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Jiao A, Sun Y, Avila C, Chiu V, Slezak J, Sacks DA, Abatzoglou JT, Molitor J, Chen JC, Benmarhnia T, Getahun D, Wu J. Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity. JAMA Netw Open 2023; 6:e2332780. [PMID: 37676659 PMCID: PMC10485728 DOI: 10.1001/jamanetworkopen.2023.32780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Importance The rate of severe maternal morbidity (SMM) is continuously increasing in the US. Evidence regarding the associations of climate-related exposure, such as environmental heat, with SMM is lacking. Objective To examine associations between long- and short-term maternal heat exposure and SMM. Design, Setting, and Participants This retrospective population-based epidemiological cohort study took place at a large integrated health care organization, Kaiser Permanente Southern California, between January 1, 2008, and December 31, 2018. Data were analyzed from February to April 2023. Singleton pregnancies with data on SMM diagnosis status were included. Exposures Moderate, high, and extreme heat days, defined as daily maximum temperatures exceeding the 75th, 90th, and 95th percentiles of the time series data from May through September 2007 to 2018 in Southern California, respectively. Long-term exposures were measured by the proportions of different heat days during pregnancy and by trimester. Short-term exposures were represented by binary variables of heatwaves with 9 different definitions (combining percentile thresholds with 3 durations; ie, ≥2, ≥3, and ≥4 consecutive days) during the last gestational week. Main Outcomes and Measures The primary outcome was SMM during delivery hospitalization, measured by 20 subconditions excluding blood transfusion. Discrete-time logistic regression was used to estimate associations with long- and short-term heat exposure. Effect modification by maternal characteristics and green space exposure was examined using interaction terms. Results There were 3446 SMM cases (0.9%) among 403 602 pregnancies (mean [SD] age, 30.3 [5.7] years). Significant associations were observed with long-term heat exposure during pregnancy and during the third trimester. High exposure (≥80th percentile of the proportions) to extreme heat days during pregnancy and during the third trimester were associated with a 27% (95% CI, 17%-37%; P < .001) and 28% (95% CI, 17%-41%; P < .001) increase in risk of SMM, respectively. Elevated SMM risks were significantly associated with short-term heatwave exposure under all heatwave definitions. The magnitude of associations generally increased from the least severe (HWD1: daily maximum temperature >75th percentile lasting for ≥2 days; odds ratio [OR], 1.32; 95% CI, 1.17-1.48; P < .001) to the most severe heatwave exposure (HWD9: daily maximum temperature >95th percentile lasting for ≥4 days; OR, 2.39; 95% CI, 1.62-3.54; P < .001). Greater associations were observed among mothers with lower educational attainment (OR for high exposure to extreme heat days during pregnancy, 1.43; 95% CI, 1.26-1.63; P < .001) or whose pregnancies started in the cold season (November through April; OR, 1.37; 95% CI, 1.24-1.53; P < .001). Conclusions and Relevance In this retrospective cohort study, long- and short-term heat exposure during pregnancy was associated with higher risk of SMM. These results might have important implications for SMM prevention, particularly in a changing climate.
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Affiliation(s)
- Anqi Jiao
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - David A. Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles
| | | | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Jiu-Chiuan Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine
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Chao CR, Slezak J, Siegmund K, Cannavale K, Shu Y, Chien GW, Chen X, Shi F, Song N, Van Den Eeden SK, Huang J. Genome-wide methylation profiling of diagnostic tumor specimens identified DNA methylation markers associated with metastasis among men with untreated localized prostate cancer. Cancer Med 2023; 12:18837-18849. [PMID: 37694549 PMCID: PMC10557825 DOI: 10.1002/cam4.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND We used a genome-wide discovery approach to identify methylation markers associated with metastasis in men with localized prostate cancer (PCa), as better identification of those at high risk of metastasis can inform treatment decision-making. METHODS We identified men with localized PCa at Kaiser Permanente California (January 1, 1997-December 31, 2006) who did not receive curative treatment and followed them for 10 years to determine metastasis status. Cases were chart review-confirmed metastasis, and controls were matched using density sampling. We extracted DNA from the cancerous areas in the archived diagnostic tissue blocks. We used Illumina's Infinium MethylationEPIC BeadChip for methylation interrogation. We used conditional logistic regression and Bonferroni's correction to identify methylation markers associated with metastasis. In a separate validation cohort (2007), we evaluated the added predictive utility of the methylation score beyond clinical risk score. RESULTS Among 215 cases and 404 controls, 31 CpG sites were significantly associated with metastasis status. Adding the methylation score to the clinical risk score did not meaningfully improve the c-statistic (0.80-0.81) in the validation cohort, though the score itself was statistically significant (p < 0.01). In the validation cohort, both clinical risk score alone and methylation marker score alone are well calibrated for predicted 10-year metastasis risks. Adding the methylation score to the clinical risk score only marginally improved predictive risk calibration. CONCLUSION Our findings do not support the use of these markers to improve clinical risk prediction. The methylation markers identified may inform novel hypothesis in the roles of these genetic regions in metastasis development.
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Affiliation(s)
- Chun R. Chao
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J Tyson School of MedicinePasadenaCaliforniaUSA
| | - Jeff Slezak
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Kimberly Siegmund
- Department of Population and Public Health Sciences, USC Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kimberly Cannavale
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Yu‐Hsiang Shu
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Gary W. Chien
- Department of Urology, Los Angeles Medical CenterKaiser Permanente Southern CaliforniaLos AngelesCaliforniaUSA
| | - Xu‐Feng Chen
- Department of Pathology, School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Feng Shi
- Department of Pathology, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
| | - Nan Song
- Department of Urology Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
| | | | - Jiaoti Huang
- Department of Pathology, School of MedicineDuke UniversityDurhamNorth CarolinaUSA
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Molitor J, Sun Y, Rubio VG, Benmarhnia T, Chen JC, Avila C, Sacks DA, Chiu V, Slezak J, Getahun D, Wu J. Modeling spatially varying compliance effects of PM 2.5 exposure reductions on gestational diabetes mellitus in southern California: Results from electronic health record data of a large pregnancy cohort. Environ Res 2023; 231:116091. [PMID: 37182828 PMCID: PMC10405446 DOI: 10.1016/j.envres.2023.116091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/06/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
Gestational diabetes mellitus (GDM) is a major pregnancy complication affecting approximately 14.0% of pregnancies around the world. Air pollution exposure, particularly exposure to PM2.5, has become a major environmental issue affecting health, especially for vulnerable pregnant women. Associations between PM2.5 exposure and adverse birth outcomes are generally assumed to be the same throughout a large geographical area. However, the effects of air pollution on health can very spatially in subpopulations. Such spatially varying effects are likely due to a wide range of contextual neighborhood and individual factors that are spatially correlated, including SES, demographics, exposure to housing characteristics and due to different composition of particulate matter from different emission sources. This combination of elevated environmental hazards in conjunction with socioeconomic-based disparities forms what has been described as a "double jeopardy" for marginalized sub-populations. In this manuscript our analysis combines both an examination of spatially varying effects of a) unit-changes in exposure and examines effects of b) changes from current exposure levels down to a fixed compliance level, where compliance levels correspond to the Air Quality Standards (AQS) set by the U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) air quality guideline values. Results suggest that exposure reduction policies should target certain "hotspot" areas where size and effects of potential reductions will reap the greatest rewards in terms of health benefits, such as areas of southeast Los Angeles County which experiences high levels of PM2.5 exposures and consist of individuals who may be particularly vulnerable to the effects of air pollution on the risk of GDM.
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Affiliation(s)
- John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
| | - Yi Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | | | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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Ackerson B, Sy LS, Slezak J, Qian L, Reynolds K, Huang R, Solano Z, Towner W, Qiu S, Simmons SR, Jacobsen SJ, Bruxvoort KJ. Post-licensure safety study of new-onset immune-mediated diseases, herpes zoster, and anaphylaxis in adult recipients of HepB-CpG vaccine versus HepB-alum vaccine. Vaccine 2023; 41:4392-4401. [PMID: 37308363 DOI: 10.1016/j.vaccine.2023.06.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND HepB-CpG (Heplisav-B) is a licensed hepatitis B vaccine with a novel adjuvant that requires 2 doses (0, 1 month) compared to HepB-alum (Engerix-B) which requires 3 doses (0, 1, 6 months). Monitoring safety outcomes following receipt of vaccines with novel adjuvants outside trial settings is important. Hence, as part of a post-marketing commitment, we compared the incidence of new-onset immune-mediated diseases, herpes zoster (HZ), and anaphylaxis among recipients of HepB-CpG versus HepB-alum. METHODS This cohort study included adults not on dialysis who received ≥1 dose of hepatitis B vaccine from 8/7/2018 to 10/31/2019, during which HepB-CpG was routinely administered in 7 of 15 Kaiser Permanente Southern California medical centers while HepB-alum was administered in the other 8 centers. Recipients of HepB-CpG or HepB-alum were followed through electronic health records for 13 months for occurrence of pre-specified new-onset immune-mediated diseases, HZ, and anaphylaxis identified using diagnosis codes. Incidence rates were compared using Poisson regression with inverse probability of treatment weighting when there was ≥80 % power to detect a relative risk (RR) of 5 for anaphylaxis and RR of 3 for other outcomes. Chart review to confirm new-onset diagnosis was conducted for outcomes with statistically significant elevated risk. RESULTS There were 31,183 HepB-CpG and 38,442 HepB-alum recipients (overall 49.0 % female, 48.5 % age ≥50 years, and 49.6 % Hispanic). Among immune-mediated events that occurred frequently enough for formal comparison, rates among HepB-CpG versus Hep-B-alum recipients were similar except for rheumatoid arthritis (RA) (adjusted RR 1.53 [95 % CI: 1.07, 2.18]). After chart confirmation of new-onset RA, the adjusted RR was 0.93 (0.34, 2.49). The adjusted RR for HZ was 1.06 (0.89, 1.27). Anaphylaxis occurred in 0 HepB-CpG and 2 HepB-alum recipients. CONCLUSIONS This large post-licensure study did not identify evidence of safety concerns for HepB-CpG compared to HepB-alum for immune-mediated diseases, HZ, or anaphylaxis.
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Affiliation(s)
- Bradley Ackerson
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA.
| | - Lina S Sy
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Runxin Huang
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Zendi Solano
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - William Towner
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Sijia Qiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Sarah R Simmons
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Katia J Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233, USA
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Jiao A, Sun Y, Avila C, Chiu V, Molitor J, Slezak J, Sacks DA, Chen JC, Benmarhnia T, Getahun D, Wu J. Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008-2018). Environ Int 2023; 177:108030. [PMID: 37329760 PMCID: PMC10947473 DOI: 10.1016/j.envint.2023.108030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/04/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is minimal evidence of relationships between maternal air pollution exposure and spontaneous premature rupture of membranes (SPROM), a critical obstetrical problem that can significantly increase maternal and fetal mortality and morbidity. No prior study has explored the PROM risk related to specific components of particulate matter with aerodynamic diameters of ≤ 2.5 µm (PM2.5). We examined associations between maternal exposure to nitrogen dioxide (NO2), ozone (O3), PM2.5, PM10, and PM2.5 constituents and SPROM. METHODS A large retrospective cohort study was conducted and included 427,870 singleton live births from Kaiser Permanente Southern California during 2008-2018. Monthly averages of NO2, O3 (8-h daily maximum), PM2.5, and PM10 were measured using empirical Bayesian kriging based on measurements from monitoring stations. Data on PM2.5 sulfate, nitrate, ammonium, organic matter, and black carbon were obtained from a fine-resolution model. A discrete time approach with pooled logistic regressions was used to estimate associations throughout the pregnancy and based on trimesters and gestational months. The quantile-based g-computation models were fitted to examine the effects of 1) the air pollution mixture of four pollutants of interest and 2) the mixture of PM2.5 components. RESULTS There were 37,857 SPROM cases (8.8%) in our study population. We observed relationships between SPROM and maternal exposure to NO2, O3, and PM2.5. PM2.5 sulfate, nitrate, ammonium, and organic matter were associated with higher SPROM risks in the single-pollutant model. Mixture analyses demonstrated that the overall effects of the air pollution mixture and PM2.5 mixture in this study were mainly driven by O3 and PM2.5 nitrate, respectively. Underweight mothers had a significantly higher risk of SPROM associated with NO2. CONCLUSION Our findings add to the literature on associations between air pollution exposure and SPROM. This is the first study reporting the impact of PM2.5 constituents on SPROM.
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Affiliation(s)
- Anqi Jiao
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA; Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jiu-Chiuan Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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Szeiffova Bacova B, Andelova K, Sykora M, T EB, Kurahara LH, Slezak J, Tribulova N. Distinct Cardiac Connexin-43 Expression in Hypertrophied and Atrophied Myocardium May Impact the Vulnerability of the Heart to Malignant Arrhythmias. A Pilot Study. Physiol Res 2023; 72:S37-S45. [PMID: 37294117 DOI: 10.33549/physiolres.935025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
Our and other studies suggest that myocardial hypertrophy in response to hypertension and hyperthyroidism increases propensity of the heart to malignant arrhythmias, while these are rare in conditions of hypothyroidism or type-1 diabetes mellitus associated with myocardial atrophy. One of the crucial factors impacting the susceptibility of the heart to life-threatening arrhythmias is gap junction channel protein connexin-43 (Cx43), which ensure cell-to-cell coupling for electrical signal propagation. Therefore, we aimed to explore Cx43 protein abundance and its topology in hypertrophic and hypotrophic cardiac phenotype. Analysis were performed in left ventricular tissue of adult male spontaneously hypertensive rat (SHR), Wistar Kyoto rats treated for 8-weeks with L-thyroxine, methimazol or strepotozotocin to induce hyperthyroid, hypothyroid and type-1 diabetic status as well as non-treated animals. Results showed that comparing to healthy rats there was a decrease of total myocardial Cx43 and its variant phosphorylated at serine368 in SHR and hyperthyroid rats. Besides, enhanced localization of Cx43 was demonstrated on lateral sides of hypertrophied cardiomyocytes. In contrast, total Cx43 protein and its serine368 variant were increased in atrophied left ventricle of hypothyroid and type-1 diabetic rats. It was associated with less pronounced alterations in Cx43 topology. In parallel, the abundance of PKCepsilon, which phosphorylates Cx43 at serine368 that stabilize Cx43 function and distribution was reduced in hypertrophied heart while enhanced in atrophied once. Findings suggest that differences in the abundance of cardiac Cx43, its variant phosphorylated at serine368 and Cx43 topology may explain, in part, distinct propensity of hypertrophied and atrophied heart to malignant arrhythmias.
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Affiliation(s)
- B Szeiffova Bacova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Teyton A, Sun Y, Molitor J, Chen JC, Sacks D, Avila C, Chiu V, Slezak J, Getahun D, Wu J, Benmarhnia T. Examining the Relationship Between Extreme Temperature, Microclimate Indicators, and Gestational Diabetes Mellitus in Pregnant Women Living in Southern California. Environ Epidemiol 2023; 7:e252. [PMID: 37304340 PMCID: PMC10256373 DOI: 10.1097/ee9.0000000000000252] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Few studies have assessed extreme temperatures' impact on gestational diabetes mellitus (GDM). We examined the relation between GDM risk with weekly exposure to extreme high and low temperatures during the first 24 weeks of gestation and assessed potential effect modification by microclimate indicators. Methods We utilized 2008-2018 data for pregnant women from Kaiser Permanente Southern California electronic health records. GDM screening occurred between 24 and 28 gestational weeks for most women using the Carpenter-Coustan criteria or the International Association of Diabetes and Pregnancy Study Groups criteria. Daily maximum, minimum, and mean temperature data were linked to participants' residential address. We utilized distributed lag models, which assessed the lag from the first to the corresponding week, with logistic regression models to examine the exposure-lag-response associations between the 12 weekly extreme temperature exposures and GDM risk. We used the relative risk due to interaction (RERI) to estimate the additive modification of microclimate indicators on the relation between extreme temperature and GDM risk. Results GDM risks increased with extreme low temperature during gestational weeks 20--24 and with extreme high temperature at weeks 11-16. Microclimate indicators modified the influence of extreme temperatures on GDM risk. For example, there were positive RERIs for high-temperature extremes and less greenness, and a negative RERI for low-temperature extremes and increased impervious surface percentage. Discussion Susceptibility windows to extreme temperatures during pregnancy were observed. Modifiable microclimate indicators were identified that may attenuate temperature exposures during these windows, which could in turn reduce the health burden from GDM.
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Affiliation(s)
- Anais Teyton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
- School of Public Health, San Diego State University, La Jolla, California
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, California
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Los Angeles, California
| | - David Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, California
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California
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Sun Y, Molitor J, Benmarhnia T, Avila C, Chiu V, Slezak J, Sacks DA, Chen JC, Getahun D, Wu J. Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California. Lancet Reg Health Am 2023; 21:100462. [PMID: 37223828 PMCID: PMC10201204 DOI: 10.1016/j.lana.2023.100462] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 05/25/2023]
Abstract
Background Little research exists regarding the relationships between green space and postpartum depression (PPD). We aimed to investigate the relationships between PPD and green space exposure, and the mediating role of physical activity (PA). Methods Clinical data were obtained from Kaiser Permanente Southern California electronic health records in 2008-2018. PPD ascertainment was based on both diagnostic codes and prescription medications. Maternal residential green space exposures were assessed using street view-based measures and vegetation types (i.e., street tree, low-lying vegetation, and grass), satellite-based measures [i.e., Normalized Difference Vegetation Index (NDVI), land-cover green space, and tree canopy cover], and proximity to the nearest park. Multilevel logistic regression was applied to estimate the association between green space and PPD. A causal mediation analysis was performed to estimate the proportion mediated by PA during pregnancy in the total effects of green space on PPD. Findings In total, we included 415,020 participants (30.2 ± 5.8 years) with 43,399 (10.5%) PPD cases. Hispanic mothers accounted for about half of the total population. A reduced risk for PPD was associated with total green space exposure based on street-view measure [500 m buffer, adjusted odds ratio (OR) per interquartile range: 0.98, 95% CI: 0.97-0.99], but not NDVI, land-cover greenness, or proximity to a park. Compared to other types of green space, tree coverage showed stronger protective effects (500 m buffer, OR = 0.98, 95% CI: 0.97-0.99). The proportions of mediation effects attributable to PA during pregnancy ranged from 2.7% to 7.2% across green space indicators. Interpretation Street view-based green space and tree coverage were associated with a decreased risk of PPD. The observed association was primarily due to increased tree coverage, rather than low-lying vegetation or grass. Increased PA was a plausible pathway linking green space to lower risk for PPD. Funding National Institute of Environmental Health Sciences (NIEHS; R01ES030353).
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Affiliation(s)
- Yi Sun
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A. Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jiu-Chiuan Chen
- Departments of Population & Public Health Sciences and Neurology, University of Southern California, Los Angeles, CA, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
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9
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Slezak J, Sacks D, Chiu V, Avila C, Khadka N, Chen JC, Wu J, Getahun D. Identification of Postpartum Depression in Electronic Health Records: Validation in a Large Integrated Health Care System. JMIR Med Inform 2023; 11:e43005. [PMID: 36857123 PMCID: PMC10018380 DOI: 10.2196/43005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The accuracy of electronic health records (EHRs) for identifying postpartum depression (PPD) is not well studied. OBJECTIVE This study aims to evaluate the accuracy of PPD reporting in EHRs and compare the quality of PPD data collected before and after the implementation of the International Classification of Diseases, Tenth Revision (ICD-10) coding in the health care system. METHODS Information on PPD was extracted from a random sample of 400 eligible Kaiser Permanente Southern California patients' EHRs. Clinical diagnosis codes and pharmacy records were abstracted for two time periods: January 1, 2012, through December 31, 2014 (International Classification of Diseases, Ninth Revision [ICD-9] period), and January 1, 2017, through December 31, 2019 (ICD-10 period). Manual chart reviews of clinical records for PPD were considered the gold standard and were compared with corresponding electronically coded diagnosis and pharmacy records using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Kappa statistic was calculated to measure agreement. RESULTS Overall agreement between the identification of depression using combined diagnosis codes and pharmacy records with that of medical record review was strong (κ=0.85, sensitivity 98.3%, specificity 83.3%, PPV 93.7%, NPV 95.0%). Using only diagnosis codes resulted in much lower sensitivity (65.4%) and NPV (50.5%) but good specificity (88.6%) and PPV (93.5%). Separately, examining agreement between chart review and electronic coding among diagnosis codes and pharmacy records showed sensitivity, specificity, and NPV higher with prescription use records than with clinical diagnosis coding for PPD, 96.5% versus 72.0%, 96.5% versus 65.0%, and 96.5% versus 65.0%, respectively. There was no notable difference in agreement between ICD-9 (overall κ=0.86) and ICD-10 (overall κ=0.83) coding periods. CONCLUSIONS PPD is not reliably captured in the clinical diagnosis coding of EHRs. The accuracy of PPD identification can be improved by supplementing clinical diagnosis with pharmacy use records. The completeness of PPD data remained unchanged after the implementation of the ICD-10 diagnosis coding.
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Affiliation(s)
- Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - David Sacks
- Kaiser Permanente Southern California, Pasadena, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Vicki Chiu
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Chantal Avila
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Nehaa Khadka
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jiu-Chiuan Chen
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, United States
| | - Darios Getahun
- Kaiser Permanente Southern California, Pasadena, CA, United States.,Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
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10
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Jiao A, Sun Y, Sacks DA, Avila C, Chiu V, Molitor J, Chen JC, Sanders KT, Abatzoglou JT, Slezak J, Benmarhnia T, Getahun D, Wu J. The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort. Environ Int 2023; 173:107824. [PMID: 36809710 PMCID: PMC10917632 DOI: 10.1016/j.envint.2023.107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/21/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM. METHODS We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined. RESULTS In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9-14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts. CONCLUSION Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.
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Affiliation(s)
- Anqi Jiao
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA; Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Jiu-Chiuan Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90033, USA
| | - Kelly T Sanders
- Department of Civil and Environmental Engineering, University of Southern California, CA, USA
| | | | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, CA La Jolla 92093, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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11
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Ackerson B, Sy LS, Slezak J, Qian L, Reynolds K, Huang R, Solano Z, Towner W, Qiu S, Simmons S, Jacobsen S, Bruxvoort KJ. 115. Post-licensure Safety Study of New-onset Immune-mediated Diseases, Herpes Zoster, and Anaphylaxis in Adult Recipients of HepB-CPG Vaccine Versus HepB-alum Vaccine. Open Forum Infect Dis 2022. [PMCID: PMC9752391 DOI: 10.1093/ofid/ofac492.193] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background HepB-CpG (Heplisav-B; Dynavax) is a licensed hepatitis B vaccine with a novel adjuvant that requires only 2 doses (0, 1 month) compared to a 3-dose (0, 1, 6 months) HepB-alum vaccine (Engerix-B; GlaxoSmithKline). Monitoring of safety outcomes following receipt of vaccines with novel adjuvants is important. Hence, as part of an FDA postmarketing commitment, we compared the incidence of new-onset immune-mediated diseases, herpes zoster (HZ), and anaphylaxis among recipients of HepB-CpG versus HepB-alum at Kaiser Permanente Southern California (KPSC). Methods This cohort study included adults not on dialysis who received ≥1 dose of a hepatitis B vaccine from 8/7/2018 to 10/31/2019, during which HepB-CpG was routinely administered in 7 of 15 KPSC medical centers while HepB-alum was administered at the other 8 medical centers. Recipients of HepB-CpG or HepB-alum were followed through electronic health records for 13 months after receipt of the first dose during the vaccine accrual period for occurrence of pre-specified new-onset immune-mediated diseases, HZ, and anaphylaxis identified using diagnosis codes. Incidence rates were compared using Poisson regression with inverse probability of treatment weighting when there was 80% power to detect a relative risk (RR) of 5 for anaphylaxis and a RR of 3 for all other outcomes Results There were 31,183 HepB-CpG and 38,442 HepB-alum recipients (overall 49.0% female, 48.5% ≥50 years of age, and 49.6% Hispanic). Among immune-mediated events that occurred frequently enough for formal comparison, rates among HepB-CpG versus Hep-B-alum recipients were similar except for rheumatoid arthritis (RA) (adjusted RR 1.53 [95% CI: 1.07, 2.18]). (Table 1) After adjudication of new-onset RA, the adjusted RR was 0.93 (0.34, 2.49). (Table 2) The adjusted RR for HZ was 1.06 (0.89, 1.27). Anaphylaxis occurred in 0 HepB-CpG and 2 HepB-alum recipients.
![]() ![]() Conclusion These data suggest no safety concerns for HepB-CpG compared to HepB-alum for select immune-mediated diseases, HZ, or anaphylaxis in this observational study of over 69,000 recipients of hepatitis B vaccines. Disclosures Bradley Ackerson, MD, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Seqirus: Grant/Research Support Jeff Slezak, MS, ALK, Inc.: Grant/Research Support|Dynavax: Grant/Research Support|Novavax, Inc.: Grant/Research Support|Pfizer, Inc.: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support Kristi Reynolds, PhD, Amgen: Grant/Research Support|Dynavax: Grant/Research Support|Merck: Grant/Research Support|Novartis: Grant/Research Support Runxin Huang, MS, Dynavax: Grant/Research Support Zendi Solano, BS, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support William Towner, MD, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|ViiV: Grant/Research Support Sijia Qiu, MS, Dynavax: Grant/Research Support|Moderna: Grant/Research Support Sarah Simmons, MPH, Dynavax: Grant/Research Support|Glaxo-Smith Kline: Grant/Research Support|Pfizer: Grant/Research Support Steven Jacobsen, MD, Dynavax: Grant/Research Support Katia J. Bruxvoort, PhD, MPH, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support.
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Affiliation(s)
| | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, California
| | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Runxin Huang
- Kaiser Permanente Southern California, Pasadena, California
| | - Zendi Solano
- Kaiser Permanente Southern California, Pasadena, California
| | - William Towner
- Kaiser Permanente Southern California, Pasadena, California
| | - Sijia Qiu
- Kaiser Permanente Southern California, Pasadena, California
| | - Sarah Simmons
- Kaiser Permanente Southern California, Pasadena, California
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12
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Haque R, Reading S, Irwin MR, Chen LH, Slezak J. Antidepressant medication use and prostate cancer recurrence in men with depressive disorders. Cancer Causes Control 2022; 33:1363-1372. [PMID: 36083407 PMCID: PMC9519663 DOI: 10.1007/s10552-022-01623-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Abstract
Purpose Whether treating prostate cancer survivors with a depressive disorder with antidepressants can affect their cancer outcomes is unknown. We evaluated the association between antidepressant use and prostate cancer recurrence, in survivors with comorbid depressive disorders. Methods We conducted a longitudinal cohort study of 10,017 men with prostate cancer (stages I–II) diagnosed who also had a comorbid depressive disorder followed a maximum of 22 years, and examined rates of biochemical recurrence by antidepressant medication use. We conducted multivariable Cox models based on time-dependent antidepressant drug use status, and examined the risk of biochemical recurrence by cumulative duration of antidepressant use. Results Of these 10,017 survivors, 1842 (18%) experienced biochemical recurrence over 69,500 person-years of follow-up. The prostate cancer biochemical recurrence rate was greater with antidepressant non-use (31.3/1000 person-years) compared to antidepressant use (23.5/1000 person-years). In Cox proportional hazards multivariable adjusted models, non-use of antidepressants was associated with a 34% increased risk of biochemical recurrence compared to antidepressant use (HR = 1.34, 95% CI: 1.24–1.44). Longer use of antidepressants was associated with a lower biochemical recurrence risk (P trend test < 0.001). Conclusion Untreated depressive disorders in prostate cancer patients may be associated with an increased risk of biochemical recurrence.
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Affiliation(s)
- Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA, 91101, USA. .,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA.
| | - Stephanie Reading
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, 90095, USA
| | - Lie Hong Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
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13
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Herma T, Slezak J, Baca V, Kachlik D. Duplicated superficial branch of the radial nerve and brachioradialis muscle belly: prevalence and significance. Folia Morphol (Warsz) 2022; 82:558-561. [PMID: 35818808 DOI: 10.5603/fm.a2022.0064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The superficial branch of the radial nerve (SBRN) is a sensory nerve innervating the dorsoradial part of the hand. It originates in the cubital fossa, runs under the belly of the brachioradialis muscle (BM), emerges from underneath in the distal third of the forearm and continues in the subcutaneous tissue towards the hand. There exist several anatomical variations of its branching and course, including a rare variation of its duplication combined with a duplication of the brachioradialis muscle belly. The aim of this study was to find out the prevalence of this variation on a sample of cadaveric human bodies which has not been reported yet. MATERIALS AND METHODS We have carefully dissected 208 cadaveric upper limbs (Central European population). All cases of limbs containing the variation of a double SBRN and/or a double BM belly were measured and documented. RESULTS We have identified 2 cases of a double SBRN combined with a double BM belly (0.96%). Both were present in the right forearm of a male donor and in both cases the nerve was impinged by muscle bundles connecting the 2 muscle bellies together. Moreover, we have encountered 1 case of a double SBRN without a double BM belly (0.48%), i.e. the total prevalence of a double SBRN was 1.44%. CONCLUSIONS The duplicated SBRN with the duplicated BM is a relatively rare anatomical variation that might cause complications while performing various surgical procedures in the forearm, moreover it might be a rare cause of Wartenberg's syndrome.
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Affiliation(s)
- T Herma
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Slezak
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - V Baca
- Department of Health Care Studies, College of Polytechnics Jihlava, Czech Republic
| | - D Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Health Care Studies, College of Polytechnics Jihlava, Czech Republic.
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14
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Sun Y, Li X, Benmarhnia T, Chen JC, Avila C, Sacks DA, Chiu V, Slezak J, Molitor J, Getahun D, Wu J. Corrigendum to "Exposure to air pollutant mixture and gestational diabetes mellitus in Southern California: Results from electronic health record data of a large pregnancy Cohort" [Environ. Int. 158 (2022) 106888]. Environ Int 2022; 163:107207. [PMID: 35339922 DOI: 10.1016/j.envint.2022.107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Xia Li
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA 92093, USA
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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15
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Bruxvoort K, Slezak J, Qian L, Sy LS, Ackerson B, Reynolds K, Huang R, Solano Z, Towner W, Mercado C, Jacobsen SJ. Association Between 2-Dose vs 3-Dose Hepatitis B Vaccine and Acute Myocardial Infarction. JAMA 2022; 327:1260-1268. [PMID: 35333303 PMCID: PMC8957040 DOI: 10.1001/jama.2022.2540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE The 2-dose hepatitis B vaccine with a cytosine phosphoguanine adjuvant (HepB-CpG vaccine; Heplisav-B) generated higher seroprotection in prelicensure trials than did a 3-dose hepatitis B vaccine with an aluminum hydroxide adjuvant (HepB-alum vaccine; Engerix-B). However, in 1 trial, a higher number of acute myocardial infarction (MI) events were observed among those who received the HepB-CpG vaccine than among those who received the HepB-alum vaccine, an outcome requiring further study. OBJECTIVE To compare the rate of acute MI between recipients of HepB-CpG vaccine and HepB-alum vaccine. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort noninferiority study was conducted at Kaiser Permanente Southern California (KPSC), an integrated health care system with 15 medical centers and approximately 4.7 million members. The study included 69 625 adults not undergoing dialysis who received at least 1 dose of a hepatitis B vaccine in either family medicine or internal medicine departments at KPSC from August 7, 2018, to October 31, 2019 (November 30, 2020, final follow-up). EXPOSURES Receipt of HepB-CpG vaccine vs HepB-alum vaccine. The first dose during the study period was the index dose. MAIN OUTCOMES AND MEASURES Individuals were followed up for 13 months after the index dose for occurrence of type 1 acute MI. Potential events were identified using diagnosis codes and adjudicated by cardiologists. The adjusted hazard ratio (HR) of acute MI was estimated comparing recipients of HepB-CpG vaccine with recipients of HepB-alum vaccine, with inverse probability of treatment weighting (IPTW) to adjust for demographic and clinical characteristics. The upper limit of the 1-sided 97.5% CI was compared with a noninferiority margin of 2. RESULTS Of the 31 183 recipients of HepB-CpG vaccine (median age, 49 years; IQR, 38-56 years), 51.2% (n = 15 965) were men, and 52.7% (n = 16 423) were Hispanic. Of the 38 442 recipients of HepB-alum (median age, 49 years; IQR, 39-56 years), 50.8% (19 533) were men, and 47.1% (n = 18 125) were Hispanic. Characteristics were well-balanced between vaccine groups after IPTW. Fifty-two type 1 acute MI events were confirmed among recipients of HepB-CpG vaccine for a rate of 1.67 per 1000-person-years, and 71 type 1 acute MI events were confirmed among recipients of HepB-alum vaccine for a rate of 1.86 per 1000 person-years (absolute rate difference, -0.19 [95% CI, -0.82 to 0.44]; adjusted HR, 0.92 [1-sided 97.5% CI, ∞ to 1.32], which was below the noninferiority margin; P < .001 for noninferiority). CONCLUSIONS AND RELEVANCE In this cohort study, receipt of HepB-CpG vaccine compared with HepB-alum vaccine did not meet the statistical criterion for increased risk of acute myocardial infarction.
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Affiliation(s)
- Katia Bruxvoort
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lina S. Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Runxin Huang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - William Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Cheryl Mercado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
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16
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Sun Y, Li X, Benmarhnia T, Chen JC, Avila C, Sacks DA, Chiu V, Slezak J, Molitor J, Getahun D, Wu J. Exposure to air pollutant mixture and gestational diabetes mellitus in Southern California: Results from electronic health record data of a large pregnancy cohort. Environ Int 2022; 158:106888. [PMID: 34563749 PMCID: PMC9022440 DOI: 10.1016/j.envint.2021.106888] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Epidemiological findings are inconsistent regarding the associations between air pollution exposure during pregnancy and gestational diabetes mellitus (GDM). Several limitations exist in previous studies, including potential outcome and exposure misclassification, unassessed confounding, and lack of simultaneous consideration of air pollution mixtures and particulate matter (PM) constituents. OBJECTIVES To assess the association between GDM and maternal residential exposure to air pollution, and the joint effect of the mixture of air pollutants and PM constituents. METHODS Detailed clinical data were obtained for 395,927 pregnancies in southern California (2008-2018) from Kaiser Permanente Southern California (KPSC) electronic health records. GDM diagnosis was based on KPSC laboratory tests. Monthly average concentrations of fine particulate matter < 2.5 μm (PM2.5), <10 μm (PM10), nitrogen dioxide (NO2), and ozone (O3) were estimated using kriging interpolation of Environmental Protection Agency's routine monitoring station data, while PM2.5 constituents (i.e., sulfate, nitrate, ammonium, organic matter and black carbon) were estimated using a fine-resolution geoscience-derived model. A multilevel logistic regression was used to fit single-pollutant models; quantile g-computation approach was applied to estimate the joint effect of air pollution and PM component mixtures. Main analyses adjusted for maternal age, race/ethnicity, education, median family household income, pre-pregnancy BMI, smoking during pregnancy, insurance type, season of conception and year of delivery. RESULTS The incidence of GDM was 10.9% in the study population. In single-pollutant models, we observed an increased odds for GDM associated with exposures to PM2.5, PM10, NO2 and PM2.5 constituents. The association was strongest for NO2 [adjusted odds ratio (OR) per interquartile range: 1.176, 95% confidence interval (CI): 1.147-1.205)]. In multi-pollutant models, increased ORs for GDM in association with one quartile increase in air pollution mixtures were found for both kriging-based regional air pollutants (NO2, PM2.5, and PM10, OR = 1.095, 95% CI: 1.082-1.108) and PM2.5 constituents (i.e., sulfate, nitrate, ammonium, organic matter and black carbon, OR = 1.258, 95% CI: 1.206-1.314); NO2 (78%) and black carbon (48%) contributed the most to the overall mixture effects among all krigged air pollutants and all PM2.5 constituents, respectively. The risk of GDM associated with air pollution exposure were significantly higher among Hispanic mothers, and overweight/obese mothers. CONCLUSION This study found that exposure to a mixture of ambient PM2.5, PM10, NO2, and PM2.5 chemical constituents was associated with an increased risk of GDM. NO2 and black carbon PM2.5 contributed most to GDM risk.
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Affiliation(s)
- Yi Sun
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA
| | - Xia Li
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Scripps Institution of Oceanography, University of California, San Diego, 9500 Gilman Drive #0725, CA La Jolla 92093, USA
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chantal Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David A Sacks
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Vicki Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Jun Wu
- Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA, USA.
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17
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Janssen RS, Bruxvoort K, Jacobsen SJ, Slezak J, David C, Hyer R, Poland GA. Considerations for estimating real-world outcomes and value in vaccination: A case study with adult hepatitis B virus vaccination. Vaccine 2021; 39:5666-5672. [PMID: 34404556 DOI: 10.1016/j.vaccine.2021.07.100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the absence of field efficacy studies, estimating the real-world effectiveness of vaccines may consider immunogenicity from randomized controlled clinical trials and real-world adherence. Combining seroprotection rates (SPRs) with regimen completion rates gives an estimate of an effective vaccine protection rate (eVPR), which can be leveraged to evaluate real-world cost-effectiveness by linking it with vaccine costs to estimate the cost-per-protected patient (CPP). METHODS This study evaluated eVPR and CPP as estimates of vaccine clinical- and cost-effectiveness of two-dose (HepB-CpG) and three-dose (HepB-Alum) hepatitis B virus (HBV) vaccines in the general adult population and a subpopulation with diabetes mellitus. eVPR was calculated from head-to-head SPR data from phase 3 clinical trials directly comparing HepB-CpG and HepB-Alum vaccine regimens and real-world head-to-head adherence data. CPP was calculated as the average cost of each regimen divided by eVPR. RESULTS Higher eVPR in the adult population was achieved with HepB-CpG (68.0%) versus HepB-Alum (41.6%), reflecting the combination of higher SPR and vaccine regimen completion. The CPP for HepB-CpG ($331.31) was $45.67 (95% CI: $36.66, $55.19) less than HepB-Alum ($377.09). Greater savings were observed among persons with diabetes, with CPP $149.60 (95% CI: $80.29, $195.63) lower with HepB-CpG ($367.57) than HepB-Alum ($517.37). CONCLUSIONS Metrics estimating vaccine real-world effectiveness and value may guide informed decisions in vaccine selection. For example, using eVPR and CPP, HepB-CpG represents a more effective, value-advantaged approach than HepB-Alum toward reducing HBV infection.
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Affiliation(s)
- Robert S Janssen
- Clinical Development, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA.
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Coline David
- Market Access and Policy, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Randall Hyer
- Medical Affairs, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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18
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Bruxvoort K, Tenggardjaja CF, Slezak J, Gullett JC, Broder B, Park CH, Aragones M, Mercado C, Wong K, McLaren S, Jacobsen SJ. Variation in SARS-CoV-2 molecular test sensitivity by specimen types in a large sample of emergency department patients. Am J Emerg Med 2021; 50:381-387. [PMID: 34478943 PMCID: PMC8367656 DOI: 10.1016/j.ajem.2021.08.034] [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: 03/24/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Provider-collected nasopharyngeal specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing are the standard of care in many clinical settings, but patient-collected saliva and anterior nares specimens are less invasive and more flexible alternatives. Prior studies comparing specimen types for SARS-CoV-2 molecular testing have been limited by small sample sizes and low pretest probability. We conducted a large observational study among symptomatic adults at 7 emergency departments of Kaiser Permanente Southern California to examine sensitivity of SARS-CoV-2 molecular tests by specimen type and patient characteristics. METHODS Provider-collected nasopharyngeal/oropharyngeal (NP/OP) specimens and patient-collected saliva and anterior nares specimens were collected at the same visit and analyzed with the Roche cobas® SARS-CoV-2 assay. Patients were considered truly positive for SARS-CoV-2 if any of the three specimens was positive and negative if all three specimens were negative. Factors associated with discordant and missed positive results were examined with multivariable logistic regression. RESULTS Of 2112 patients, 350 (16.6%) were positive for SARS-CoV-2. Sensitivity of NP/OP was 93.7% (95% confidence interval [CI] 90.6%-96.0%), sensitivity of saliva was 87.7% (83.8%-91.0%), and sensitivity of anterior nares was 85.4% (81.3%-89.0%). Patients ages 18-39 years versus ≥40 years were more likely to have discordant results [adjusted odds ratio (aOR) 1.97 (1.12-3.45)], as were patients with <4 symptoms versus ≥4 [aOR 2.43 (1.39-4.25)]. Cycle threshold values were higher for saliva and anterior nares than NP/OP specimens, as well as for specimens in discordant versus concordant sets and patients with fewer symptoms. CONCLUSION This study provides robust evidence that patient-collected saliva and anterior nares are sensitive for SARS-CoV-2 molecular testing in emergency department settings, particularly among adults ages ≥40 years and those with multiple symptoms. Higher sensitivity of provider-collected NP/OP specimens must be weighed against the benefits of patient-collected specimens in tailored strategies for SARS-CoV-2 testing.
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Affiliation(s)
- Katia Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA.
| | - Christopher F Tenggardjaja
- Department of Urology, Southern California Permanente Medical Group, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA
| | - Jonathan C Gullett
- Regional Reference Laboratories, Southern California Permanente Medical Group, 11668 Sherman Way, North Hollywood, CA 91605, USA
| | - Benjamin Broder
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, 393 East Walnut Street, Pasadena, CA 91188, USA
| | - Claire H Park
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA; Currently with the Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, 313 North Figueroa Street, Los Angeles, California 90012, USA
| | - Michael Aragones
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA
| | - Cheryl Mercado
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA
| | - Katherine Wong
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA
| | - Steven McLaren
- Regional Reference Laboratories, Southern California Permanente Medical Group, 11668 Sherman Way, North Hollywood, CA 91605, USA
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA
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19
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Slezak J, Bruxvoort K, Fischer H, Broder B, Ackerson B, Tartof S. Rate and severity of suspected SARS-Cov2 reinfection in a cohort of PCR-positive COVID-19 patients. Clin Microbiol Infect 2021; 27:1860.e7-1860.e10. [PMID: 34419576 PMCID: PMC8373524 DOI: 10.1016/j.cmi.2021.07.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 04/21/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022]
Abstract
Objectives To estimate the burden and severity of suspected reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A retrospective cohort of members of Kaiser Permanente Southern California with PCR-positive SARS-CoV-2 infection between 1st March 2020 and 31st October 2020 was followed through electronic health records for subsequent positive SARS-CoV-2 tests (suspected reinfection) ≥90 days after initial infection, through 31st January 2021. Incidence of suspected reinfection was estimated using the Kaplan–Meier method. Cox proportional hazards models estimated the association of suspected reinfection with demographic and clinical characteristics, hospitalization, and date of initial infection. Results The cohort of 75 149 was predominantly Hispanic (49 648/75 149, 66.1%) and included slightly more females than males (39 736, 52.9%), with few immunocompromised patients (953, 1.3%); 315 suspected reinfections were identified, with a cumulative incidence at 270 days of 0.8% (95% confidence interval (CI) 0.7–1.0%). Hospitalization was more common at suspected reinfection (36/315, 11.4%) than initial infection (4094/75 149, 5.4%). Suspected reinfection rates were higher in females (1.0%, CI 0.8–1.2% versus 0.7%, CI 0.5–0.9%, p 0.002) and immunocompromised patients (2.1%, CI 1.0–4.2% versus 0.8%, CI 0.7–1.0%, p 0.004), and lower in children than adults (0.2%, CI 0.1–0.4% versus 0.9%, CI 0.7–1.0%, p 0.023). Patients hospitalized at initial infection were more likely to have suspected reinfection (1.2%, CI 0.6–1.7% versus 0.8%, CI 0.7–1.0%, p 0.030), as were those with initial infections later in 2020 (150-day incidence 0.4%, CI 0.2–0.5% September–October versus 0.2%, CI 0.1–0.3% March–May and 0.3%, CI 0.2–0.3% June–August, p 0.008). In an adjusted Cox proportional hazards model, being female (hazard ratio (HR) 1.44, CI 1.14–1.81), adult (age 18–39, HR 2.71, CI 1.38–5.31, age 40–59 HR 2.22, CI 1.12–4.41, age ≥60 HR 2.52, CI 1.23–5.17 versus <18 years), immunocompromised (HR 2.48, CI 1.31–4.68), hospitalized (HR 1.60, CI 1.07–2.38), and initially infected later in 2020 (HR 2.26, CI 1.38–3.71 September–October versus March–May) were significant independent predictors of suspected reinfection. Conclusions Reinfection with SARS-CoV-2 is uncommon, with suspected reinfections more likely in women, adults, immunocompromised subjects, and those previously hospitalized for coronavirus 2019 (COVID-19). This suggests a need for continued precautions and vaccination in patients with COVID-19 to prevent reinfection.
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Affiliation(s)
- Jeff Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Katia Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Heidi Fischer
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Benjamin Broder
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Regional Assistant Medical Director of Quality and Clinical Analysis (Regional Offices), Diplomate of Clinical Informatics, Hospitalist, KFH Baldwin Park
| | - Bradley Ackerson
- Department of Pediatrics, Southern California Permanente Medical Group, Los Angeles, CA
| | - Sara Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science
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20
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Wong K, Bruxvoort K, Slezak J, Hsu JWY, Reynolds K, Sy LS, Jacobsen SJ. Hepatitis B vaccine and risk of acute myocardial infarction among individuals with diabetes mellitus. Pharmacoepidemiol Drug Saf 2021; 30:1441-1446. [PMID: 34245081 DOI: 10.1002/pds.5327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE A pre-licensure clinical trial of a two-dose cytosine phosphoguanine adjuvanted hepatitis B vaccine (HEPLISAV-B® [Dynavax, USA]; HepB-CpG vaccine) found an unanticipated numerical imbalance in acute myocardial infarction (AMI) compared to recipients of a three-dose aluminum adjuvanted hepatitis B vaccine (ENGERIX-B® [GlaxoSmithKline, Belgium]; HepB-alum vaccine). A post-licensure study was required to compare AMI rates among recipients of HepB-CpG vaccine and HepB-alum vaccine. Individuals with diabetes mellitus (DM), who are at higher risk of AMI, comprise more than half of the post-licensure study cohort. To inform the ongoing post-licensure study, we examined the association between AMI and receipt of HepB-alum vaccine in individuals with DM. METHODS We conducted a case-control study nested in a cohort of individuals with DM ages ≥40 years at Kaiser Permanente Southern California using electronic health records. AMI cases from 2012 to 2017 were identified by principal discharge diagnosis and matched 1:1 with randomly selected controls. The adjusted odds ratio (aOR) for receipt of ≥1 HepB-alum vaccine dose was compared for AMI cases and controls using conditional logistic regression. We subsequently performed the same matched case-control analysis stratified by year. RESULTS Of 8138 matched case-control pairs, 17.4% of cases and 15.0% of controls received HepB-alum vaccine. The aOR of HepB-alum vaccination comparing cases and controls was 0.97 (95% confidence interval 0.87-1.08). Similarly, there was no significant association between HepB-alum vaccine and AMI in any of the study years. CONCLUSIONS HepB-alum vaccination was not associated with AMI in individuals with DM. This finding will provide contextual insight for the ongoing post-licensure study of HepB-CpG vaccine.
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Affiliation(s)
- Katherine Wong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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21
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Bruxvoort K, Sy LS, Ackerson BK, Slezak J, Qian L, Towner W, Reynolds K, Solano Z, Carlson CM, Jacobsen SJ. Challenges in Phase 4 post-licensure safety studies using real world data in the United States: Hepatitis B vaccine example. Vaccine X 2021; 8:100101. [PMID: 34195599 PMCID: PMC8233154 DOI: 10.1016/j.jvacx.2021.100101] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 01/01/2023] Open
Abstract
Post-licensure vaccine safety studies are essential to identify adverse events that may not have been detected in pre-licensure clinical trials and to address questions that arose during the pre-licensure phase. These studies are increasingly conducted using real-world data collected as part of routine health care delivery. However, design of post-licensure vaccine safety studies involves many pragmatic and scientific decisions, which must be made while balancing diverse stakeholder opinions. Challenges include selecting exposure and comparison groups, deciding on the most appropriate outcome, determining sample size and length of follow-up time, and other analytic considerations. As an example of this process and to inform other post-licensure vaccine safety studies in real-world settings, we discuss our experience with design of an FDA-required Phase 4 post-licensure safety study of a hepatitis B vaccine in a large integrated health care organization in the United States.
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Affiliation(s)
- Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Bradley K Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - William Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Cheryl M Carlson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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22
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Abstract
This cohort study examines the association of mask use with COVID-19 transmission among health care workers in California.
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Affiliation(s)
- Aldon Li
- Permanente Medicine, Southern California Permanente Medical Group, Pasadena
- University of California, Riverside School of Medicine, Riverside
| | - Jeff Slezak
- Kaiser Permanente Department of Research and Evaluation, Pasadena, California
| | | | | | | | - Gunter Rieg
- Permanente Medicine, Southern California Permanente Medical Group, Pasadena
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
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23
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Ackerson B, An J, Sy LS, Solano Z, Slezak J, Tseng HF. Cost of Hospitalization Associated With Respiratory Syncytial Virus Infection Versus Influenza Infection in Hospitalized Older Adults. J Infect Dis 2021; 222:962-966. [PMID: 32300806 DOI: 10.1093/infdis/jiaa183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/24/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Despite the severity of respiratory syncytial virus (RSV) disease in older adults, data on its costs are limited. We compared hospitalization costs for 2090 adults aged ≥ 60 years hospitalized with RSV or influenza by assigning direct health care costs. Hospitalization with RSV was associated with longer hospitalization and increased frequency of diagnosis-related groups for pulmonary complications, resulting in costs at least as great as those for influenza ($16 034 vs $15 163; 95% confidence interval for the difference, -$811 to $2547). Awareness of RSV disease burden in adults is needed to facilitate vaccination and treatment when they become available.
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Affiliation(s)
- Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jaejin An
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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24
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Tseng HF, Sy LS, Ackerson B, Solano Z, Slezak J, Luo Y, Fischetti CA, Shinde V. Severe Morbidity and Short- and Mid- to Long-term Mortality in Older Adults Hospitalized with Respiratory Syncytial Virus Infection. J Infect Dis 2021; 222:1298-1310. [PMID: 32591787 DOI: 10.1093/infdis/jiaa361] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We describe the clinical epidemiology and outcomes among a large cohort of older adults hospitalized with respiratory syncytial virus (RSV) infection in the United States. METHODS Hospitalized adults aged ≥60 years who tested positive for RSV between 1 January 2011 and 30 June 2015 were identified from Kaiser Permanente Southern California. Patient-level demographics, comorbidities, clinical presentation, utilization, complications, and mortality were evaluated. RESULTS There were 664 patients hospitalized with RSV (61% female, 64% aged ≥75 years). Baseline chronic diseases were prevalent (all >30%); 66% developed pneumonia, 80% of which were radiographically confirmed. Very severe tachypnea (≥26 breaths/minute) was common (56%); 21% required ventilator support and 18% were admitted to intensive care unit. Mortality during hospitalization was 5.6% overall (4.6% in 60-74 year olds and 6.1% in ≥75 year olds). Cumulative mortality within 1, 3, 6, and 12 months of admission was 8.6%, 12.3%, 17.2%, and 25.8%, respectively. CONCLUSION RSV infection in hospitalized older adults often manifested as severe, life-threatening lower respiratory tract illness with high rates of pneumonia, requirement for ventilatory support, and short- and long-term mortality. Increased recognition of the substantial RSV disease burden in adults will be important in evaluation and use of urgently needed interventions.
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Affiliation(s)
- Hung Fu Tseng
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bradley Ackerson
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Zendi Solano
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Yi Luo
- Kaiser Permanente Southern California, Pasadena, California, USA
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25
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Bruxvoort K, Slezak J, Huang R, Ackerson B, Sy LS, Qian L, Reynolds K, Towner W, Solano Z, Mercado C, Hyer R, Janssen R, Jacobsen SJ. Association of Number of Doses With Hepatitis B Vaccine Series Completion in US Adults. JAMA Netw Open 2020; 3:e2027577. [PMID: 33252692 PMCID: PMC7705595 DOI: 10.1001/jamanetworkopen.2020.27577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Receipt of hepatitis B virus vaccine is important to prevent infection. However, adherence to the hepatitis B vaccine series among adults at risk of infection has been low. OBJECTIVE To assess whether recipients of a 2-dose hepatitis B vaccine with cytosine phosphoguanine adjuvant (HepB-CpG vaccine; Heplisav-B) are more likely to complete their series compared with recipients of a 3-dose vaccine with alum adjuvant (comparator vaccine; Engerix-B [HepB-alum]). DESIGN, SETTING, AND PARTICIPANTS This nested cohort study was conducted from August 7 to December 31, 2018, at Kaiser Permanente Southern California, an integrated health care system with a diverse population of approximately 4.6 million members. Adults not receiving dialysis who received a first dose of a hepatitis B vaccine series in family practice or internal medicine departments of 15 Kaiser Permanente Southern California medical centers were followed up through electronic health records for up to 1 year after receipt of the first dose. Data were analyzed from March 16 to September 23, 2020. EXPOSURES Receipt of a first dose of the HepB-CpG vaccine (2-dose vaccine) vs receipt of a first dose of the HepB-alum vaccine (3-dose vaccine). MAIN OUTCOMES AND MEASURES Series completion within the recommended vaccine schedule plus 3 months (primary outcome) and series completion within 1 year after receipt of the first dose (secondary outcome). RESULTS Of 4727 individuals who initiated the HepB-CpG vaccine series and 6161 individuals who initiated the HepB-alum vaccine series included in the study, 2876 (60.8%) and 3789 (61.5%), respectively, were ages 40 to 59 years, 2415 (51.1%) and 3113 (50.5%) were male, and 2364 (50.0%) and 2881 (46.8%) were Hispanic. The vaccine series was completed within the recommended schedule plus 3 months for 2111 (44.7%) individuals who initiated the HepB-CpG vaccine series and 1607 (26.1%) individuals who initiated the HepB-alum vaccine series, and within 1 year for 2858 (60.5%) and 1989 (32.3%) individuals, respectively. The individuals who initiated the HepB-CpG vaccine series were significantly more likely to complete the series (adjusted relative risk, 1.77; 95% CI, 1.68-1.87). Results were consistent across clinical and demographic strata. CONCLUSIONS AND RELEVANCE In this study, use of the HepB-CpG vaccine was associated with hepatitis B vaccine series completion, but tailored strategies to increase completion of hepatitis B vaccine series are warranted.
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Affiliation(s)
- Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Runxin Huang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lina S. Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - William Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Cheryl Mercado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Randall Hyer
- Dynavax Technologies Corporation, Emeryville, California
| | - Robert Janssen
- Dynavax Technologies Corporation, Emeryville, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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Chao CR, Shu YH, Slezak J, Cannavale KL, Chien G, Van Den Eeden S. Abstract 3515: Statin use and risk of metastasis in a cohort of men with untreated localized prostate cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Statins have been shown to possess anti-cancer properties and their use has been associated with reduced cancer mortality. Several prior studies found inverse associations between statin use and risk of biochemical recurrence of prostate cancer (PCa). There is, however, little research on the impact of statin use post PCa diagnosis on risk of metastasis among men on active surveillance. A potential preventive effect of post-diagnostic statin use can have implication for managing PCa in those patients. Here we examined the association between statin use and risk of metastasis in men with untreated localized PCa.
Methods: Men diagnosed with PCa at Kaiser Permanente Southern California (KPSC) between 1997 and 2007 who met the following inclusion criteria were included in this retrospective cohort: (1) diagnosed at stage I and II; (2) Gleason grade ≤ 7; and (3) did not have any active treatment for PCa for at least 6 months after diagnosis. All men were followed to identify PCa metastasis and were censored at the initiation prostatectomy or radiation, non-PCa related death, termination of KPSC membership, or end of 2016. Potential metastasis was initially captured based on diagnosis codes, utilizations and cause of death, then manually reviewed and confirmed. Data on statin use and other clinical history were collected from KPSC's electronic medical records. Time-dependent Cox regression was used to evaluate the association between post-diagnostic statin use and risk of metastasis, adjusting for statin use prior to PCa diagnosis, index year at diagnosis, age at diagnosis, prostate-specific antigen level at diagnosis, use of hormone therapy, hypertension, and diabetes. A sensitivity analysis was conducted excluding men with statin use prior to PCa diagnosis.
Results: A total of 4,326 men were included in this cohort study. During the study follow-up, 207 men developed metastasis while still untreated. The mean age at diagnosis was 67.5 years. The cohort is racial/ethnically diverse: 59% non-Hispanic white, 14% Hispanic, 20% black and 5% Asian. Thirty-one and forty-nine percent used statins before and after PCa diagnosis, respectively. In Cox regression, post-diagnostic statin use was not associated with the development of metastasis: Hazard ratio = 0.94 (95% confidence interval 0.69-1.29) after adjusting for covariates. There was no evidence of dose-response for the proportion of at-risk person-time post PCa diagnosis on statins. In addition, statin use prior to diagnosis was also not associated with risk of metastasis (HR=0.88 (0.62-1.23)). Sensitivity analysis excluding men who used statins prior to PCa diagnosis led to similar findings.
Conclusion: Statin use after the diagnosis of localized PCa was not associated with lower risk of metastatic progression in this large cohort of untreated men. This finding does not support the chemopreventive use of statins for men with PCa on active surveillance.
Citation Format: Chun R. Chao, Yu-Hsiang Shu, Jeff Slezak, Kimberly L. Cannavale, Gary Chien, Stephen Van Den Eeden. Statin use and risk of metastasis in a cohort of men with untreated localized prostate cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3515.
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Affiliation(s)
- Chun R. Chao
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | - Yu-Hsiang Shu
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | - Jeff Slezak
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | | | - Gary Chien
- 2Kaiser Permanente - Southern California, Los Angeles, CA
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Cannavale K, Slezak J, Shu YH, Chien GW, Chen X, Shi F, Siegmund K, Eeden SVD, Huang J, Chao CR. Abstract 3514: DNA methylation markers for risk of metastasis in a cohort of men with localized prostate cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Most localized prostate cancers (PCa) are indolent and will not require treatment, but a small proportion can progress to metastasis. Distinguishing aggressive from indolent tumors can better inform treatment decisions. There has been interest in cancer genomics to predict PCa aggressiveness but with no consensus on methylation's role. We examined whether DNA methylation status of selected candidate genes can predict risk of PCa metastasis in the absence of curative treatment.
Methods: A retrospective cohort of men diagnosed with PCa at Kaiser Permanente Southern California 1997-2007 who met the following inclusion criteria were identified: (1) diagnosed at stage I and II and (2) did not receive PCa treatment for at least 6 months after diagnosis. Men were followed for metastasis and censored at the initiation of prostatectomy or radiation, non-PCa related death, membership termination, or end of 2016. Potential metastasis was identified by an algorithm, then manually reviewed and confirmed. For each metastasis case, up to 4 controls were selected using density sampling, matched on age, race (black vs. non-black) and Gleason grade. For each case and control, FFPE blocks of diagnostic prostate biopsy cores were retrieved. The study pathologists reviewed the H/E slides and circled cancerous areas, which were macro-dissected for DNA extraction. Methylation status was obtained using Illumina's Infinium Methylation EPIC BeadChip. The candidate genes (N=118) were selected from the literature in the functional categories of cell cycle control; tumor suppressors; cell signaling; cell adhesion; angiogenesis; immune function; and stem cell markers. In total, 4,518 CpG markers from the Infinium assay covered regions of the candidate genes. Three statistical methods were used to detect the genetic associations, including univariate, principal components (PC)-based, and cluster-based analysis. To adjust for multiple comparisons within a gene and across genes, a double false discovery rate (DFDR) procedure was applied. The DFDR-adjusted p-value for each marker was calculated at 0.05 alpha level.
Results: In total 163 cases and 311 matched controls were included in the analyses after excluding those with insufficient DNA or that failed the assay. For each analysis, univariate, PC-based, and cluster-based, the following number of candidate genes were found significant after DFDR procedure: 5 genes (PLAU, RASSF1, SLC5A6, KDR, CCL2), 8 genes (BCL2, KLF4, CTNND2, NRP2, RAP1GAP, LPL, EFEMP1, HSPA1A), and 7 genes (ETV4, ANGPTL4, BRMS1, LPL, BCL2, NANOG, ADM), respectively. The overall agreement of gene-level testing significances was at 84% between PC-based and cluster-based analysis.
Conclusions: Among those showing consistent statistical significance, two genes, BCL2 and LPL, were identified in two analyses. Further study may provide insight to predict risk of prostate cancer metastasis.
Citation Format: Kim Cannavale, Jeff Slezak, Yu-Hsiang Shu, Gary W. Chien, XuFeng Chen, Feng Shi, Kim Siegmund, Stephen Van Den Eeden, Jiaoti Huang, Chun R. Chao. DNA methylation markers for risk of metastasis in a cohort of men with localized prostate cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3514.
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Affiliation(s)
- Kim Cannavale
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | - Jeff Slezak
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | - Yu-Hsiang Shu
- 1Kaiser Permanente - Southern California, Pasadena, CA
| | - Gary W. Chien
- 2Kaiser Permanente - Southern California, Los Angeles, CA
| | - XuFeng Chen
- 3Duke University School of Medicine, Durham, NC
| | - Feng Shi
- 3Duke University School of Medicine, Durham, NC
| | - Kim Siegmund
- 4University of Southern California, Los Angeles, CA
| | | | | | - Chun R. Chao
- 1Kaiser Permanente - Southern California, Pasadena, CA
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Ackerson B, Tseng HF, Sy LS, Solano Z, Slezak J, Luo Y, Fischetti CA, Shinde V. Severe Morbidity and Mortality Associated With Respiratory Syncytial Virus Versus Influenza Infection in Hospitalized Older Adults. Clin Infect Dis 2020; 69:197-203. [PMID: 30452608 PMCID: PMC6603263 DOI: 10.1093/cid/ciy991] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is an important cause of serious respiratory illness in older adults. Comparison of RSV and influenza infection in hospitalized older adults may increase awareness of adult RSV disease burden. Methods Hospitalized adults aged ≥60 years who tested positive for RSV or influenza between 1 January 2011 and 30 June 2015 were identified from Kaiser Permanente Southern California electronic medical records. Baseline characteristics, comorbidities, utilization, and outcomes were compared. Results The study included 645 RSV- and 1878 influenza-infected hospitalized adults. Patients with RSV were older than those with influenza (mean, 78.5 vs 77.4 years; P = .035) and more likely to have congestive heart failure (35.3% vs 24.5%; P < .001) and chronic obstructive pulmonary disease (COPD) (29.8% vs 24.3%; P = .006) at baseline. In adjusted analyses, RSV infection was associated with greater odds of length of stay ≥7 days (odds ratio [OR] = 1.5; 95% confidence interval [CI], 1.2–1.8; P < .001); pneumonia (OR = 2.7; 95% CI, 2.2–3.2; P < .001); intensive care unit admission (OR = 1.3; 95% CI, 1.0–1.7; P = .023); exacerbation of COPD (OR = 1.7; 95% CI, 1.3–2.4; P = .001); and greater mortality within 1 year of admission (OR = 1.3; 95% CI, 1.0–1.6; P = .019). Conclusions RSV infection may result in greater morbidity and mortality among older hospitalized adults than influenza. Increased recognition of adult RSV disease burden will be important in the evaluation and use of new RSV vaccines and antivirals.
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Affiliation(s)
- Bradley Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Christine A Fischetti
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vivek Shinde
- Clinical Development, Novavax Inc., Gaithersburg, Maryland
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Chen MC, Kilday PS, Elliott PA, Artenstein D, Slezak J, Jacobsen SJ, Chien GW. Neoadjuvant Leuprolide Therapy with Radical Prostatectomy: Long-term Effects on Health-related Quality of Life. Eur Urol Focus 2020; 7:779-787. [PMID: 32165116 DOI: 10.1016/j.euf.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/30/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neoadjuvant androgen ablation (neoadjuvant androgen deprivation therapy [NADT]) is used prior to radical prostatectomy, contrary to guidelines, but its long-term effects on quality of life is unknown. OBJECTIVE To determine the effect of NADT on patient's long-term recovery following surgery. DESIGN, SETTING, AND PARTICIPANTS From March 2011 to August 2013, 5808 men with newly diagnosed prostate were followed up to 24 mo. A cohort of men who received NADT prior to robotic-assisted laparoscopic prostatectomy (RALP; n=51) was compared 1:3 with a matched group that underwent RALP only (n=153). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were matched on Charlson comorbidities, biopsy Gleason score, and node status on final pathology. The Kruskall-Wallis test was used to compare the groups on their bowel, urinary, sexual, and hormonal domains of the 26-item Expanded Prostate Cancer Index Composite at baseline and at 1, 3, 6, 12, 18, and 24 mo postoperatively. RESULTS AND LIMITATIONS The urinary irritative, urinary incontinence, and bowel domains were similar in the two groups during the 24 mo (p=0.832, 0.901, and 0.732, respectively). In the hormonal domain, the NADT group did worse (p<0.001). The sexual domain was also worse for the NADT group. However, when accounting for nerve sparing, there was no significant difference in sexual outcomes between the two groups (p=0.069). CONCLUSIONS Patients who received NADT prior to RALP do not have worse sexual function, but have worse hormonal scores for up to 2yr after surgery. PATIENT SUMMARY Neoadjuvant androgen deprivation therapy (NADT) is administered prior to robotic-assisted laparoscopic prostatectomy (RALP), contrary to clinical guidelines. NADT may not have worse sexual function outcomes up to 2yr after RALP.
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Affiliation(s)
- Michael C Chen
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Patrick S Kilday
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Peter A Elliott
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Daniel Artenstein
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
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Kalocayova B, Kovacicova I, Radosinska J, Tothova L, Fulop M, Slezak J, Vrbjar N. Localization dependent sensitivity of cerebral Na,K-ATPase to irradiation induced oxidative imbalance in rats. J Physiol Pharmacol 2019; 70. [PMID: 31642819 DOI: 10.26402/jpp.2019.4.08] [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] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/28/2019] [Indexed: 11/03/2022]
Abstract
Na,K-ATPase represents the key enzyme maintaining the ionic gradient across plasma membrane. It was documented that in directly irradiated organs the activity of this enzyme is decreased. The aim of present study was to clarify the remote effect of irradiation in mediastinal area on the activity of the Na,K-ATPase in selected brain regions in rats. Ionizing radiation in single dose 25 Gy induced alterations in oxidative status of blood plasma. Irradiation also decreased the activity of the Na,K-ATPase in cerebral cortex. Measurements of kinetic properties of the enzyme dependently on the concentration of energy substrate ATP or cofactor Na+ indicated that the lowered enzyme activity is probably a consequence of decreased number of active molecules of the enzyme, as suggested by lowered Vmax values (by 13 - 14%). Immunoblot analysis revealed that this effect is connected namely to decreased presence of α2 and α3 subunits (by 25% and 30% respectively). Considering the current concepts about involvement of the malfunction of α2 α3 subunits in development of primary brain dysfunctions, it may be hypothesized that the lowered functionality of those subunits of Na,K-ATPase may represent a predisposition to neurodegenerative disorders after irradiation. The observed effect seems to be localization dependent as the enzyme in cerebellum resisted to irradiation.
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Affiliation(s)
- B Kalocayova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - I Kovacicova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - J Radosinska
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic.,Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - L Tothova
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - M Fulop
- Slovak Medical University, Bratislava, Slovak Republic
| | - J Slezak
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - N Vrbjar
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Bruxvoort K, Slezak J, Huang R, Sy LS, Towner W, Ackerson B, Reynolds K, Qian L, Carlson CM, Solano Z, Hyer RN, Janssen R, Jacobsen SJ. 286. Hepatitis B Vaccine Compliance: Comparing 2-Dose and 3-Dose Vaccines. Open Forum Infect Dis 2019. [PMCID: PMC6810827 DOI: 10.1093/ofid/ofz360.361] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Less than 1 in 3 US adults who initiated the 3-dose (0, 1, 6 months) hepatitis B vaccine series have completed it. HepB-CpG (Heplisav-B; Dynavax) is a new licensed adjuvanted vaccine that requires only 2 doses (0, 1 month). As part of a cluster study performed at Kaiser Permanente Southern California, we compared compliance with second dose and series completion for HepB-CpG vs. comparator vaccine (Engerix-B; GlaxoSmithKline) recipients. Methods The cohort included adults not on dialysis who received their first dose of hepatitis B vaccine in family or internal medicine departments from 8/7/2018 to 2/1/2019. Second dose compliance was assessed for the full cohort, but series completion was assessed for a subset vaccinated from August 7, 2018 to September 30, 2018 to allow at least 6 months’ follow-up. Compliance rates were estimated using the Kaplan Meier method. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard regression with robust variance to account for within medical center correlation, adjusting for age, race/ethnicity, census block income and education, prior healthcare utilization, and factors that trigger alerts for hepatitis B vaccination (diabetes and testing for sexually transmitted infections). Results There were 6500 HepB-CpG and 7733 comparator vaccine recipients (1,442 and 2,604 prior to September 30, 2018). Rates of second dose compliance at 60 days were 32.9% for HepB-CpG and 29.1% for comparator vaccine, and rates of series completion at 210 days were 56.9% and 20.6%. There was no significant difference in second dose compliance (aHR 1.14, 95% CI: 0.91, 1.47), but HepB-CpG recipients were 5 times more likely to complete the series (aHR 5.17; 95% CI: 3.84, 6.98). Second dose compliance and series completion were significantly less likely among Blacks compared with Whites and significantly more likely among Asians, adults ≥60 years compared with those < 30 years, and adults living in census blocks with a median annual income of $40,000–69,000 compared with < $40,000. Conclusion Overall, second dose compliance was similar, but series completion was better for HepB-CpG recipients than comparator vaccine recipients, suggesting that the 2-dose vaccine could lead to improvements in coverage and protection against hepatitis B virus. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Jeff Slezak
- Kaiser Permanente Southern California, Pasadena, California
| | - Runxin Huang
- Kaiser Permanente Southern California, Pasadena, California
| | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena, California
| | - William Towner
- Kaiser Permanente Southern California, Pasadena, California
| | - Bradley Ackerson
- Kaiser Permanente, South Bay Medical Center, Harbor City, California
| | | | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, California
| | - Cheryl M Carlson
- Southern California Kaiser Permanente Medical Group, Pasadena, California
| | - Zendi Solano
- Kaiser Permanente Southern California, Pasadena, California
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Bruxvoort K, Slezak J, Hsu J, Reynolds K, Sy L, Jacobsen S. Hepatitis B vaccine and risk of acute myocardial infarction among patients with diabetes. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.06.009] [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: 10/26/2022]
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Sykora M, Bacova B, Benova T, Barancik M, Zurmanova J, Rauchova H, Frimmel K, Pavelka S, Slezak J, Soukup T, Tribulova N. RESPONSES OF CARDIAC CONNEXIN-43 AND EXTRACELLULAR MATRIX PROTEINS TO ALTERED THYROID STATUS DIFFER IN HYPERTENSIVE VERSUS NORMOTENSIVE RATS. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000572216.88761.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Slezak J, Eeden SVD, Cannavale KL, Chein GW, Chao CR. Abstract 4197: Long-term follow-up of a racially and ethnically diverse population of patients with localized prostate cancer who did not undergo initial active treatment. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Long-term studies of men who were not initially treated for prostate cancer have been limited, especially among ethnic minorities. We sought to provide detailed long-term outcomes of a large, diverse cohort of men diagnosed with prostate cancer between 1997 and 2007 in a large managed care organization.
Methods: Incident prostate cancer cases diagnosed at localized stage were identified using a SEER cancer registry. Treatments were identified by the cancer registry and patients’ medical records. Men were excluded if an initial course of treatment was started within 6 months of diagnosis. All patients were followed to identify later initiation of treatment, suspected prostate cancer metastasis or death. Suspected metastases were manually reviewed and confirmed. Death due to prostate cancer (PCD) was identified using the underlying cause of death on the death certificate. Competing risks methods were used to estimate the cumulative incidence of treatment initiation or metastasis (naive of treatment), and the incidence of death due to prostate cancer or other causes.
Results: A total of 6207 men were included: 60.4% white, 18.9% Black, 15.2% Hispanic and 5.5% Asian or Pacific Islander (API). At 19 years after diagnosis, the estimated incidence of treatment initiation, metastasis, PCD, and death due to other causes was 39.1%, 13.4%, 12.0% and 52.9%, respectively. Rates of treatment initiation at 19 years were highest in Hispanic (44.5%) and Black (44.7%) men, compared to 35.4% in white and 38.6% in API men. Rates of treatment-naïve metastasis as well as PCD were highest in Blacks (19.3% and 14.1%, respectively) and lowest among Hispanics (7.7% and 9.9%, respectively). API men had low rates of PCD through the first 10 years after diagnosis (2.4% compared to 5.6-6.9% for other groups), after which rates increased and at 19 years their estimated rates of PCD (12.0%) approximated those of whites (11.7%).
Conclusions: Significant risks of metastasis and prostate cancer death remains even 15 years after diagnosis among men who were initially untreated. Notably, there is an apparent increasing risk of PCD in API more than 10 years after diagnosis.
Citation Format: Jeff Slezak, Stephen Van Den Eeden, Kimberly L. Cannavale, Gary W. Chein, Chun R. Chao. Long-term follow-up of a racially and ethnically diverse population of patients with localized prostate cancer who did not undergo initial active treatment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4197.
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Affiliation(s)
- Jeff Slezak
- 1Kaiser Permanente Southern California, Pasadena, CA
| | | | | | - Gary W. Chein
- 1Kaiser Permanente Southern California, Pasadena, CA
| | - Chun R. Chao
- 1Kaiser Permanente Southern California, Pasadena, CA
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Castillo JG, Slezak J, Reich DL. Commemorating 50 years since the first heart transplantation in Bratislava - Czechoslovakia. BRATISL MED J 2019; 120:89. [PMID: 30685999 DOI: 10.4149/bll_2019_014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okruhlicova L, Cicakova Z, Frimmel K, Weismann P, Krizak J, Sotnikova R, Knezl V, Slezak J. Lipopolysaccharide-induced redistribution of myocardial connexin43 is associated with increased macrophage infiltration in both normotensive and spontaneously hypertensive rats. J Physiol Pharmacol 2019; 69. [PMID: 30683822 DOI: 10.26402/jpp.2018.5.05] [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] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/30/2018] [Indexed: 11/03/2022]
Abstract
We investigated whether changes in gap junction alpha-1 protein (Cx43) expression may be associated with macrophage-induced inflammation in the heart of spontaneously hypertensive rats (SHR). To examine mutual interactions of macrophage infiltration with Cx43 expression and redistribution, we applied a bolus of bacterial lipopolysaccharide (LPS) to SHR and age-matched normotensive Wistar rats. The results demonstrated association of Cx43 downregulation with increased infiltration of cardiac CD-68 macrophages and upregulation of nuclear factor-κB (NFκB) and tumor necrosis factor-α (TNF-α) expression in the heart of SHR. LPS application to SHR caused further degradation and redistribution of Cx43 accompanied with extensively increased macrophage infiltration and NFκB and TNF-α expression. LPS administration to Wistar rats resulted in elevation of cardiac CD-68 macrophages but it did not significantly affect total Cx43 expression. Our results are suggestive of regulation of Cx43 expression with macrophages-related inflammation in the heart of SHR. The data also indicate that SHR can be more sensitive to LPS than are normotensive rats.
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Affiliation(s)
- L Okruhlicova
- Institute for Heart Research Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic.
| | - Z Cicakova
- Institute for Heart Research Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - K Frimmel
- Institute for Heart Research Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - P Weismann
- Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovak Republic
| | - J Krizak
- Institute for Heart Research Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - R Sotnikova
- Institute of Experimental Pharmacology and Toxicology Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - V Knezl
- Institute of Experimental Pharmacology and Toxicology Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
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Tribulova N, Viczenczova C, Kura B, Chaudagar KK, Szeiffova Bacova B, Egan Benova T, Knezl V, Barancik M, Ravingerova T, Slezak J. P259Up-regulation of myocardial connexin-43 is involved in compensatory response of the heart to acute injury. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Tribulova
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - C Viczenczova
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - B Kura
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | | | - B Szeiffova Bacova
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - T Egan Benova
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - V Knezl
- Slovak Academy of Sciences, Institute of Experimental Pharmacology & Toxicology, Bratislava, Slovak Republic
| | - M Barancik
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - T Ravingerova
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
| | - J Slezak
- Slovak Academy of Sciences, Institute for Heart Research, Bratislava, Slovak Republic
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Slezak J, Meyer K, Sy LS, Chao C, Takhar H, Ackerson B, Cheetham TC, Jacobsen S. An imputation method for calculating and comparing autoimmune disease incidence using partial case review. Vaccine 2017; 35:6672-6675. [PMID: 29079102 DOI: 10.1016/j.vaccine.2017.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Estimate incidence of autoimmune conditions in a population who received HPV4 vaccine and a comparison unvaccinated population. Electronic health record (EHR) data may contain inaccurate or incomplete coding, while manual chart review of all cases may not be feasible. We propose a method to estimate incidence using EHR data and case review for a sample. METHODS Suspected incident cases were identified using ICD-9 codes, laboratory results and medications related to the condition. A random sample of charts was reviewed to confirm the diagnosis and determine disease onset date. Multiple imputation, using a Monte Carlo model including age and disease indicators was used to impute case status of non-reviewed cases. Incidence rate was calculated in each imputed dataset, with median and percentiles giving a distribution for the estimated incidence rate. Sensitivity analyses compared modeled results to results without imputation and results where imputation was applied to the subset of cases identified using specific ICD-9 codes. RESULTS The model accounted for differential case confirmation rates by age and method of case identification, identifying a potential safety signal that was missed relying on EHR data alone. CONCLUSIONS This method may be useful for computing incidence when full case review is not feasible.
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Affiliation(s)
- Jeff Slezak
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States.
| | - Kristin Meyer
- LA County Department of Public Health, Division of HIV & STD Programs, 600 South Commonwealth Avenue, 10th Floor, Los Angeles, CA 90005, United States
| | - Lina S Sy
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States
| | - Chun Chao
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States
| | - Harpreet Takhar
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States
| | - Brad Ackerson
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States
| | - T Craig Cheetham
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States; Western University for Health Sciences, College of Pharmacy, 309 E 2nd St, Pomona, CA 91766, United States
| | - Steven Jacobsen
- Kaiser Permanente, Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA 91101, United States
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Tseng HF, Sy LS, Ackerson B, Fischetti C, Slezak J, Luo Y, Solano Z, Chen S, Shinde V. Morbidity, and Short- and Intermediate-term Mortality, in Adults ≥60 Years Hospitalized with Respiratory Syncytial Virus Infection vs. Seasonal Influenza Virus Infection. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.747] [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: 11/14/2022] Open
Abstract
Abstract
Background
There is increasing evidence that respiratory syncytial virus (RSV) infection can cause serious health problems among older adults, whether healthy and community-dwelling, or high-risk. In older adults, RSV infection can lead to complications that are similar to those resulting from seasonal influenza infection. The aim of this study was to compare the morbidity and mortality in older adults ≥60 years hospitalized with RSV disease vs. those hospitalized with seasonal influenza.
Methods
This cohort study included members of Kaiser Permanente Southern California aged ≥ 60 years who tested positive for RSV or influenza A/B by multiplex RT-PCR in clinical diagnostic testing during January 1, 2011 to June 30, 2015 and were hospitalized. For multiple eligible hospitalizations, only the first RSV hospitalization for the RSV cohort or first influenza A/B hospitalization for the influenza cohort was included. Electronic medical records for each hospitalized individual were used to extract necessary information, including baseline characteristics, symptoms, comorbidities, and outcomes.
Results
The study included 664 RSV (mean age 78.5 years, 39.5% male) and 1922 influenza A/B (mean age 77.5 years, 49.7% male) hospitalizations. There were 310 (46.7%) RSV patients and 501 (26.1%) influenza patients with a diagnosis of pneumonia. There were 119 RSV patients (17.9%) vs. 272 (14.2%) influenza patients that were admitted to the intensive care unit during hospitalization (mean stay 6.8 vs. 7.8 days). The short-term mortality rate during hospitalization and within 90 days of discharge was 5.6% (n = 37) and 7.4% (n = 49) in the RSV cohort vs. 4.4% (n = 85) and 6.7%
(n = 129) in the influenza cohort. The intermediate-term mortality rate within 91–180 days of discharge was significantly different between the RSV and the influenza cohorts (4.4% vs. 2.5%).
Conclusion
RSV infection can lead to complications and severe outcomes that are similar to those of seasonal influenza in older adults. Effective prevention and treatment strategies such as vaccination and antivirals against RSV could potentially reduce the burden of RSV infection as well as complications from disease.
Disclosures
H. F. Tseng, Novavax: Grant Investigator, Research grant. L. S. Sy, Novavax: Collaborator, Research grant. C. Fischetti, Novavax: Collaborator, Research grant. J. Slezak, Novavax: Collaborator, Grant recipient. Y. Luo, Novavax: Collaborator, Grant recipient. Z. Solano, Novavax Inc.: Collaborator, My employer received research funds to conduct the study. S. Chen, Novavax: Collaborator, Research grant. V. Shinde, Novavax Inc.: Collaborator, My employer received research funds to conduct the study.
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Affiliation(s)
- Hung Fu Tseng
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Lina S Sy
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bradley Ackerson
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Christine Fischetti
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yi Luo
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Zendi Solano
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Songyue Chen
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Tribulova N, Egan Benova T, Szeiffova Bacova B, Viczenczova C, Kurahara LH, Knezl V, Nagibin V, Slezak J. 111Cardiac connexin43 modulates susceptibility of the heart to life-threatening arrhythmias in various experimental models. Europace 2017. [DOI: 10.1093/ehjci/eux135] [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: 11/13/2022] Open
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Ravingerova T, Farkasova V, Griecsova L, Carnicka S, Murarikova M, Barlaka E, Kolar F, Bartekova M, Lonek L, Slezak J, Lazou A. Remote preconditioning as a novel "conditioning" approach to repair the broken heart: potential mechanisms and clinical applications. Physiol Res 2017; 65 Suppl 1:S55-64. [PMID: 27643940 DOI: 10.33549/physiolres.933392] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Remote ischemic preconditioning (RIPC) is a novel strategy of protection against ischemia-reperfusion (IR) injury in the heart (and/or other organs) by brief episodes of non-lethal IR in a distant organ/tissue. Importantly, RIPC can be induced noninvasively by limitation of blood flow in the extremity implying the applicability of this method in clinical situations. RIPC (and its delayed phase) is a form of relatively short-term adaptation to ischemia, similar to ischemic PC, and likely they both share triggering mechanisms, whereas mediators and end-effectors may differ. It is hypothesized that communication between the signals triggered in the remote organs and protection in the target organ may be mediated through substances released from the preconditioned organ and transported via the circulation (humoral pathways), by neural pathways and/or via systemic anti-inflammatory and antiapoptotic response to short ischemic bouts. Identification of molecules involved in RIPC cascades may have therapeutic and diagnostic implications in the management of myocardial ischemia. Elucidation of the mechanisms of endogenous cardioprotection triggered in the remote organ could lead to the development of diverse pharmacological RIPC mimetics. In the present article, the authors provide a short overview of RIPC-induced protection, proposed underlying mechanisms and factors modulating RIPC as a promising cardioprotective strategy.
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Affiliation(s)
- T Ravingerova
- Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Loo R, Ng C, Slezak J, Jacobsen S. PD57-01 HEMATURIA RISK INDEX - RISK OF UROTHELIAL MALIGNANCY IN PATIENTS WITH ASYMPTOMATIC MICROSCOPIC HEMATURIA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Andre E, Yaniz-Galende E, Hamilton C, Dusting GJ, Hellen N, Poulet CE, Diez Cunado M, Smits AM, Lowe V, Eckardt D, Du Pre B, Sanz Ruiz R, Moerkamp AT, Tribulova N, Smani T, Liskova YV, Greco S, Guzzolino E, Franco D, Lozano-Velasco E, Knorr M, Pavoine C, Bukowska A, Van Linthout S, Miteva K, Sulzgruber P, Latet SC, Portnychenko A, Cannavo A, Kamilova U, Sagach VF, Santin Y, Octavia Y, Haller PM, Octavia Y, Rubies C, Dei Zotti F, Wong KHK, Gonzalez Miqueo A, Kruithof BPT, Kadur Nagaraju C, Shaposhnikova Y, Songia P, Lindner D, Wilson C, Benzoni P, Fabbri A, Campostrini G, Jorge E, Casini S, Mengarelli I, Nikolov A, Bublikov DS, Kheloufi M, Rubies C, Walker RE, Van Dijk RA, Posthuma JJ, Dumitriu IE, Karshovska E, Sakic A, Alexandru N, Martin-Lorenzo M, Molica F, Taylor RF, Mcarthur L, Crocini C, Matsuyama TA, Mazzoni L, Lin WK, Owen TJ, Scigliano M, Sheehan A, Bezerra Gurgel AR, Bromage DI, Kiss A, Ikeda G, Pickard JMJ, Wirth G, Casos K, Khudiakov A, Nistal JF, Ferrantini C, Park SJ, Di Maggio S, Gentile F, Dini L, Buyandelger B, Larrasa-Alonso J, Schirmer I, Chin SH, Cimiotti D, Martini H, Hohensinner PJ, Garabito M, Zeni F, Licholai S, De Bortoli M, Sivitskaya L, Viczenczova C, Rainer PP, Smith LE, Suna G, Gambardella J, Cozma A, De Gonzalo Calvo D, Scoditti E, Clark BJ, Mansfield C, Eckardt D, Gomez L, Llucia-Valldeperas A, De Pauw A, Porporato P, Bouzin C, Draoui N, Sonveaux P, Balligand JL, Mougenot N, Formicola L, Nadaud S, Dierick F, Hajjar RJ, Marazzi G, Sassoon D, Hulot JS, Zamora VR, Burton FL, Macquaide N, Smith GL, Hernandez D, Sivakumaran P, Millard R, Wong RCB, Pebay A, Shepherd RK, Lim SY, Owen T, Jabbour RJ, Kloc M, Kodagoda T, Denning C, Harding SE, Ramos S, Terracciano C, Gorelik J, Wei K, Bushway P, Ruiz-Lozano P, Mercola M, Moerkamp AT, Vegh AMD, Dronkers E, Lodder K, Van Herwaarden T, Goumans MJ, Pellet-Many C, Zachary I, Noack K, Bosio A, Feyen DAM, Demkes EJ, Dierickx PJ, Doevendans PA, Vos MA, Van Veen AAB, Van Laake LW, Fernandez Santos ME, Suarez Sancho S, Fuentes Arroyo L, Plasencia Martin V, Velasco Sevillano P, Casado Plasencia A, Climent AM, Guillem M, Atienza Fernandez F, Fernandez-Aviles F, Dingenouts CKE, Lodder K, Kruithof BPT, Van Herwaarden T, Vegh AMD, Goumans MJ, Smits AM, Knezl V, Szeiffova Bacova B, Egan Benova T, Viczenczova C, Goncalvesova E, Slezak J, Calderon-Sanchez E, Diaz I, Ordonez A, Salikova SP, Zaccagnini G, Voellenkle C, Sadeghi I, Maimone B, Castelvecchio S, Gaetano C, Menicanti L, Martelli F, Hatcher C, D'aurizio R, Groth M, Baugmart M, Mercatanti A, Russo F, Mariani L, Magliaro C, Pitto L, Lozano-Velasco E, Jodar-Garcia A, Galiano-Torres J, Lopez-Navarrete I, Aranega A, Wagensteen R, Quesada A, Aranega A, Franco D, Finger S, Karbach S, Kossmann S, Muenzel T, Wenzel P, Keck M, Mougenot N, Favier S, Fuand A, Atassi F, Barbier C, Lompre AM, Hulot JS, Nikonova Y, Pluteanu F, Kockskaemper J, Chilukoti RK, Wolke C, Lendeckel U, Gardemann A, Goette A, Miteva K, Pappritz K, Mueller I, El-Shafeey M, Ringe J, Tschoepe C, Pappritz K, El-Shafeey M, Ringe J, Tschoepe C, Van Linthout S, Koller L, Richter B, Blum S, Koprak M, Huelsmann M, Pacher R, Goliasch G, Wojta J, Niessner A, Van Herck PL, Claeys MJ, Haine SE, Lenders GD, Miljoen HP, Segers VF, Vandendriescche TR, Hoymans VY, Vrints CJ, Lapikova-Bryhinska T, Gurianova V, Portnichenko H, Vasylenko M, Zapara Y, Portnichenko V, Liccardo D, Lymperopoulos A, Santangelo M, Leosco D, Koch WJ, Ferrara N, Rengo G, Alieva T, Rasulova Z, Masharipova D, Dorofeyeva NA, Drachuk KO, Sicard P, Yucel Y, Dutaur M, Vindis C, Parini A, Mialet-Perez J, Van Deel ED, De Boer M, De Waard MC, Duncker DJ, Nagel F, Inci M, Santer D, Hallstroem S, Podesser BK, Kararigas G, De Boer M, Kietadisorn R, Swinnen M, Duimel H, Verheyen F, Chrifi I, Brandt MM, Cheng C, Janssens S, Moens AL, Duncker DJ, Batlle M, Dantas AP, Sanz M, Sitges M, Mont L, Guasch E, Lobysheva I, Beauloye C, Balligand JL, Vanhoutte PM, Tang EHC, Beaumont J, Lopez B, Ravassa S, Hermida N, Valencia F, Gomez-Doblas JJ, San Jose G, De Teresa E, Diez J, Van De Merbel AF, Kruithof-De Julio M, Goumans MJ, Claus P, Dries E, Angelo Singh A, Vermeulen K, Roderick HL, Sipido KR, Driesen RB, Ilchenko I, Bobronnikova L, Myasoedova V, Alamanni F, Tremoli E, Poggio P, Becher PM, Gotzhein F, Klingel K, Blankenberg S, Westermann D, Zi M, Cartwright E, Campostrini G, Bonzanni M, Milanesi R, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Fantini M, Wilders R, Severi S, Benzoni P, Dell' Era P, Serzanti M, Olesen MS, Muneretto C, Bisleri G, Difrancesco D, Baruscotti M, Bucchi A, Barbuti A, Amoros-Figueras G, Raga S, Campos B, Alonso-Martin C, Rodriguez-Font E, Vinolas X, Cinca J, Guerra JM, Mengarelli I, Schumacher CA, Veldkamp MW, Verkerk AO, Remme CA, Veerman C, Guan K, Stauske M, Tan H, Barc J, Wilde A, Verkerk A, Bezzina C, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Garev A, Andrienko AV, Lychev VG, Vorobova EN, Anchugina DA, Vion AC, Hammoutene A, Poisson J, Dupont N, Souyri M, Tedgui A, Codogno P, Boulanger CM, Rautou PE, Dantas AP, Batlle M, Guasch E, Torres M, Montserrat JM, Almendros I, Mont L, Austin CA, Holt CM, Rijs K, Wezel A, Hamming JF, Kolodgie FD, Virmani R, Schaapherder AF, Lindeman JHN, Posma JJN, Van Oerle R, Spronk HMH, Ten Cate H, Dinkla S, Kaski JC, Schober A, Chaabane C, Ambartsumian N, Grigorian M, Bochaton-Piallat ML, Dragan E, Andrei E, Niculescu L, Georgescu A, Gonzalez-Calero L, Maroto AS, Martinez PJ, Heredero A, Aldamiz-Echevarria G, Vivanco F, Alvarez-Llamas G, Meens MJ, Pelli G, Foglia B, Scemes E, Kwak BR, Caldwell JL, Eisner DA, Dibb KM, Trafford AW, Chilton L, Smith GL, Nicklin SA, Coppini R, Ferrantini C, Yan P, Loew LM, Poggesi C, Cerbai E, Pavone FS, Sacconi L, Tanaka H, Ishibashi-Ueda H, Takamatsu T, Coppini R, Ferrantini C, Gentile F, Pioner JM, Santini L, Sartiani L, Bargelli V, Poggesi C, Mugelli A, Cerbai E, Maciejewska M, Bolton EL, Wang Y, O'brien F, Ruas M, Lei M, Sitsapesan R, Galione A, Terrar DA, Smith JG, Garcia D, Barriales-Villa R, Monserrat L, Harding SE, Denning C, Marston SB, Watson S, Tkach S, Faggian G, Terracciano CM, Perbellini F, Eiros Zamora J, Papadaki M, Messer A, Marston S, Gould I, Johnston A, Dunne M, Smith G, Kemi OJ, Pillai M, Davidson SM, Yellon DM, Tratsiakovich Y, Jang J, Gonon AT, Pernow J, Matoba T, Koga J, Egashira K, Burke N, Davidson SM, Yellon DM, Korpisalo P, Hakkarainen H, Laidinen S, Yla-Herttuala S, Ferrer-Curriu G, Perez M, Permanyer E, Blasco-Lucas A, Gracia JM, Castro MA, Barquinero J, Galinanes M, Kostina D, Kostareva A, Malashicheva A, Merino D, Ruiz L, Gomez J, Juarez C, Gil A, Garcia R, Hurle MA, Coppini R, Pioner JM, Gentile F, Mazzoni L, Rossi A, Tesi C, Belardinelli L, Olivotto I, Cerbai E, Mugelli A, Poggesi C, Eun-Ji EJ, Lim BK, Choi DJ, Milano G, Bertolotti M, De Marchis F, Zollo F, Sommariva E, Capogrossi MC, Pompilio G, Bianchi ME, Raucci A, Pioner JM, Coppini R, Scellini B, Tardiff J, Tesi C, Poggesi C, Ferrantini C, Mazzoni L, Sartiani L, Coppini R, Diolaiuti L, Ferrari P, Cerbai E, Mugelli A, Mansfield C, Luther P, Knoell R, Villalba M, Sanchez-Cabo F, Lopez-Olaneta MM, Ortiz-Sanchez P, Garcia-Pavia P, Lara-Pezzi E, Klauke B, Gerdes D, Schulz U, Gummert J, Milting H, Wake E, Kocsis-Fodor G, Brack KE, Ng GA, Kostareva A, Smolina N, Majchrzak M, Moehner D, Wies A, Milting H, Stehle R, Pfitzer G, Muegge A, Jaquet K, Maggiorani D, Lefevre L, Dutaur M, Mialet-Perez J, Parini A, Cussac D, Douin-Echinard V, Ebenbauer B, Kaun C, Prager M, Wojta J, Rega-Kaun G, Costa G, Onetti Y, Jimenez-Altayo F, Vila E, Dantas AP, Milano G, Bertolotti M, Scopece A, Piacentini L, Bianchi ME, Capogrossi MC, Pompilio G, Colombo G, Raucci A, Blaz M, Kapelak B, Sanak M, Bauce B, Calore C, Lorenzon A, Calore M, Poloni G, Mazzotti E, Rigato I, Daliento L, Basso C, Thiene G, Melacini P, Corrado D, Rampazzo A, Danilenko NG, Vaikhanskaya TG, Davydenko OG, Szeiffova Bacova B, Kura B, Egan Benova T, Yin CH, Kukreja R, Slezak J, Tribulova N, Lee DI, Sorge M, Glabe C, Paolocci N, Guarnieri C, Tomaselli GF, Kass DA, Van Eyk JE, Agnetti G, Cordwell SJ, White MY, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin X, Mayr U, White S, Jahingiri M, Hill J, Mayr M, Sorriento D, Ciccarelli M, Fiordelisi A, Campiglia P, Trimarco B, Iaccarino G, Sitar Taut AV, Schiau S, Orasan O, Halloumi W, Negrean V, Zdrenghea D, Pop D, Van Der Meer RW, Rijzewijk LJ, Smit JWA, Revuelta-Lopez E, Nasarre L, Escola-Gil JC, Lamb HJ, Llorente-Cortes V, Pellegrino M, Massaro M, Carluccio MA, Calabriso N, Wabitsch M, Storelli C, De Caterina R, Church SJ, Callagy S, Begley P, Kureishy N, Mcharg S, Bishop PN, Unwin RD, Cooper GJS, Mawad D, Perbellini F, Tonkin J, Bello SO, Simonotto JD, Lyon AR, Stevens MM, Terracciano CM, Harding SE, Kernbach M, Czichowski V, Bosio A, Fuentes L, Hernandez-Redondo I, Guillem MS, Fernandez ME, Sanz R, Atienza F, Climent AM, Fernandez-Aviles F, Soler-Botija C, Prat-Vidal C, Galvez-Monton C, Roura S, Perea-Gil I, Bragos R, Bayes-Genis A. Poster session 1Cell growth, differentiation and stem cells - Heart72Understanding the metabolism of cardiac progenitor cells: a first step towards controlling their proliferation and differentiation?73Expression of pw1/peg3 identifies a new cardiac adult stem cell population involved in post-myocardial infarction remodeling74Long-term stimulation of iPS-derived cardiomyocytes using optogenetic techniques to promote phenotypic changes in E-C coupling75Benefits of electrical stimulation on differentiation and maturation of cardiomyocytes from human induced pluripotent stem cells76Constitutive beta-adrenoceptor-mediated cAMP production controls spontaneous automaticity of human induced pluripotent stem cell-derived cardiomyocytes77Formation and stability of T-tubules in cardiomyocytes78Identification of miRNAs promoting human cardiomyocyte proliferation by regulating Hippo pathway79A direct comparison of foetal to adult epicardial cell activation reveals distinct differences relevant for the post-injury response80Role of neuropilins in zebrafish heart regeneration81Highly efficient immunomagnetic purification of cardiomyocytes derived from human pluripotent stem cells82Cardiac progenitor cells posses a molecular circadian clock and display large 24-hour oscillations in proliferation and stress tolerance83Influence of sirolimus and everolimus on bone marrow-derived mesenchymal stem cell biology84Endoglin is important for epicardial behaviour following cardiac injuryCell death and apoptosis - Heart87Ultrastructural alterations reflecting Ca2+ handling and cell-to-cell coupling disorders precede occurrence of severe arrhythmias in intact animal heart88Urocortin-1 promotes cardioprotection through ERK1/2 and EPAC pathways: role in apoptosis and necrosis89Expression p38 MAPK and Cas-3 in myocardium LV of rats with experimental heart failure at melatonin and enalapril introductionTranscriptional control and RNA species - Heart92Accumulation of beta-amyloid 1-40 in HF patients: the role of lncRNA BACE1-AS93Role of miR-182 in zebrafish and mouse models of Holt-Oram syndrome94Mir-27 distinctly regulates muscle-enriched transcription factors and growth factors in cardiac and skeletal muscle cells95AF risk factors impair PITX2 expression leading to Wnt-microRNA-ion channel remodelingCytokines and cellular inflammation - Heart98Post-infarct survival depends on the interplay of monocytes, neutrophils and interferon gamma in a mouse model of myocardial Infarction99Inflammatory cd11b/c cells play a protective role in compensated cardiac hypertrophy by promoting an orai3-related pro-survival signal100Anti-inflammatory effects of endothelin receptor blockade in the atrial tissue of spontaneously hypertensive rats101Mesenchymal stromal cells reduce NLRP3 inflammasome activity in Coxsackievirus B3-induced myocarditis102Mesenchymal stromal cells modulate monocytes trafficking in Coxsackievirus B3-induced myocarditis103The impact of regulatory T lymphocytes on long-term mortality in patients with chronic heart failure104Temporal dynamics of dendritic cells after ST-elevation myocardial infarction relate with improvement of myocardial functionGrowth factors and neurohormones - Heart107Preconditioning of hypertrophied heart: miR-1 and IGF-1 crosstalk108Modulation of catecholamine secretion from human adrenal chromaffin cells by manipulation of G protein-coupled receptor kinase-2 activity109Evaluation of cyclic adenosin-3,5- monophosphate and neurohormones in patients with chronic heart failureNitric oxide and reactive oxygen species - Heart112Hydrogen sulfide donor inhibits oxidative and nitrosative stress, cardiohemodynamics disturbances and restores cNOS coupling in old rats113Role and mechanisms of action of aldehydes produced by monoamine oxidase A in cardiomyocyte death and heart failure114Exercise training has contrasting effects in myocardial infarction and pressure-overload due to different endothelial nitric oxide synthase regulation115S-Nitroso Human Serum Albumin dose-dependently leads to vasodilation and alters reactive hyperaemia in coronary arteries of an isolated mouse heart model116Modulating endothelial nitric oxide synthase with folic acid attenuates doxorubicin-induced cardiomyopathy119Effects of long-term very high intensity exercise on aortic structure and function in an animal model120Electron paramagnetic resonance spectroscopy quantification of nitrosylated hemoglobin (HbNO) as an index of vascular nitric oxide bioavailability in vivo121Deletion of repressor activator protein 1 impairs acetylcholine-induced relaxation due to production of reactive oxygen speciesExtracellular matrix and fibrosis - Heart124MicroRNA-19b is associated with myocardial collagen cross-linking in patients with severe aortic stenosis. Potential usefulness as a circulating biomarker125A new ex vivo model to study cardiac fibrosis126Heterogeneity of fibrosis and fibroblast differentiation in the left ventricle after myocardial infarction127Effect of carbohydrate metabolism degree compensation to the level of galectin-3 changes in hypertensive patients with chronic heart failure and type 2 diabetes mellitus128Statin paradox in association with calcification of bicuspid aortic valve interstitial cells129Cardiac function remains impaired despite reversible cardiac fibrosis after healed experimental viral myocarditisIon channels, ion exchangers and cellular electrophysiology - Heart132Identifying a novel role for PMCA1 (Atp2b1) in heart rhythm instability133Mutations of the caveolin-3 gene as a predisposing factor for cardiac arrhythmias134The human sinoatrial node action potential: time for a computational model135iPSC-derived cardiomyocytes as a model to dissect ion current alterations of genetic atrial fibrillation136Postextrasystolic potentiation in healthy and diseased hearts: effects of the site of origin and coupling interval of the preceding extrasystole137Absence of Nav1.8-based (late) sodium current in rabbit cardiomyocytes and human iPSC-CMs138hiPSC-derived cardiomyocytes from Brugada Syndrome patients without identified mutations do not exhibit cellular electrophysiological abnormalitiesMicrocirculation141Atherogenic indices, collagen type IV turnover and the development of microvascular complications- study in diabetics with arterial hypertension142Changes in the microvasculature and blood viscosity in women with rheumatoid arthritis, hypercholesterolemia and hypertensionAtherosclerosis145Shear stress regulates endothelial autophagy: consequences on endothelial senescence and atherogenesis146Obstructive sleep apnea causes aortic remodeling in a chronic murine model147Aortic perivascular adipose tissue displays an aged phenotype in early and late atherosclerosis in ApoE-/- mice148A systematic evaluation of the cellular innate immune response during the process of human atherosclerosis149Inhibition of Coagulation factor Xa increases plaque stability and attenuates the onset and progression of atherosclerotic plaque in apolipoprotein e-deficient mice150Regulatory CD4+ T cells from patients with atherosclerosis display pro-inflammatory skewing and enhanced suppression function151Hypoxia-inducible factor (HIF)-1alpha regulates macrophage energy metabolism by mediating miRNAs152Extracellular S100A4 is a key player of smooth muscle cell phenotypic transition: implications in atherosclerosis153Microparticles of healthy origins improve atherosclerosis-associated endothelial progenitor cell dysfunction via microRNA transfer154Arterial remodeling and metabolism impairment in early atherosclerosis155Role of pannexin1 in atherosclerotic plaque formationCalcium fluxes and excitation-contraction coupling158Amphiphysin II induces tubule formation in cardiac cells159Interleukin 1 beta regulation of connexin 43 in cardiac fibroblasts and the effects of adult cardiac myocyte:fibroblast co-culture on myocyte contraction160T-tubular electrical defects contribute to blunted beta-adrenergic response in heart failure161Beat-to-beat variability of intracellular Ca2+ dynamics of Purkinje cells in the infarct border zone of the mouse heart revealed by rapid-scanning confocal microscopy162The efficacy of late sodium current blockers in hypertrophic cardiomyopathy is dependent on genotype: a study on transgenic mouse models with different mutations163Synthesis of cADPR and NAADP by intracellular CD38 in heart: role in inotropic and arrhythmogenic effects of beta-adrenoceptor signalingContractile apparatus166Towards an engineered heart tissue model of HCM using hiPSC expressing the ACTC E99K mutation167Diastolic mechanical load delays structural and functional deterioration of ultrathin adult heart slices in culture168Structural investigation of the cardiac troponin complex by molecular dynamics169Exercise training restores myocardial and oxidative skeletal muscle function from myocardial infarction heart failure ratsOxygen sensing, ischaemia and reperfusion172A novel antibody specific to full-length stromal derived factor-1 alpha reveals that remote conditioning induces its cleavage by endothelial dipeptidyl peptidase 4173Attenuation of myocardial and vascular arginase activity by vagal nerve stimulation via a mechanism involving alpha-7 nicotinic receptor during cardiac ischemia and reperfusion174Novel nanoparticle-mediated medicine for myocardial ischemia-reperfusion injury simultaneously targeting mitochondrial injury and myocardial inflammation175Acetylcholine plays a key role in myocardial ischaemic preconditioning via recruitment of intrinsic cardiac ganglia176The role of nitric oxide and VEGFR-2 signaling in post ischemic revascularization and muscle recovery in aged hypercholesterolemic mice177Efficacy of ischemic preconditioning to protect the human myocardium: the role of clinical conditions and treatmentsCardiomyopathies and fibrosis180Plakophilin-2 haploinsufficiency leads to impaired canonical Wnt signaling in ARVC patient181Improved technique for customized, easier, safer and more reliable transverse aortic arch banding and debanding in mice as a model of pressure overload hypertrophy182Late sodium current inhibitors for the treatment of inducible obstruction and diastolic dysfunction in hypertrophic cardiomyopathy: a study on human myocardium183Angiotensin II receptor antagonist fimasartan has protective role of left ventricular fibrosis and remodeling in the rat ischemic heart184Role of High-Mobility Group Box 1 (HMGB1) redox state on cardiac fibroblasts activities and heart function after myocardial infarction185Atrial remodeling in hypertrophic cardiomyopathy: insights from mouse models carrying different mutations in cTnT186Electrophysiological abnormalities in ventricular cardiomyocytes from a Maine Coon cat with hypertrophic cardiomyopathy: effects of ranolazine187ZBTB17 is a novel cardiomyopathy candidate gene and regulates autophagy in the heart188Inhibition of SRSF4 in cardiomyocytes induces left ventricular hypertrophy189Molecular characterization of a novel cardiomyopathy related desmin frame shift mutation190Autonomic characterisation of electro-mechanical remodeling in an in-vitro leporine model of heart failure191Modulation of Ca2+-regulatory function by three novel mutations in TNNI3 associated with severe infant restrictive cardiomyopathyAging194The aging impact on cardiac mesenchymal like stromal cells (S+P+)195Reversal of premature aging markers after bariatric surgery196Sex-associated differences in vascular remodeling during aging: role of renin-angiotensin system197Role of the receptor for advanced glycation end-products (RAGE) in age dependent left ventricle dysfunctionsGenetics and epigenetics200hsa-miR-21-5p as a key factor in aortic remodeling during aneurysm formation201Co-inheritance of mutations associated with arrhythmogenic and hypertrophic cardiomyopathy in two Italian families202Lamin a/c hot spot codon 190: form various amino acid substitutions to clinical effects203Treatment with aspirin and atorvastatin attenuate cardiac injury induced by rat chest irradiation: Implication of myocardial miR-1, miR-21, connexin-43 and PKCGenomics, proteomics, metabolomics, lipidomics and glycomics206Differential phosphorylation of desmin at serines 27 and 31 drives the accumulation of preamyloid oligomers in heart failure207Potential role of kinase Akt2 in the reduced recovery of type 2 diabetic hearts subjected to ischemia / reperfusion injury208A proteomics comparison of extracellular matrix remodelling in porcine coronary arteries upon stent implantationMetabolism, diabetes mellitus and obesity211Targeting grk2 as therapeutic strategy for cancer associated to diabetes212Effects of salbutamol on large arterial stiffness in patients with metabolic syndrome213Circulating microRNA-1 and microRNA-133a: potential biomarkers of myocardial steatosis in type 2 diabetes mellitus214Anti-inflammatory nutrigenomic effects of hydroxytyrosol in human adipocytes - protective mechanisms of mediterranean diets in obesity-related inflammation215Alterations in the metal content of different cardiac regions within a rat model of diabetic cardiomyopathyTissue engineering218A novel conductive patch for application in cardiac tissue engineering219Establishment of a simplified and improved workflow from neonatal heart dissociation to cardiomyocyte purification and characterization220Effects of flexible substrate on cardiomyocytes cell culture221Mechanical stretching on cardiac adipose progenitors upregulates sarcomere-related genes. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ackerson BK, Sy LS, Slezak J, Chao CR, Hechter RC, Takhar HS, Jacobsen SJ. Unmasking in an observational vaccine safety study: Using type 2 diabetes mellitus as an example. Vaccine 2015; 33:6224-6. [PMID: 26440925 DOI: 10.1016/j.vaccine.2015.09.080] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In observational vaccine safety studies, diagnosis codes assigned prior to or on the day of vaccination (Day 0) are often excluded from analysis of safety signals since they usually represent pre-existing conditions. The limitations of this approach have been described for autoimmune conditions but not for other chronic conditions. We draw on our experience in a post-licensure quadrivalent human papillomavirus vaccine (HPV4) safety study to examine the effectiveness of exclusion of pre-existing and Day 0 diagnoses of type 2 diabetes mellitus (T2DM) in excluding prevalent T2DM. METHODS Subjects included all 117,402 females ages 9-26 years who received HPV4 August 2006-March 2008 in Kaiser Permanente Southern California. We identified potential incident T2DM cases using ICD9 code 250.xx associated with inpatient and emergency room visits during the 60 days following each HPV4 dose, excluding those with this code prior to their first HPV4 dose. Electronic medical records were reviewed to determine the dates of symptom onset, diagnostic labs, vaccine administration and T2DM diagnosis. RESULTS Of 33 potential incident T2DM cases identified using automated data, 4 (12%) were confirmed to have new onset T2DM after medical record review. Nineteen cases were excluded that did not have T2DM or had T2DM diagnosed before Day 0; nine had an abnormal fasting blood sugar (FBS) ordered on Day 0, prompting subsequent evaluation and diagnosis of T2DM; and one had elevated FBS and glucosuria prior to the first dose of HPV4 but T2DM diagnosed at a visit following vaccination. CONCLUSION These results suggest that among adolescents and young adults, the workup and subsequent diagnosis of pre-existing conditions may result from a visit at which a vaccination is administered. This "unmasking" phenomenon is not entirely eliminated by exclusion of pre-existing and Day 0 diagnoses. Medical record review should be considered in the evaluation of potential safety signals.
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Affiliation(s)
- Bradley K Ackerson
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA.
| | - Lina S Sy
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
| | - Jeff Slezak
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
| | - Chun R Chao
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
| | - Rulin C Hechter
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
| | - Harpreet S Takhar
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
| | - Steven J Jacobsen
- Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA 91101, USA
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Kilday P, Elliott P, Abdelsayed G, Slezak J, Rodriguez E, Harrison T, Jacobsen SJ, Chien GW. MP14-01 USING THE EPIC 26 QOL QUESTIONNAIRE TO DETECT AND ASSESS DEPRESSION IN PATIENTS WITH PROSTATE CANCER. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chu WG, Kim BJ, Slezak J, Harrison TN, Gelfond J, Jacobsen SJ, Chien GW. The effect of urologist experience on choosing active surveillance for prostate cancer. World J Urol 2015; 33:1701-6. [PMID: 25761737 DOI: 10.1007/s00345-015-1528-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/12/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the impact of the urologist's experience in selecting active surveillance (AS) versus immediate treatment (IT) for low-risk prostate cancer. METHODS Men with low-risk prostate cancer were enrolled from March 2011 to August 2013 at 13 medical centers in Kaiser Permanente Southern California. The AS cohort was defined as men who had cT1-T2a stage prostate cancer, prostate-specific antigen <10 ng/ml, a biopsy revealing Gleason grade ≤6, fewer than three biopsy cores positive, ≤50 % cancer in any core, and not undergone immediate therapy (surgery, radiation, other) within 6 months following diagnosis. The urologist's experience (age, number of years in practice, number of robotic surgeries performed, and fellowship experience in oncology and/or robotics) was then compared between AS and IT cohorts. RESULTS A total of 4754 men were diagnosed with prostate cancer, and 713 men satisfied with inclusion criteria; 433 (60.7 %) and 280 (39.3 %) chose AS and IT, respectively. A total of 87 urologists were included. Univariate and multivariate adjusted analyses revealed no differences in urologist's age or years in practice. Patients who saw urologists who had performed ≥50 robotic surgeries were less likely to choose AS (OR 0.40, 95 % CI 0.25-0.66). Patients who saw urologists with a fellowship in oncology and/or robotics were more than twice as likely to choose AS (OR 2.27, 95 % CI 1.38-3.75). CONCLUSION These data suggest that the decision to pursue AS may be influenced by the urologist's experience.
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Affiliation(s)
- William G Chu
- Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA
| | - Brian J Kim
- Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA
| | - Jeff Slezak
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA
| | - Teresa N Harrison
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA
| | - Joy Gelfond
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA
| | - Steven J Jacobsen
- Research and Evaluation Department, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101, USA
| | - Gary W Chien
- Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, 4900 Sunset Blvd., 2nd Floor, Los Angeles, CA, 90027, USA.
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Lawson RD, Hunt GC, Giap AQ, Krinsky ML, Slezak J, Tang RS, Gonzalez I, Kwong WT, Fehmi SA, Savides TJ. Pancreatic cysts suspected to be branch duct intraductal papillary mucinous neoplasm without concerning features have low risk for development of pancreatic cancer. Ann Gastroenterol 2015; 28:487-94. [PMID: 26423829 PMCID: PMC4585397] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The risk of developing pancreatic cancer is uncertain in patients with clinically suspected branch duct intraductal papillary mucinous neoplasm (BD-IPMN) based on the "high-risk stigmata" or "worrisome features" criteria proposed in the 2012 international consensus guidelines ("Fukuoka criteria"). METHODS Retrospective case series involving patients referred for endoscopic ultrasound (EUS) of indeterminate pancreatic cysts with clinical and EUS features consistent with BD-IPMN. Rates of pancreatic cancer occurring at any location in the pancreas were compared between groups of patients with one or more Fukuoka criteria ("Highest-Risk Group", HRG) and those without these criteria ("Lowest-Risk Group", LRG). RESULTS After exclusions, 661 patients comprised the final cohort (250 HRG and 411 LRG patients), 62% female with an average age of 67 years and 4 years of follow up. Pancreatic cancer, primarily adenocarcinoma, occurred in 60 patients (59 HRG, 1 LRG). Prevalent cancers diagnosed during EUS, immediate surgery, or first year of follow up were found in 48/661 (7.3%) of cohort and exclusively in HRG (33/77, 42.3%). Using Kaplan-Meier method, the cumulative incidence of cancer at 7 years was 28% in HRG and 1.2% in LRG patients (P<0.001). CONCLUSIONS This study supports using Fukuoka criteria to stratify the immediate and long-term risks of pancreatic cancer in presumptive BD-IPMN. The risk of pancreatic cancer was highest during the first year and occurred exclusively in those with "high-risk stigmata" or "worrisome features" criteria. After the first year all BD-IPMN continued to have a low but persistent cancer risk.
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Affiliation(s)
- Robert D. Lawson
- Department of Gastroenterology, Naval Medical Center, San Diego, California (Robert D. Lawson),
Correspondence to: Robert D. Lawson, MD, Department of Gastroenterology, Naval Medical Center, Bob Wilson Drive, San Diego, California 92134, USA, Fax: +619 532 9720, e-mail:
| | - Gordon C. Hunt
- Department of Gastroenterology, Kaiser Permanente, San Diego, California (Gordon C. Hunt)
| | - Andrew Q. Giap
- Department of Gastroenterology, Kaiser Permanente, Anaheim, California (Andrew Q. Giap)
| | - Mary L. Krinsky
- Department of Gastroenterology, Veterans Affairs Medical Center, La Jolla, California (Mary L. Krinsky)
| | - Jeff Slezak
- Department of Gastroenterology, Department of Research and Evaluation, Kaiser Permanente, Pasadena, California (Jeff Slezak)
| | - Raymond S. Tang
- Department of Gastroenterology, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (Raymond S. Tang)
| | - Ingrid Gonzalez
- Department of Gastroenterology, Digestive Health Specialists, Winston-Salem, North Carolina (Ingrid Gonzalez)
| | - Wilson T. Kwong
- Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides)
| | - Syed A. Fehmi
- Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides)
| | - Thomas J. Savides
- Department of Gastroenterology, Division of Gastroenterology, University of California, La Jolla, California (Wilson T. Kwong, Sayed A. Fehmi, Thomas J. Savides)
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Chao C, Preciado M, Slezak J, Xu L. A randomized intervention of reminder letter for human papillomavirus vaccine series completion. J Adolesc Health 2015; 56:85-90. [PMID: 25438965 DOI: 10.1016/j.jadohealth.2014.08.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Completion rate for the three-dose series of the human papillomavirus (HPV) vaccine has generally been low. This study evaluated the effectiveness of a reminder letter intervention on HPV vaccine three-dose series completion. METHODS Female members of Kaiser Permanente Southern California Health Plan who received at least one dose, but not more than two doses, of the HPV vaccine by February 13, 2013, and who were between ages 9 and 26 years at the time of first HPV vaccination were included. Eighty percent of these females were randomized to receive the reminder letter, and 20% were randomized to receive standard of care (control). The reminder letters were mailed quarterly to those who had not completed the series. The proportion of series completion at the end of the 12-month evaluation period was compared using chi-square test. RESULTS A total of 9,760 females were included in the intervention group and 2,445 in the control group. HPV vaccine series completion was 56.4% in the intervention group and 46.6% in the control groups (p < .001). The effect of the intervention appeared to be stronger in girls aged 9-17 years compared with young women aged 18-26 years at the first dose and in blacks compared with whites. CONCLUSIONS Reminder letters scheduled quarterly were effective to enhance HPV vaccine series completion among those who initiated the vaccine. However, a large gap in series completion remained despite the intervention. Future studies should address other barriers to series completion, including those at the providers and the health care system level.
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Affiliation(s)
- Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
| | - Melissa Preciado
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Lanfang Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Viczenczova C, Bacova B, Benova T, Kura B, Yin C, Kukreja R, Slezak J, Tribulova N. P571Irradiation of thorax triggers signaling with potential acute cardioprotective benefits in rats. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tribulova N, Benova T, Radosinska J, Bacova B, Viczenczova C, Knezl V, Zeman M, Obsitnik B, Slezak J. P242Non-pharmacological interventions protect from malignant arrhythmias partially by targeting myocardial Cx43 channels in experimental model of hypertension. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.174] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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