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Lee MK, Alfego D, Dale SE. Prevalence and trends in mono- and co-infection of COVID-19, influenza A/B, and respiratory syncytial virus, January 2018-June 2023. Front Public Health 2023; 11:1297981. [PMID: 38162614 PMCID: PMC10754957 DOI: 10.3389/fpubh.2023.1297981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study aimed to determine the impact of the COVID-19 pandemic on the overall prevalence and co-infection rates for COVID-19, influenza A/B, and respiratory syncytial virus in a large national population. Methods We conducted a retrospective review of 1,318,118 multi-component nucleic acid amplification tests for COVID-19, influenza A/B, and RSV performed at Labcorp® sites from January 2018 to June 2023, comparing positivity rates and co-infection rates by age, sex, and seasonality. Results In 2021-2023, 1,232 (0.10%) tested positive for COVID-19 and influenza A/B, 366 (0.03%) tested positive for COVID-19 and RSV, 874 (0.07%) tested for influenza A/B and RSV, and 13 (0.001%) tested positive for COVID-19, influenza A/B, and RSV. RSV positivity rates were particularly higher in Q2 and Q3 of 2021 and in Q3 of 2022. Higher influenza A positivity proportions were found in Q4 of 2021 and again in Q2 and Q4 of 2022. Influenza B positivity had been minimal since the start of the pandemic, with a slight increase observed in Q2 of 2023. Conclusion Our findings highlight the need for adaptability in preparation for upper respiratory infection occurrences throughout the year as we adjust to the COVID-19 pandemic due to the observed changes in the seasonality of influenza and RSV. Our results highlight low co-infection rates and suggest heightened concerns for co-infections during peaks of COVID-19, influenza, and RSV, which may perhaps be reduced.
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2
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Sullivan A, Alfego D, Hu P, Gillim L, Grover A, Garcia C, Cohen O, Letovsky S. Antibody titer levels and the effect on subsequent SARS-CoV-2 infection in a large US-based cohort. Heliyon 2023; 9:e13103. [PMID: 36712916 PMCID: PMC9862663 DOI: 10.1016/j.heliyon.2023.e13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Despite a growing amount of data around the kinetics and durability of the antibody response induced by vaccination and previous infection, there is little understanding of whether or not a given quantitative level of antibodies correlates to protection against SARS-CoV-2 infection or reinfection. In this study, we examine SARS-CoV-2 anti-spike receptor binding domain (RBD) antibody titers and subsequent SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) tests in a large cohort of US-based patients. We analyzed antibody test results in a cohort of 22,204 individuals, 6.8% (n = 1,509) of whom eventually tested positive for SARS-CoV-2 RNA, suggesting infection or reinfection. Kaplan-Meier curves were plotted to understand the effect of various levels of anti-spike RBD antibody titers (classified into discrete ranges) on subsequent RT-PCR positivity rates. Statistical analyses included fitting a Cox proportional hazards model to estimate the age-, sex- and exposure-adjusted hazard ratios for S antibody titer, using zip-code positivity rates by week as a proxy for COVID-19 exposure. It was found that the best models of the temporally associated infection risk were those based on log antibody titer level (HR = 0.836 (p < 0.05)). When titers were binned, the hazard ratio associated with antibody titer >250 Binding Antibody Units (BAU) was 0.27 (p < 0.05, 95% CI [0.18, 0.41]), while the hazard ratio associated with previous infection was 0.20 (p < 0.05, 95% CI [0.10, 0.39]). Fisher exact odds ratio (OR) for Ab titers <250 BAU showed OR = 2.84 (p < 0.05; 95% CI: [2.30, 3.53]) for predicting the outcome of a subsequent PCR test. Antibody titer levels correlate with protection against subsequent SARS-CoV-2 infection or reinfection when examining a cohort of real-world patients who had the spike RBD antibody assay performed.
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3
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Alfego D, Ennis J, Gillespie B, Lewis MJ, Montgomery E, Ferrè S, Vassalotti JA, Letovsky S. Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database. Diabetes Care 2021; 44:2025-2032. [PMID: 34353883 PMCID: PMC8740927 DOI: 10.2337/dc21-0723] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE An estimated 37 million Americans have chronic kidney disease (CKD). Nearly 90% do not know about their condition because of low awareness about the importance of CKD testing and diagnosis among practitioners and people at risk for CKD. This study uses data from a national clinical laboratory to identify guideline-recommended CKD testing rates across the U.S. RESEARCH DESIGN AND METHODS Patients with Laboratory Corporation of America Holdings (Labcorp) testing between 2013 and 2019 were defined as at risk for CKD if they had any testing ordered with diagnosis codes for diabetes and/or hypertension. Guideline-concordant CKD assessment was defined by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) testing within the study year. RESULTS We identified 28,295,982 at-risk patients (mean age 60.6 ± 14.8 years; 53.6% women): 16.2% had diabetes, 63.8% had hypertension, and 20.1% had both comorbidities. Of these, 80.3% did not receive guideline-concordant assessment during the study period. Furthermore, only 21.0% had uACR testing versus 89.6% with eGFR. CKD assessment occurred at least once in 28.7% of patients with diabetes, 10.5% of patients with hypertension, and 41.4% of patients with both conditions. In a state-by-state comparison, annual testing rates ranged from 5 to 30%. The nationwide rate increased modestly each year between 2013 and 2018 (from 10.7% to 15.2%). CONCLUSIONS Despite guideline recommendations, testing for CKD with uACR and eGFR in U.S. adults with diabetes and hypertension is low in routine clinical care. These data highlight the need for strategies to improve routine CKD assessment nationwide.
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Affiliation(s)
- David Alfego
- Laboratory Corporation of America Holdings, Burlington, NC
| | - Jennifer Ennis
- Laboratory Corporation of America Holdings, Burlington, NC.,Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Barbara Gillespie
- Covance Inc., Princeton, NJ.,Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Joseph A Vassalotti
- National Kidney Foundation, New York, NY.,Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Darukhanavala A, Puhr S, Dinunno K, Alfego D, Welsh J, Butler L, Magyar K. Association between attendance at an American diabetes camp and improvements in glycaemic control and treatment satisfaction. Endocrinol Diabetes Metab 2021; 4:e00254. [PMID: 34277978 PMCID: PMC8279631 DOI: 10.1002/edm2.254] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Few studies have evaluated glycaemic control using continuous glucose monitoring (CGM) in individuals before and after attendance at a diabetes camp or by comparing control groups at home to control groups at camp. Methods Youth (6–17 years) with T1D and receiving insulin therapy were enrolled at a week‐long diabetes camp. They participated in three clinic visits: at the start of a week at home, by initiating a Dexcom G6 CGM system; at the start of a week at camp, where the home week G6 was removed and a camp week G6 was inserted; and after camp, where the camp week G6 was removed. We administered Problem Areas in Diabetes (PAID) surveys at the second and third visits. Participants with <80% CGM data coverage or who did not complete all PAID surveys were excluded from analysis. We compared glycaemic control and PAID scores between the week at home and week at camp. Results Of 76 enrolled campers, 69 completed the study and 52 had results that qualified for analysis. The mean participant age was 12.5 ± 2.2 years. Camp was associated with significantly improved treatment satisfaction, time in desired glucose range and insulin sensitivity. Time in hyperglycaemia and basal insulin requirements decreased significantly. Conclusions Diabetes camp is associated with significant improvements in diabetes treatment satisfaction and glycaemic control compared to home care.
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Affiliation(s)
- Amy Darukhanavala
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Kyle Dinunno
- The Barton Center for Diabetes Education North Oxford MA USA
| | - David Alfego
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Lynn Butler
- The Barton Center for Diabetes Education North Oxford MA USA
| | - Kendra Magyar
- The Barton Center for Diabetes Education North Oxford MA USA
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Rojas-Rodriguez R, Ziegler R, DeSouza T, Majid S, Madore AS, Amir N, Pace VA, Nachreiner D, Alfego D, Mathew J, Leung K, Moore Simas TA, Corvera S. PAPPA-mediated adipose tissue remodeling mitigates insulin resistance and protects against gestational diabetes in mice and humans. Sci Transl Med 2021; 12:12/571/eaay4145. [PMID: 33239385 DOI: 10.1126/scitranslmed.aay4145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 04/25/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
Pregnancy is a physiological state of continuous adaptation to changing maternal and fetal nutritional needs, including a reduction of maternal insulin sensitivity allowing for appropriately enhanced glucose availability to the fetus. However, excessive insulin resistance in conjunction with insufficient insulin secretion results in gestational diabetes mellitus (GDM), greatly increasing the risk for pregnancy complications and predisposing both mothers and offspring to future metabolic disease. Here, we report a signaling pathway connecting pregnancy-associated plasma protein A (PAPPA) with adipose tissue expansion in pregnancy. Adipose tissue plays a central role in the regulation of insulin sensitivity, and we show that, in both mice and humans, pregnancy caused remodeling of adipose tissue evidenced by altered adipocyte size, vascularization, and in vitro expansion capacity. PAPPA is known to be a metalloprotease secreted by human placenta that modulates insulin-like growth factor (IGF) bioavailability through prolteolysis of IGF binding proteins (IGFBPs) 2, 4, and 5. We demonstrate that recombinant PAPPA can stimulate ex vivo human adipose tissue expansion in an IGFBP-5- and IGF-1-dependent manner. Moreover, mice lacking PAPPA displayed impaired adipose tissue remodeling, pregnancy-induced insulin resistance, and hepatic steatosis, recapitulating multiple aspects of human GDM. In a cohort of 6361 pregnant women, concentrations of circulating PAPPA are inversely correlated with glycemia and odds of developing GDM. These data identify PAPPA and the IGF signaling pathway as necessary for the regulation of maternal adipose tissue physiology and systemic glucose homeostasis, with consequences for long-term metabolic risk and potential for therapeutic use.
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Affiliation(s)
- Raziel Rojas-Rodriguez
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.,Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Rachel Ziegler
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Tiffany DeSouza
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Sana Majid
- Clinical Translational Research Pathway, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Aylin S Madore
- Departments of Obstetrics and Gynecology, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01605, USA
| | - Nili Amir
- Departments of Obstetrics and Gynecology, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01605, USA
| | - Veronica A Pace
- Clinical Translational Research Pathway, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Daniel Nachreiner
- Clinical Translational Research Pathway, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - David Alfego
- Division of Data Sciences and Technology, IT, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Jomol Mathew
- Division of Data Sciences and Technology, IT, University of Massachusetts Medical School, Worcester, MA 01605, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Katherine Leung
- Departments of Obstetrics and Gynecology, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01605, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics and Gynecology, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA 01605, USA
| | - Silvia Corvera
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Alfego D, Sullivan A, Poirier B, Williams J, Adcock D, Letovsky S. A population-based analysis of the longevity of SARS-CoV-2 antibody seropositivity in the United States. EClinicalMedicine 2021; 36:100902. [PMID: 34056568 PMCID: PMC8143650 DOI: 10.1016/j.eclinm.2021.100902] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to track population-based SARS-CoV-2 antibody seropositivity duration across the United States using observational data from a national clinical laboratory registry of patients tested by nucleic acid amplification (NAAT) and serologic assays. Knowledge of antibody seropositivity and its duration may help dictate post-pandemic planning. METHODS Using assays to detect antibodies to either nucleocapsid (N) or spike (S) proteins performed on specimens from 39,086 individuals with confirmed positive COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) from March 2020 to January 2021, we analyzed nationwide seropositivity rates of IgG up to 300 days following patients' initial positive NAAT test. Linear regression identified trends in seropositivity rates and logistic regression tested positive predictability by age, sex, assay type and days post-infection. FINDINGS Seropositivity of IgG antibodies to both SARS-CoV-2 S and N-proteins followed a linear trend reaching approximately 90% positivity at 21 days post-index. The rate of N-protein seropositivity declined at a sharper rate, decaying to 68·2% [95% CI: 63·1-70·8%] after 293 days, while S-antibody seropositivity maintained a rate of 87·8% [95% CI: 86·3-89·1%] through 300 days. In addition to antigen type and the number of days post-positive PCR, age and gender were also significant factors in seropositivity prediction, with those under 65 years of age showing a more sustained seropositivity rate. INTERPRETATION Observational data from a national clinical laboratory, though limited by an epidemiological view of the U.S. population, offer an encouraging timeline for the development and sustainability of antibodies up to ten months from natural infection and could inform post-pandemic planning.
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Affiliation(s)
- David Alfego
- Laboratory Corporation of America® Holdings, 3595 Johns Hopkins Court, San Diego, CA 92121, United States
| | - Adam Sullivan
- Laboratory Corporation of America® Holdings, Burlington, NC, United States
| | - Brian Poirier
- Laboratory Corporation of America® Holdings, Burlington, NC, United States
| | - Jonathan Williams
- Laboratory Corporation of America® Holdings, Burlington, NC, United States
| | - Dorothy Adcock
- Laboratory Corporation of America® Holdings, Burlington, NC, United States
| | - Stanley Letovsky
- Laboratory Corporation of America® Holdings, Burlington, NC, United States
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7
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Sullivan A, Alfego D, Poirier B, Williams J, Adcock D, Letovsky S. Follow-Up SARS-CoV-2 PCR Testing Outcomes From a Large Reference Lab in the US. Front Public Health 2021; 9:679012. [PMID: 34136460 PMCID: PMC8200821 DOI: 10.3389/fpubh.2021.679012] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
By analyzing COVID-19 sequential COVID-19 test results of patients across the United States, we herein attempt to quantify some of the observations we've made around long-term infection (and false-positive rates), as well as provide observations on the uncertainty of sampling variability and other dynamics of COVID-19 infection in the United States. Retrospective cohort study of a registry of RT-PCR testing results for all patients tested at any of the reference labs operated by Labcorp® including both positive, negative, and inconclusive results, from March 1, 2020 to January 28, 2021, including patients from all 50 states and outlying US territories. The study included 22 million patients with RT-PCR qualitative test results for SARS-CoV-2, of which 3.9 million had more than one test at Labcorp. We observed a minuscule <0.1% basal positive rate for follow up tests >115 days, which could account for false positives, long-haulers, and/or reinfection but is indistinguishable in the data. In observing repeat-testing, for patients who have a second test after a first RT-PCR, 30% across the cohort tested negative on the second test. For patients who test positive first and subsequently negative within 96 h (40% of positive test results), 18% of tests will subsequently test positive within another 96-h span. For those who first test negative and then positive within 96 h (2.3% of negative tests), 56% will test negative after a third and subsequent 96-h period. The sudden changes in RT-PCR test results for SARS-CoV-2 from this large cohort study suggest that negative test results during active infection or exposure can change rapidly within just days or hours. We also demonstrate that there does not appear to be a basal false positive rate among patients who test positive >115 days after their first RT-PCR positive test while failing to observe any evidence of widespread reinfection.
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Affiliation(s)
- Adam Sullivan
- Labcorp Holdings of America, Inc., Burlington, NC, United States
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8
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Darukhanavala A, Van Dessel F, Ho J, Hansen M, Kremer T, Alfego D. Use of hemoglobin A1c to identify dysglycemia in cystic fibrosis. PLoS One 2021; 16:e0250036. [PMID: 33882078 PMCID: PMC8059836 DOI: 10.1371/journal.pone.0250036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cystic fibrosis (CF) leads to pancreatic endocrine dysfunction with progressive glycemic disturbance. Approximately 30%–50% of people with CF eventually develop CF–related diabetes (CFRD). Pre-CFRD states progress from indeterminant glycemia (INDET) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Screening guidelines recommend inconvenient annual 2-hour oral glucose tolerance tests (OGTTs), beginning at age 10 years. More efficient methods, such as hemoglobin A1C (HbA1c), have been evaluated, but only limited, relatively small studies have evaluated the association between HbA1c and pre-CFRD dysglycemic states. Objective To determine whether HbA1c is an appropriate screening tool for identifying patients with pre-CFRD dysglycemia to minimize the burden of annual OGTTs. Methods This retrospective review evaluated medical records data of all University of Massachusetts Memorial Health System CF patients with an HbA1c result within 90 days of an OGTT between 1997 and 2019. Exclusion criteria were uncertain CF diagnosis, other forms of diabetes, or incomplete OGTT. In total, 56 patients were included and categorized according to OGTT results (American Diabetes Association criteria): normal glucose tolerance, INDET, IFG, or IGT. Associations were evaluated between HbA1c and OGTT results and between HbA1c and pre-CFRD dysglycemic states. Results Mean HbA1c was not significantly different between patients with normal glucose tolerance and those in the INDET (p = 0.987), IFG (p = 0.690), and IGT (p = 0.874) groups. Analysis of variance confirmed the lack of association between HbA1c and glycemia, as mean HbA1c was not significantly different amongst the four categories (p = 0.250). Conclusion There is increasing awareness of the impact of pre-CFRD states, including reduced pulmonary function and nutritional status. Unfortunately, our results do not support using HbA1c as a screening tool for pre-CFRD dysglycemia, specifically INDET, IFG, and IGT. Further studies are warranted to evaluate more efficient screening methods to reduce the burden of annual OGTTs.
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Affiliation(s)
- Amy Darukhanavala
- Department of Pediatric Endocrinology, University of Massachusetts Medical Center, Worcester, MA, United States of America
- * E-mail:
| | - Filia Van Dessel
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jannifer Ho
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Megan Hansen
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Ted Kremer
- Department of Pediatric Pulmonology, University of Massachusetts Medical Center, Worcester, MA, United States of America
| | - David Alfego
- University of Massachusetts Medical School, Worcester, MA, United States of America
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9
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Fazzalari A, Alfego D, Shortsleeve JT, Shi Q, Mathew J, Litwin D, Cahan M. Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care? J Surg Res 2020; 252:183-191. [PMID: 32278973 DOI: 10.1016/j.jss.2020.03.008] [Citation(s) in RCA: 3] [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] [Received: 12/14/2019] [Revised: 02/12/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Timing of surgical treatment of facial fractures may vary with the patient age, injury type, and presence of polytrauma. Previous studies using national data sets have suggested that trauma patients with government insurance experience fewer operations, longer length of hospital stay (LOS), and worse outcomes compared with privately insured patients. The objective of this study is to compare treatment of facial fractures in patients with and without Medicaid insurance (excluding Medicare). METHODS All adults with mandibular, orbital, and midface fractures at a Level 1 Trauma Center between 2009 and 2018 were included. Statistical analyses were performed to assess the differences in the frequency of surgery, time to surgery (TTS), LOS, and mortality based on insurance type. RESULTS The sample included 1541 patients with facial fractures (mandible, midface, orbital), of whom 78.8% were male, and 13.1% (208) were enrolled in Medicaid. Mechanism of injury was predominantly assault for Medicaid enrollees and falls or motor vehicle accidents for non-Medicaid enrollees (P < 0.001). Patients with mandible and midface fractures underwent similar rates of surgical repair. Medicaid enrollees with orbital fractures underwent less frequent surgery for facial fractures (24.8% versus 34.7%, P = 0.0443) and had higher rates of alcohol and drug intoxication compared with non-Medicaid enrollees (42.8% versus 31.6%, P = 0.008). TTS, LOS, and mortality were similar in both groups with facial fractures. CONCLUSIONS Overall, the treatment of facial fractures was similar regardless of the insurance type, but Medicaid enrollees with orbital fractures experienced less frequent surgery for facial fractures. Further studies are needed to identify specific socioeconomic and geographic factors contributing to these disparities in care.
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Affiliation(s)
- Amanda Fazzalari
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - David Alfego
- Division of Data Sciences and Technology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - J Taylor Shortsleeve
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Qiming Shi
- Division of Data Sciences and Technology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jomol Mathew
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Demetrius Litwin
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mitchell Cahan
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
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10
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Fazzalari A, Pozzi N, Alfego D, Erskine N, Shi Q, Tourony G, Mathew J, Litwin D, Cahan MA. Treatment of appendicitis: Do Medicaid and non-Medicaid–enrolled patients receive the same care? Surgery 2019; 166:793-799. [DOI: 10.1016/j.surg.2019.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 11/15/2022]
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11
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Fazzalari A, Alfego D, Shortsleeve JT, Shi Q, Mathew J, Litwin D, Cahan MA. Treatment of Facial Fractures at a Level I Trauma Center: Does Insurance Type Make a Difference? J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.506] [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: 10/25/2022]
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12
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Abstract
Biological aging is a complex process dependent on the interplay of cell autonomous and tissue contextual changes which occur in response to cumulative molecular stress and manifest through adaptive transcriptional reprogramming. Here we describe a transcription factor (TF) meta-analysis of gene expression datasets accrued from 18 tissue sites collected at different biological ages and from 7 different in-vitro aging models. In-vitro aging platforms included replicative senescence and an energy restriction model in quiescence (ERiQ), in which ATP was transiently reduced. TF motifs in promoter regions of trimmed sets of target genes were scanned using JASPAR and TRANSFAC. TF signatures established a global mapping of agglomerating motifs with distinct clusters when ranked hierarchically. Remarkably, the ERiQ profile was shared with the majority of in-vivo aged tissues. Fitting motifs in a minimalistic protein-protein network allowed to probe for connectivity to distinct stress sensors. The DNA damage sensors ATM and ATR linked to the subnetwork associated with senescence. By contrast, the energy sensors PTEN and AMPK connected to the nodes in the ERiQ subnetwork. These data suggest that metabolic dysfunction may be linked to transcriptional patterns characteristic of many aged tissues and distinct from cumulative DNA damage associated with senescence.
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Affiliation(s)
- David Alfego
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Ulrich Rodeck
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Andres Kriete
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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13
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Yalamanchili N, Kriete A, Alfego D, Danowski KM, Kari C, Rodeck U. Distinct Cell Stress Responses Induced by ATP Restriction in Quiescent Human Fibroblasts. Front Genet 2016; 7:171. [PMID: 27757122 PMCID: PMC5047886 DOI: 10.3389/fgene.2016.00171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/14/2016] [Accepted: 09/09/2016] [Indexed: 12/22/2022] Open
Abstract
Quiescence is the prevailing state of many cell types under homeostatic conditions. Yet, surprisingly little is known about how quiescent cells respond to energetic and metabolic challenges. To better understand compensatory responses of quiescent cells to metabolic stress, we established, in human primary dermal fibroblasts, an experimental ‘energy restriction’ model. Quiescence was achieved by short-term culture in serum-deprived media and ATP supply restricted using a combination of glucose transport inhibitors and mitochondrial uncouplers. In aggregate, these measures led to markedly reduced intracellular ATP levels while not compromising cell viability over the observation period of 48 h. Analysis of the transcription factor (TF) landscape induced by this treatment revealed alterations in several signal transduction nodes beyond the expected biosynthetic adaptations. These included increased abundance of NF-κB regulated TFs and altered TF subsets regulated by Akt and p53. The observed changes in gene regulation and corresponding alterations in key signaling nodes are likely to contribute to cell survival at intracellular ATP concentrations substantially below those achieved by growth factor deprivation alone. This experimental model provides a benchmark for the investigation of cell survival pathways and related molecular targets that are associated with restricted energy supply associated with biological aging and metabolic diseases.
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Affiliation(s)
- Nirupama Yalamanchili
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia PA, USA
| | - Andres Kriete
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia PA, USA
| | - David Alfego
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia PA, USA
| | - Kelli M Danowski
- Department of Dermatology, St. Joseph Mercy Health System, Michigan State University, East Lansing MI, USA
| | - Csaba Kari
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia PA, USA
| | - Ulrich Rodeck
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia PA, USA
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Jablonowski LJ, Alfego D, Andorko JI, Eisenbrey JR, Teraphongphom N, Wheatley MA. Balancing stealth and echogenic properties in an ultrasound contrast agent with drug delivery potential. Biomaterials 2016; 103:197-206. [DOI: 10.1016/j.biomaterials.2016.06.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 12/16/2022]
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