Dellaripa
- Harvard Medical School, Boston, MA, United States,Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, United States
| | - Augustine M.K. Choi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Edy Y. Kim
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Ivan O. Rosas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Fernando J. Martinez
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Tracy J. Doyle
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
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2
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Krishnan JK, Ancy KM, Oromendia C, Hoffman KL, Easthausen I, Leidy NK, Han MK, Bowler RP, Christenson SA, Couper DJ, Criner GJ, Curtis JL, Dransfield MT, Hansel NN, Iyer AS, Paine III R, Peters SP, Wedzicha JA, Woodruff PG, Ballman KV, Martinez FJ. Characterizing COPD Symptom Variability in the Stable State Utilizing the Evaluating Respiratory Symptoms in COPD Instrument. Chronic Obstr Pulm Dis 2022; 9:195-208. [PMID: 35403414 PMCID: PMC9166327 DOI: 10.15326/jcopdf.2021.0263] [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] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE It has been suggested that patients with chronic obstructive pulmonary disease (COPD) experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and understand the implications of day-to-day symptom variability. OBJECTIVES To compare standard deviation with other statistical measures of symptom variability and identify characteristics of individuals with higher symptom variability. METHODS Individuals in the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained 4 weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during 4 follow-up weeks was explored. MEASUREMENTS AND MAIN RESULTS Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week 4 was 0.32. Higher variability participants had higher St George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 versus 39.6 ± 21.5, p=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and health care resource utilization-defined exacerbations. CONCLUSIONS WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.
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Affiliation(s)
- Jamuna K. Krishnan
- Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
- *Co-first authors, both authors contributed equally to the work
| | - Kayley M. Ancy
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
- *Co-first authors, both authors contributed equally to the work
| | - Clara Oromendia
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Katherine L. Hoffman
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Imaani Easthausen
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | | | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Russell P. Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, United States
| | - Stephanie A. Christenson
- Pulmonary and Critical Care, University of California San Francisco, San Francisco, California, United States
| | - David J. Couper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Gerard J. Criner
- Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Mark T. Dransfield
- Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore Maryland, United States
| | - Anand S. Iyer
- Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Robert Paine III
- Division of Pulmonary and Critical Care Medicine, Department of Veterans Affairs Medical Center, University of Utah, Salt Lake City, Utah, United States
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine Medical Center, Winston-Salem, North Carolina, United States
| | | | - Prescott G. Woodruff
- Pulmonary and Critical Care, University of California San Francisco, San Francisco, California, United States
| | - Karla V. Ballman
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Fernando J. Martinez
- Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
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3
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van der Mijn JC, Eng KW, Chandra P, Fernandez E, Ramazanoglu S, Sigaras A, Oromendia C, Gudas LJ, Tagawa ST, Nanus DM, Faltas BF, Beltran H, Sternberg CN, Elemento O, Sboner A, Mosquera JM, Molina AM. The genomic landscape of metastatic clear cell renal cell carcinoma after systemic therapy. Mol Oncol 2022; 16:2384-2395. [PMID: 35231161 PMCID: PMC9208073 DOI: 10.1002/1878-0261.13204] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Primary clear cell renal cell carcinoma (ccRCC) has been previously characterized, but the genomic landscape of metastatic ccRCC is largely unexplored. Here, we performed whole exome sequencing (WES) in 68 samples from 44 patients with ccRCC, including 52 samples from a metastatic site. SETD2, PBRM1, APC and VHL were the most frequently mutated genes in the metastatic ccRCC cohort. RBM10 and FBXW7 were also among the 10 most frequently mutated genes in metastatic tissues. Recurrent somatic copy number variations (CNV) were observed at the previously identified regions 3p25, 9p21 and 14q25, but also at 6p21 (CDKN1A) and 13q14 (RB1). No statistically significant differences were found between samples from therapy‐naïve and pretreated patients. Clonal evolution analyses with multiple samples from 13 patients suggested that early appearance of CNVs at 3p25, 9p21 and 14q25 may be associated with rapid clinical progression. Overall, the genomic landscapes of primary and metastatic ccRCC seem to share frequent CNVs at 3p25, 9p21 and 14q25. Future work will clarify the implication of RBM10 and FBXW7 mutations and 6p21 and 13q14 CNVs in metastatic ccRCC.
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Affiliation(s)
- Johannes C van der Mijn
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.,Department of Medical Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands.,Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth W Eng
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Pooja Chandra
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Evan Fernandez
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Sinan Ramazanoglu
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Alexandros Sigaras
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Clara Oromendia
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Scott T Tagawa
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David M Nanus
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Bishoy F Faltas
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Himisha Beltran
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York
| | - Andrea Sboner
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York
| | - Juan Miguel Mosquera
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ana M Molina
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.,Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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4
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Schenck EJ, Hoffman KL, Oromendia C, Sanchez E, Finkelsztein EJ, Hong KS, Kabariti J, Torres LK, Harrington JS, Siempos II, Choi AMK, Campion TR. A Comparative Analysis of the Respiratory Subscore of the Sequential Organ Failure Assessment Scoring System. Ann Am Thorac Soc 2021; 18:1849-1860. [PMID: 33760709 PMCID: PMC8641830 DOI: 10.1513/annalsats.202004-399oc] [Citation(s) in RCA: 9] [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: 04/29/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: The Sequential Organ Failure Assessment (SOFA) tool is a commonly used measure of illness severity. Calculation of the respiratory subscore of SOFA is frequently limited by missing arterial oxygen pressure (PaO2) data. Although missing PaO2 data are commonly replaced with normal values, the performance of different methods of substituting PaO2 for SOFA calculation is unclear. Objectives: The study objective was to compare the performance of different substitution strategies for missing PaO2 data for SOFA score calculation. Methods: This retrospective cohort study was performed using the Weill Cornell Critical Care Database for Advanced Research from a tertiary care hospital in the United States. All adult patients admitted to an intensive care unit (ICU) from 2011 to 2019 with an available respiratory SOFA score were included. We analyzed the availability of the PaO2/fraction of inspired oxygen (FiO2) ratio on the first day of ICU admission. In those without a PaO2/FiO2 ratio available, the ratio of oxygen saturation as measured by pulse oximetry to FiO2 was used to calculate a respiratory SOFA subscore according to four methods (linear substitution [Rice], nonlinear substitution [Severinghaus], modified respiratory SOFA, and multiple imputation by chained equations [MICE]) as well as the missing-as-normal technique. We then compared how well the different total SOFA scores discriminated in-hospital mortality. We performed several subgroup and sensitivity analyses. Results: We identified 35,260 unique visits, of which 9,172 included predominant respiratory failure. PaO2 data were available for 14,939 (47%). The area under the receiver operating characteristic curve for each substitution technique for discriminating in-hospital mortality was higher than that for the missing-as-normal technique (0.78 [0.77-0.79]) in all analyses (modified, 0.80 [0.79-0.81]; Rice, 0.80 [0.79-0.81]; Severinghaus, 0.80 [0.79-0.81]; and MICE, 0.80 [0.79-0.81]) (P < 0.01). Each substitution method had a higher accuracy for discriminating in-hospital mortality (MICE, 0.67; Rice, 0.67; modified, 0.66; and Severinghaus, 0.66) than the missing-as-normal technique. Model calibration for in-hospital mortality was less precise for the missing-as-normal technique than for the other substitution techniques at the lower range of SOFA and among the subgroups. Conclusions: Using physiologic and statistical substitution methods improved the total SOFA score's ability to discriminate mortality compared with the missing-as-normal technique. Treating missing data as normal may result in underreporting the severity of illness compared with using substitution. The simplicity of a direct oxygen saturation as measured by pulse oximetry/FiO2 ratio-modified SOFA technique makes it an attractive choice for electronic health record-based research. This knowledge can inform comparisons of severity of illness across studies that used different techniques.
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Affiliation(s)
- Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | | | | | - Elizabeth Sanchez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Eli J Finkelsztein
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Kyung Sook Hong
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- Department of Surgery and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | - Lisa K Torres
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - John S Harrington
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Ilias I Siempos
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Thomas R Campion
- Department of Population Health Sciences
- Information Technologies and Services, and
- Clinical and Translational Science Center, Weill Cornell Medicine, Cornell University, New York, New York
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5
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Msaouel P, Oromendia C, Siefker-Radtke AO, Tannir NM, Subudhi SK, Gao J, Wang Y, Siddiqui BA, Shah AY, Aparicio AM, Campbell MT, Zurita AJ, Shaw LK, Lopez LP, McCord H, Chakraborty SN, Perales J, Lu C, Van Alstine ML, Elashoff M, Logothetis C. Evaluation of Technology-Enabled Monitoring of Patient-Reported Outcomes to Detect and Treat Toxic Effects Linked to Immune Checkpoint Inhibitors. JAMA Netw Open 2021; 4:e2122998. [PMID: 34459906 PMCID: PMC8406081 DOI: 10.1001/jamanetworkopen.2021.22998] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Immune checkpoint inhibitors can produce distinct toxic effects that require prompt recognition and timely management. OBJECTIVE To develop a technology-enabled, dynamically adaptive protocol that can provide the accurate information needed to inform specific remedies for immune toxic effects in patients treated with immune checkpoint inhibitors. DESIGN, SETTING, AND PARTICIPANTS An open-label cohort study was conducted at a single tertiary referral center from September 6, 2019, to September 3, 2020. The median follow-up duration was 63 (interquartile range, 35.5-122) days. Fifty patients with genitourinary cancers treated with immune checkpoint inhibitors were enrolled. INTERVENTIONS A fit-for-purpose electronic platform was developed to enable active patient and care team participation. A smartphone application downloaded onto patients' personal mobile devices prompted them to report their symptoms at least 3 times per week. The set of symptoms and associated queries were paired with alert thresholds for symptoms requiring clinical action. MAIN OUTCOMES AND MEASURES The primary end point of this interim analysis was feasibility, as measured by patient and care team adherence, and lack of increase in care team staffing. Operating characteristics were estimated for each symptom alert and used to dynamically adapt the alert thresholds to ensure sensitivity while reducing unnecessary alerts. RESULTS Of the 50 patients enrolled, 47 had at least 1 follow-up visit and were included in the analysis. Median age was 65 years (range, 37-86), 39 patients (83%) were men, and 39 patients (83%) had metastatic cancer, with the most common being urothelial cell carcinoma and renal cell carcinoma (22 [47%] patients each). After initial onboarding, no further care team training or additional care team staffing was required. Patients had a median study adherence rate of 74% (interquartile range, 60%-86%) and 73% of automated alerts were reviewed within 3 days by the clinic team. Symptoms with the highest positive predictive value for adverse events requiring acute intervention included dizziness (21%), nausea/vomiting (26%), and shortness of breath (14%). The symptoms most likely to result in unnecessary alerts were arthralgia and myalgia, fatigue, and cough. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest an acceptable and fiscally sound method can be developed to create a dynamic learning system to detect and manage immune-related toxic effects.
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Affiliation(s)
- Pavlos Msaouel
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Arlene O. Siefker-Radtke
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Nizar M. Tannir
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sumit K. Subudhi
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jianjun Gao
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Yinghong Wang
- Division of Internal Medicine, Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston
| | - Bilal A. Siddiqui
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Amishi Y. Shah
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ana M. Aparicio
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew T. Campbell
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Amado J. Zurita
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Leah K. Shaw
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Lidia P. Lopez
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Heather McCord
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sandip N. Chakraborty
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jacqueline Perales
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cong Lu
- The Ronin Project, San Mateo, California
| | | | | | - Christopher Logothetis
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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6
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Zhang WZ, Hoffman KL, Schiffer KT, Oromendia C, Rice MC, Barjaktarevic I, Peters SP, Putcha N, Bowler RP, Wells JM, Couper DJ, Labaki WW, Curtis JL, Han MK, Paine R, Woodruff PG, Criner GJ, Hansel NN, Diaz I, Ballman KV, Nakahira K, Choi ME, Martinez FJ, Choi AMK, Cloonan SM. Association of plasma mitochondrial DNA with COPD severity and progression in the SPIROMICS cohort. Respir Res 2021; 22:126. [PMID: 33902556 PMCID: PMC8074408 DOI: 10.1186/s12931-021-01707-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a lack of mechanism-driven, clinically relevant biomarkers in chronic obstructive pulmonary disease (COPD). Mitochondrial dysfunction, a proposed disease mechanism in COPD, is associated with the release of mitochondrial DNA (mtDNA), but plasma cell-free mtDNA has not been previously examined prospectively for associations with clinical COPD measures. METHODS P-mtDNA, defined as copy number of mitochondrially-encoded NADH dehydrogenase-1 (MT-ND1) gene, was measured by real-time quantitative PCR in 700 plasma samples from participants enrolled in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Associations between p-mtDNA and clinical disease parameters were examined, adjusting for age, sex, smoking status, and for informative loss to follow-up. RESULTS P-mtDNA levels were higher in participants with mild or moderate COPD, compared to smokers without airflow obstruction, and to participants with severe COPD. Baseline increased p-mtDNA levels were associated with better CAT scores in female smokers without airflow obstruction and female participants with mild or moderate COPD on 1-year follow-up, but worse 6MWD in females with severe COPD. Higher p-mtDNA levels were associated with better 6MWD in male participants with severe COPD. These associations were no longer significant after adjusting for informative loss to follow-up. CONCLUSION In this study, p-mtDNA levels associated with baseline COPD status but not future changes in clinical COPD measures after accounting for informative loss to follow-up. To better characterize mitochondrial dysfunction as a potential COPD endotype, these results should be confirmed and validated in future studies. TRIAL REGISTRATION ClinicalTrials.gov NCT01969344 (SPIROMICS).
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Affiliation(s)
- William Z Zhang
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Katherine L Hoffman
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Kristen T Schiffer
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Clara Oromendia
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Michelle C Rice
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephen P Peters
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | | | - David J Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert Paine
- Section of Pulmonary and Critical Care Medicine, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | - Gerard J Criner
- Department of Pulmonary & Critical Care Medicine, Temple University, Philadelphia, PA, USA
| | - Nadia N Hansel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Diaz
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Karla V Ballman
- Department of Population Health Science, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Kiichi Nakahira
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mary E Choi
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Suzanne M Cloonan
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland and Tallaght University Hospital, Dublin, Ireland.
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, USA.
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7
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Torres LK, Hoffman KL, Oromendia C, Diaz I, Harrington JS, Schenck EJ, Price DR, Gomez-Escobar L, Higuera A, Vera MP, Baron RM, Fredenburgh LE, Huh JW, Choi AMK, Siempos II. Attributable mortality of acute respiratory distress syndrome: a systematic review, meta-analysis and survival analysis using targeted minimum loss-based estimation. Thorax 2021; 76:1176-1185. [PMID: 33863829 DOI: 10.1136/thoraxjnl-2020-215950] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although acute respiratory distress syndrome (ARDS) is associated with high mortality, its direct causal link with death is unclear. Clarifying this link is important to justify costly research on prevention of ARDS. OBJECTIVE To estimate the attributable mortality, if any, of ARDS. DESIGN First, we performed a systematic review and meta-analysis of observational studies reporting mortality of critically ill patients with and without ARDS matched for underlying risk factor. Next, we conducted a survival analysis of prospectively collected patient-level data from subjects enrolled in three intensive care unit (ICU) cohorts to estimate the attributable mortality of critically ill septic patients with and without ARDS using a novel causal inference method. RESULTS In the meta-analysis, 44 studies (47 cohorts) involving 56 081 critically ill patients were included. Mortality was higher in patients with versus without ARDS (risk ratio 2.48, 95% CI 1.86 to 3.30; p<0.001) with a numerically stronger association between ARDS and mortality in trauma than sepsis. In the survival analysis of three ICU cohorts enrolling 1203 critically ill patients, 658 septic patients were included. After controlling for confounders, ARDS was found to increase the mortality rate by 15% (95% CI 3% to 26%; p=0.015). Significant increases in mortality were seen for severe (23%, 95% CI 3% to 44%; p=0.028) and moderate (16%, 95% CI 2% to 31%; p=0.031), but not for mild ARDS. CONCLUSIONS ARDS has a direct causal link with mortality. Our findings provide information about the extent to which continued funding of ARDS prevention trials has potential to impart survival benefit. PROSPERO REGISTRATION NUMBER CRD42017078313.
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Affiliation(s)
- Lisa K Torres
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Katherine L Hoffman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Ivan Diaz
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - John S Harrington
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Edward J Schenck
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - David R Price
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Luis Gomez-Escobar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Angelica Higuera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mayra Pinilla Vera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebecca M Baron
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura E Fredenburgh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center/University of Ulsan College of Medicine, Seoul, South Korea
| | - Augustine M K Choi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Ilias I Siempos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA .,First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Athens General Hospital/National and Kapodistrian University of Athens Medical School, Athens, Greece
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8
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Price DR, Hoffman KL, Oromendia C, Torres LK, Schenck EJ, Choi ME, Choi AMK, Baron RM, Huh JW, Siempos II. Effect of Neutropenic Critical Illness on Development and Prognosis of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2021; 203:504-508. [PMID: 32986956 DOI: 10.1164/rccm.202003-0753le] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ilias I Siempos
- Weill Cornell Medicine New York, New York.,National and Kapodistrian University of Athens Medical School Athens, Greece
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9
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Zhang WZ, Oromendia C, Kikkers SA, Butler JJ, O'Beirne S, Kim K, O'Neal WK, Freeman CM, Christenson SA, Peters SP, Wells JM, Doerschuk C, Putcha N, Barjaktarevic I, Woodruff PG, Cooper CB, Bowler RP, Comellas AP, Criner GJ, Paine R, Hansel NN, Han MK, Crystal RG, Kaner RJ, Ballman KV, Curtis JL, Martinez FJ, Cloonan SM. Increased airway iron parameters and risk for exacerbation in COPD: an analysis from SPIROMICS. Sci Rep 2020; 10:10562. [PMID: 32601308 PMCID: PMC7324559 DOI: 10.1038/s41598-020-67047-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Levels of iron and iron-related proteins including ferritin are higher in the lung tissue and lavage fluid of individuals with chronic obstructive pulmonary disease (COPD), when compared to healthy controls. Whether more iron in the extracellular milieu of the lung associates with distinct clinical phenotypes of COPD, including increased exacerbation susceptibility, is unknown. We measured iron and ferritin levels in the bronchoalveolar lavage fluid (BALF) of participants enrolled in the SubPopulations and InteRmediate Outcome Measures In COPD (SPIROMICS) bronchoscopy sub-study (n = 195). BALF Iron parameters were compared to systemic markers of iron availability and tested for association with FEV1 % predicted and exacerbation frequency. Exacerbations were modelled using a zero-inflated negative binomial model using age, sex, smoking, and FEV1 % predicted as clinical covariates. BALF iron and ferritin were higher in participants with COPD and in smokers without COPD when compared to non-smoker control participants but did not correlate with systemic iron markers. BALF ferritin and iron were elevated in participants who had COPD exacerbations, with a 2-fold increase in BALF ferritin and iron conveying a 24% and 2-fold increase in exacerbation risk, respectively. Similar associations were not observed with plasma ferritin. Increased airway iron levels may be representative of a distinct pathobiological phenomenon that results in more frequent COPD exacerbation events, contributing to disease progression in these individuals.
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Affiliation(s)
- William Z Zhang
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Clara Oromendia
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, New York, USA
| | - Sarah Ann Kikkers
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
| | - James J Butler
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
| | - Sarah O'Beirne
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- Department of Genetic Medicine, Weill Cornell Medicine, New York, New York, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Kihwan Kim
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
| | - Wanda K O'Neal
- University of North Carolina Marsico Lung Institute, Chapel Hill, North Carolina, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Christine M Freeman
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Stephanie A Christenson
- University of California at San Francisco, San Francisco, California, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Stephen P Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, UK
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Claire Doerschuk
- University of North Carolina Marsico Lung Institute, Chapel Hill, North Carolina, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Prescott G Woodruff
- University of California at San Francisco, San Francisco, California, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Russell P Bowler
- University of Colorado School of Medicine, Aurora, Colorado, USA
- National Jewish Health, Denver, Colorado, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Alejandro P Comellas
- Division of Pulmonary and Critical Care, University of Iowa, Iowa City, Iowa, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Gerard J Criner
- Department of Pulmonary & Critical Care Medicine, Temple University, Philadelphia, Pennsylvania, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Robert Paine
- Section of Pulmonary and Critical Care Medicine, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Nadia N Hansel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Meilan K Han
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert J Kaner
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- Department of Genetic Medicine, Weill Cornell Medicine, New York, New York, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Karla V Ballman
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey L Curtis
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA
- New York-Presbyterian Hospital, New York, New York, USA
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA
| | - Suzanne M Cloonan
- Joan and Sanford I. Weill Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, USA.
- School of Medicine, Trinity Biomedical Sciences Institute and Tallaght University Hospital, Trinity College Dublin, Trinity, Ireland.
- SPIROMICS investigators, Collaborative Studies Coordinating Center, Department of Biostatistics Gillings School of Global Public Health, University of North Carolina at Chapel Hill 123 W. Franklin Street Suite 450, Chapel Hill, NC 27516, USA.
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10
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Msaouel P, Van Alstine ML, Oromendia C, Gao J, Wang Y, Siddiqui BA, Siefker-Radtke AO, Shah AY, Shaw L, Lopez L, Laccetti AL, Tannir NM, Elashoff M, Logothetis C. Technology-enabled longitudinal monitoring of patient-reported outcomes (PROs) to individualize care of immune-related adverse events (irAEs) in patients (pts) treated with immune checkpoint inhibitors (ICIs). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps2088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2088 Background: ICIs have become the therapeutic standard for many cancers but are associated with unique and diverse irAEs that often occur at home. Appropriately timed and specific interventions are critical to recovery. Thus, there is a need to effectively & efficiently monitor in real time pts treated with ICIs. To improve outcomes, we have activated a clinical trial developed to determine the feasibility and safety of an electronically enabled strategy to remotely monitor symptoms and prompt communication that will guide and inform specific patient-driven “course corrections” in response to potential irAEs. Methods: This is an adaptive prospective trial that uses a mobile irAE-specific PRO application we developed to monitor and alert the care team in real time when severe symptoms are reported. In parallel with the mobile symptom collection, serum and urine biomarkers are collected at baseline, first tumor restaging, and upon the development of irAEs. Optional stool microbiome analyses are also performed. To facilitate the generalizability of our inferences, we are using broad inclusion criteria: ECOG performance status ≤3; any line of ICI given as standard of care or as part of therapeutic clinical trials; elderly pts are included. Because the relationship between PROs and irAEs is currently undefined, we designed our trial to use adaptive symptom thresholds that will notify the healthcare team of suspicion for irAEs. The mobile application will use these dynamic thresholds to determine whether or not to alert the healthcare team. The positive and negative predictive value of each symptom for identifying subsequent irAEs will be assessed at scheduled interim analysis time points. The care teams’ responses to the alerts, and all of the clinical outcomes for the pts over time will be collected as part of the trial. The primary goal of the trial is the assessment of the predictive power of the mobile PRO symptom collection in combination with serum and urine markers to identify grade 2 or higher adverse events that require intervention (e.g., dose modifications, hospitalizations, and therapeutic interventions) within two weeks of symptom onset. Effective remote monitoring of irAEs will leverage our understanding of ICI toxicity and empower pts to be effective partners in their care. The trial has currently enrolled 17 pts towards the enrollment target of 100 pts. Clinical trial information: PA19-0095 .
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Affiliation(s)
- Pavlos Msaouel
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Jianjun Gao
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yinghong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Leah Shaw
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Christopher Logothetis
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Shoag J, Liu D, Ma X, Oromendia C, Christos P, Ballman K, Angulo C, Cai PY, Gaffney C, Klein E, Karnes J, Den RB, Liu Y, Davicioni E, Barbieri CE. Prognostic value of the SPOP mutant genomic subclass in prostate cancer. Urol Oncol 2020; 38:418-422. [PMID: 32192889 DOI: 10.1016/j.urolonc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/07/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Speckle-type POZ protein (SPOP) mutation defines one of the dominant prostate cancer genomic subtypes, yet the impact of this mutation on clinical prognosis is unknown. METHODS We defined SPOP mutation status either by DNA sequencing or by transcriptional signature in a pooled retrospective multi-institutional cohort, the Decipher retrospective cohort, the Decipher Genomics Resource Information Database prospective cohort, and The Cancer Genome Atlas. Kaplan-Meier survival analysis and multivariable Cox models were used to assess the independent impact of SPOP mutation on survival, biochemical recurrence and time to metastasis. The Decipher retrospective cohort was also used to assess the impact of the addition of SPOP mutation status to a model predicting adverse pathology at prostatectomy which was then validated in the Decipher prospective cohort. RESULTS A fixed-effect model incorporating results from multivariable Cox regression including 5,811 subjects demonstrated that SPOP mutation was associated with a lower rate of adverse pathology at radical prostatectomy (odds ratios 0.57, 95% confidence interval 0.34-0.93), independent of preoperative prostate-specific antigen, age, and pathologic Gleason score. SPOP was not associated with biochemical recurrence, metastasis-free survival, or cancer-specific survival independent of pathologic information. The addition of SPOP status to prognostic models reclassified a large proportion of patients with the mutation (55%) into a favorable risk group when used to predict adverse pathology. CONCLUSION While the clinical utility of delineating any single molecular alteration in prostate cancer remains unclear, these results illustrates the importance of genomic subtypes in prostate cancer behavior and potential role in prognostic tools.
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Affiliation(s)
- Jonathan Shoag
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Deli Liu
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY; Institute for Computational Biomedicine, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Paul Christos
- Department of Healthcare Policy and Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Karla Ballman
- Department of Healthcare Policy and Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Cynthia Angulo
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Peter Y Cai
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Christopher Gaffney
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Eric Klein
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Robert B Den
- Department of Radiation Oncology, Bodine Center for Cancer Treatment, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | - Christopher E Barbieri
- Department of Urology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY; Sandra and Edward Meyer Cancer Center, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY.
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12
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O’Beirne SL, Kikkers SA, Oromendia C, Salit J, Rostmai MR, Ballman KV, Kaner RJ, Crystal RG, Cloonan SM. Alveolar Macrophage Immunometabolism and Lung Function Impairment in Smoking and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 201:735-739. [PMID: 31751151 PMCID: PMC7068819 DOI: 10.1164/rccm.201908-1683le] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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13
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Zhang WZ, Rice MC, Hoffman KL, Oromendia C, Barjaktarevic IZ, Wells JM, Hastie AT, Labaki WW, Cooper CB, Comellas AP, Criner GJ, Krishnan JA, Paine R, Hansel NN, Bowler RP, Barr RG, Peters SP, Woodruff PG, Curtis JL, Han MK, Ballman KV, Martinez FJ, Choi AM, Nakahira K, Cloonan SM, Choi ME. Association of urine mitochondrial DNA with clinical measures of COPD in the SPIROMICS cohort. JCI Insight 2020; 5:133984. [PMID: 31895696 DOI: 10.1172/jci.insight.133984] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDMitochondrial dysfunction, a proposed mechanism of chronic obstructive pulmonary disease (COPD) pathogenesis, is associated with the leakage of mitochondrial DNA (mtDNA), which may be detected extracellularly in various bodily fluids. Despite evidence for the increased prevalence of chronic kidney disease in COPD subjects and for mitochondrial dysfunction in the kidneys of murine COPD models, whether urine mtDNA (u-mtDNA) associates with measures of disease severity in COPD is unknown.METHODSCell-free u-mtDNA, defined as copy number of mitochondrially encoded NADH dehydrogenase-1 (MTND1) gene, was measured by quantitative PCR and normalized to urine creatinine in cell-free urine samples from participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Urine albumin/creatinine ratios (UACR) were measured in the same samples. Associations between u-mtDNA, UACR, and clinical disease parameters - including FEV1 % predicted, clinical measures of exercise tolerance, respiratory symptom burden, and chest CT measures of lung structure - were examined.RESULTSU-mtDNA and UACR levels were measured in never smokers (n = 64), smokers without airflow obstruction (n = 109), participants with mild/moderate COPD (n = 142), and participants with severe COPD (n = 168). U-mtDNA was associated with increased respiratory symptom burden, especially among smokers without COPD. Significant sex differences in u-mtDNA levels were observed, with females having higher u-mtDNA levels across all study subgroups. U-mtDNA associated with worse spirometry and CT emphysema in males only and with worse respiratory symptoms in females only. Similar associations were not found with UACR.CONCLUSIONU-mtDNA levels may help to identify distinct clinical phenotypes and underlying pathobiological differences in males versus females with COPD.TRIAL REGISTRATIONThis study has been registered at ClinicalTrials.gov ( NCT01969344).FUNDINGUS NIH, National Heart, Lung and Blood Institute, supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer-Ingelheim Pharmaceuticals Inc., Chiesi Farmaceutici S.p.A., Forest Research Institute Inc., GlaxoSmithKline, Grifols Therapeutics Inc., Ikaria Inc., Novartis Pharmaceuticals Corporation, Nycomed GmbH, ProterixBio, Regeneron Pharmaceuticals Inc., Sanofi, Sunovion, Takeda Pharmaceutical Company, and Theravance Biopharma and Mylan.
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Affiliation(s)
- William Z Zhang
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Michelle C Rice
- Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, and
| | - Katherine L Hoffman
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, UCLA Medical Center, Los Angeles, California, USA
| | - J Michael Wells
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Annette T Hastie
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, UCLA Medical Center, Los Angeles, California, USA
| | - Alejandro P Comellas
- Division of Pulmonary and Critical Care, University of Iowa, Iowa City, Iowa, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care Medicine, National Jewish Health, Denver, Colorado, USA
| | - R Graham Barr
- Columbia University Medical Center, New York, New York, USA
| | - Stephen P Peters
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, UCSF, School of Medicine, San Francisco, California, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Karla V Ballman
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Augustine Mk Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA.,New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Kiichi Nakahira
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA
| | - Suzanne M Cloonan
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, New York, New York, USA
| | - Mary E Choi
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Division of Nephrology and Hypertension, Joan and Sanford I. Weill Department of Medicine, and
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14
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Krieger AC, Anand R, Hernandez-Rosa E, Maidman A, Milrad S, DeGrazia MQ, Choi AJ, Oromendia C, Marcus AJ, Drosopoulos JHF. Increased platelet activation in sleep apnea subjects with intermittent hypoxemia. Sleep Breath 2020; 24:1537-1547. [PMID: 32036486 DOI: 10.1007/s11325-020-02021-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is independently associated with increased risk for stroke and other cardiovascular diseases. Since activated platelets play an important role in cardiovascular disease, the objective of this study was to determine whether platelet reactivity was altered in OSA subjects with intermittent nocturnal hypoxemia. METHODS Thirty-one subjects, without hypertension or cardiovascular disease and not taking medication, participated in the study. Subjects were stratified based on OSA-related oxygen desaturation index (ODI) recorded during overnight polysomnography. Platelet reactivity to a broad panel of agonists (collagen, thrombin, protease-activated receptor1 hexapeptide, epinephrine, ADP) was measured by monitoring platelet aggregation and ATP secretion. Expression of platelet activation markers CD154 (CD40L) and CD62P (P-selectin) and platelet-monocyte aggregates (PMA) was quantified by flow cytometry. RESULTS Epinephrine-induced platelet aggregation was substantially decreased in OSA subjects with significant intermittent hypoxemia (ODI ≥ 15) compared with subjects with milder hypoxemia levels (ODI < 15) (area under curve, p = 0.01). In addition, OSA subjects with ODI ≥ 15 exhibited decreased thrombin-induced platelet aggregation (p = 0.02) and CD40L platelet surface expression (p = 0.05). Platelet responses to the other agonists, CD62P platelet surface expression, and PMA levels were not significantly different between groups. Reduction in platelet responses to epinephrine and thrombin, and decreased CD40L surface marker expression in significant hypoxemic OSA individuals, is consistent with their platelets being in an activated state. CONCLUSIONS Increased platelet activation was present in otherwise healthy subjects with intermittent nocturnal hypoxemia due to underlying OSA. This prothrombotic milieu in the vasculature is likely a key contributing factor toward development of thrombosis and cardiovascular disease. TRIAL REGISTRATION NCT00859950.
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Affiliation(s)
- Ana C Krieger
- Department of Neurology, Weill Cornell Medicine, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Ranjini Anand
- Thrombosis Research Laboratory, Research Service, VA New York Harbor Healthcare System, 423 East 23rd Street, Room 13026W, New York, NY, 10010, USA.,Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, 10065, USA.,Medical Department, PureSinse Inc., Mississauga, ON, L4W 5K4, Canada
| | - Evelyn Hernandez-Rosa
- Thrombosis Research Laboratory, Research Service, VA New York Harbor Healthcare System, 423 East 23rd Street, Room 13026W, New York, NY, 10010, USA.,Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, 10065, USA.,Department of Pathology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, 10032, USA
| | - Allison Maidman
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Department of Pediatrics, NYU Langone Hospital, Brooklyn, NY, 11220, USA
| | - Sara Milrad
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Miles Q DeGrazia
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexander J Choi
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, 10065, USA.,Project Rōnin Inc., San Mateo, CA, 94401, USA
| | - Aaron J Marcus
- Thrombosis Research Laboratory, Research Service, VA New York Harbor Healthcare System, 423 East 23rd Street, Room 13026W, New York, NY, 10010, USA.,Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, 10065, USA.,Department of Pathology and Laboratory Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Joan H F Drosopoulos
- Thrombosis Research Laboratory, Research Service, VA New York Harbor Healthcare System, 423 East 23rd Street, Room 13026W, New York, NY, 10010, USA. .,Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, 10065, USA.
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15
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Sanchez E, Price DR, Chung KP, Oromendia C, Choi AMK, Schenck EJ, Siempos II. Persistent severe acute respiratory distress syndrome for the prognostic enrichment of trials. PLoS One 2020; 15:e0227346. [PMID: 31986174 PMCID: PMC6984692 DOI: 10.1371/journal.pone.0227346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is heterogeneous. As an indication of the heterogeneity of ARDS, there are patients whose syndrome improves rapidly (i.e., within 24 hours), others whose hypoxemia improves gradually and still others whose severe hypoxemia persists for several days. The latter group of patients with persistent severe ARDS poses challenges to clinicians. We attempted to assess the baseline characteristics and outcomes of persistent severe ARDS and to identify which variables are useful to predict it. METHODS A secondary analysis of patient-level data from the ALTA, EDEN and SAILS ARDSNet clinical trials was conducted. We defined persistent severe ARDS as a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) of equal to or less than 100 mmHg on the second study day following enrollment. Regularized logistic regression with an L1 penalty [Least Absolute Shrinkage and Selection Operator (LASSO)] techniques were used to identify predictive variables of persistent severe ARDS. RESULTS Of the 1531 individuals with ARDS alive on the second study day after enrollment, 232 (15%) had persistent severe ARDS. Of the latter, 100 (43%) individuals had mild or moderate hypoxemia at baseline. Usage of vasopressors was greater [144/232 (62%) versus 623/1299 (48%); p<0.001] and baseline severity of illness was higher in patients with versus without persistent severe ARDS. Mortality at 60 days [95/232 (41%) versus 233/1299 (18%); p<0.001] was higher, and ventilator-free (p<0.001), intensive care unit-free [0 (0-14) versus 19 (7-23); p<0.001] and non-pulmonary organ failure-free [3 (0-21) versus 20 (1-26); p<0.001] days were fewer in patients with versus without persistent severe ARDS. PaO2:FiO2, FiO2, hepatic failure and positive end-expiratory pressure at enrollment were useful predictive variables. CONCLUSIONS Patients with persistent severe ARDS have distinct baseline characteristics and poor prognosis. Identifying such patients at enrollment may be useful for the prognostic enrichment of trials.
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Affiliation(s)
- Elizabeth Sanchez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, New York, United States of America
| | - David R. Price
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, New York, United States of America
| | - Kuei-Pin Chung
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Clara Oromendia
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States of America
| | - Augustine M. K. Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, New York, United States of America
| | - Edward J. Schenck
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, New York, United States of America
| | - Ilias I. Siempos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, New York, United States of America
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece
- * E-mail:
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16
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Abstract
Patients with primary or secondary antiphospholipid syndrome (APS) have an increased risk of recurrent venous, arterial thrombosis and pregnancy complications. Therefore, determining thrombotic risk is important when individualizing antithrombotic therapy in patients with APS. To identify thrombotic risk factors in a cohort of APS patients. We conducted a retrospective review of APS patients who received care at a Hematology clinic of a university medical center from 2004 to 2017. Demographics, clinical features, antithrombotic therapy and thrombotic outcomes were collected. Time to event analysis identified clinical risk factors for thrombosis. The time varying effects of antithrombotic treatments on thrombosis outcome were analyzed. We identified 84 subjects with APS with a median age at diagnosis of 40.7 years [interquartile range [IQR] 33.5-57.6]. The majority were female (n = 63, 75%) and White (n = 45, 54%). Twenty-eight (33%) patients had concomitant autoimmune disease (AID) and of these, 15 (54%) had systemic lupus erythematosus. A thrombotic event occurred in 15 (18%) patients during a median follow-up of 48 months. A significantly higher rate of thrombotic events was observed in APS patients with AID compared to those without AID (hazard ratio (HR) 4.93, 95% CI 1.7-14.3, p = 0.04), and in black patients compared to whites (HR 5.94, 95% CI 1.1-32.1, p = 0.039). Patients on therapeutic anticoagulation regardless of type (warfarin, low molecular weight heparin or direct oral anticoagulants) were significantly less likely to have a recurrent thrombotic event compared to those on prophylactic anticoagulation (HR 0.11, 95% confidence interval [CI] 0.031-0.395, p = 0.001). However the numbers are too small to draw conclusions. Our study suggests that APS patients with concomitant AID and of Black race are at increased risk of recurrent thrombotic events.
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Affiliation(s)
- Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue 7th Floor, New York, NY, 10021, USA
| | - Clara Oromendia
- Division of Biostatistics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Maria T DeSancho
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue 7th Floor, New York, NY, 10021, USA.
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17
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van der Mijn JC, Al Hussein Al Awamlh B, Islam Khan A, Posada-Calderon L, Oromendia C, Fainberg J, Alshak M, Elahjji R, Pierce H, Taylor B, Gudas LJ, Nanus DM, Molina AM, Del Pizzo J, Scherr DS. Validation of risk factors for recurrence of renal cell carcinoma: Results from a large single-institution series. PLoS One 2019; 14:e0226285. [PMID: 31815952 PMCID: PMC6901215 DOI: 10.1371/journal.pone.0226285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To validate prognostic factors and determine the impact of obesity, hypertension, smoking and diabetes mellitus (DM) on risk of recurrence after surgery in patients with localized renal cell carcinoma (RCC). Materials and methods We performed a retrospective cohort study among patients that underwent partial or radical nephrectomy at Weill Cornell Medicine for RCC and collected preoperative information on RCC risk factors, as well as pathological data. Cases were reviewed for radiographic evidence of RCC recurrence. A Cox proportional-hazards model was developed to determine the contribution of RCC risk factors to recurrence risk. Disease-free survival and overall survival were analyzed using the Kaplan-Meier method and log-rank test. Results We identified 873 patients who underwent surgery for RCC between the years 2000–2015. In total 115 patients (13.2%) experienced a disease recurrence after a median follow up of 4.9 years. In multivariate analysis, increasing pathological T-stage (HR 1.429, 95% CI 1.265–1.614) and Nuclear grade (HR 2.376, 95% CI 1.734–3.255) were independently associated with RCC recurrence. In patients with T1-2 tumors, DM was identified as an additional independent risk factor for RCC recurrence (HR 2.744, 95% CI 1.343–5.605). Patients with DM had a significantly shorter median disease-free survival (1.5 years versus 2.6 years, p = 0.004), as well as median overall survival (4.1 years, versus 5.8 years, p<0.001). Conclusions We validated high pathological T-stage and nuclear grade as independent risk factors for RCC recurrence following nephrectomy. DM is associated with an increased risk of recurrence among patients with early stage disease.
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Affiliation(s)
- Johannes C. van der Mijn
- Department of Pharmacology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bashir Al Hussein Al Awamlh
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Aleem Islam Khan
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Lina Posada-Calderon
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Clara Oromendia
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Jonathan Fainberg
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Mark Alshak
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Rahmi Elahjji
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Hudson Pierce
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Benjamin Taylor
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Lorraine J. Gudas
- Department of Pharmacology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - David M. Nanus
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Ana M. Molina
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Joseph Del Pizzo
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Douglas S. Scherr
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, United States of America
- * E-mail:
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18
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Simon RP, Oromendia C, Sanso LM, Ramos LG, Rajwani K. Bronchoscopic delivery of aminocaproic acid as a treatment for pulmonary bleeding: A case series. Pulm Pharmacol Ther 2019; 60:101871. [PMID: 31783097 DOI: 10.1016/j.pupt.2019.101871] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Bronchoscopy is an essential therapeutic modality in the treatment of pulmonary bleeding. Although numerous endoscopic treatments exist, topical ε-aminocaproic acid has not been described in the literature. This study documents the use of this novel treatment for pulmonary bleeding and compares it to available evidence for tranexamic acid, a similar anti-fibrinolytic agent. DESIGN Case-series study. SETTING ICU and general inpatient floors of a tertiary medical center. PATIENTS Forty-six patients receiving endobronchial ε-aminocaproic acid for the treatment or prevention of pulmonary bleeding. MEASUREMENTS AND MAIN RESULTS Of the 46 patients included in the study, 41.6% and 13% presented with non-massive and massive hemoptysis, respectively. In patients with active pulmonary bleeding, endobronchial application of ε-aminocaproic acid and accompanying therapies resulted in cessation of bleeding in 94.7% of cases. A total of six patients received ε-aminocaproic acid monotherapy; in three patients with active bleeding, 100% achieved hemostasis after treatment. Of the 36 patients successfully treated for active pulmonary bleeding, 27.8% had recurrent bleeding within 30 days. Thirty-day adverse events were as follows: death (10 patients), deep vein thrombosis (2 patients), renal failure (2 patients), and stroke (2 patients). CONCLUSIONS Endobronchial administration of ε-aminocaproic acid during bronchoscopy may be a safe and efficacious option in the treatment and prevention of pulmonary bleeding. Further studies are necessary to better define ε-aminocaproic acid's safety profile, optimal routes of administration, and comparative effectiveness to tranexamic acid.
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Affiliation(s)
- Russell P Simon
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Clara Oromendia
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Lourdes M Sanso
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Liz G Ramos
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kapil Rajwani
- Department of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
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19
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Conteduca V, Oromendia C, Eng KW, Bareja R, Sigouros M, Molina A, Faltas BM, Sboner A, Mosquera JM, Elemento O, Nanus DM, Tagawa ST, Ballman KV, Beltran H. Clinical features of neuroendocrine prostate cancer. Eur J Cancer 2019; 121:7-18. [PMID: 31525487 PMCID: PMC6803064 DOI: 10.1016/j.ejca.2019.08.011] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/18/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neuroendocrine prostate cancer (NEPC) is an aggressive variant of prostate cancer that may arise de novo or in patients previously treated with hormonal therapies for prostate adenocarcinoma as a mechanism of resistance. Despite being important to recognise, the clinical features of NEPC are poorly defined and could help guide when to perform a biopsy to look for NEPC histologic transformation. METHODS We reviewed baseline, treatment and outcome data of 87 patients with metastatic prostate cancer and tumour biopsy confirming NEPC histology. Forty-seven (54.0%) NEPC cases presented de novo, and 40 (46.0%) were therapy-related (t-NEPC). Thirty-six (41.4%) were classified as pure small-cell carcinoma, and 51 (58.6%) demonstrated mixed features with both small-cell carcinoma and adenocarcinoma present. Genomic data were available for 47 patients. RESULTS The median age at time of NEPC was 68.1 years, median prostate-specific antigen (PSA) was 1.20 ng/ml (0.14 ng/mL small-cell carcinoma, 1.55 ng/mL mixed carcinoma) and sites of metastases included bone (72.6%), lymph node (47.0%), and viscera (65.5%). Median time from adenocarcinoma to t-NEPC diagnosis was 39.7 months (range, 24.5-93.8) with a median of two lines of prior systemic therapy. Platinum chemotherapy was used to treat 57.5% of patients, with a median progression-free survival of 3.9 months. Small-cell carcinoma was associated with worse overall survival (OS) than mixed histology (8.9 months from NEPC diagnosis versus 26.1 months, P < 0.001). Median OS of de novo NEPC was shorter than that of t-NEPC (16.8 months from prostate cancer diagnosis versus 53.5 months, P = 0.043). An average PSA rise per month of ≤0.7 ng/ml before t-NEPC; elevated lactate dehydrogenase levels, RB1 and TP53 loss and liver metastases were poor prognostic features. CONCLUSIONS We describe the clinical features of a cohort of patients with NEPC. These characteristics may inform future diagnostic strategies.
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Affiliation(s)
- Vincenza Conteduca
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Clara Oromendia
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth W Eng
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA; Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Rohan Bareja
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA; Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael Sigouros
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Ana Molina
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA
| | - Bishoy M Faltas
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA
| | - Andrea Sboner
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA; Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Juan Miguel Mosquera
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA; Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - David M Nanus
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA
| | - Scott T Tagawa
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, NY, USA
| | - Karla V Ballman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Himisha Beltran
- Department of Medicine, Division of Medical Oncology, Weill Cornell Medicine, New York, NY, USA; Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
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20
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Silverstein J, Cortes M, Tsagaris KZ, Climent A, Gerber LM, Oromendia C, Fonzetti P, Ratan RR, Kitago T, Iacoboni M, Wu A, Dobkin B, Edwards DJ. Paired Associative Stimulation as a Tool to Assess Plasticity Enhancers in Chronic Stroke. Front Neurosci 2019; 13:792. [PMID: 31427918 PMCID: PMC6687765 DOI: 10.3389/fnins.2019.00792] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose The potential for adaptive plasticity in the post-stroke brain is difficult to estimate, as is the demonstration of central nervous system (CNS) target engagement of drugs that show promise in facilitating stroke recovery. We set out to determine if paired associative stimulation (PAS) can be used (a) as an assay of CNS plasticity in patients with chronic stroke, and (b) to demonstrate CNS engagement by memantine, a drug which has potential plasticity-modulating effects for use in motor recovery following stroke. Methods We examined the effect of PAS in fourteen participants with chronic hemiparetic stroke at five time-points in a within-subjects repeated measures design study: baseline off-drug, and following a week of orally administered memantine at doses of 5, 10, 15, and 20 mg, comprising a total of seventy sessions. Each week, MEP amplitude pre and post-PAS was assessed in the contralesional hemisphere as a marker of enhanced or diminished plasticity. Strength and dexterity were recorded each week to monitor motor-specific clinical status across the study period. Results We found that MEP amplitude was significantly larger after PAS in baseline sessions off-drug, and responsiveness to PAS in these sessions was associated with increased clinical severity. There was no observed increase in MEP amplitude after PAS with memantine at any dose. Motor threshold (MT), strength, and dexterity remained unchanged during the study. Conclusion Paired associative stimulation successfully induced corticospinal excitability enhancement in chronic stroke subjects at the group level. However, this response did not occur in all participants, and was associated with increased clinical severity. This could be an important way to stratify patients for future PAS-drug studies. PAS was suppressed by memantine at all doses, regardless of responsiveness to PAS off-drug, indicating CNS engagement.
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Affiliation(s)
- Joshua Silverstein
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States
| | - Mar Cortes
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Katherine Zoe Tsagaris
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States
| | - Alejandra Climent
- Sant Joan de Deu Hospital, Department of Neurology, University of Barcelona, Barcelona, Spain
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States
| | - Pasquale Fonzetti
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States.,Memory Evaluation and Treatment Service, Burke Rehabilitation Hospital, White Plains, NY, United States
| | - Rajiv R Ratan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States.,Burke Neurological Institute, White Plains, NY, United States.,Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, United States
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States.,Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Allan Wu
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bruce Dobkin
- Department of Neurology, Geffen School of Medicine, Reed Neurologic Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Dylan J Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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21
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Schenck EJ, Ma KC, Price DR, Nicholson T, Oromendia C, Gentzler ER, Sanchez E, Baron RM, Fredenburgh LE, Huh JW, Siempos II, Choi AM. Circulating cell death biomarker TRAIL is associated with increased organ dysfunction in sepsis. JCI Insight 2019; 4:127143. [PMID: 31045578 DOI: 10.1172/jci.insight.127143] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 01/02/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In sepsis, there may be dysregulation in programed cell death pathways, typified by apoptosis and necroptosis. Programmed cell death pathways may contribute to variability in the immune response. TRAIL is a potent inducer of apoptosis. Receptor-interacting serine/threonine protein kinase-3 (RIPK3) is integral to the execution of necroptosis. We explored whether plasma TRAIL levels were associated with in-hospital mortality, organ dysfunction, and septic shock. We also explored the relationship between TRAIL and RIPK3. METHODS We performed an observational study of critically ill adults admitted to intensive care units at 3 academic medical centers across 2 continents, using 1 as derivation and the other 2 as validation cohorts. Levels of TRAIL were measured in the plasma of 570 subjects by ELISA. RESULTS In all cohorts, lower (<28.5 pg/ml) versus higher levels of TRAIL were associated with increased organ dysfunction (P ≤ 0.002) and septic shock (P ≤ 0.004). Lower TRAIL levels were associated with in-hospital mortality in 2 of 3 cohorts (Weill Cornell-Biobank of Critical Illness, P = 0.012; Brigham and Women's Hospital Registry of Critical Illness, P = 0.011; Asan Medical Center, P = 0.369). Lower TRAIL was also associated with increased RIPK3 (P ≤ 0.001). CONCLUSION Lower levels of TRAIL were associated with septic shock and organ dysfunction in 3 independent ICU cohorts. TRAIL was inversely associated with RIPK3 in all cohorts. FUNDING NIH (R01-HL055330 and KL2-TR002385).
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Affiliation(s)
- Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,New York-Presbyterian Hospital Weill Cornell Medical Center, New York, New York, USA
| | - Kevin C Ma
- Section of Interventional Pulmonology and Thoracic Oncology, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David R Price
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,New York-Presbyterian Hospital Weill Cornell Medical Center, New York, New York, USA
| | - Thomas Nicholson
- New York-Presbyterian Hospital Weill Cornell Medical Center, New York, New York, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Eliza Rose Gentzler
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth Sanchez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Fredenburgh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ilias I Siempos
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece
| | - Augustine Mk Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,New York-Presbyterian Hospital Weill Cornell Medical Center, New York, New York, USA
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22
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Ko D, Oromendia C, Scher R, Lipner SR. Retrospective single-center study evaluating clinical and dermoscopic features of longitudinal melanonychia, ABCDEF criteria, and risk of malignancy. J Am Acad Dermatol 2019; 80:1272-1283. [DOI: 10.1016/j.jaad.2018.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 11/27/2022]
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23
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Edwards DJ, Cortes M, Rykman-Peltz A, Chang J, Elder J, Thickbroom G, Mariman JJ, Gerber LM, Oromendia C, Krebs HI, Fregni F, Volpe BT, Pascual-Leone A. Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS. Restor Neurol Neurosci 2019; 37:167-180. [DOI: 10.3233/rnn-180869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Australia
| | - Mar Cortes
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avrielle Rykman-Peltz
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Johanna Chang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Gary Thickbroom
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Juan J. Mariman
- Metropolitan University of Educational Sciences, Santiago, Chile
- University of Chile, Neurosystems Laboratory, Santiago, Chile
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA, USA
| | - Felipe Fregni
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center, Berenson-Allen Center for Noninvasive Brain Stimulation, and Harvard Medical School, Boston, MA, USA
- Institut de Neurorehabilitacio Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
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24
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Vlachostergios PJ, Peruzzo N, Nauseef J, Oromendia C, Manohar J, Molina AM, Nanus DM, Beltran H, Tagawa ST. Value of serum neuroendocrine markers in evaluation of neuroendocrine prostate cancer: A validation study using metastatic biopsies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
278 Background: NEPC, de novo or treatment-related in late stage CRPC, is a distinct entity with poor prognosis. Developing non-invasive methods for detection of NEPC is important for clinical practice and trial enrollment. We previously reported on the clinical and genomic characterization of NEPC (Conteduca et al ESMO 2018). A separate study (Aggarwal et al JCO 2018) suggested that low levels of NSE and CgA were associated with a strong NPV for NEPC on biopsy (bx). This study aimed to validate the utility of NSE and CgA in evaluation of NEPC by comparison with met bx. Methods: Our IRB-approved NEPC database was screened for pts who underwent met bx and had concurrent serum NSE, CgA. Clinical data, serum PSA, LDH, ALP, Hb were recorded at time of bx. Comparison of continuous variables between CRPC adeno and NEPC was assessed by nonparametric Kruskal-Wallis test. ROC curve analysis was performed for evaluation of predictive models with serum NE markers. Results: 152 men were identified, median age 71 yrs (49-97). 35 pts had pure/mixed NEPC, while the rest (N=117) had typical adenoca on bx. Half of pts (80/152, 52.6%) received abiraterone or/and enzalutamide. Liver mets were more common in NEPC pts (P=0.001). Median serum NSE (11.2 vs 8.6 ng/mL, P=0.008) and CgA (211 vs 135 ng/mL, P=0.035) were higher in pts with NEPC vs CRPC adeno (Table). Using ROC curve analysis for NSE (normal 3.7-8.9 ng/mL) and CgA (normal 0-95 ng/mL) as independent diagnostic tests, the following cut-offs were identified: NSE 30.1 (Sn: 37%, Sp: 94%, PPV: 34%, NPV: 82%), CgA 170 (Sn: 63%, Sp: 59%, PPV: 23%, NPV: 83%). Conclusions: Our study confirms the potential utility of serum NSE and CgA in excluding a morphological dx of NEPC when below certain thresholds. However, our findings cannot support deferring a met bx in such cases. Larger studies are needed to evaluate for a more robust predictive ability of serum NE markers. [Table: see text]
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Affiliation(s)
| | | | - Jones Nauseef
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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25
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Conteduca V, Oromendia C, Vlachostergios PJ, Hackett A, Thomas C, Case A, Manohar J, Eng K, Sboner A, Ballman KV, Elemento O, Nanus DM, Beltran H, Tagawa ST. Clinical and molecular analysis of patients treated with prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
272 Background: PSMA targeted therapy has recently emerged as a promising approach for patients with advanced prostate cancer. However, there is still a need for reliable biomarkers that provide information about clinically meaningful outcomes and treatment responses. Methods: Baseline, treatment and outcomes data along with tumor whole-exome sequencing (WES) data were retrospectively evaluated in anti-PSMA-treated patients (pts). Statistical comparisons utilized Cox regression analysis and Kaplan-Meier method for association with overall/progression-free/survival (OS/PFS) and PSA response. Results: We analyzed 25 pts treated with PSMA targeted radionuclide therapies refractory to standard therapy. 15 received 177Lu-J591, 8 received 177Lu-PSMA-617, 1 received both, and 1 225Ac-J591. WES data (n=28) showed an incidence of AR, BRCA1, BRCA2, ATM alterations (copy number variations and point somatic mutations) in 71.4% (n=20), 11.1% (n=3), 29.6% (n=8), and 14.3% (n=4), respectively. Variables found with backward selection with AIC criterion for PFS and OS suggest significant clinical and molecular predictors of PFS/OS (Table). Conclusions: Knowledge of prognostic factors such as baseline narcotic use and ALP, and BRCA1/BRCA2 and TP53 alterations may have potential clinical utility in patients being considered for anti-PSMA targeted radionuclide therapies. Validation of these findings in larger prospective trials is warranted.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Andrea Sboner
- Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY
| | | | - Olivier Elemento
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY
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26
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Van Der Mijn J, Eng K, Fernandez E, Oromendia C, Zhang T, Bareja R, Ramazanoglu S, Vosoughi A, Gudas. LJ, Elemento O, Tagawa ST, Faltas BM, Nanus DM, Beltran H, Mosquera JM, Sboner A, Molina AM. The genomic landscape of metastatic clear cell renal cell carcinoma (ccRCC) after treatment with systemic therapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.675] [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: 11/20/2022] Open
Abstract
675 Background: The most frequent genomic alterations in patients (pts) with ccRCC have been identified in primary tumors. Here we investigated the genomic landscape of ccRCC in a cohort enriched for metastatic tumors after treatment with systemic therapy. Methods: We prospectively enrolled pts with ccRCC in a clinical study in which Whole-Exome Sequencing (WES) of normal and tumor tissue was performed. Clinical features, treatment outcome and survival were evaluated. Results: Forty-five pts with ccRCC with a median age of 65 years (range 38–86) were enrolled. According to the Heng risk criteria, 15 pts (33.3%) were classified as favorable-risk 23 pts (51.1%) were intermediate-risk and 7 pts (15.6%) were poor-risk. Pts received a median number of 3 lines (range 0–9) of therapy including cytokines (n=7), anti-VEGF (n=36), mTOR inhibitors (n=10) and/or immune checkpoint inhibitors (n=23). The median progression free survival (PFS) after treatment was 3.5 months (0.7-13.1), 11.1 months (1.1–54.2), 2.7 months (0.7-36.2) and 4.9 months (1.4–29.2) after cytokines, VEGF-, mTOR- and immune checkpoint inhibitors, respectively. The median overall survival (OS) from start of treatment to last follow up was 2.2 years (range 0.2–14.9 years). A total of 68 samples were sequenced. These included 9 (12.5%) primary tumors, 38 (55.9%) collected after treatment with anti-VEGF, 16 (23.5%) after mTOR- and 8 (11.8%) after immune checkpoint inhibitor. VHL, KDM5C, SETD2 and PBRM1 were the most frequent somatic mutations detected in this cohort. In two cases with a short and long response to VEGF targeted therapy (PFS 2.8 versus 50.3 months) rapid autopsies were performed which allowed multiregional (n=7, n=4) sampling. The multiregional sequencing in the rapid autopsy case with a prolonged response to VEGF targeted therapy revealed recurrent KDM5C mutations. Conclusions: We present the genomic landscape of metastatic ccRCC after treatment with systemic therapy. We report an increased frequency of KDM5C mutations, previously described to be associated with a favorable response to VEGF-inhibitors.
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Affiliation(s)
| | | | | | | | - Tuo Zhang
- Weill Cornell Medicine, New York City, NY
| | - Rohan Bareja
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY
| | | | | | | | - Olivier Elemento
- Department of Physiology and Biophysics, Institute for Computational Biomedicine, Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Juan Miguel Mosquera
- Department of Pathology & Laboratory Medicine, Englander Institute for Precision Medicine, Weill Cornell Medical College & New York-Presbyterian Hospital, New York, NY
| | - Andrea Sboner
- Englander Institute for Precision Medicine, Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY
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27
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Palathra BC, Kawai F, Oromendia C, Bushan A, Patel Y, Morris J, Pan CX. To Code or Not To Code: Teaching Multidisciplinary Clinicians to Conduct Code Status Discussions. J Palliat Med 2019; 22:566-571. [PMID: 30615558 DOI: 10.1089/jpm.2018.0362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Code status discussions (CSDs) can be challenging for many clinicians. Barriers associated with them include lack of education, comfort level, and experience. Objective: To conduct an educational intervention to improve knowledge and communication approaches related to CSDs. Design: A cross-sectional multidisciplinary educational intervention was conducted over one year consisting of an interactive presentation, live role-play, and pre- and post-intervention tests to measure impact of the formal training. Evaluations and comments were also collected. Setting/Subjects: Attending physicians, nurses, residents, fellows, and physician assistants (PAs) at an urban community teaching hospital of 500 beds serving an ethnically diverse population. Measurements: Data from pre- and post-intervention tests evaluating knowledge and communication approach regarding CSDs were collected. Participants completed a qualitative evaluation of the program. Results: There were 165 participants: 29 attending physicians, 26 residents, 17 fellows, 18 PAs, and 75 nurses. All (100%) completed the pre-intervention test and 154 (93.3%) completed the post-intervention test. There was an overall improvement in scores, 43.8% pre-intervention to 75.6% post-intervention (p-values <0.005). Attending physicians and fellows had the highest pre-intervention scores, while nurses and PAs had the lowest. Most participants (97%) reported they learned new information and 91% stated they would change patient management. Conclusions: Our study found that a brief educational intervention with multipronged teaching tools improved knowledge concerning CSDs. Participants felt it provided new insights and would change their practice. This study contributes to the literature by examining CSD training across different disciplines, allowing for cross-group comparisons. Future studies should try to correlate educational interventions and clinician knowledge with clinical practice outcomes.
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Affiliation(s)
- Brigit C Palathra
- 1 Division of Geriatrics and Palliative Care, NewYork-Presbyterian Queens, Flushing, New York
| | - Fernando Kawai
- 1 Division of Geriatrics and Palliative Care, NewYork-Presbyterian Queens, Flushing, New York
| | - Clara Oromendia
- 2 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Archana Bushan
- 3 Department of Medicine, Sinai Hospital, Baltimore, Maryland
| | - Yera Patel
- 4 Department of Medicine, Jamaica Hospital Medical Center, Jamaica, New York
| | - Jane Morris
- 5 Department of Nursing, NewYork-Presbyterian Queens, Flushing, New York
| | - Cynthia X Pan
- 1 Division of Geriatrics and Palliative Care, NewYork-Presbyterian Queens, Flushing, New York
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28
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Cohen-Mekelburg S, Gold S, Schneider Y, Dennis M, Oromendia C, Yeo H, Michelassi F, Scherl E, Steinlauf A. Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients. Dig Dis Sci 2019; 64:196-203. [PMID: 29876778 DOI: 10.1007/s10620-018-5159-4] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 05/31/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence. AIMS We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. METHODS We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively. RESULTS A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy. CONCLUSIONS There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA.
| | - Stephanie Gold
- Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Yecheskel Schneider
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Madison Dennis
- Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Clara Oromendia
- Division of Healthcare Policy and Research, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Heather Yeo
- Department of Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Fabrizio Michelassi
- Department of Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Ellen Scherl
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Adam Steinlauf
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
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29
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Fredenburgh LE, Perrella MA, Barragan-Bradford D, Hess DR, Peters E, Welty-Wolf KE, Kraft BD, Harris RS, Maurer R, Nakahira K, Oromendia C, Davies JD, Higuera A, Schiffer KT, Englert JA, Dieffenbach PB, Berlin DA, Lagambina S, Bouthot M, Sullivan AI, Nuccio PF, Kone MT, Malik MJ, Porras MAP, Finkelsztein E, Winkler T, Hurwitz S, Serhan CN, Piantadosi CA, Baron RM, Thompson BT, Choi AM. A phase I trial of low-dose inhaled carbon monoxide in sepsis-induced ARDS. JCI Insight 2018; 3:124039. [PMID: 30518685 DOI: 10.1172/jci.insight.124039] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a prevalent disease with significant mortality for which no effective pharmacologic therapy exists. Low-dose inhaled carbon monoxide (iCO) confers cytoprotection in preclinical models of sepsis and ARDS. METHODS We conducted a phase I dose escalation trial to assess feasibility and safety of low-dose iCO administration in patients with sepsis-induced ARDS. Twelve participants were randomized to iCO or placebo air 2:1 in two cohorts. Four subjects each were administered iCO (100 ppm in cohort 1 or 200 ppm in cohort 2) or placebo for 90 minutes for up to 5 consecutive days. Primary outcomes included the incidence of carboxyhemoglobin (COHb) level ≥10%, prespecified administration-associated adverse events (AEs), and severe adverse events (SAEs). Secondary endpoints included the accuracy of the Coburn-Forster-Kane (CFK) equation to predict COHb levels, biomarker levels, and clinical outcomes. RESULTS No participants exceeded a COHb level of 10%, and there were no administration-associated AEs or study-related SAEs. CO-treated participants had a significant increase in COHb (3.48% ± 0.7% [cohort 1]; 4.9% ± 0.28% [cohort 2]) compared with placebo-treated subjects (1.97% ± 0.39%). The CFK equation was highly accurate at predicting COHb levels, particularly in cohort 2 (R2 = 0.9205; P < 0.0001). Circulating mitochondrial DNA levels were reduced in iCO-treated participants compared with placebo-treated subjects. CONCLUSION Precise administration of low-dose iCO is feasible, well-tolerated, and appears to be safe in patients with sepsis-induced ARDS. Excellent agreement between predicted and observed COHb should ensure that COHb levels remain in the target range during future efficacy trials. TRIAL REGISTRATION ClinicalTrials.gov NCT02425579. FUNDING NIH grants P01HL108801, KL2TR002385, K08HL130557, and K08GM102695.
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Affiliation(s)
- Laura E Fredenburgh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark A Perrella
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Diana Barragan-Bradford
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dean R Hess
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Peters
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Karen E Welty-Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - R Scott Harris
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rie Maurer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kiichi Nakahira
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - John D Davies
- Department of Respiratory Care, Duke University Medical Center, Durham, North Carolina, USA
| | - Angelica Higuera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen T Schiffer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joshua A Englert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul B Dieffenbach
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David A Berlin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Susan Lagambina
- Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark Bouthot
- Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew I Sullivan
- Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul F Nuccio
- Department of Respiratory Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mamary T Kone
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mona J Malik
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Maria Angelica Pabon Porras
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Eli Finkelsztein
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Tilo Winkler
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Claude A Piantadosi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Augustine Mk Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Buchwald A, Falconer C, Rykman-Peltz A, Cortes M, Pascual-Leone A, Thickbroom GW, Krebs HI, Fregni F, Gerber LM, Oromendia C, Chang J, Volpe BT, Edwards DJ. Robotic Arm Rehabilitation in Chronic Stroke Patients With Aphasia May Promote Speech and Language Recovery (but Effect Is Not Enhanced by Supplementary tDCS). Front Neurol 2018; 9:853. [PMID: 30405512 PMCID: PMC6207995 DOI: 10.3389/fneur.2018.00853] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to determine the extent to which robotic arm rehabilitation for chronic stroke may promote recovery of speech and language function in individuals with aphasia. Methods: We prospectively enrolled 17 individuals from a hemiparesis rehabilitation study pairing intensive robot assisted therapy with sham or active tDCS and evaluated their speech (N = 17) and language (N = 9) performance before and after a 12-week (36 session) treatment regimen. Performance changes were evaluated with paired t-tests comparing pre- and post-test measures. There was no speech therapy included in the treatment protocol. Results: Overall, the individuals significantly improved on measures of motor speech production from pre-test to post-test. Of the subset who performed language testing (N = 9), overall aphasia severity on a standardized aphasia battery improved from pre-test baseline to post-test. Active tDCS was not associated with greater gains than sham tDCS. Conclusions: This work indicates the importance of considering approaches to stroke rehabilitation across different domains of impairment, and warrants additional exploration of the possibility that robotic arm motor treatment may enhance rehabilitation for speech and language outcomes. Further investigation into the role of tDCS in the relationship of limb and speech/language rehabilitation is required, as active tDCS did not increase improvements over sham tDCS.
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Affiliation(s)
- Adam Buchwald
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Carolyn Falconer
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Avrielle Rykman-Peltz
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States
| | - Mar Cortes
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States.,Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
| | - Gary W Thickbroom
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA, United States
| | - Linda M Gerber
- Weill Cornell Medicine, New York City, NY, United States
| | | | - Johanna Chang
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Bruce T Volpe
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Dylan J Edwards
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States.,Moss Rehabilitation Research Institute, Elkins Park, PA, United States.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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31
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Schenck EJ, Oromendia C, Torres LK, Berlin DA, Choi AMK, Siempos II. Rapidly Improving ARDS in Therapeutic Randomized Controlled Trials. Chest 2018; 155:474-482. [PMID: 30359616 DOI: 10.1016/j.chest.2018.09.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 06/06/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Observational studies suggest that some patients meeting criteria for ARDS no longer fulfill the oxygenation criterion early in the course of their illness. This subphenotype of rapidly improving ARDS has not been well characterized. We attempted to assess the prevalence, characteristics, and outcomes of rapidly improving ARDS and to identify which variables are useful to predict it. METHODS A secondary analysis was performed of patient level data from six ARDS Network randomized controlled trials. We defined rapidly improving ARDS, contrasted with ARDS > 1 day, as extubation or a Pao2 to Fio2 ratio (Pao2:Fio2) > 300 on the first study day following enrollment. RESULTS The prevalence of rapidly improving ARDS was 10.5% (458 of 4,361 patients) and increased over time. Of the 1,909 patients enrolled in the three most recently published trials, 197 (10.3%) were extubated on the first study day, and 265 (13.9%) in total had rapidly improving ARDS. Patients with rapidly improving ARDS had lower baseline severity of illness and lower 60-day mortality (10.2% vs 26.3%; P < .0001) than ARDS > 1 day. Pao2:Fio2 at screening, change in Pao2:Fio2 from screening to enrollment, use of vasopressor agents, Fio2 at enrollment, and serum bilirubin levels were useful predictive variables. CONCLUSIONS Rapidly improving ARDS, mostly defined by early extubation, is an increasingly prevalent and distinct subphenotype, associated with better outcomes than ARDS > 1 day. Enrollment of patients with rapidly improving ARDS may negatively affect the prognostic enrichment and contribute to the failure of therapeutic trials.
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Affiliation(s)
- Edward J Schenck
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY
| | - Lisa K Torres
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY
| | - David A Berlin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY
| | - Augustine M K Choi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY
| | - Ilias I Siempos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece.
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32
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Conteduca V, Oromendia C, Sigouros M, Sborner A, Nanus D, Tagawa S, Ballman K, Beltran H. Clinico-genomic profiling and outcome prediction of neuroendocrine prostate cancer (NEPC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Tagawa S, Vallabhajosula S, Jhanwar Y, Hackett A, Oromendia C, Naiz M, Goldsmith S, Nanus D, Beltran H, Molina A, Faltas B, Sreekumar J, Babich J, Ballman K, Bander N. Phase I dose-escalation study of fractionated dose 177Lu-PSMA-617 for progressive metastatic castration resistant prostate cancer (mCRPC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Beltran H, Oromendia C, Danila DC, Montgomery B, Hoimes C, Szmulewitz RZ, Vaishampayan U, Armstrong AJ, Stein M, Pinski J, Mosquera JM, Sailer V, Bareja R, Romanel A, Gumpeni N, Sboner A, Dardenne E, Puca L, Prandi D, Rubin MA, Scher HI, Rickman DS, Demichelis F, Nanus DM, Ballman KV, Tagawa ST. A Phase II Trial of the Aurora Kinase A Inhibitor Alisertib for Patients with Castration-resistant and Neuroendocrine Prostate Cancer: Efficacy and Biomarkers. Clin Cancer Res 2018; 25:43-51. [PMID: 30232224 DOI: 10.1158/1078-0432.ccr-18-1912] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/12/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Neuroendocrine prostate cancer (NEPC) is an aggressive variant of prostate cancer that may develop de novo or as a mechanism of treatment resistance. N-myc is capable of driving NEPC progression. Alisertib inhibits the interaction between N-myc and its stabilizing factor Aurora-A, inhibiting N-myc signaling, and suppressing tumor growth. PATIENTS AND METHODS Sixty men were treated with alisertib 50 mg twice daily for 7 days every 21 days. Eligibility included metastatic prostate cancer and at least one: small-cell neuroendocrine morphology; ≥50% neuroendocrine marker expression; new liver metastases without PSA progression; or elevated serum neuroendocrine markers. The primary endpoint was 6-month radiographic progression-free survival (rPFS). Pretreatment biopsies were evaluated by whole exome and RNA-seq and patient-derived organoids were developed. RESULTS Median PSA was 1.13 ng/mL (0.01-514.2), number of prior therapies was 3, and 68% had visceral metastases. Genomic alterations involved RB1 (55%), TP53 (46%), PTEN (29%), BRCA2 (29%), and AR (27%), and there was a range of androgen receptor signaling and NEPC marker expression. Six-month rPFS was 13.4% and median overall survival was 9.5 months (7.3-13). Exceptional responders were identified, including complete resolution of liver metastases and prolonged stable disease, with tumors suggestive of N-myc and Aurora-A overactivity. Patient organoids exhibited concordant responses to alisertib and allowed for the dynamic testing of Aurora-N-myc complex disruption. CONCLUSIONS Although the study did not meet its primary endpoint, a subset of patients with advanced prostate cancer and molecular features supporting Aurora-A and N-myc activation achieved significant clinical benefit from single-agent alisertib.
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Affiliation(s)
- Himisha Beltran
- Department of Medicine, Weill Cornell Medicine, New York, New York. .,Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
| | - Clara Oromendia
- Department of Biostatistics, Weill Cornell Medicine, New York, New York
| | - Daniel C Danila
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Bruce Montgomery
- Department of Medicine, University of Washington, Seattle, Washington
| | - Christopher Hoimes
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Ulka Vaishampayan
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | - Andrew J Armstrong
- Departments of Medicine, Surgery, and Pharmacology and Cancer Biology, Duke Cancer Institute, Duke University, Durham, North California
| | - Mark Stein
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jacek Pinski
- Division of Oncology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, California
| | - Juan M Mosquera
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Verena Sailer
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
| | - Rohan Bareja
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
| | - Alessandro Romanel
- Centre for Integrative Biology (CIBIO), University of Trento, Trento Italy
| | - Naveen Gumpeni
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Andrea Sboner
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Etienne Dardenne
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Loredana Puca
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
| | - Davide Prandi
- Centre for Integrative Biology (CIBIO), University of Trento, Trento Italy
| | - Mark A Rubin
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Howard I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - David S Rickman
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Francesca Demichelis
- Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York.,Centre for Integrative Biology (CIBIO), University of Trento, Trento Italy
| | - David M Nanus
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
| | - Karla V Ballman
- Department of Biostatistics, Weill Cornell Medicine, New York, New York
| | - Scott T Tagawa
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Englander Institute for Precision Medicine, New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York
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35
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Ma KC, Schenck EJ, Siempos II, Cloonan SM, Finkelsztein EJ, Pabon MA, Oromendia C, Ballman KV, Baron RM, Fredenburgh LE, Higuera A, Lee JY, Chung CR, Jeon K, Yang JH, Howrylak JA, Huh JW, Suh GY, Choi AM. Circulating RIPK3 levels are associated with mortality and organ failure during critical illness. JCI Insight 2018; 3:99692. [PMID: 29997296 DOI: 10.1172/jci.insight.99692] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/08/2018] [Accepted: 06/06/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Necroptosis is a form of programmed necrotic cell death that is rapidly emerging as an important pathophysiological pathway in numerous disease states. Necroptosis is dependent on receptor-interacting protein kinase 3 (RIPK3), a protein shown to play an important role in experimental models of critical illness. However, there is limited clinical evidence regarding the role of extracellular RIPK3 in human critical illness. METHODS Plasma RIPK3 levels were measured in 953 patients prospectively enrolled in 5 ongoing intensive care unit (ICU) cohorts in both the USA and Korea. RIPK3 concentrations among groups were compared using prospectively collected phenotypic and outcomes data. RESULTS In all 5 cohorts, extracellular RIPK3 levels in the plasma were higher in patients who died in the hospital compared with those who survived to discharge. In a combined analysis, increasing RIPK3 levels were associated with elevated odds of in-hospital mortality (odds ratio [OR] 1.7 for each log10-unit increase in RIPK3 level, P < 0.0001). When adjusted for baseline severity of illness, the OR for in-hospital mortality remained statistically significant (OR 1.33, P = 0.007). Higher RIPK3 levels were also associated with more severe organ failure. CONCLUSIONS Our findings suggest that elevated levels of RIPK3 in the plasma of patients admitted to the ICU are associated with in-hospital mortality and organ failure. FUNDING Supported by NIH grants P01 HL108801, R01 HL079904, R01 HL055330, R01 HL060234, K99 HL125899, and KL2TR000458-10. Supported by Samsung Medical Center grant SMX1161431.
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Affiliation(s)
- Kevin C Ma
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine.,NewYork-Presbyterian Hospital
| | - Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine.,NewYork-Presbyterian Hospital
| | - Ilias I Siempos
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Suzanne M Cloonan
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Eli J Finkelsztein
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Maria A Pabon
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine.,Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, and
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Karla V Ballman
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School. Boston, Massachusetts, USA
| | - Laura E Fredenburgh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School. Boston, Massachusetts, USA
| | - Angelica Higuera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School. Boston, Massachusetts, USA
| | - Jin Young Lee
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Judie A Howrylak
- Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Augustine Mk Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine.,NewYork-Presbyterian Hospital
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Bach PV, Patel N, Najari BB, Oromendia C, Flannigan R, Brannigan R, Goldstein M, Hu JC, Kashanian JA. Changes in practice patterns in male infertility cases in the United States: the trend toward subspecialization. Fertil Steril 2018; 110:76-82. [DOI: 10.1016/j.fertnstert.2018.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
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37
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Harrington JS, Schenck EJ, Oromendia C, Choi AMK, Siempos II. Acute respiratory distress syndrome without identifiable risk factors: A secondary analysis of the ARDS network trials. J Crit Care 2018; 47:49-54. [PMID: 29898428 DOI: 10.1016/j.jcrc.2018.06.002] [Citation(s) in RCA: 6] [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: 02/20/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE We examined whether patients with acute respiratory distress syndrome (ARDS) lacking risk factors are enrolled in therapeutic trials and assessed their clinical characteristics and outcomes. METHODS We performed a secondary analysis of patient-level data pooled from the ARMA, ALVEOLI, FACTT, ALTA and EDEN ARDSNet randomized controlled trials obtained from the Biologic Specimen and Data Repository Information Coordinating Center of the National Heart, Lung and Blood Institute. We compared baseline characteristics and clinical outcomes (before and after adjustment using Poisson regression model) of ARDS patients with versus without risk factors. RESULTS Of 3733 patients with ARDS, 81 (2.2%) did not have an identifiable risk factor. Patients without risk factors were younger, had lower baseline severity of illness, were more likely to have the ARDS resolve rapidly (i.e., within 24 h) (p < 0.001) and they had more ventilator-free days (median 21; p = 0.003), more intensive care unit-free days (18; p = 0.010), and more non-pulmonary organ failure-free days (24; p < 0.001) than comparators (17, 14 and 18, respectively). Differences persisted after adjustment for potential confounders. CONCLUSIONS Patients with ARDS without identifiable risk factors are enrolled in therapeutic trials and may have better outcomes, including a higher proportion of rapidly resolving ARDS, than those with risk factors.
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Affiliation(s)
- John S Harrington
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, United States
| | - Edward J Schenck
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, United States
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, United States
| | - Augustine M K Choi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, United States
| | - Ilias I Siempos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, United States; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece.
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Abstract
PURPOSE Recent years have brought many changes in the management of localized prostate cancer as national screening guidelines have been updated and diagnostic practice patterns evolved. We sought to better understand how the changing landscape influenced treatment utilization in the United States. METHODS We used the SEER database in this retrospective analysis of patients with clinically localized prostate cancer between 2004 and 2013. We evaluated utilization of primary treatment modalities over time with descriptive and trend analyses, and examined treatment utilization by cancer risk group and age at diagnosis. RESULTS Of 398 074 patients in the analytic data set, 38% elected radiation therapy, 38% underwent radical prostatectomy, and 24% opted for expectant management. While in 2004 radiation treatment was almost twice as common as expectant management (42% vs 23%), by 2013 approximately equal percentages of patients were treated with each of the three modalities. Expectant management use increased over time, while the proportion of patients opting for surgery decreased remarkably with increasing age at diagnosis in intermediate- and higher-risk disease. Among radiotherapy options, brachytherapy was most common among lower-risk patients in 2004 but substantially decreased over time (P < 0.001). CONCLUSIONS Management of localized prostate cancer changed substantially over time in the United States. Utilization of expectant management has increased for men with low- and intermediate risk cancer. Among those who pursue curative therapy, younger men remain more likely to elect surgery whereas older men tend to choose radiotherapy. Further studies are needed to better characterize factors contributing to treatment selection.
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Affiliation(s)
- Junchao Chen
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Joshua A Halpern
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Karla V Ballman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
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Phongtankuel V, Adelman RD, Trevino K, Abramson E, Johnson P, Oromendia C, Henderson CR, Reid MC. Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population. Am J Hosp Palliat Care 2018; 35:316-323. [PMID: 28285542 PMCID: PMC5494025 DOI: 10.1177/1049909117697933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. OBJECTIVES The study's purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. DESIGN A retrospective cohort study using Medicare data. PARTICIPANTS Medicare hospice beneficiaries who were ≥18 years old in 2012. OUTCOME MEASURED Hospitalization within 2 days of hospice disenrollment. RESULTS The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). CONCLUSIONS More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Ronald D. Adelman
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Kelly Trevino
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Erika Abramson
- New York-Presbyterian Hospital, New York, NY, USA
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Phyllis Johnson
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | | | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
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Shamapant S, Wortman-Jutt S, Boutin E, Bennett S, Oromendia C, Gerber L, Marquardt TP, Edwards DJ. Abstract TP139: Transcranial Direct Current Stimulation as an Adjuvant to an Intensive Comprehensive Aphasia Program in Chronic Stroke. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp139] [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
Background and Purpose:
In this proof-of-concept pilot study, transcranial direct current stimulation (tDCS) was used as an adjuvant to speech therapy in an intensive comprehensive aphasia program (ICAP).
Methods:
Using a double-blind, sham controlled, between-group design, 1 mA of direct current was delivered via NEO-24 PiStim gel electrodes using a Starstim tDCS device.The anode was placed over the inferior frontal gyrus (FC5), with the cathode placed over the supra-orbital frontal area (AF8) of the contralesional side during the first 20 minutes of daily intensive speech therapy for a period of 15 consecutive weekdays, commencing on day-1 of an 8-week ICAP. Pre- and post-treatment standardized assessments and discourse analysis, as well as bi-weekly trained and untrained probes, were used as outcome measures.
Results:
Six subjects were analyzed; three received ICAP-tDCS and three received ICAP-sham. Five subjects were male. Ages ranged from 50 to 67 years. Time post-stroke at enrollment ranged from 8 months to 5.2 years. Subjects receiving ICAP-tDCS treatment demonstrated significantly higher improvement than ICAP-sham patients on the Boston Naming Test ( p=0.05), trained and untrained probes (p=0.05, untrained absolute increase p=0.05, percent increase p=0.38), and picture-description discourse (absolute increase p=0.05, percent increase p=0.38). There was no difference in the improvement of Western Aphasia Battery-AQ between ICAP-tDCS and ICAP-sham patients (absolute and percent increases both p=0.28). No adverse effects of tDCS or intensive behavioral training were reported. Following completion of the initial 3 weeks of adjunctive tDCS and tDCS-sham treatment, all subjects continued participation in the ICAP therapy with behavioral intervention only, and concluded the 8-week program.
Conclusions:
In this proof-of-concept pilot rehabilitation study, we demonstrate significant language improvements in chronic post-stroke aphasia, following intensive speech therapy combined with tDCS. Results should be confirmed in a larger randomized clinical trial.
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Affiliation(s)
| | | | | | | | - Clara Oromendia
- Div of Biostatistics and Epidemiology, Weill Cornell Med College, NY, NY
| | - Linda Gerber
- Div of Biostatistics and Epidemiology, Weill Cornell Med College, New York, NY
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Halpern JA, Oromendia C, Shoag JE, Mittal S, Cosiano MF, Ballman KV, Vickers AJ, Hu JC. Use of Digital Rectal Examination as an Adjunct to Prostate Specific Antigen in the Detection of Clinically Significant Prostate Cancer. J Urol 2017; 199:947-953. [PMID: 29061540 DOI: 10.1016/j.juro.2017.10.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Guidelines from the NCCN® (National Comprehensive Cancer Network®) advocate digital rectal examination screening only in men with elevated prostate specific antigen. We investigated the effect of prostate specific antigen on the association of digital rectal examination and clinically significant prostate cancer in a large American cohort. MATERIALS AND METHODS We evaluated the records of the 35,350 men who underwent digital rectal examination in the screening arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial for the development of clinically significant prostate cancer (Gleason 7 or greater). Followup was 343,273 person-years. The primary outcome was the rate of clinically significant prostate cancer among men with vs without suspicious digital rectal examination. We performed competing risks regression to evaluate the interaction between time varying suspicious digital rectal examination and prostate specific antigen. RESULTS A total of 1,713 clinically significant prostate cancers were detected with a 10-year cumulative incidence of 5.9% (95% CI 5.6-6.2). Higher risk was seen for suspicious vs nonsuspicious digital rectal examination. Increases in absolute risk were small and clinically irrelevant for normal (less than 2 ng/ml) prostate specific antigen (1.5% vs 0.7% risk of clinically significant prostate cancer at 10 years), clinically relevant for elevated (3 ng/ml or greater) prostate specific antigen (23.0% vs 13.7%) and modestly clinically relevant for equivocal (2 to 3 ng/ml) prostate specific antigen (6.5% vs 3.5%). CONCLUSIONS Digital rectal examination demonstrated prognostic usefulness when prostate specific antigen was greater than 3 ng/ml, limited usefulness for less than 2 ng/ml and marginal usefulness for 2 to 3 ng/ml. These findings support the restriction of digital rectal examination to men with higher prostate specific antigen as a reflex test to improve specificity. It should not be used as a primary screening modality to improve sensitivity.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Jonathan E Shoag
- Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Sameer Mittal
- Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Michael F Cosiano
- Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Karla V Ballman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York.
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Feuer ZS, Segal DA, Oromendia C, Myers FA, Gold S, Weiss JP, McNeil BK, Hyacinthe LM, Winer A. Use of Prostate-Specific Antigen Velocity as a Screening Tool for Pre-Biopsy Detection of Prostate Cancer in African-American Men: A Single Institutional Analysis. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.483] [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: 10/18/2022]
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Heerdt PM, Korfhagen S, Ezz H, Oromendia C. Accuracy of a Simulation Algorithm for Modelling LV Contractility, Diastolic Capacitance, and Energetics Using Data Available From Common Hemodynamic Monitors and Echocardiography. J Cardiothorac Vasc Anesth 2017; 32:381-388. [PMID: 29153929 DOI: 10.1053/j.jvca.2017.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the hypothesis that a simulation algorithm populated with data readily available from hemodynamic monitors and echocardiography can accurately model cardiac contractility, diastolic capacitance, and energetics. DESIGN Bland-Altman analysis of paired data sets. SETTING University laboratory. PARTICIPANTS Archived data previously recorded from 7 anesthetized swine. MEASUREMENTS AND MAIN RESULTS Left ventricular pressure and volume (LVV) data that had been continuously recorded over a range of inotropic conditions were used as reference data. One investigator performed conventional analysis of measured pressure/volume loops during preload reduction to derive reference values for end-systolic elastance (Ees-a measure of contractility), the predicted LVV at an end-diastolic pressure of 30 mmHg (V30-an index of diastolic capacitance and chamber dilation), and pressure-volume area (PVA-a correlate of myocardial oxygen consumption). Other investigators blinded to these results entered pressure, cardiac output, and ejection fraction measurements into a simulator that predicts Ees, V30, and PVA. Analysis of simulated data was performed before and after correction of the estimated LVV at which pressure would be 0 mmHg (V0), which was initially fixed in the model. Before V0 correction, accuracy and precision of Ees, V30, and PVA tended to fall outside predefined limits for method interchangeability, but utility for qualitative assessment of acute changes was evident. After V0 correction, the accuracy and precision of simulated data were within the defined limits for method interchangeability. CONCLUSIONS These data support the potential for clinical utility of simulation models populated with data readily available at the bedside to characterize left ventricular mechanical performance and energetics.
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Affiliation(s)
- Paul M Heerdt
- Department of Anesthesiology, Division of Applied Hemodynamics, Yale School of Medicine, New Haven, CT.
| | - Scott Korfhagen
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Hesham Ezz
- Department of Anesthesiology, Division of Applied Hemodynamics, Yale School of Medicine, New Haven, CT
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY
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Lewicki P, Shoag J, Golombos DM, Oromendia C, Ballman KV, Halpern JA, Stone BV, O’Malley P, Barbieri CE, Scherr DS. Prognostic Significance of a Negative Prostate Biopsy: An Analysis of Subjects Enrolled in a Prostate Cancer Screening Trial. J Urol 2017; 197:1014-1019. [DOI: 10.1016/j.juro.2016.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Patrick Lewicki
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Jonathan Shoag
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - David M. Golombos
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Clara Oromendia
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Karla V. Ballman
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Joshua A. Halpern
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Benjamin V. Stone
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Padraic O’Malley
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Christopher E. Barbieri
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
| | - Douglas S. Scherr
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
- Department of Healthcare Policy and Research, Weill Cornell Medicine (CO, KVB), New York, New York
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Kerwin LJ, Estes C, Oromendia C, Christos P, Sulica L. Long-term consequences of vocal fold hemorrhage. Laryngoscope 2016; 127:900-906. [DOI: 10.1002/lary.26302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Christine Estes
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York, New York U.S.A
| | - Clara Oromendia
- Department of Biostatistics and Epidemiology; Weill Cornell Medical College; New York New York U.S.A
| | - Paul Christos
- Department of Biostatistics and Epidemiology; Weill Cornell Medical College; New York New York U.S.A
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medical College; New York, New York U.S.A
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Beltran H, Danila D, Montgomery B, Szmulewitz R, Vaishampayan U, Armstrong A, Stein M, Hoimes C, Pinski J, Scher H, Puca L, Bareja R, Wong W, Rubin M, Mosquera J, Sboner A, Oromendia C, Nanus D, Ballman K, Tagawa S. A phase 2 study of the aurora kinase A inhibitor alisertib for patients with neuroendocrine prostate cancer (NEPC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kim S, Oromendia C, Christos P, Wernicke A, Parashar B. Sequence of Radiation Therapy Versus Surgery on Outcomes in Gastroesophageal Junction Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1093] [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: 11/24/2022]
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Bach P, Najari B, Oromendia C, Neto F, Goldstein M, Hu J, Kashanian J. Changes in practice patterns in male infertility cases in the United States - the trend toward subspecialization. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.138] [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: 10/21/2022]
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