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Tailor PD, Dalvin LA, Chen JJ, Iezzi R, Olsen TW, Scruggs BA, Barkmeier AJ, Bakri SJ, Ryan EH, Tang PH, Parke DW, Belin PJ, Sridhar J, Xu D, Kuriyan AE, Yonekawa Y, Starr MR. A Comparative Study of Responses to Retina Questions from Either Experts, Expert-Edited Large Language Models, or Expert-Edited Large Language Models Alone. Ophthalmol Sci 2024; 4:100485. [PMID: 38660460 PMCID: PMC11041826 DOI: 10.1016/j.xops.2024.100485] [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] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/03/2024] [Accepted: 02/01/2024] [Indexed: 04/26/2024]
Abstract
Objective To assess the quality, empathy, and safety of expert edited large language model (LLM), human expert created, and LLM responses to common retina patient questions. Design Randomized, masked multicenter study. Participants Twenty-one common retina patient questions were randomly assigned among 13 retina specialists. Methods Each expert created a response (Expert) and then edited a LLM (ChatGPT-4)-generated response to that question (Expert + artificial intelligence [AI]), timing themselves for both tasks. Five LLMs (ChatGPT-3.5, ChatGPT-4, Claude 2, Bing, and Bard) also generated responses to each question. The original question along with anonymized and randomized Expert + AI, Expert, and LLM responses were evaluated by the other experts who did not write an expert response to the question. Evaluators judged quality and empathy (very poor, poor, acceptable, good, or very good) along with safety metrics (incorrect information, likelihood to cause harm, extent of harm, and missing content). Main Outcome Mean quality and empathy score, proportion of responses with incorrect information, likelihood to cause harm, extent of harm, and missing content for each response type. Results There were 4008 total grades collected (2608 for quality and empathy; 1400 for safety metrics), with significant differences in both quality and empathy (P < 0.001, P < 0.001) between LLM, Expert and Expert + AI groups. For quality, Expert + AI (3.86 ± 0.85) performed the best overall while GPT-3.5 (3.75 ± 0.79) was the top performing LLM. For empathy, GPT-3.5 (3.75 ± 0.69) had the highest mean score followed by Expert + AI (3.73 ± 0.63). By mean score, Expert placed 4 out of 7 for quality and 6 out of 7 for empathy. For both quality (P < 0.001) and empathy (P < 0.001), expert-edited LLM responses performed better than expert-created responses. There were time savings for an expert-edited LLM response versus expert-created response (P = 0.02). ChatGPT-4 performed similar to Expert for inappropriate content (P = 0.35), missing content (P = 0.001), extent of possible harm (P = 0.356), and likelihood of possible harm (P = 0.129). Conclusions In this randomized, masked, multicenter study, LLM responses were comparable with experts in terms of quality, empathy, and safety metrics, warranting further exploration of their potential benefits in clinical settings. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of the article.
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Affiliation(s)
| | | | - John J. Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Sophie J. Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Edwin H. Ryan
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Peter H. Tang
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - D. Wilkin. Parke
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Jayanth Sridhar
- Olive View Medical Center, University of California Los Angeles, Los Angeles, California
| | - David Xu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Chen JJ, Jiang YR. [Standardized diagnosis and assessment of overweight or obesity in children]. Zhonghua Er Ke Za Zhi 2024; 62:494-496. [PMID: 38623023 DOI: 10.3760/cma.j.cn112140-20240130-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- J J Chen
- Child Health Care Medical Division, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
| | - Y R Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Aboseif A, Vorasoot N, Pinto MV, Guo Y, Hasan S, Zekeridou A, Chen JJ, Dubey D. Immune Checkpoint Inhibitor-Associated Kelch-Like Protein-11 IgG Brainstem Encephalitis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200218. [PMID: 38484218 DOI: 10.1212/nxi.0000000000200218] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/19/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Kelch-like protein-11 (KLHL11)-IgG is associated with rhombencephalitis and seminoma. It has not previously been described as a neurologic immune checkpoint inhibitor (ICI)-related adverse event (nirAE) or in association with esophageal adenocarcinoma. METHODS We describe a 61-year-old man with metastatic esophageal adenocarcinoma treated with folinic acid, fluorouracil, oxaliplatin (FOLFOX), and nivolumab, who subsequently developed diplopia, vertigo, and progressive gait ataxia after 8 weeks of treatment. RESULTS Owing to a concern for ICI-associated myasthenia gravis, nivolumab was held and he was treated with prednisone and pyridostigmine. EMG showed no neuromuscular junction dysfunction, and acetylcholine-receptor antibodies were negative. Brain MRI was unrevealing. Murine brain tissue immunofluorescence assay revealed KLHL11-IgG in both serum and CSF, confirmed by cell-based assay. Tumor histopathology demonstrated poorly differentiated, highly proliferative adenocarcinoma with increased mitotic figures and cytoplasmic KLHL11 immunoreactivity. He was initiated on 6 months of cyclophosphamide in addition to FOLFOX for post-ICI-associated KLHL11-IgG rhombencephalitis. DISCUSSION We report KLHL11-IgG rhombencephalitis associated with poorly differentiated esophageal cancer as a novel nirAE. Tumor staining revealed KLHL11 immunoreactivity, supporting a cancer-antigen-driven ICI-associated paraneoplastic syndrome. Recognition of novel nirAEs can expedite treatment and potentially prevent progressive neurologic disability.
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Affiliation(s)
- Albert Aboseif
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Nisa Vorasoot
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Marcus V Pinto
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Yong Guo
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Shemonti Hasan
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Anastasia Zekeridou
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - John J Chen
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
| | - Divyanshu Dubey
- From the Center for Multiple Sclerosis and Autoimmune Neurology (A.A., N.V., Y.G., S.H., A.Z., J.J.C., D.D.), Department of Neurology; Department of Laboratory Medicine and Pathology (N.V., Y.G., A.Z., D.D.); Department of Neurology (N.V.), Mayo Clinic College of Medicine, Rochester, MN; Division of Neurology (M.V.P.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; and Department of Ophthalmology (J.J.C.), Mayo Clinic College of Medicine, Rochester, MN
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Tisavipat N, Stiebel-Kalish H, Palevski D, Bialer OY, Moss HE, Chaitanuwong P, Padungkiatsagul T, Henderson AD, Sotirchos ES, Singh S, Salman AR, Tajfirouz DA, Chodnicki KD, Pittock SJ, Flanagan EP, Chen JJ. Acute Optic Neuropathy in Older Adults: Differentiating Between MOGAD Optic Neuritis and Nonarteritic Anterior Ischemic Optic Neuropathy. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200214. [PMID: 38547435 DOI: 10.1212/nxi.0000000000200214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. METHODS In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. RESULTS Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50-61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299-473.181), while crowded optic disc (OR 0.033; 95% CI 0.002-0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002-0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%-14%) of those had false-positive serum MOG-IgG at low titers. DISCUSSION Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Hadas Stiebel-Kalish
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Dahlia Palevski
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Omer Y Bialer
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Heather E Moss
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pareena Chaitanuwong
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Tanyatuth Padungkiatsagul
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Amanda D Henderson
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elias S Sotirchos
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Shonar Singh
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Abdul-Rahman Salman
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Deena A Tajfirouz
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Kevin D Chodnicki
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
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5
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Redenbaugh V, Fryer JP, Cacciaguerra L, Chen JJ, Greenwood TM, Gilligan M, Thakolwiboon S, Majed M, Chia NH, McKeon A, Mills JR, Lopez Chiriboga AS, Tillema JM, Yang B, Abdulrahman Y, Guo K, Vorasoot N, Valencia Sanchez C, Tajfirouz DA, Toledano M, Zekeridou A, Dubey D, Gombolay GY, Caparó-Zamalloa C, Kister I, Pittock SJ, Flanagan EP. Diagnostic Utility of MOG Antibody Testing in Cerebrospinal Fluid. Ann Neurol 2024. [PMID: 38591875 DOI: 10.1002/ana.26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic utility of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) testing. METHODS We retrospectively identified patients for CSF MOG-IgG testing from January 1, 1996, to May 1, 2023, at Mayo Clinic and other medical centers that sent CSF MOG-IgG for testing including: controls, 282; serum MOG-IgG positive MOG antibody-associated disease (MOGAD), 74; serum MOG-IgG negative high-risk phenotypes, 73; serum false positive MOG-IgG with alternative diagnoses, 18. A live cell-based assay assessed CSF MOG-IgG positivity (IgG-binding-index [IBI], ≥2.5) using multiple anti-human secondary antibodies and end-titers were calculated if sufficient sample volume. Correlation of CSF MOG-IgG IBI and titer was assessed. RESULTS The pan-IgG Fc-specific secondary was optimal, yielding CSF MOG-IgG sensitivity of 90% and specificity of 98% (Youden's index 0.88). CSF MOG-IgG was positive in: 4/282 (1.4%) controls; 66/74 (89%) serum MOG-IgG positive MOGAD patients; and 9/73 (12%) serum MOG-IgG negative patients with high-risk phenotypes. Serum negative but CSF positive MOG-IgG accounted for 9/83 (11%) MOGAD patients, and all fulfilled 2023 MOGAD diagnostic criteria. Subgroup analysis of serum MOG-IgG low-positives revealed CSF MOG-IgG positivity more in MOGAD (13/16[81%]) than other diseases with false positive serum MOG-IgG (3/15[20%]) (p = 0.01). CSF MOG-IgG IBI and CSF MOG-IgG titer (both available in 29 samples) were correlated (Spearman's r = 0.64, p < 0.001). INTERPRETATION CSF MOG-IgG testing has diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG, and those with low positive serum MOG-IgG results and diagnostic uncertainty. These findings support a role for CSF MOG-IgG testing in the appropriate clinical setting. ANN NEUROL 2024.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - James P Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laura Cacciaguerra
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John J Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tammy M Greenwood
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michael Gilligan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Smathorn Thakolwiboon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Masoud Majed
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nicholas H Chia
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Jan-Mendelt Tillema
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Binxia Yang
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Yahya Abdulrahman
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kai Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nisa Vorasoot
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Deena A Tajfirouz
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michel Toledano
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Grace Y Gombolay
- Emory University, Children's Healthcare of Atlanta: Pediatrics Institute, Atlanta, Georgia, USA
| | - César Caparó-Zamalloa
- Basic Research Center in Dementia and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Sean J Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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6
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Bruno MK, Matsunaga M, Krening E, Gao F, Chen JJ, Seto T, Ross GW. The Prevalence of Hospitalized Parkinson's Disease Patients in All Case Hospitalization among Different Race/Ethnic Subgroups in Hawai'i. J Parkinsons Dis 2024:JPD230341. [PMID: 38607763 DOI: 10.3233/jpd-230341] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Background Little is known about the epidemiology of Parkinson's disease (PD) patients in Native Hawaiian Or Other Pacific Islander (NHPI) and Asian American (AA) subgroups. Objective To determine if the prevalence of hospitalized PD patients is different across age groups and racial/ethnic subgroups in Hawai'i. Methods We conducted a retrospective analysis of Hawai'i statewide registry (2016-2020) hospitalization data for patients who were 50 years or older. PD patients were identified using an ICD 10 code: Parkinson's Disease (G20) as their primary/secondary hospitalization discharge diagnosis code. Demographic and clinical characteristics among racial/ethnic subgroups (White, Japanese, Filipino, Chinese, NHPI, or Other) were compared. Results Of 146,844 total hospitalized patients (n = 429,879 records), 1.6% (n = 2,401) had a PD diagnosis. The prevalence of hospitalized PD patients was 2.3% among Japanese and Chinese, followed by 1.7% for Whites, 1.2% for Filipinos and was lowest for NHPI with 0.9% (p < 0.001). As patient's age increased, the prevalence of hospitalized PD patients increased, with 80-84 years old for the highest age range (3.4%). The prevalence of hospitalized PD patients at 80-84 years old varied across the race/ethnic subgroups (Chinese 4.3%, Japanese 4.0%, Whites 3.7%, Filipinos 2.5%, NHPI 2.3%). Conclusions The prevalence of hospitalized PD patients among all case hospitalizations were lower for NHPI and Filipino compared to that of Japanese, Chinese, and Whites. As patients' age increased, the prevalence of hospitalized patients with PD increased, but less so in NHPI and Filipino groups. Further research is warranted to understand the reason for these observed differences among racial/ethnic subgroups.
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Affiliation(s)
- Michiko Kimura Bruno
- The Queen's Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Masako Matsunaga
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | | | - Fay Gao
- The Queen's Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - John J Chen
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - Todd Seto
- The Queen's Medical Center, Honolulu, HI, USA
- University of Hawaii John A, Burns School of Medicine, Honolulu, HI, USA
| | - G Webster Ross
- Pacific Health Research and Education Institute, VA Pacific Islands Health CareSystem, Honolulu, HI, USA
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7
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Tailor PD, Dalvin LA, Starr MR, Tajfirouz DA, Chodnicki KD, Brodsky MC, Mansukhani SA, Moss HE, Lai KE, Ko MW, Mackay DD, Di Nome MA, Dumitrascu OM, Pless ML, Eggenberger ER, Chen JJ. A Comparative Study of Large Language Models, Human Experts, and Expert-Edited Large Language Models to Neuro-Ophthalmology Questions. J Neuroophthalmol 2024:00041327-990000000-00607. [PMID: 38564282 DOI: 10.1097/wno.0000000000002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND While large language models (LLMs) are increasingly used in medicine, their effectiveness compared with human experts remains unclear. This study evaluates the quality and empathy of Expert + AI, human experts, and LLM responses in neuro-ophthalmology. METHODS This randomized, masked, multicenter cross-sectional study was conducted from June to July 2023. We randomly assigned 21 neuro-ophthalmology questions to 13 experts. Each expert provided an answer and then edited a ChatGPT-4-generated response, timing both tasks. In addition, 5 LLMs (ChatGPT-3.5, ChatGPT-4, Claude 2, Bing, Bard) generated responses. Anonymized and randomized responses from Expert + AI, human experts, and LLMs were evaluated by the remaining 12 experts. The main outcome was the mean score for quality and empathy, rated on a 1-5 scale. RESULTS Significant differences existed between response types for both quality and empathy (P < 0.0001, P < 0.0001). For quality, Expert + AI (4.16 ± 0.81) performed the best, followed by GPT-4 (4.04 ± 0.92), GPT-3.5 (3.99 ± 0.87), Claude (3.6 ± 1.09), Expert (3.56 ± 1.01), Bard (3.5 ± 1.15), and Bing (3.04 ± 1.12). For empathy, Expert + AI (3.63 ± 0.87) had the highest score, followed by GPT-4 (3.6 ± 0.88), Bard (3.54 ± 0.89), GPT-3.5 (3.5 ± 0.83), Bing (3.27 ± 1.03), Expert (3.26 ± 1.08), and Claude (3.11 ± 0.78). For quality (P < 0.0001) and empathy (P = 0.002), Expert + AI performed better than Expert. Time taken for expert-created and expert-edited LLM responses was similar (P = 0.75). CONCLUSIONS Expert-edited LLM responses had the highest expert-determined ratings of quality and empathy warranting further exploration of their potential benefits in clinical settings.
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Affiliation(s)
- Prashant D Tailor
- Department of Ophthalmology (PDT, LAD, MRS, DAT, KDC, MCB, SAM, JJC), Mayo Clinic, Rochester, Minnesota; Departments of Ophthalmology (HEM) and Neurology & Neurological Sciences (HEM), Stanford University, Palo Alto, California; Department of Ophthalmology (KEL, MWK, DDM), Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana; Ophthalmology Service (KEL), Richard L. Roudebush Veterans' Administration Medical Center, Indianapolis, Indiana; Department of Ophthalmology and Visual Sciences (KEL), University of Louisville, Louisville, Kentucky; Midwest Eye Institute (KEL), Carmel, Indiana; Circle City Neuro-Ophthalmology (KEL), Carmel, Indiana; Department of Neurology (MWK, DDM), Indiana University, Indianapolis, Indiana; Department of Ophthalmology (MADN, OMD), Mayo Clinic, Scottsdale, Arizona; and Department of Ophthalmology (MLP, ERE), Mayo Clinic, Jacksonville, Florida
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8
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Chen JJ, McNussen PJ, Lee AG, Subramanian PS. Re: Pakravan et al.: Demographics, practice analysis and geographic distribution of neuro-ophthalmologists in the United States in 2023 (Ophthalmology. 2024;131:333-340). Ophthalmology 2024; 131:e17-e18. [PMID: 38189696 DOI: 10.1016/j.ophtha.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota.
| | | | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Neurology, Neurosurgery, and Ophthalmology, Weill Cornell Medicine, New York, New York; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology, Texas A&M University College of Medicine, Houston, Texas; Baylor College of Medicine and Center for Space Medicine, Houston, Texas; University of Iowa Hospitals and Clinics, Iowa City, Iowa; University of Buffalo, Buffalo, New York
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine and Sue Anschutz-Rodgers UC Health Eye Center, Aurora, Colorado
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9
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Bruno MK, Matsunaga M, Krening E, Nakagawa K, Chen JJ, Seto T, Gao F, Tanner C, Ross GW. Racial disparities in hospitalization characteristics among Native Hawaiians, Pacific Islanders and Asian American subgroups with Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106018. [PMID: 38359475 DOI: 10.1016/j.parkreldis.2024.106018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Differences among Native Hawaiians/Pacific Islanders (NHPI) and Asian American (AA) subgroups have not been adequately studied in Parkinson's disease (PD). OBJECTIVE To determine differences in demographics, comorbidities, and healthcare utilization among NHPI, AA subgroups, and White hospitalized PD patients. METHODS We conducted a retrospective cross-sectional analysis of Hawai'is statewide registry (2016-2020). Patients with PD were identified using ICD10 code G20 and categorized as White, Japanese, Filipino, Chinese, NHPI, or Other. Variables collected included: age, sex, residence (county), primary source of payment, discharge status, length of stay, in-hospital expiration, Charlson Comorbidity Index (CCI) and Deep Brain Stimulation (DBS) utilization. Bivariate analyses were performed: differences in age and CCI were further examined by multivariable linear regression and proportional odds models. RESULTS Of 229,238 hospitalizations, 2428 had PD (Japanese: 31.3 %, White: 30.4 %, Filipino: 11.3 %, NHPI: 9.6 %, Chinese: 8.0 %). NHPI were younger compared to rest of the subgroups [estimate in years (95 % CI): Whites: 4.4 (3.0-5.8), Filipinos: 4.3 (2.7-5.9), Japanese: 7.7 (6.4-9.1), Chinese: 7.9 (6.1-9.7), p < 0.001)]. NHPI had a higher CCI compared to White, Japanese, and Chinese (p < 0.001). Among AA subgroups, Filipinos were younger and had a higher CCI compared to Japanese and Chinese (p < 0.001). There were no significant differences in DBS utilization among subgroups. CONCLUSIONS NHPI and Filipinos with PD were hospitalized at a younger age and had a greater comorbidity burden compared to other AAs and Whites. Further research, ideally prospective studies, are needed to understand these racial disparities.
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Affiliation(s)
- Michiko Kimura Bruno
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA.
| | - Masako Matsunaga
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Kazuma Nakagawa
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - John J Chen
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Todd Seto
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Fay Gao
- The Queen's Medical Center, Honolulu, HI, USA; University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - G Webster Ross
- Pacific Health Research and Education Institute, VA Pacific Islands Health Care System, USA
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10
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Roman M, Cruz MRD, Soon R, Ma C, Chen JJ. Understanding Factors Affecting Health Providers' Perceptions of Pharmacist Roles in HPV Vaccine Administration. Hawaii J Health Soc Welf 2024; 83:92-98. [PMID: 38585287 PMCID: PMC10990833 DOI: 10.62547/rdrv2180] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Human papillomavirus (HPV) is a viral infection that sexually active females and males may be exposed to in their lifetime. The HPV vaccine is highly recommended especially among children to protect them before their anticipated exposure to HPV, however, vaccination uptake in Hawai'i remains low. As of 2017, legislation allows pharmacists to vaccinate for adolescent vaccines with the potential to increase access and opportunities for patients to complete the HPV vaccine series. Physicians in Hawai'i were surveyed to examine physicians' awareness of this law, their perceptions of the role of pharmacists, and willingness to send adolescent patients to pharmacies; 137 responses were received and analyzed. Overall, 72% (n=99) of respondents were willing while 28% (n=38) were unwilling to send patients to pharmacies for vaccines. Physicians view pharmacists' role as helpful but have concerns regarding correct administration and tracking doses given. Results show potential for more physician-pharmacist collaborations through further education and trainings for pharmacists and health providers to increase physician referrals for adolescent vaccine services in pharmacies.
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Affiliation(s)
- Meliza Roman
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MR, JJC)
| | - May Rose Dela Cruz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI (MRDC)
| | - Reni Soon
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (RS)
| | - Carolyn Ma
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (CM)
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (MR, JJC)
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11
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Matsunaga M, Donnelly P, Chen JJ. Hospital usage for oral and dental conditions in Hawaii: A cross-sectional study using the 2021 Hawaii statewide hospital data. J Public Health Dent 2024. [PMID: 38509055 DOI: 10.1111/jphd.12610] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social-demographic factors associated with the identified ED visits. METHODS This was a cross-sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non-traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC. RESULTS Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21-44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0-9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu). CONCLUSIONS Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals.
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Affiliation(s)
- Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Patrick Donnelly
- Hawai'i Oral Health Coalition, Hawai'i Public Health Institute, Honolulu, Hawaii, USA
| | - John J Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
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12
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Li X, Chen JJ, Hur M, Paton GR, McKeon A, Zekeridou A. Papillitis associated with IgLON5 autoimmunity: A novel clinical phenotype. J Neuroimmunol 2024; 388:578312. [PMID: 38364528 DOI: 10.1016/j.jneuroim.2024.578312] [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: 10/27/2023] [Revised: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To describe papillitis as a clinical phenotype of IgLON5 autoimmunity. METHODS We retrospectively reviewed patients with IgLON5 autoimmunity who had optic neuropathy, optic neuritis, or optic disc edema. Sera from patients with recurrent papillitis were tested for IgLON5 antibodies. RESULTS We found two elderly males presenting with papillitis in the presence of IgLON5 antibodies. CSF pleocytosis was present and partial vision improvement occurred in one patient despite immunotherapy. Sera from 18 patients with recurrent papillitis were negative for IgLON5 antibodies. CONCLUSION Papillitis could be a manifestation of IgLON5 disease, with or without accompanying cognitive, sleep, and movement disorders.
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Affiliation(s)
- Xiaoyang Li
- Department of Neurology, Mayo Clinic, Rochester, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, USA; Department of Ophthalmology, Mayo Clinic, Rochester, USA; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, USA
| | - Minjun Hur
- Department of Neurology, Mayo Clinic, Rochester, USA; Department of Ophthalmology, Mayo Clinic, Rochester, USA
| | - Gillian R Paton
- Casey Eye Institute Division of Neuro-ophthalmology, Oregon Health & Science University, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, USA; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, USA; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
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13
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Kraker JA, Xu SC, Flanagan EP, Foster R, Wang F, Chen JJ. Ocular Manifestations of Multiple Sclerosis: A Population-Based Study. J Neuroophthalmol 2024:00041327-990000000-00593. [PMID: 38457238 DOI: 10.1097/wno.0000000000002116] [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: 03/10/2024]
Abstract
BACKGROUND To evaluate the population-based frequency and severity of multiple sclerosis (MS)-related ocular diseases. METHODS Retrospective, population-based study examining patients with MS between January 1, 1998 and December 31, 2011. Patients were identified using the Rochester Epidemiology Project, which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. Diagnosis of MS was confirmed based on neuroimaging, cerebrospinal fluid studies, and serum studies for each patient according to the 2017 McDonald criteria. Patient data were obtained using the medical records and followed through April 1, 2018. RESULTS Of the 116 patients with MS, 66% were female and the median age of onset was 36 years (interquartile range 27.5-43.5 years). About half (61/116, 53%) had MS-related neuro-ophthalmic manifestations during their disease course, and about one-fourth (33/116, 28%) had visual symptoms as their presenting symptom of MS, most commonly as optic neuritis (26/116, 22%). Optic neuritis was the leading MS-related ocular condition (37%), followed by internuclear ophthalmoplegia (16%) and nystagmus (13%). Optic neuritis was mostly unilateral (40/43, 93%), with 16% (6/43) having a visual acuity of 20/200 or worse at nadir but ultimately 95% (35/37) improving to a visual acuity of 20/40 or better. CONCLUSIONS This study provides the population-based frequency of MS-related ocular disease, which demonstrates a high frequency of ocular manifestations in MS both at disease onset and during the disease course, emphasizing the utility of neuro-ophthalmologists, or collaboration between neurologists and ophthalmologists, in the care of patients with MS.
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Affiliation(s)
- Jessica A Kraker
- Department of Ophthalmology (JAK, SCX, RF, FW, JJC), Mayo Clinic Hospital, Rochester, Minnesota; and Department of Neurology (EPF, JJC), Mayo Clinic Hospital, Rochester, Minnesota
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14
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Wu QH, Chen Q, Yang T, Chen J, Chen L, Xiang XL, Jia FY, Wu LJ, Hao Y, Li L, Zhang J, Ke XY, Yi MJ, Hong Q, Chen JJ, Fang SF, Wang YC, Wang Q, Li TY. [A survey on the current situation of serum vitamin A and vitamin D levels among children aged 2-<7 years of 20 cities in China]. Zhonghua Er Ke Za Zhi 2024; 62:231-238. [PMID: 38378284 DOI: 10.3760/cma.j.cn112140-20230923-00216] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China. Methods: A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors. Results: The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A (χ2=7.91 and 8.06, both P=0.005) and vitamin D (χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively (OR=0.68 and 0.22, 95%CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB (χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively (χ2=93.22 and 202.54, both P<0.001). Conclusions: Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.
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Affiliation(s)
- Q H Wu
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - Q Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - T Yang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - J Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - L Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - X L Xiang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - F Y Jia
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun 130031, China
| | - L J Wu
- Department of Children's and Adolescent Health, Public Health College of Harbin Medical University, Harbin 150001, China
| | - Y Hao
- Division of Child Healthcare, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - L Li
- Department of Children Rehabilitation, Hainan Women and Children's Medical Center, Haikou 570206, China
| | - J Zhang
- Children Health Care Center, Xi'an Children's Hospital, Xi'an 710003, China
| | - X Y Ke
- Child Mental Health Research Center, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210000, China
| | - M J Yi
- Department of Child Health Care, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Q Hong
- Department of Child Psychology and Behavior, Maternal and Child Health Hospital of Baoan, Shenzhen 518000, China
| | - J J Chen
- Department of Child Healthcare, Children's Hospital Affiliated to Shanghai Jiao Tong University, Children's Hospital of Shanghai, Shanghai 200000, China
| | - S F Fang
- Department of Child Health Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Y C Wang
- National Health Commission Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410008, China
| | - Q Wang
- Department of Child Health Care, Deyang Maternity & Child Healthcare Hospital, Deyang 618000, China
| | - T Y Li
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
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15
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Tailor PD, Xu TT, Fortes BH, Iezzi R, Olsen TW, Starr MR, Bakri SJ, Scruggs BA, Barkmeier AJ, Patel SV, Baratz KH, Bernhisel AA, Wagner LH, Tooley AA, Roddy GW, Sit AJ, Wu KY, Bothun ED, Mansukhani SA, Mohney BG, Chen JJ, Brodsky MC, Tajfirouz DA, Chodnicki KD, Smith WM, Dalvin LA. Appropriateness of Ophthalmology Recommendations From an Online Chat-Based Artificial Intelligence Model. Mayo Clin Proc Digit Health 2024; 2:119-128. [PMID: 38577703 PMCID: PMC10994056 DOI: 10.1016/j.mcpdig.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Objective To determine the appropriateness of ophthalmology recommendations from an online chat-based artificial intelligence model to ophthalmology questions. Patients and Methods Cross-sectional qualitative study from April 1, 2023, to April 30, 2023. A total of 192 questions were generated spanning all ophthalmic subspecialties. Each question was posed to a large language model (LLM) 3 times. The responses were graded by appropriate subspecialists as appropriate, inappropriate, or unreliable in 2 grading contexts. The first grading context was if the information was presented on a patient information site. The second was an LLM-generated draft response to patient queries sent by the electronic medical record (EMR). Appropriate was defined as accurate and specific enough to serve as a surrogate for physician-approved information. Main outcome measure was percentage of appropriate responses per subspecialty. Results For patient information site-related questions, the LLM provided an overall average of 79% appropriate responses. Variable rates of average appropriateness were observed across ophthalmic subspecialties for patient information site information ranging from 56% to 100%: cataract or refractive (92%), cornea (56%), glaucoma (72%), neuro-ophthalmology (67%), oculoplastic or orbital surgery (80%), ocular oncology (100%), pediatrics (89%), vitreoretinal diseases (86%), and uveitis (65%). For draft responses to patient questions via EMR, the LLM provided an overall average of 74% appropriate responses and varied by subspecialty: cataract or refractive (85%), cornea (54%), glaucoma (77%), neuro-ophthalmology (63%), oculoplastic or orbital surgery (62%), ocular oncology (90%), pediatrics (94%), vitreoretinal diseases (88%), and uveitis (55%). Stratifying grades across health information categories (disease and condition, risk and prevention, surgery-related, and treatment and management) showed notable but insignificant variations, with disease and condition often rated highest (72% and 69%) for appropriateness and surgery-related (55% and 51%) lowest, in both contexts. Conclusion This LLM reported mostly appropriate responses across multiple ophthalmology subspecialties in the context of both patient information sites and EMR-related responses to patient questions. Current LLM offerings require optimization and improvement before widespread clinical use.
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Affiliation(s)
- Prashant D Tailor
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Timothy T Xu
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Blake H Fortes
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Raymond Iezzi
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Timothy W Olsen
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Matthew R Starr
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Sophie J Bakri
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Brittni A Scruggs
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Andrew J Barkmeier
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Sanjay V Patel
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Keith H Baratz
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Ashlie A Bernhisel
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Lilly H Wagner
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Andrea A Tooley
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Gavin W Roddy
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Arthur J Sit
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Kristi Y Wu
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Erick D Bothun
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Sasha A Mansukhani
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Brian G Mohney
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - John J Chen
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Michael C Brodsky
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Deena A Tajfirouz
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Kevin D Chodnicki
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Wendy M Smith
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
| | - Lauren A Dalvin
- Department of Ophthalmology (P.D.T., T.T.X., B.H.F., R.I., T.W.O., M.R.S., S.J.B., B.A.S., A.J.B., S.J.B., B.A.S., A.J.B., S.V.P., K.H.B., A.A.B., L.H.W., A.A.T., G.W.R., A.J.S., K.Y.W., E.D.B., S.A.M., B.G.M., J.J.C., M.C.B., D.A.T., K.D.C., W.M.S., L.A.D.) and Department of Neurology (J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology, Duke University, Durham, NC (K.Y.W.)
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Tailor PD, Aul BJ, Sit AJ, Fautsch MP, Chen JJ. Determination of the Trans-Lamina Cribrosa Pressure Difference in a Community-Based Population and its Association with Open-Angle Glaucoma. Ophthalmol Glaucoma 2024; 7:168-176. [PMID: 37783273 PMCID: PMC10960720 DOI: 10.1016/j.ogla.2023.09.002] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To determine the trans-lamina cribrosa pressure difference (TLCPD) in a cohort of normal community-based patients and the relationship to primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). DESIGN Retrospective cohort study of the Mayo Clinic Study of Aging. PARTICIPANTS The Mayo Clinic Study of Aging is a prospective study evaluating the normal aging population. METHODS Mayo Clinic Study of Aging patients who underwent routine lumbar puncture (LP) studies with eye examinations were reviewed. The trans-lamina cribrosa pressure difference was calculated in 2 contexts of intraocular pressure (IOP): (1) maximum IOP at eye visit closest in time to the LP (closest-in-time TLCPD); and (2) IOP before IOP-lowering treatment (pretreatment IOP and pretreatment TLCPD) in POAG and NTG patients. Glaucoma patients without POAG or NTG were excluded. Regression analyses were performed to determine the relationship with glaucoma. MAIN OUTCOME MEASURES IOP, intracranial pressure, TLCPD, POAG, normal-tension glaucoma (NTG) diagnosis, glaucoma parameters. RESULTS Five hundred forty-eight patients were analyzed. Of these, there were 38 treated glaucoma patients (14 POAG and 24 NTG) and 510 nonglaucomatous patients. Cerebral spinal fluid (CSF) opening pressure was 155.0 ± 42.2 mmH2O in nonglaucomatous patients, 144.0 ± 34.0 mmH2O in POAG (P = 0.15 vs. nonglaucomatous patients), and 136.6 ± 29.3 mmH2O in NTG (P = 0.017 vs. nonglaucomatous patients). Intraocular pressure was 15.47 ± 2.9 mmHg in nonglaucomatous patients, 26.6 ± 3.7 mmHg in POAG, and 17.4 ± 3.4 mmHg in NTG. The closest-in-time TLCPD in the nonglaucomatous cohort was 4.07 ± 4.22 mmHg, which was lower than both the POAG cohort (7.19 ± 3.6 mmHg) and the NTG cohort (5.79 ± 4.5 mmHg, P = 0.04). Pretreatment TLCPD for the overall glaucoma cohort was 10.57 ± 6.1 mmHg. The POAG cohort had a higher pretreatment TLCPD (16.05 ± 5.2 mmHg) than the NTG cohort (7.37 ± 4.1 mmHg; P < 0.0001). Closest-in-time TLCPD for the nonglaucoma cohort (4.07± 4.2 mmHg) was significantly lower than pretreatment TLCPDs for both POAG (16.05 ± 5.2 mmHg; P < 0.0001) and NTG (7.37 ± 4.1 mmHg; P < 0.0001) cohorts. CONCLUSIONS This study establishes the baseline TLCPD in a large cohort of normal, community-based patients. The differences in regression analysis between TLCPD and IOP suggests NTG pathophysiology is partially driven by TLCPD, but is also likely multifactorial. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Bryce J Aul
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Arthur J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Neurology, Mayo Clinic, Rochester, Minnesota.
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Kobeissi H, Bilgin C, Ghozy S, Adusumilli G, Thurnham J, Hardy N, Xu T, Tarchand R, Kallmes KM, Brinjikji W, Kadirvel R, Chen JJ, Sinclair A, Mollan SP, Kallmes DF. Common Design and Data Elements Reported on Idiopathic Intracranial Hypertension Trials: A Systematic Review. J Neuroophthalmol 2024; 44:66-73. [PMID: 37342870 DOI: 10.1097/wno.0000000000001902] [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]
Abstract
BACKGROUND There are an increasing number of controlled clinical trials and prospective studies, ongoing and recently completed, regarding management options for idiopathic intracranial hypertension (IIH). We present a Common Design and Data Element (CDDE) analysis of controlled and prospective IIH studies with the aim of aligning essential design and recommending data elements in future trials and enhancing data synthesis potential in IIH trials. METHODS We used PubMed and ClinicalTrials.gov to screen for ongoing and published trials assessing treatment modalities in people with IIH. After our search, we used the Nested Knowledge AutoLit platform to extract pertinent information regarding each study. We examined outputs from each study and synthesized the data elements to determine the degree of homogeneity between studies. RESULTS The most CDDE for inclusion criteria was the modified Dandy criteria for diagnosis of IIH, used in 9/14 studies (64%). The most CDDE for outcomes was change in visual function, reported in 12/14 studies (86%). Evaluation of surgical procedures (venous sinus stenting, cerebrospinal fluid shunt placement, and others) was more common, seen in 9/14 studies (64%) as compared with interventions with medical therapy 6/14 (43%). CONCLUSIONS Although all studies have similar focus to improve patient care, there was a high degree of inconsistency among studies regarding inclusion criteria, exclusion criteria, and outcomes measures. Furthermore, studies used different time frames to assess outcome data elements. This heterogeneity will make it difficult to achieve a consistent standard, and thus, making secondary analyses and meta-analyses less effective in the future. Consensus on design of trials is an unmet research need for IIH.
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Affiliation(s)
- Hassan Kobeissi
- Departments of Radiology (HK, CB, SG, WB, RK, DFK), Ophthalmology (TX, JJC), and Neurologic Surgery (RK), Mayo Clinic, Rochester, Minnesota; Department of Radiology (GA), Massachusetts General Hospital, Boston, Massachusetts; Nested Knowledge (JT, NH, RT, KMK), St Paul, Minnesota; Department of Neurology (AS), University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom; Translational Brain Science (AS, SPM), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; and Birmingham Neuro-Ophthalmology (SPM), University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
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18
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Lee AY, Jahansooz JR, Guittu D, Suzuki R, Pak L, Ishikawa KM, Goo C, Chen JJ, Carrazana E, Viereck J, Liow KK. Barriers to Alzheimer Disease Clinical Trial Participation in a Minority Population. Cogn Behav Neurol 2024; 37:40-47. [PMID: 37878413 PMCID: PMC10948321 DOI: 10.1097/wnn.0000000000000359] [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: 10/01/2022] [Accepted: 06/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations. OBJECTIVE To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment. METHOD We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods. RESULTS Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial. CONCLUSION Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials.
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Affiliation(s)
- Anson Y Lee
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Julia R Jahansooz
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Darrell Guittu
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Rexton Suzuki
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Lauren Pak
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
| | - Kyle M Ishikawa
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Connor Goo
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - John J Chen
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Enrique Carrazana
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jason Viereck
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Kore K Liow
- Memory Disorders Center & Alzheimer's Research Unit, Hawaii Pacific Neuroscience, Honolulu, Hawaii
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
- Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Miller MJ, Charoenkijkajorn C, Pakravan M, Mortensen PW, Chen JJ, Lee AG. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis Mimicking Pituitary Apoplexy With Bitemporal Field Loss. J Neuroophthalmol 2024; 44:e73-e75. [PMID: 36542667 DOI: 10.1097/wno.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Matthew J Miller
- Baylor College of Medicine (MJM), Houston, Texas; Department of Ophthalmology (CC, MP, PWM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Ophthalmology (JJC), Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa; and Departments of Ophthalmology (AGL), Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York
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Chen JJ. Multicenter Observational Studies: Understanding the Basics of Data Sharing and Data User Agreements. J Neuroophthalmol 2024; 44:1-4. [PMID: 38277221 DOI: 10.1097/wno.0000000000002086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota
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Bodi TB, Klaehn LD, Kramer AM, Bhatti MT, Brodsky MC, Eggenberger ER, Di Nome MA, Leavitt JA, Garrity JA, Chen JJ, Mansukhani SA. Ocular Neuromyotonia: Clinical Features, Diagnosis, and Outcomes. Am J Ophthalmol 2024; 263:61-69. [PMID: 38369222 DOI: 10.1016/j.ajo.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The purpose of this study was to describe the clinical features, management, outcomes, and diagnostic pitfalls in a large series of patients with ocular neuromyotonia. DESIGN Retrospective cohort. METHODS Patients diagnosed with ocular neuromyotonia from January 1, 2004, through January 1, 2023, seen at one of the 3 Mayo Clinic sites in Rochester, MN, Scottsdale, AZ, and Jacksonville, FL, comprised the study population. We ascertained patients with ocular neuromyotonia through a search using the medical records database. Only patients with an observed episode of ocular neuromyotonia were included and the medical records were reviewed. The main outcome measures were clinical features and outcomes of patients with ocular neuromyotonia. RESULTS Forty-two patients who were diagnosed with ocular neuromyotonia were included. The median age was 58 years (range, 16-80 years). A history of cranial radiation therapy was present in 39 patients (93%). The sixth cranial nerve was involved in 31 patients (74%). Bilateral disease was found in 2 patients (5%). The median time from onset of diplopia to diagnosis was 8 months (range, 1 month-25 years), with a high rate of initial misdiagnosis in 52%. Twenty of 42 patients (48%) were treated with oral medication, of whom 95% had significant improvement or resolution of symptoms. CONCLUSION Prior cranial irradiation is the most common cause for ocular neuromyotonia, affecting the sixth cranial nerve most often. Although delayed and initial misdiagnosis is common, most patients show improved symptoms on medical treatment.
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Affiliation(s)
- Tia B Bodi
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota
| | - Lindsay D Klaehn
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota
| | - Andrea M Kramer
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota
| | - M Tariq Bhatti
- Department of Ophthalmology, The Permanente Medical Group, Kaiser Permanente (M.T.B.), Roseville, California
| | - Michael C Brodsky
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine (M.C.B., J.J.C.), Rochester, Minnesota
| | - Eric R Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine (E.R.E.), Jacksonville, Florida
| | - Marie A Di Nome
- Departments of Ophthalmology and Neurosurgery, Mayo Clinic College of Medicine (M.A.D.N.), Scottsdale, Arizona
| | - Jacqueline A Leavitt
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota
| | - James A Garrity
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine (M.C.B., J.J.C.), Rochester, Minnesota
| | - Sasha A Mansukhani
- From the Department of Ophthalmology, Mayo Clinic College of Medicine (T.B.B., L.D.K., A.M.K., J.A.L., J.A.G., S.A.M.), Rochester, Minnesota; Departments of Ophthalmology, Mayo Clinic Health Systems (S.A.M.), Eau Claire, Wisconsin, USA.
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Foster RC, Bhatti MT, Crum OM, Lesser ER, Hodge DO, Chen JJ. Reexamining the Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy: A Rochester Epidemiology Project Study. J Neuroophthalmol 2024:00041327-990000000-00573. [PMID: 38358828 DOI: 10.1097/wno.0000000000002102] [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: 02/17/2024]
Abstract
BACKGROUND This study aims to determine the population-based incidence and characterize the features of nonarteritic anterior ischemic optic neuropathy (NAION) using the Rochester Epidemiology Project (REP). METHODS All patients diagnosed with an optic neuropathy from January 1, 1990, to December 31, 2016, were retrospectively reviewed to identify incident cases of NAION using the REP database, which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. The overall incidence of NAION was estimated using the age-specific and sex-specific population figures for Olmsted County census data for 1990 through 2016. Visual outcomes and risk factors were evaluated. The systemic risk factors were compared with age-matched controls. RESULTS One hundred four patients were diagnosed with NAION during the 26-year study period. The overall age and sex adjusted incidence was 3.89 per 100,000 individuals (95% confidence interval [CI]: 3.14-4.65). The incidence was 7.73 (CI: 6.24-9.22) in patients aged 40 years or older and 10.19 (CI: 8.15-12.23) in patients aged 50 years or older. Median age at diagnosis was 65 years (range, 40-90 years), and 59 (56.7%) were male. The median logMAR visual acuity at presentation was 0.35 (Snellen equivalent of 20/40) with 14 patients (13.5%) having vision of counting fingers or worse. Among the 91 patients with final visual acuity outcome data available, the median visual acuity was 0.40 (Snellen equivalent of 20/50) with 12 patients (13.2%) having vision of counting fingers or worse. Twenty-four patients (26.4%) were noted to have final acuity at least 3 Snellen lines worse than at presentation, whereas 17 patients (18.7%) were noted to improve by at least 3 lines. The median mean deviation on automated visual field testing was -10.2 dB at presentation and -11.1 dB at follow-up. Twenty-two patients (21.2%) suffered NAION in the fellow eye; the median interval between involvement of the first and second eyes was 1.39 years. Systemic diseases present in the NAION cohort included hypertension (79.8%), diabetes mellitus (39.4%), obstructive sleep apnea (23.1%), and hyperlipidemia (74.0%), which were all statistically higher than age-matched controls. CONCLUSIONS NAION is a relatively common optic neuropathy in elderly patients with vascular risk factors. Our data indicate that the incidence of NAION has remained relatively stable in the population of Olmsted County over the past 4 decades.
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Affiliation(s)
- Robert C Foster
- Departments of Ophthalmology (RCF, MTB, JJC) and Neurology (MTB, JJC), Mayo Clinic, Rochester, Minnesota; The Permanente Medical Group (MTB), Department of Ophthalmology, Kaiser Permanente-Northern California, Roseville, California; College of Medicine (OMC), Mayo Clinic, Rochester, Minnesota; and Department of Health Sciences Research (ERL, DOH), Mayo Clinic, Jacksonville, Florida
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Sattarova V, Flowers A, Gospe SM, Chen JJ, Stunkel L, Bhatti MT, Dattilo M, Kedar S, Biousse V, McClelland CM, Lee MS. A multi-centre case series of patients with coexistent intracranial hypertension and malignant arterial hypertension. Eye (Lond) 2024; 38:274-278. [PMID: 37491440 PMCID: PMC10811224 DOI: 10.1038/s41433-023-02672-z] [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: 10/12/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To describe the clinical characteristics, outcomes, and management of a large cohort of patients with concomitant malignant arterial hypertension and intracranial hypertension. METHODS Design: Retrospective case series. SUBJECTS Patients aged ≥ 18 years with bilateral optic disc oedema (ODE), malignant arterial hypertension and intracranial hypertension at five academic institutions. Patient demographics, clinical characteristics, diagnostic studies, and management were collected. RESULTS Nineteen patients (58% female, 63% Black) were included. Median age was 35 years; body mass index (BMI) was 30 kg/m2. Fourteen (74%) patients had pre-existing hypertension. The most common presenting symptom was blurred vision (89%). Median blood pressure (BP) was 220 mmHg systolic (IQR 199-231.5 mmHg) and 130 mmHg diastolic (IQR 116-136 mmHg) mmHg), and median lumbar puncture opening pressure was 36.5 cmH2O. All patients received treatment for arterial hypertension. Seventeen (89%) patients received medical treatment for raised intracranial pressure, while six (30%) patients underwent a surgical intervention. There was significant improvement in ODE, peripapillary retinal nerve fibre layer thickness, and visual field in the worst eye (p < 0.05). Considering the worst eye, 9 (47%) presented with acuity ≥ 20/25, while 5 (26%) presented with ≤ 20/200. Overall, 7 patients maintained ≥ 20/25 acuity or better, 6 demonstrated improvement, and 5 demonstrated worsening. CONCLUSIONS Papilloedema and malignant arterial hypertension can occur simultaneously with potentially greater risk for severe visual loss. Clinicians should consider a workup for papilloedema among patients with significantly elevated blood pressure and bilateral optic disc oedema.
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Affiliation(s)
- Victoria Sattarova
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA
| | - Alexis Flowers
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, USA
| | - Sidney M Gospe
- Department of Ophthalmology Duke University, Durham, USA
| | - John J Chen
- Departments of Ophthalmology and Neurology Mayo Clinic College of Medicine, Rochester, USA
| | - Leanne Stunkel
- Department of Ophthalmology and Visual Sciences Washington University in St. Louis, St. Louis, USA
| | - M Tariq Bhatti
- Department of Ophthalmology The Permanente Medical Group Northern California, California, USA
| | - Michael Dattilo
- Department of Ophthalmology Emory University, Atlanta, Georgia
| | - Sachin Kedar
- Department of Ophthalmology Emory University, Atlanta, Georgia
- Department of Neurology Emory University, Atlanta, Georgia
| | - Valerie Biousse
- Department of Ophthalmology Emory University, Atlanta, Georgia
- Department of Neurology Emory University, Atlanta, Georgia
| | - Collin M McClelland
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA.
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Tajfirouz D, Chen JJ. Paraneoplastic vision loss. Handb Clin Neurol 2024; 200:203-210. [PMID: 38494278 DOI: 10.1016/b978-0-12-823912-4.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic vision loss, which represents a small percentage of paraneoplastic neurologic syndromes, can be a blinding disease. Presenting visual symptoms are variable, making diagnosis challenging. History of the presenting illness, ocular examination, and utilization of various modalities, such as automated perimetry, ocular coherence tomography, and electroretinogram allow for localization of vision loss to the optic nerves or retina, guiding in diagnosis and management. Paraneoplastic vision loss is often painless, bilateral, and subacute, and accompanies other neurologic symptoms but can be the first presenting symptom. Paraneoplastic optic neuropathy has been described in association with several antibodies, but most commonly anti-CRMP5. Cancer-associated retinopathy is the most common paraneoplastic autoimmune retinopathy; however, melanoma-associated retinopathy and bilateral diffuse uveal melanocytic proliferation have also been described to be associated with a paraneoplastic process affecting the retina. Paraneoplastic visual loss is an expanding field and advances in research have improved phenotypic characterization; however, further work is needed to identify more reliable biomarkers of disease and to better understand the underlying mechanisms and management.
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Affiliation(s)
- Deena Tajfirouz
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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Tooley AA, Law J, Lelli GJ, Sun G, Godfrey KJ, Tran AQ, Kim E, Solomon JM, Chen JJ, Khan AR, Wayman L, Olson JH, Lee MS, Harrison AR, Espinoza GM, Davitt BV, Tao J, Hodge DO, Barkmeier AJ. Predictors of Ophthalmology Resident Performance From Medical Student Application Materials. Journal of Surgical Education 2024; 81:151-160. [PMID: 38036387 DOI: 10.1016/j.jsurg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To determine whether elements in ophthalmology residency applications are predictors of future resident performance. DESIGN This multi-institutional, cross-sectional, observational study retrospectively reviewed the residency application materials of ophthalmology residents who graduated from residency from 2006 through 2018. Resident performance was scored by 2 faculty reviewers in 4 domains (clinical, surgical, academic, and global performance). Correlation between specific elements of the residency application and resident performance was assessed by Spearman correlation coefficients (univariate) and linear regression (multivariate) for continuous variables and logistic regression (multivariate) for categorical variables. SETTING Seven ophthalmology residency programs in the US. PARTICIPANTS Ophthalmology residents who graduated from their residency program. RESULTS High-performing residents were a diverse group, in terms of sex, ethnicity, visa status, and educational background. Residents with United States Medical Licensing Examination Step 1 scores higher than the national average for that year had significantly higher scores in all 4 performance domains than those who scored at or below the mean (all domains P < 0.05). Residents who had honors in at least 4 core clerkships and who were members of Alpha Omega Alpha Medical Honor Society also had higher scores in all 4 performance domains (all domains P ≤ 0.04). Step 1 score (ρ=0.26, P < 0.001) and the difference between Step 1 score and the national average for that year (ρ=0.19, P = 0.009) positively correlated with total resident performance scores. Residents who passed the American Board of Ophthalmology Written Qualifying Examination or Oral Examination on their first attempt had significantly higher Step 1/2 scores (P ≤ 0.005), Ophthalmology Knowledge Assessment Program scores (P = 0.001), and resident performance scores (P ≤ 0.004). CONCLUSIONS In this new landscape of increasing numbers of applicants to residency programs and changing of the Step 1 score to pass/fail, our findings may help guide selection committees as they holistically review applicants to select exceptional future residents in ophthalmology.
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Affiliation(s)
- Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - Janice Law
- Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee
| | - Gary J Lelli
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Kyle J Godfrey
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Ann Q Tran
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Eleanore Kim
- Department of Ophthalmology, New York University, New York, New York
| | - Joel M Solomon
- Department of Ophthalmology, New York University, New York, New York
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Amir R Khan
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Laura Wayman
- Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee
| | - Joshua H Olson
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | | | - Bradley V Davitt
- Department of Ophthalmology, Saint Louis University, St. Louis, Missouri
| | - Jeremiah Tao
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| | - David O Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
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Tisavipat N, Juan HY, Chen JJ. Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Saudi J Ophthalmol 2024; 38:2-12. [PMID: 38628414 PMCID: PMC11017007 DOI: 10.4103/sjopt.sjopt_102_23] [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: 05/06/2023] [Accepted: 08/20/2023] [Indexed: 04/19/2024] Open
Abstract
Monoclonal antibody therapies mark the new era of targeted treatment for relapse prevention in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD). For over a decade, rituximab, an anti-CD20 B-cell-depleting agent, had been the most effectiveness treatment for AQP4-IgG+NMOSD. Tocilizumab, an anti-interleukin-6 receptor, was also observed to be effective. In 2019, several randomized, placebo-controlled trials were completed that demonstrated the remarkable efficacy of eculizumab (anti-C5 complement inhibitor), inebilizumab (anti-CD19 B-cell-depleting agent), and satralizumab (anti-interleukin-6 receptor), leading to the Food and Drug Administration (FDA) approval of specific treatments for AQP4-IgG+NMOSD for the first time. Most recently, ravulizumab (anti-C5 complement inhibitor) was also shown to be highly efficacious in an open-label, external-controlled trial. Although only some patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) warrant immunotherapy, there is currently no FDA-approved treatment for relapse prevention in MOGAD. Observational studies showed that tocilizumab was associated with a decrease in relapses, whereas rituximab seemed to have less robust effectiveness in MOGAD compared to AQP4-IgG+NMOSD. Herein, we review the evidence on the efficacy and safety of each monoclonal antibody therapy used in AQP4-IgG+NMOSD and MOGAD, including special considerations in children and women of childbearing potential.
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Affiliation(s)
| | - Hui Y. Juan
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - John J. Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
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27
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Elsbernd P, Cacciaguerra L, Krecke KN, Chen JJ, Gritsch D, Lopez-Chiriboga AS, Sechi E, Redenbaugh V, Morris PP, Carter JL, Wingerchuk DM, Tillema JM, Valencia-Sanchez C, Thakolwiboon S, Pittock SJ, Flanagan EP. Cerebral enhancement in MOG antibody-associated disease. J Neurol Neurosurg Psychiatry 2023; 95:14-18. [PMID: 37221051 PMCID: PMC10679850 DOI: 10.1136/jnnp-2023-331137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Limited data exist on brain MRI enhancement in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) and differences from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD), and multiple sclerosis (MS). METHODS In this retrospective observational study, we identified 122 Mayo Clinic MOGAD patients (1 January 1996-1 July 2020) with cerebral attacks. We explored enhancement patterns using a discovery set (n=41). We assessed enhancement frequency and Expanded Disability Status Scale scores at nadir and follow-up in the remainder (n=81). Two raters assessed T1-weighted-postgadolinium MRIs (1.5T/3T) for enhancement patterns in MOGAD, AQP4+NMOSD (n=14) and MS (n=26). Inter-rater agreement was assessed. Leptomeningeal enhancement clinical correlates were analysed. RESULTS Enhancement occurred in 59/81 (73%) MOGAD cerebral attacks but did not influence outcome. Enhancement was often patchy/heterogeneous in MOGAD (33/59 (56%)), AQP4+NMOSD (9/14 (64%); p=0.57) and MS (16/26 (62%); p=0.63). Leptomeningeal enhancement favoured MOGAD (27/59 (46%)) over AQP4+NMOSD (1/14 (7%); p=0.01) and MS (1/26 (4%); p<0.001) with headache, fever and seizures frequent clinical correlates. Ring enhancement favoured MS (8/26 (31%); p=0.006) over MOGAD (4/59 (7%)). Linear ependymal enhancement was unique to AQP4+NMOSD (2/14 (14%)) and persistent enhancement (>3 months) was rare (0%-8%) across all groups. Inter-rater agreement for enhancement patterns was moderate. CONCLUSIONS Enhancement is common with MOGAD cerebral attacks and often has a non-specific patchy appearance and rarely persists beyond 3 months. Leptomeningeal enhancement favours MOGAD over AQP4+NMOSD and MS.
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Affiliation(s)
- Paul Elsbernd
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Laura Cacciaguerra
- Department of Neurology, Vita-Salute San Raffaele University, Milano, Italy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Gritsch
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Neurology, Mass General Brigham Inc, Boston, Massachusetts, USA
| | | | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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28
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Xie ZY, Cao G, Chen JJ, Chen TT, Sun LJ, Li YX, Zu WL, Ye JJ, Du YX, Zhao ZG, Ye HF. [Investigation and analysis on the detection of IgG antibodies against the rubella virus among rural childbearing-age women in preconception period in Yunnan Province from 2013 to 2019]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:2134-2139. [PMID: 38186167 DOI: 10.3760/cma.j.cn112150-20230118-00045] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
A study was conducted on rural women of childbearing age aged 20-49 who underwent the National Free Preconception Health Examination Project (NFPHEP)in Yunnan Province from 2013 to 2019. Descriptive analysis was conducted to determine the negative rate of IgG antibodies against the rubella virus and its differences among various socio-demographic characteristics. Among the 1 511 203 study subjects, the negative rate of IgG antibodies against the rubella virus was 24.36%. Only 2.64% of the population had received rubella virus vaccine. The negative rate of IgG antibodies among rural childbearing-age women in the preconception period in Yunnan Province decreased with age and educational level (Ptrend<0.001). The negative rate of IgG antibodies in ethnic minority women of childbearing age in the preconception period (25.19%) was higher than that of Han women (23.88%). Among the 22 ethnic groups with over 1 000 participants, the negative rates of IgG antibodies in women of childbearing age from the Blang (32.85%), Bouyei (31.03%), Zhuang (31.01%), and Miao (30.70%) ethnic groups were higher than those of women from other ethnic groups. Among the 16 states (cities) in Yunnan Province, the negative rate of IgG antibodies in pregnant women of childbearing age in Wenshan Zhuang and Miao Autonomous Prefecture (38.06%) and Lincang City (32.63%) was higher than that in other states (cities). The negative rate of serum IgG antibodies in women who reported having received rubella virus vaccine (18.60%) was lower than that in other non-vaccinated populations (24.52%). The proportion of rural women of childbearing age in Yunnan Province who were susceptible to the rubella virus before pregnancy was still high. It is necessary to promote rubella vaccination among people susceptible to rubella, especially pregnant women, to prevent rubella virus infection and reduce the incidence rate and disease burden of rubella people.
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Affiliation(s)
- Z Y Xie
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - G Cao
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education,Yunnan University/Yunnan Provincial Center for Research & Development of Natural Products/School of Pharmacy,Yunnan University, Kunming 650500, China
| | - J J Chen
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - T T Chen
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - L J Sun
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - Y X Li
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - W L Zu
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - J J Ye
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - Y X Du
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - Z G Zhao
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
| | - H F Ye
- Population and Family Planning Institute of Yunnan Province/NHC Key Laboratory of Periconception Health Birth in Western China,Kunming 650021,China
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Cohen DA, Tajfirouz D, Vodopivec I, Kyle K, Bouffard MA, Bhattacharyya S, Douglas VC, Rasool N, Bhatti MT, McKeon A, Pittock S, Flanagan EP, Prasad S, Nagagopal V, Egan RA, Chen JJ, Chwalisz BK. Fluorescein Angiography Findings in Susac Syndrome: A Multicenter Retrospective Case Series. J Neuroophthalmol 2023; 43:481-490. [PMID: 37075250 DOI: 10.1097/wno.0000000000001826] [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: 04/21/2023]
Abstract
BACKGROUND Susac syndrome is a vasculopathy, resulting in the classic triad of branch retinal artery occlusion (BRAO), inner ear ischemia, and brain ischemia. In this retrospective chart review, we characterize fluorescein angiography (FA) findings and other ancillary studies in Susac syndrome, including the appearance of persistent disease activity and the occurrence of new subclinical disease on FA. METHODS This multicenter, retrospective case series was institutional review board-approved and included patients with the complete triad of Susac syndrome evaluated with FA, contrasted MRI of the brain, and audiometry from 2010 to 2020. The medical records were reviewed for these ancillary tests, along with demographics, symptoms, visual acuity, visual field defects, and findings on fundoscopy. Clinical relapse was defined as any objective evidence of disease activity during the follow-up period after initial induction of clinical quiescence. The main outcome measure was the sensitivity of ancillary testing, including FA, MRI, and audiometry, to detect relapse. RESULTS Twenty of the 31 (64%) patients had the complete triad of brain, retinal, and vestibulocochlear involvement from Susac syndrome and were included. Median age at diagnosis was 43.5 years (range 21-63), and 14 (70%) were women. Hearing loss occurred in 20 (100%), encephalopathy in 13 (65%), vertigo in 15 (75%), and headaches in 19 (95%) throughout the course of follow-up. Median visual acuity at both onset and final visit was 20/20 in both eyes. Seventeen (85%) had BRAO at baseline, and 10 (50%) experienced subsequent BRAO during follow-up. FA revealed nonspecific leakage from previous arteriolar damage in 20 (100%), including in patients who were otherwise in remission. Of the 11 episodes of disease activity in which all testing modalities were performed, visual field testing/fundoscopy was abnormal in 4 (36.4%), MRI brain in 2 (18.2%), audiogram in 8 (72.7%), and FA in 9 (81.8%). CONCLUSIONS New leakage on FA is the most sensitive marker of active disease. Persistent leakage represents previous damage, whereas new areas of leakage suggest ongoing disease activity that requires consideration of modifying immunosuppressive therapy.
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Affiliation(s)
- Devon A Cohen
- Cleveland Clinic (DAC), Cleveland, Ohio; Mayo Clinic (DT, MTB, AM, SP, EPF, JJC), Rochester, Minnesota; Roche (IV), Basel, Switzerland; Massachusetts General Hospital (KK, VN, BKC), Boston, Massachusetts; Beth Israel Deaconess (MAB), Boston, Massachusetts; Brigham and Women's Hospital (SB, SP), Boston, Massachusetts; UCSF (VD, NR), San Francisco, California; and Eye and Vascular Neurology (RE), Carlton, Oregon
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30
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Bilgin C, Oliver AA, Cutsforth-Gregory JK, Chen JJ, Rammos SK, Cloft HJ, Lanzino G, Kallmes DF, Brinjikji W. Zilver stent versus Carotid Wallstent for endovascular treatment of idiopathic intracranial hypertension. J Neurointerv Surg 2023; 15:1269-1273. [PMID: 36627193 DOI: 10.1136/jnis-2022-019659] [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: 09/18/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Venous sinus stenting (VSS) is a promising treatment option for medically refractory idiopathic intracranial hypertension (IIH). There are no published studies comparing the performance of different types of stents employed in VSS procedures. In this study we aimed to compare the safety and efficacy outcomes of the Zilver 518 (Cook Medical, Bloomington, Indiana, USA) and the Carotid Wallstent (Boston Scientific, Marlborough, Massachusetts, USA) devices. METHODS Records of patients with IIH who underwent VSS between January 2015 and February 2022 at a single referral center were retrospectively reviewed. Patients treated with the Zilver stent or Carotid Wallstent were included in the study. Stent model and size data, pre- and post-treatment pressure gradients, technical and safety outcomes, and pre- and post- stenting papilledema, headache, and tinnitus severity were collected. The χ2 and Fisher-Freeman-Halton tests were used for categorical data and the Student's t-test and Mann-Whitney U test were employed to examine the differences in non-categorical variables. RESULTS A total of 81 procedures (28 (34.5%) with the Zilver stent and 53 (65.5%) with the Carotid Wallstent) were performed in 76 patients. The mean procedure time was significantly shorter with the Zilver stent (22.56±10.2 vs 33.9±15 min, p=0.001). The papilledema improvement and resolution rates did not significantly differ between groups (94.7% vs 94.5%, p>0.99 for improvement; 78.9% vs 67.5%, p=0.37 for resolution). The tinnitus improvement and resolution rates in the Zilver stent group were significantly higher than those of the Carotid Wallstent group (100% vs 78.9%, p=0.041; 90% vs 63.1%, p=0.03, respectively). Additionally, the Zilver stent provided a significantly higher rate of headache resolution and improvement than the Carotid Wallstent (84.6% vs 27.6%, p=0.001 for resolution; 92.3% vs 72.3%, p=0.043 for improvement). One patient from the Carotid Wallstent group underwent re-stenting due to in-stent stenosis and refractory papilledema. No significant in-stent stenosis was observed in the Zilver stent group. CONCLUSION Stent choice may affect VSS outcomes. The Zilver stent provided better clinical outcomes than the Carotid Wallstent, with significantly shorter procedure times. Larger studies are needed to determine the efficacy of available venous stents for IIH.
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Affiliation(s)
- Cem Bilgin
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander A Oliver
- Biomedical Engineering, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | | | - John J Chen
- Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stylianos K Rammos
- Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas, USA
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Kraker JA, Tajfirouz DA, Bhatti MT, Chen JJ. Tachyphylaxis With Sustained Apraclonidine Use in the Treatment of Ptosis Associated With Horner Syndrome. J Neuroophthalmol 2023; 43:e245-e246. [PMID: 36279499 DOI: 10.1097/wno.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica A Kraker
- Mayo Clinic Department of Ophthalmology (JAK, DAT, MTB, JJC), Rochester, Minnesota; and Mayo Clinic Department of Neurology (MTB, JJC), Rochester, Minnesota
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32
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Wang LQ, Zhang CY, Chen JJ, Lin WJ, Yu GY, Deng LS, Ji XR, Duan XM, Xiong YS, Jiang GJ, Wang JT, Liao XW, Liu LH. Ru-Based Organometallic Agents Bearing Phenyl Hydroxide: Synthesis and Antibacterial Mechanism Study against Staphylococcus aureus. ChemMedChem 2023; 18:e202300306. [PMID: 37527976 DOI: 10.1002/cmdc.202300306] [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: 06/13/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/03/2023]
Abstract
The development of antimicrobial agents with novel model of actions is a promising strategy to combat multiple resistant bacteria. Here, three ruthenium-based complexes, which acted as potential antimicrobial agents, were synthesized and characterized. Importantly, three complexes all showed strong bactericidal potency against Staphylococcus aureus. In particular, the most active one has a MIC of 6.25 μg/mL. Mechanistic studies indicated that ruthenium complex killed S. aureus by releasing ROS and damaging the integrity of bacterial cell membrane. In addition, the most active complex not only could inhibit the biofilm formation and hemolytic toxin secretion of S. aureus, but also serve as a potential antimicrobial adjuvant as well, which showed synergistic effects with eight traditional antibiotics. Finally, both G. mellonella larva infection model and mouse skin infection model all demonstrated that ruthenium complex also showed significant efficacy against S. aureus in vivo. In summary, our study suggested that ruthenium-based complexes bearing a phenyl hydroxide are promising antimicrobial agents for combating S. aureus.
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Affiliation(s)
- L Q Wang
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - C Y Zhang
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - J J Chen
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - W J Lin
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - G Y Yu
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - L S Deng
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - X R Ji
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - X M Duan
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - Y S Xiong
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - G J Jiang
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - J T Wang
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - X W Liao
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang, 330013, China
| | - L H Liu
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua, 418000, China
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Saraf A, Sim AJ, Chen JJ, Gill GS, Le A, Lichter K, Mills MN, Razavian N, Jimenez RB. Teaching Trainees to be Effective Mentors: A Needs-Based Assessment in Radiation Oncology. Int J Radiat Oncol Biol Phys 2023; 117:S114. [PMID: 37784298 DOI: 10.1016/j.ijrobp.2023.06.444] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Mentorship plays a critical role in the training and career development of medical trainees. Teaching-the-teacher workshops for residents translate to higher long-term job satisfaction and improved patient communication skills. Further, near-peer mentorship has been associated with increased job satisfaction and patient care experience. Resident-as-mentors can add benefit to the mentorship networks of students, particularly in resource-limited environments, while benefiting residents' own mentorship relations and career satisfaction. We hypothesized that residents would desire to be a mentor, but would lack specific skills needed for effective mentoring of students in radiation oncology. MATERIALS/METHODS A multi-institution, cross-sectional study was conducted among residents in the Radiation Oncology Education Collaborative Study Group (ROECSG) Graduate Medical Education working group from 06/2022-10/2022. Participants completed the Mentorship Competency Assessment (MCA), a validated 26-item questionnaire, scored on a Likert scale from 0-7 (0: most unprepared with mentorship skill, 7: most prepared with mentorship skill). The primary endpoint was the average score in individual mentorship skills among participants. Kruskal-Wallis test assessed associations between total MCA score (range 0-182) and demographics. RESULTS A total of 36 of 39 participants (92% response rate) responded. A majority were male (58%), from a residency size >10 (75%), and P Gy-2/3 (52%). Most had no formal training in teaching (86%) or mentorship (89%). Many believed they would be a good mentor to students on a rotation (89%), but most felt they would benefit from a formal mentorship program (92%). From the MCA, the mentorship skills residents felt most unprepared for were: coordinating effectively with other mentors (3.4/7), helping mentees acquire resources (3.6/7), negotiating a path to professional independence with mentees (3.6/7), helping mentees network effectively (3.7/7), and working with mentees to set clear expectations of the mentoring relationship (3.9/7). The mentorship skills residents felt most prepared for were: acknowledging mentees' professional contributions (5.6/7), establishing a relationship based on trust (5.6/7), active listening (5.5/7), building mentees' confidence (4.9/7), and working effectively with mentees with personal backgrounds differing from one's own (4.8/7). Higher MCA scores were associated with former training in mentorship (p = 0.0143), and a trend for former training in teaching (p = 0.0525), but was not associated with sex (p = 0.5986), residency size (p = 0.1415), or P Gy-year (p = 0.9747). CONCLUSION Residents are interested in mentorship training and report unpreparedness in several important skills. Future work should focus on formal training and assessment of mentoring skills for residents.
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Affiliation(s)
- A Saraf
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Boston, MA
| | - A J Sim
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - G S Gill
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - A Le
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - K Lichter
- University of California, San Francisco Department of Radiation Oncology, San Francisco, CA
| | - M N Mills
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - N Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC
| | - R B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Kraker JA, Chen JJ. An update on optic neuritis. J Neurol 2023; 270:5113-5126. [PMID: 37542657 DOI: 10.1007/s00415-023-11920-x] [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: 07/09/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
Optic neuritis (ON) is the most common cause of subacute optic neuropathy in young adults. Although most cases of optic neuritis (ON) are classified as typical, meaning idiopathic or associated with multiple sclerosis, there is a growing understanding of atypical forms of optic neuritis such as antibody mediated aquaporin-4 (AQP4)-IgG neuromyelitis optica spectrum disorder (NMOSD) and the recently described entity, myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). Differentiating typical ON from atypical ON is important because they have different prognoses and treatments. Findings of atypical ON, including severe vision loss with poor recovery with steroids or steroid dependence, prominent optic disc edema, bilateral vision loss, and childhood or late adult onset, should prompt serologic testing for AQP4-IgG and MOG-IgG. Although the traditional division of typical and atypical ON can be helpful, it should be noted that there can be severe presentations of otherwise typical ON and mild presentations of atypical ON that blur these traditional lines. Rare causes of autoimmune optic neuropathies, such as glial fibrillary acidic protein (GFAP) and collapsin response-mediator protein 5 (CRMP5) autoimmunity also should be considered in patients with bilateral painless optic neuropathy associated with optic disc edema, especially if there are other accompanying suggestive neurologic symptoms/signs. Typical ON usually recovers well without treatment, though recovery may be expedited by steroids. Atypical ON is usually treated with intravenous steroids, and some forms, such as NMOSD, often require plasma exchange for acute attacks and long-term immunosuppressive therapy to prevent relapses. Since treatment is tailored to the cause of the ON, elucidating the etiology of the ON is of the utmost importance.
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Affiliation(s)
- Jessica A Kraker
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN, USA.
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Qian AS, Friesner I, Chen JJ, Boreta L, Braunstein SE, Hong JC. Natural Language Processing Identification of Symptoms in Emergency Department Visits in Patients Receiving Radiation. Int J Radiat Oncol Biol Phys 2023; 117:S144. [PMID: 37784369 DOI: 10.1016/j.ijrobp.2023.06.558] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients undergoing radiotherapy (RT) for cancer often require emergency department (ED) attention with possible hospitalization. Designing strategies to mitigate hospital admissions requires understanding the causal symptoms to tailor interventional strategies. Natural language processing (NLP) has previously been shown to accurately identify documented symptoms and may help characterize factors contributing to admission. The objective of this study was to use NLP to identify documented symptoms during ED visits and their association with subsequent hospital admission of patients undergoing RT. MATERIALS/METHODS A de-identified, single tertiary-care institution cohort of patients who received radiation between 2013 and 2022 was identified from the electronic health record using International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes. We applied a previously validated clinical Text Analysis and Knowledge Extraction System (cTAKES)-based NLP pipeline to extract Common Terminology Criteria for Adverse Events (CTCAE) encoded symptoms from ED encounter clinical notes. Chi-squared testing was used to compare demographics, and logistic regression was used to identify symptoms associated with subsequent admission from ED visits. RESULTS We identified 14,007 patients who received radiation, of whom 270 (1.9%) experienced 302 ED visits during their radiation course. 141 (46.7%) of ED visits resulted in an admission. Among patients with an ED encounter, there were no differences in admission rates based on primary language (p = 0.771), sex (p = 0.824), marital status (p = 0.753), race (p = 0.222), or age (p = 0.123). In admitted patients, the top 5 symptoms were pain (94.3%), nausea (92.1%), vomiting (73.7%), constipation (70.9%), and weakness (63.8%). In patients who did not require admission, the most common symptoms were pain (84.5%), nausea (67.1%), vomiting (47.2%), headache (36.6%), and weakness (35.4%). The 10 symptoms most associated with admission from the ED based on logistic regression were malaise (OR 21.7, [95% CI 10.1 - 51.0]), lethargy (19.1, [8.5 - 51.3]), flushing (15.7, [8.6 - 30.4]), agitation (12.4, [3.5 - 78.7]), somnolence (10.3, [4.7 - 25.9]), fall (8.5, [3.7 - 23.2]), fatigue (7.8, [4.6 - 13.4]), constipation (6.9, [4.2 - 11.6]), nausea (5.8, [3.0 - 12.2]), and swelling (5.4, [3.3 - 9.1]). CONCLUSION Admitted and non-admitted ED patients with cancer seen in the ED during radiotherapy are documented to experience similar symptoms, but certain symptoms are associated with a higher risk of hospital admission. NLP may offer a mechanism for early, automated identification to facilitate supportive interventions for patients at high risk for admission during radiotherapy.
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Affiliation(s)
- A S Qian
- University of California, San Francisco, San Francisco, CA
| | - I Friesner
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - L Boreta
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - S E Braunstein
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - J C Hong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
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Majed M, Valencia Sanchez C, Bennett JL, Fryer J, Mulligan MD, Redenbaugh V, McKeon A, Mills JR, Wingerchuk DM, Lennon VA, Weinshenker B, Chen JJ, Flanagan EP, Pittock SJ, Kunchok A. Alterations in Aquaporin-4-IgG Serostatus in 986 Patients: A Laboratory-Based Longitudinal Analysis. Ann Neurol 2023; 94:727-735. [PMID: 37314750 DOI: 10.1002/ana.26722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was undertaken to investigate factors associated with aquaporin-4 (AQP4)-IgG serostatus change using a large serological database. METHODS This retrospective study utilizes Mayo Clinic Neuroimmunology Laboratory data from 2007 to 2021. We included all patients with ≥2 AQP4-IgG tests (by cell-based assay). The frequency and clinical factors associated with serostatus change were evaluated. Multivariable logistic regression analysis examined whether age, sex, or initial titer was associated with serostatus change. RESULTS There were 933 patients who had ≥2 AQP4-IgG tests with an initial positive result. Of those, 830 (89%) remained seropositive and 103 (11%) seroreverted to negative. Median interval to seroreversion was 1.2 years (interquartile range [IQR] = 0.4-3.5). Of those with sustained seropositivity, titers were stable in 92%. Seroreversion was associated with age ≤ 20 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.09-4.63; p = 0.028) and low initial titer of ≤1:100 (OR = 11.44, 95% CI = 3.17-41.26, p < 0.001), and 5 had clinical attacks despite seroreversion. Among 62 retested after seroreversion, 50% returned to seropositive (median = 224 days, IQR = 160-371). An initial negative AQP4-IgG test occurred in 9,308 patients. Of those, 99% remained seronegative and 53 (0.3%) seroconverted at a median interval of 0.76 years (IQR = 0.37-1.68). INTERPRETATION AQP4-IgG seropositivity usually persists over time with little change in titer. Seroreversion to negative is uncommon (11%) and associated with lower titers and younger age. Seroreversion was often transient, and attacks occasionally occurred despite prior seroreversion, suggesting it may not reliably reflect disease activity. Seroconversion to positive is rare (<1%), limiting the utility of repeat testing in seronegative patients unless clinical suspicion is high. ANN NEUROL 2023;94:727-735.
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Affiliation(s)
- Masoud Majed
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Martin D Mulligan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Vyankya Redenbaugh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Brian Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Amy Kunchok
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
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Bui NT, Kazemi A, Sit AJ, Larson NB, Greenleaf J, Chen JJ, Zhang X. Non-invasive Measurement of the Viscoelasticity of the Optic Nerve and Sclera for Assessing Papilledema: A Pilot Clinical Study. Ultrasound Med Biol 2023; 49:2227-2233. [PMID: 37517885 PMCID: PMC10529623 DOI: 10.1016/j.ultrasmedbio.2023.07.006] [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: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate our novel ultrasound vibro-elastography (UVE) technique for assessing patients with papilledema by non-invasively measuring shear wave speed (SWS), elasticity and viscosity properties of the optic nerve and sclera. METHODS Shear wave speeds were measured at three frequencies-100, 150 and 200 Hz-on the optic nerve and sclera tissues for assessing patients with papilledema resulting from idiopathic intracranial hypertension (IIH). The method was evaluated in six papilledema patients and six controls on two separate locations for each participant (i.e., optic nerve and posterior sclera). SWSs of the optic nerve and sclera were analyzed by using a 2-D speed map technique within a circular region of interest (ROI) (i.e., the diameter of the ROI was 1.5 mm × 3.0 mm at the optic nerve and sclera, respectively). Elasticity and viscosity were then analyzed using the wave speed dispersion over the three frequencies. RESULTS We measured values of SWS at both locations, optic nerve and sclera, of the right eye and left eye at three different frequencies in IIH patients and controls. The SWS (mean ± standard deviation [m/s]) of the right eye was significantly higher at the sclera in IIH patients compared with controls (i.e., patients vs. controls: 5.91 ± 0.54 vs. 3.86 ± 0.56, p < 0.0001 at 100 Hz), but there was no significant difference at the optic nerve (i.e., patients vs. controls: 3.62 ± 0.39 vs. 3.36 ± 0.35, p = 0.1100 at 100Hz). We observed increased elasticity (kPa) in IIH patients, indicating there are significant differences in elasticity between patients and controls at the optic nerve and sclera (i.e., right eye [patients vs. controls]: 14.42 ± 6.59 vs. 6.5 ± 5.71, p = 0.0065 [optic nerve]; 33.04 ± 10.62 vs. 9.16 ± 7.15, p < 0.0001 [sclera]). Viscosity was also (Pa·s) higher in the sclera and optic nerve of the left eye (i.e., left eye [patient vs. control]: 8.89 ± 4.37 vs. 7.27 ± 5.01, p = 0.3790 (optic nerve); 16.05 ± 10.79 vs. 8.49 ± 6.09, p < 0.0194 [sclera]). CONCLUSION This research illustrates the feasibility of using our UVE system to evaluate stiffness of different tissues in the eye non-invasively. It suggests that the viscoelasticity of the posterior sclera is higher than that of the optic nerve. We found that the posterior sclera is stiffer than the optic nerve in patients with papilledema resulting from IIH, making UVE a potential non-invasive technique for assessing papilledema.
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Affiliation(s)
- Ngoc Thang Bui
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Arash Kazemi
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Arthur J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | - James Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
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MacDuffie E, Lichter K, Ponce SEB, LeCompte MC, Krc RF, Taswell CSS, Chen JJ, Wang K, Saripalli A, LoTemplio AA, Barry PN, Henson C, Marshall A, Jagsi R, Kahn JM. Attitudes and Barriers to Planned Family Building among Professionals and Trainees in Radiation Oncology. Int J Radiat Oncol Biol Phys 2023; 117:e40-e41. [PMID: 37785335 DOI: 10.1016/j.ijrobp.2023.06.737] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The timing of residency training often coincides with peak biological fertility. However, family building is frequently deferred and may lead to unanticipated infertility. The attitudes and barriers to family planning are not well described among medical professionals and trainees in radiation oncology (RO). MATERIALS/METHODS The Society for Women in Radiation Oncology (SWRO) conducted an electronic survey among practicing physicians, physicists, and residents between January and February 2023, using email and social media as recruitment tools. The survey questions queried demographics, family planning, fertility. Frequencies of responses were summarized using descriptive statistics. RESULTS On interim analysis, 147 responses were collected; 123 (89.8%) were SWRO members. Gender identities reported were female (136, 93.2%), male (7, 4.8%), nonbinary or gender diverse (2, 1.4%), and transgender female (1, 0.7%). 95 (64.6%) respondents were age 35 or younger. The majority were practicing physicians (72, 49.0%) followed by RO residents (45, 30.6%), medical physicists (17, 11.6%), medical students, (5, 3.4%), and medical physics residents (4, 2.7%). Most respondents agreed that their reproductive timeline had been impacted by medical training (106, 76.3%). Of those who deferred parenthood due to training or career, 40 (36.7%) were dissatisfied with their choice and 33 (30.2%) were satisfied. 129 (92.8%) reported not receiving any information about fertility preservation during training. Only 65 (47.4%) felt they had a mentor with whom they could approach to discuss family planning. Overall, 84 (60.4%) expressed concern about their fertility and 34 (24.5%) had previously undergone fertility testing. 16 (11.5%) completed at least one cycle of elective fertility preservation and 12 (8.6%) were planning to do so. 39 (28.1%) had considered elective fertility preservation but not pursued it, while 65 (46.8%) had not considered it. Among those two groups, the common reported barriers to accessing fertility services were financial burden (n = 28, 28.6%), lack of awareness of available options (n = 12, 12.2%), difficulty accessing fertility services (n = 6, 6.1%), and difficulty finding time during training (n = 4, 4.1%). Insurance coverage for elective fertility preservation was fully or partially covered by insurance for 12 (8.8%), not covered for 53 (38.7%), and 72 (52.6%) were uncertain of their coverage. CONCLUSION The study highlights the impact of training on family building plans of medical professionals in RO. Despite high levels of concern about fertility, few respondents received education about fertility options in training and a limited number had access to mentors to discuss this issue. Significant barriers exist to accessing fertility services, including knowledge gaps about insurance coverage, highlighting a need for further exploration of these barriers and advocacy for improved family planning support for those in RO who desire it.
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Affiliation(s)
- E MacDuffie
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - K Lichter
- University of California, San Francisco Department of Radiation Oncology, San Francisco, CA
| | - S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M C LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R F Krc
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | | | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - K Wang
- Department of Radiation Oncology, UAMS Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - A Saripalli
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | | | - P N Barry
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - C Henson
- University of Oklahoma College of Medicine, Oklahoma City, OK
| | - A Marshall
- Department of Hematology, Penn Medicine, Philadelphia, PA
| | - R Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - J M Kahn
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
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Saraf A, Sim AJ, Chen JJ, Gill GS, Le A, Lichter K, Mills MN, Razavian N, Jimenez RB. TEAMRO: TEAching Mentorship in Radiation Oncology, a Multicenter Prospective Phase 2 Intervention Study on Teaching Mentorship Skills to Residents Working with Medical Students. Int J Radiat Oncol Biol Phys 2023; 117:e541-e542. [PMID: 37785673 DOI: 10.1016/j.ijrobp.2023.06.1836] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While formal curriculum on resident teaching have been associated with improved career growth and sustained positive impact on patient care, mentorship skills are rarely taught in academic medicine. We hypothesized that a formalized resident mentorship curriculum coupled with a near-peer resident-medical student mentoring program would improve resident career growth. MATERIALS/METHODS A multi-institutional, prospective, phase 2 intervention study, approved by each participating center's institutional review board, was conducted from 4/2022-10/2022 among interested residents in the Radiation Oncology Education Collaborative Study Group Graduate Medical Education. Intervention included: 1) a 4-week mentorship curriculum (utilizing a Six Steps approach) composed of self-guided readings, didactic lecture, and 30-minute faculty check-in, and 2) a formalized 1:1 resident-medical student mentorship program during an existing radiation oncology sub-internship with weekly meetings. Resident participants completed the Mentorship Competency Assessment (MCA), a 26-item validated survey on mentorship skills in medicine scored from 0 (most unprepared) to 7 (most prepared) before and after the intervention. The primary endpoint was average change in MCA skill from pre- to post-intervention survey, with score ranges from -7 (a decrease in 7 points) to +7 (an increase of 7 points). RESULTS A total of 8 residents participated and all completed pre- and post-intervention surveys. Most residents were PGY-4/5 (75%), from programs with >10 residents (68%), and did not have prior training in teaching (88%) or mentorship (88%). Residents met students on average twice weekly (range 1-3) for an average of 2 hours a week (range 1-5). After the program, most residents felt confident in being a future mentor to students (100%), their overall well-being was positively impacted (63%), and their mentorship relationships were positively impacted (50%). All 26 mentorship skills increased on MCA after intervention (average +1.3/7 per skill). Skills that showed greatest improvement were helping mentees network effectively (+2.6/7), acquire resources (+2.1/7), negotiate a path to professional independence (+2.0/7), set career goals (+1.8/7), and balance work and personal life (+1.7/7). Skills that showed least improvement were establishing a relationship based on trust (+0.4/7), identifying and accommodating different communication styles (+0.6/7), providing constructive feedback (+0.7/7), and aligning mentor-mentee expectations (+0.8/7). CONCLUSION The formalized mentorship program improved mentorship skills among residents, translating to increased satisfaction in residents' own mentorship relations and overall well-being. Further studies are needed to assess the sustainability of these skills, as well as impact on career growth and satisfaction.
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Affiliation(s)
- A Saraf
- Sarah Cannon Research Institute at Rose Medical Center, Denver, CO; Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - A J Sim
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - G S Gill
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - A Le
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - K Lichter
- University of California, San Francisco Department of Radiation Oncology, San Francisco, CA
| | - M N Mills
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - N Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC
| | - R B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Matsunaga M, Ishikawa KM, Siriwardhana C, Ahn HJ, Chen JJ. Stepwise Proportional Weighting Algorithm for Single-Race Population Estimation Using Hawai'i Census Data. Hawaii J Health Soc Welf 2023; 82:97-103. [PMID: 37901658 PMCID: PMC10612413] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Many health and health disparities studies require population prevalence information of various race groups, but the estimation of single-race population sizes using the US Census data has been challenging. For each Census race group, Census only provides the counts of those reported being single race ("race alone") and those reported of that specific race regardless of whether the individuals were multiracial or not ("race alone or in (any) combination"). The issue of how to classify Census multiracial individuals is especially important for the state of Hawai'i due to its large multiracial population. The current study developed the Stepwise Proportional Weighting Algorithm (SPWA) for single-race population estimation using US Census data for major race groups in the Census and their nested detailed races. Additionally, given that "partial Native Hawaiian" has often been treated as "Native Hawaiian" in health disparities studies in Hawai'i, the algorithm can also adjust for the unique partial Native Hawaiian race categorization. This paper describes the estimation process with the SPWA and demonstrates its ability to estimate single-races for the 5 most common race groups in Hawai'i. This new methodology addresses an important concern regarding how to classify multiracial individuals to strengthen health and health disparities research in Hawai'i.
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Affiliation(s)
- Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Kyle M. Ishikawa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Chathura Siriwardhana
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Chen JJ, Brown AM, Garda AE, Kim E, McAvoy SA, Perni S, Rooney MK, Shiue K, Tonning KL, Warren L, Golden DW, Croke JM. Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers. Int J Radiat Oncol Biol Phys 2023; 117:e371. [PMID: 37785265 DOI: 10.1016/j.ijrobp.2023.06.2471] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education. MATERIALS/METHODS An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses. RESULTS A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery. CONCLUSION Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.
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Affiliation(s)
- J J Chen
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | | | - A E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - E Kim
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - S A McAvoy
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - S Perni
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M K Rooney
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - K L Tonning
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - L Warren
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - D W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - J M Croke
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Krc RF, Lichter K, Taswell CSS, Ponce SEB, MacDuffie E, LeCompte MC, Chen JJ, Wang K, Lotemplio A, Saripalli A, Kaya E, Barry PN, Masters AH, Jagsi R, Kahn JM. The Society for Women in Radiation Oncology: Where are We Five Years Later? Int J Radiat Oncol Biol Phys 2023; 117:e31-e32. [PMID: 37785121 DOI: 10.1016/j.ijrobp.2023.06.717] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The Society for Women in Radiation Oncology (SWRO) was founded in 2017 with a mission to promote representation and gender equity in the field of radiation oncology (RO). SWRO members include faculty and trainee radiation oncologists and medical physicists. We aim to assess the current experiences of SWRO members using a comprehensive survey of gender-related workforce issues we developed. Data was used to establish a 5-year benchmark. MATERIALS/METHODS From January to February 2023, an anonymous survey was distributed to current SWRO members. Questions included demographics, family planning/fertility issues, perceptions of the field, and membership needs. Descriptive statistics were used to summarize frequencies of the multiple-choice items on the survey. RESULTS On interim analysis, 115 of 680 (17%) completed the survey from 11 countries, 81% of which reside in the US. 55% were faculty physicians, 26% resident physicians, 10% faculty physicists, and 3% physics residents. The majority were female (97%) and either married or in a domestic partnership (74%). 47% reported having at least one child, and 26% reported that they or their partner became pregnant during residency. Length of leave was impacted by residents' desire to complete residency training on schedule. 53% felt RO was perceived as family-friendly, but much fewer (17%) agreed that it is. After clinical responsibilities (70%), insufficient mentorship was cited as the second most common limitation to professional productivity (35%). 48% reported being somewhat or extremely satisfied with current mentorship availability at their institution, while 56% reported being similarly satisfied with the mentorship available within the field. 69% reported seeking or having sought female mentorship outside of their institution. Unwanted sexual comments, attention, or advances by superiors or colleagues was reported by 38% of respondents. Additionally, 72% either agreed or strongly agreed that SWRO membership and participation were a valuable use of their time, with the top three reasons for joining being networking opportunities, mentorship opportunities, and increasing the visibility of women and gender minorities in RO. Suggested improvements included increasing female physics representation and advocacy, and physics-related events, as well as providing opportunities for members to socialize and interact. CONCLUSION This study provides an update on the experiences of women and gender minorities in the field of RO since the creation of SWRO in 2017. The study highlights ongoing targets for improvement such as gender-based obstacles, opportunity for additional education and advocacy, support of family-friendly culture shifts, mentorship, and increased physics inclusion and advocacy. These findings support the need for organizations such as SWRO to continue to promote representation and gender equity in RO.
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Affiliation(s)
- R F Krc
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - K Lichter
- University of California, San Francisco Department of Radiation Oncology, San Francisco, CA
| | | | - S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E MacDuffie
- University of Pennsylvania, Philadelphia, PA
| | - M C LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Chen
- University of California, San Francisco, San Francisco, CA
| | - K Wang
- Department of Radiation Oncology, UAMS Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - A Lotemplio
- SUNY Upstate Medical University, Syracuse, NY
| | - A Saripalli
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - E Kaya
- Washington State University Elson S Floyd College of Medicine, Spokane, WA
| | - P N Barry
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - R Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - J M Kahn
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
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Ishikawa KM, Matsunaga M, Ahn HJ, Siriwardhana C, Chen JJ. Age and Sex Distributions of 31 Common Racial Groups in Hawai'i: A Shiny Web Application. Hawaii J Health Soc Welf 2023; 82:89-96. [PMID: 37901668 PMCID: PMC10612410] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i.
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Affiliation(s)
- Kyle M. Ishikawa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘I, Honolulu, HI
| | - Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘I, Honolulu, HI
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘I, Honolulu, HI
| | - Chathura Siriwardhana
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘I, Honolulu, HI
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘I, Honolulu, HI
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Siriwardhana C, Carrazana E, Liow K, Chen JJ. Racial/Ethnic Disparities in the Alzheimer's Disease Link with Cardio and Cerebrovascular Diseases, Based on Hawaii Medicare Data. J Alzheimers Dis Rep 2023; 7:1103-1120. [PMID: 37849625 PMCID: PMC10578323 DOI: 10.3233/adr-230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/22/2023] [Indexed: 10/19/2023] Open
Abstract
Background There is an expanding body of literature implicating heart disease and stroke as risk factors for Alzheimer's disease (AD). Hawaii is one of the six majority-minority states in the United States and has significant racial health disparities. The Native-Hawaiians/Pacific-Islander (NHPI) population is well-known as a high-risk group for a variety of disease conditions. Objective We explored the association of cardiovascular disease with AD development based on the Hawaii Medicare data, focusing on racial disparities. Methods We utilized nine years of Hawaii Medicare data to identify subjects who developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), stroke, and progressed to AD, using multistate models. Propensity score-matched controls without cardiovascular disease were identified to compare the risk of AD after heart disease and stroke. Racial/Ethnic differences in progression to AD were evaluated, accounting for other risk factors. Results We found increased risks of AD for AF, HF, IHD, and stroke. Socioeconomic (SE) status was found to be critical to AD risk. Among the low SE group, increased AD risks were found in NHPIs compared to Asians for all conditions selected and compared to whites for HF, IHD, and stroke. Interestingly, these observations were found reversed in the higher SE group, showing reduced AD risks for NHPIs compared to whites for AF, HF, and IHD, and to Asians for HF and IHD. Conclusions NHPIs with poor SE status seems to be mostly disadvantaged by the heart/stroke and AD association compared to corresponding whites and Asians.
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Affiliation(s)
- Chathura Siriwardhana
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Enrique Carrazana
- Department of Medicine, University of Hawaii John Burns School of Medicine, Honolulu, HI, USA
| | - Kore Liow
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
- Department of Medicine, University of Hawaii John Burns School of Medicine, Honolulu, HI, USA
- Memory Disorders Center, Stroke & Neurologic Restoration Center, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - John J. Chen
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
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Cacciaguerra L, Redenbaugh V, Chen JJ, Morris P, Sechi E, Syc-Mazurek SB, Lopez-Chiriboga AS, Tillema JM, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Timing and Predictors of T2-Lesion Resolution in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Neurology 2023; 101:e1376-e1381. [PMID: 37336767 PMCID: PMC10558168 DOI: 10.1212/wnl.0000000000207478] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES To determine the timing and predictors of T2-lesion resolution in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS This retrospective observational study using standard-of-care data had inclusion criteria of MOGAD diagnosis, ≥2 MRIs 12 months apart, and ≥1 brain/spinal cord T2-lesion. The median (interquartile range [IQR]) number of MRIs (82% at disease onset) per-patient were: brain, 5 (2-8); spine, 4 (2-8). Predictors of T2-lesion resolution were assessed with age- and sex-adjusted generalized estimating equations and stratified by T2-lesion size (small <1 cm; large ≥1 cm). RESULTS We studied 583 T2-lesions (brain, 512 [88%]; spinal cord, 71 [12%]) from 55 patients. At last MRI (median follow-up 54 months [IQR 7-74]) 455 T2-lesions (78%) resolved. The median (IQR) time to resolution was 3 months (1.4-7.0). Small T2-lesions resolved more frequently and faster than large T2-lesions. Acute T1-hypointensity decreased the likelihood (odds ratio [95% CI]) of T2-lesion resolution independent of size (small: 0.23 [0.09-0.60], p = 0.002; large: 0.30 [0.16-0.55], p < 0.001), whereas acute steroids favored resolution of large T2-lesions (1.75 [1.01-3.03], p = 0.046). Notably, 32/55 (58%) T2-lesions resolved without treatment. DISCUSSION The high frequency of spontaneous T2-lesion resolution suggests that this represents MOGAD's natural history. The speed of T2-lesion resolution and influence of size, corticosteroids, and T1-hypointensity on this phenomenon gives insight into MOGAD pathogenesis.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elia Sechi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Stephanie B Syc-Mazurek
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Maria A Rocca
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Massimo Filippi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN.
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46
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Chen B, Gomez-Figueroa E, Redenbaugh V, Francis A, Satukijchai C, Wu Y, Messina S, Sa M, Woodhall M, Paul F, Robertson NP, Lim M, Wassmer E, Kneen R, Huda S, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin RJ, Dobson R, Cooper SA, Williams V, Waters P, Chen JJ, Pittock SJ, Ramdas S, Leite MI, Flanagan EP, Geraldes R, Palace J. Do Early Relapses Predict the Risk of Long-Term Relapsing Disease in an Adult and Paediatric Cohort with MOGAD? Ann Neurol 2023; 94:508-517. [PMID: 37394961 DOI: 10.1002/ana.26731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD. METHODS A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. "Early relapses" were defined as attacks within the first 12 months from onset, with "very early relapses" defined within 30 to 90 days from onset and "delayed early relapses" defined within 90 to 365 days. "Long-term relapses" were defined as relapses beyond 12 months. Cox regression modeling and Kaplan-Meier survival analysis were used to estimate the long-term relapse risk and rate. RESULTS Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any "early relapses" were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026). INTERPRETATION The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508-517.
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Affiliation(s)
- Bo Chen
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Enrique Gomez-Figueroa
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Mexico
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Anna Francis
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | | | - Yan Wu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Mario Sa
- Department of Paediatric Neurology, Oxford University NHS Foundation Trust, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Neil P Robertson
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Ming Lim
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK
- Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Evangeline Wassmer
- Women and Children's Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Kneen
- Department of Paediatric Neurology, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Saif Huda
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Camilla Blain
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher Halfpenny
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Southampton General Hospital, Southampton, UK
| | - Eoin O'Sullivan
- Department of Paediatric Neurology, Great Ormond St. Hospital for Children, London, UK
| | - Jeremy Hobart
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Leonora K Fisniku
- Department of Neurology, University Hospitals Plymouth National Health Service Foundation Trust, Devon, UK
| | - Roswell J Martin
- Department of Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Dobson
- Department of Neurology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | - Sarah A Cooper
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Victoria Williams
- Department of Neurology, University Hospitals Sussex National Health Service Foundation Trust, Brighton, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John J Chen
- Department of Neurology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Sean J Pittock
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN
| | - Sithara Ramdas
- Centre MS and Autoimmune Neurology, Department Neurology, Mayo Clinic, Rochester, MN
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Eoin P Flanagan
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
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47
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Chen JJ. Don't Forget the Oy-sters When It Comes to Tolosa-Hunt Syndrome. Neurology 2023; 101:337-338. [PMID: 37185125 DOI: 10.1212/wnl.0000000000207450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- John J Chen
- From the Department of Ophthalmology and Neurology, Mayo Cinic, Rochester, MN.
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48
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Dai YC, Lin YC, Ching LL, Tsai JJ, Ishikawa K, Tsai WY, Chen JJ, Nerurkar VR, Wang WK. Determining the Time of Booster Dose Based on the Half-Life and Neutralization Titers against SARS-CoV-2 Variants of Concern in Fully Vaccinated Individuals. Microbiol Spectr 2023; 11:e0408122. [PMID: 37428104 PMCID: PMC10434144 DOI: 10.1128/spectrum.04081-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/20/2023] [Indexed: 07/11/2023] Open
Abstract
Although mRNA-based COVID-19 vaccines reduce the risk of severe disease, hospitalization and death, vaccine effectiveness (VE) against infection and disease from variants of concern (VOC) wanes over time. Neutralizing antibodies (NAb) are surrogates of protection and are enhanced by a booster dose, but their kinetics and durability remain understudied. Current recommendation of a booster dose does not consider the existing NAb in each individual. Here, we investigated 50% neutralization (NT50) titers against VOC among COVID-19-naive participants receiving the Moderna (n = 26) or Pfizer (n = 25) vaccine for up to 7 months following the second dose, and determined their half-lives. We found that the time it took for NT50 titers to decline to 24, equivalent to 50% inhibitory dilution of 10 international units/mL, was longer in the Moderna (325/324/235/274 days for the D614G/alpha/beta/delta variants) group than in the Pfizer (253/252/174/226 days) group, which may account for the slower decline in VE of the Moderna vaccine observed in real-world settings and supports our hypothesis that measuring the NT50 titers against VOC, together with information on NAb half-lives, can be used to dictate the time of booster vaccination. Our study provides a framework to determine the optimal time of a booster dose against VOC at the individual level. In response to future VOC with high morbidity and mortality, a quick evaluation of NAb half-lives using longitudinal serum samples from clinical trials or research programs of different primary-series vaccinations and/or one or two boosters could provide references for determining the time of booster in different individuals. IMPORTANCE Despite improved understanding of the biology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the evolutionary trajectory of the virus is uncertain, and the concern of future antigenically distinct variants remains. Current recommendations for a COVID-19 vaccine booster dose are primarily based on neutralization capacity, effectiveness against circulating variants of concern (VOC), and other host factors. We hypothesized that measuring neutralizing antibody titers against SARS-CoV-2 VOC together with half-life information can be used to dictate the time of booster vaccination. Through detailed analysis of neutralizing antibodies against VOC among COVID-19-naive vaccinees receiving either of two mRNA vaccines, we found that the time it took for 50% neutralization titers to decline to a reference level of protection was longer in the Moderna than in the Pfizer group, which supports our hypothesis. In response to future VOC with potentially high morbidity and mortality, our proof-of-concept study provides a framework to determine the optimal time of a booster dose at the individual level.
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Affiliation(s)
- Yu-Ching Dai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Yen-Chia Lin
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Lauren L. Ching
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
- Pacific Center for Emerging Infectious Diseases, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Jih-Jin Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kyle Ishikawa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
- Pacific Center for Emerging Infectious Diseases, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Vivek R. Nerurkar
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
- Pacific Center for Emerging Infectious Diseases, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
- Pacific Center for Emerging Infectious Diseases, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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49
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Cohen DA, Sanchez Moreno FR, Bhatti MT, Lanzino G, Chen JJ. Evaluating the Incidence and Neuro-Ophthalmic Manifestations of Carotid-Cavernous Fistulas. J Neuroophthalmol 2023:00041327-990000000-00439. [PMID: 37581565 PMCID: PMC10864674 DOI: 10.1097/wno.0000000000001973] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND To determine the incidence of carotid-cavernous fistula (CCF) and describe the neuro-ophthalmic manifestations and eventual clinical outcomes. METHODS This was a population-based, retrospective cohort study using the Rochester Epidemiology Project to identify patients aged 18 years or older residing in Olmsted County, MN, diagnosed with CCF from 1997 to 2019. The medical records were reviewed for ophthalmic signs and symptoms, including conjunctival chemosis, proptosis, orbital bruit, diplopia, ophthalmoplegia, orbital pain, ocular hypertension, and blurred vision. Also determined was the number of patients with CCF found incidentally on neuroimaging, without clinical manifestations. RESULTS Ten patients were diagnosed with a CCF between 1997 and 2019 with an overall incidence rate of 0.37 per 100,000 per year (95% CI 0.20-0.68). The median age was 50.5 years (range 23-74 years), 6 (60%) were female, and 9 were White and 1 patient was Korean. Three patients (30%) were asymptomatic and found incidentally on imaging that was obtained for unrelated reasons, and one patient's ocular details were unavailable because she passed away from severe head trauma. The following neuro-ophthalmologic or ocular manifestations were identified in the remaining 6 patients: chemosis/conjunctival injection (n = 6), cranial nerve (CN) VI palsy (n = 6), CN III palsy (n = 2), proptosis (n = 4), ocular/orbital pain (n = 3), audible orbital bruit (n = 2), ocular hypertension (n = 1), and blurred vision (n = 1). Of those patients with symptomatic CCFs, all underwent treatment except for one that spontaneously resolved. None of the patients suffered a stroke or cerebral hemorrhage. The 3 patients with incidentally discovered CCFs were asymptomatic and did not require treatment. CONCLUSIONS This is the first population-based study to show a low incidence rate of CCFs, supporting the notion that it is an uncommon condition. Neuro-ophthalmic manifestations are common, especially chemosis/conjunctival injection and CN VI palsy. Up to a third of patients with CCF can be asymptomatic and may be found incidentally on neuroimaging during the evaluation for unrelated symptoms.
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Affiliation(s)
- Devon A. Cohen
- Department of Ophthalmology, Cleveland Clinic Foundation, Cleveland, OH
| | | | - M. Tariq Bhatti
- Department of Ophthalmology, The Permanente Medical Group, Roseville, CA
| | | | - John J. Chen
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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50
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Lotan I, Chen JJ, Hacohen Y, Abdel-Mannan O, Mariotto S, Huda S, Gibbons E, Wilf-Yarkoni A, Hellmann MA, Stiebel-Kalish H, Pittock SJ, Flanagan EP, Molazadeh N, Anderson M, Salky R, Romanow G, Schindler P, Duchow AS, Paul F, Levy M. Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease. Mult Scler 2023; 29:1080-1089. [PMID: 37431144 DOI: 10.1177/13524585231184738] [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] [Indexed: 07/12/2023]
Abstract
BACKGROUND The potential therapeutic benefit of intravenous immunoglobulins (IVIGs) for acute attacks of myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is unknown. OBJECTIVE The objective was to describe the outcomes of IVIG treatment for acute MOGAD attacks. METHODS A retrospective observational study involving seven tertiary neuroimmunology centers. Data collection included patients' demographics, Expanded Disability Status Scale (EDSS), and visual acuity (VA) before the attack, at the nadir of the attack before IVIG treatment, and at follow-up visits ⩾3 months after treatment. RESULTS Thirty-nine patients were included, of which 21 (53.8%) were female. The median age was 23 years (range 5-74 years), and the median disease duration was 4 months (range 0-93 months). The most common type of attack treated with IVIG was isolated optic neuritis (ON) (unilateral n = 14, bilateral n = 5, associated with transverse myelitis (TM), n = 1), followed by acute disseminated encephalomyelitis (ADEM) (n = 8), multifocal (n = 7), TM (n = 3), brainstem (n = 1), and other encephalitis (n = 1). A significant improvement in both the EDSS and VA measures was observed at follow-up compared to the time of IVIG treatment initiation (p < 0.0001 for both outcome measures). CONCLUSION IVIG may be an effective treatment option for acute MOGAD attacks. Further prospective studies are warranted to validate our results.
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Affiliation(s)
- Itay Lotan
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yael Hacohen
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Omar Abdel-Mannan
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Gibbons
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Adi Wilf-Yarkoni
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Hellmann
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Stiebel-Kalish
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Negar Molazadeh
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Monique Anderson
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca Salky
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Romanow
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ankelien Solveig Duchow
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Experimental and Clinical Research Center, Berlin, Germany
| | - Michael Levy
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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