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Maripuri M, Dey A, Honerlaw J, Hong C, Ho YL, Tanukonda V, Chen AW, Panickan VA, Wang X, Zhang HG, Yang D, Samayamuthu MJ, Morris M, Visweswaran S, Beaulieu-Jones B, Ramoni R, Muralidhar S, Gaziano JM, Liao K, Xia Z, Brat GA, Cai T, Cho K. Characterization of Post-COVID-19 Definitions and Clinical Coding Practices: Longitudinal Study. Online J Public Health Inform 2024; 16:e53445. [PMID: 38700929 PMCID: PMC11073632 DOI: 10.2196/53445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Post-COVID-19 condition (colloquially known as "long COVID-19") characterized as postacute sequelae of SARS-CoV-2 has no universal clinical case definition. Recent efforts have focused on understanding long COVID-19 symptoms, and electronic health record (EHR) data provide a unique resource for understanding this condition. The introduction of the International Classification of Diseases, Tenth Revision (ICD-10) code U09.9 for "Post COVID-19 condition, unspecified" to identify patients with long COVID-19 has provided a method of evaluating this condition in EHRs; however, the accuracy of this code is unclear. OBJECTIVE This study aimed to characterize the utility and accuracy of the U09.9 code across 3 health care systems-the Veterans Health Administration, the Beth Israel Deaconess Medical Center, and the University of Pittsburgh Medical Center-against patients identified with long COVID-19 via a chart review by operationalizing the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) definitions. METHODS Patients who were COVID-19 positive with either a U07.1 ICD-10 code or positive polymerase chain reaction test within these health care systems were identified for chart review. Among this cohort, we sampled patients based on two approaches: (1) with a U09.9 code and (2) without a U09.9 code but with a new onset long COVID-19-related ICD-10 code, which allows us to assess the sensitivity of the U09.9 code. To operationalize the long COVID-19 definition based on health agency guidelines, symptoms were grouped into a "core" cluster of 11 commonly reported symptoms among patients with long COVID-19 and an extended cluster that captured all other symptoms by disease domain. Patients having ≥2 symptoms persisting for ≥60 days that were new onset after their COVID-19 infection, with ≥1 symptom in the core cluster, were labeled as having long COVID-19 per chart review. The code's performance was compared across 3 health care systems and across different time periods of the pandemic. RESULTS Overall, 900 patient charts were reviewed across 3 health care systems. The prevalence of long COVID-19 among the cohort with the U09.9 ICD-10 code based on the operationalized WHO definition was between 23.2% and 62.4% across these health care systems. We also evaluated a less stringent version of the WHO definition and the CDC definition and observed an increase in the prevalence of long COVID-19 at all 3 health care systems. CONCLUSIONS This is one of the first studies to evaluate the U09.9 code against a clinical case definition for long COVID-19, as well as the first to apply this definition to EHR data using a chart review approach on a nationwide cohort across multiple health care systems. This chart review approach can be implemented at other EHR systems to further evaluate the utility and performance of the U09.9 code.
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Affiliation(s)
- Monika Maripuri
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Andrew Dey
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | | | - Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Yuk-Lam Ho
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Vidisha Tanukonda
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Alicia W Chen
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | | | - Xuan Wang
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Harrison G Zhang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Doris Yang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | | | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Rachel Ramoni
- Office of Research and Development, US Department of Veterans Affairs, Washington, DC, United States
| | - Sumitra Muralidhar
- Office of Research and Development, US Department of Veterans Affairs, Washington, DC, United States
| | - J Michael Gaziano
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Division of Aging, Department of Medicine, Mass General Brigham, Harvard Medical School, Boston, MA, United States
| | - Katherine Liao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gabriel A Brat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Kelly Cho
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Division of Aging, Department of Medicine, Mass General Brigham, Harvard Medical School, Boston, MA, United States
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Li MM, Huang Y, Sumathipala M, Liang MQ, Valdeolivas A, Ananthakrishnan AN, Liao K, Marbach D, Zitnik M. Contextualizing protein representations using deep learning on protein networks and single-cell data. bioRxiv 2024:2023.07.18.549602. [PMID: 37503080 PMCID: PMC10370131 DOI: 10.1101/2023.07.18.549602] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Understanding protein function and developing molecular therapies require deciphering the cell types in which proteins act as well as the interactions between proteins. However, modeling protein interactions across diverse biological contexts, such as tissues and cell types, remains a significant challenge for existing algorithms. We introduce Pinnacle, a flexible geometric deep learning approach that is trained on contextualized protein interaction networks to generate context-aware protein representations. Leveraging a human multi-organ single-cell transcriptomic atlas, Pinnacle provides 394,760 protein representations split across 156 cell type contexts from 24 tissues and organs. Pinnacle's contextualized representations of proteins reflect cellular and tissue organization and Pinnacle's tissue representations enable zero-shot retrieval of the tissue hierarchy. Pretrained Pinnacle's protein representations can be adapted for downstream tasks: to enhance 3D structure-based protein representations for important protein interactions in immuno-oncology (PD-1/PD-L1 and B7-1/CTLA-4) and to study the effects of drugs across cell type contexts. Pinnacle outperforms state-of-the-art, yet context-free, models in nominating therapeutic targets for rheumatoid arthritis and inflammatory bowel diseases, and can pinpoint cell type contexts that predict therapeutic targets better than context-free models (29 out of 156 cell types in rheumatoid arthritis; 13 out of 152 cell types in inflammatory bowel diseases). Pinnacle is a graph-based contextual AI model that dynamically adjusts its outputs based on biological contexts in which it operates.
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Affiliation(s)
| | | | | | | | - Alberto Valdeolivas
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, Basel, Switzerland
| | - Ashwin N Ananthakrishnan
- Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Liao
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Marbach
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, Basel, Switzerland
| | - Marinka Zitnik
- Harvard Medical School, Boston, MA, USA
- Kempner Institute for the Study of Natural and Artificial Intelligence, Harvard University, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Data Science Initiative, Cambridge, MA, USA
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3
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Negri A, Ward C, Bucci A, D'Angelo G, Cauchy P, Radesco A, Ventura AB, Walton DS, Clarke M, Mandriani B, Pappagallo SA, Mondelli P, Liao K, Gargano G, Zaccaria GM, Viggiano L, Lasorsa FM, Ahmed A, Di Molfetta D, Fiermonte G, Cives M, Guarini A, Vegliante MC, Ciavarella S, Frampton J, Volpe G. Reversal of MYB-dependent suppression of MAFB expression overrides leukaemia phenotype in MLL-rearranged AML. Cell Death Dis 2023; 14:763. [PMID: 37996430 PMCID: PMC10667525 DOI: 10.1038/s41419-023-06276-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
The transcription factor MYB plays a pivotal role in haematopoietic homoeostasis and its aberrant expression is involved in the genesis and maintenance of acute myeloid leukaemia (AML). We have previously demonstrated that not all AML subtypes display the same dependency on MYB expression and that such variability is dictated by the nature of the driver mutation. However, whether this difference in MYB dependency is a general trend in AML remains to be further elucidated. Here, we investigate the role of MYB in human leukaemia by performing siRNA-mediated knock-down in cell line models of AML with different driver lesions. We show that the characteristic reduction in proliferation and the concomitant induction of myeloid differentiation that is observed in MLL-rearranged and t(8;21) leukaemias upon MYB suppression is not seen in AML cells with a complex karyotype. Transcriptome analyses revealed that MYB ablation produces consensual increase of MAFB expression in MYB-dependent cells and, interestingly, the ectopic expression of MAFB could phenocopy the effect of MYB suppression. Accordingly, in silico stratification analyses of molecular data from AML patients revealed a reciprocal relationship between MYB and MAFB expression, highlighting a novel biological interconnection between these two factors in AML and supporting new rationales of MAFB targeting in MLL-rearranged leukaemias.
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Affiliation(s)
- A Negri
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - C Ward
- Edge Impulse Inc., San Jose, CA, USA
| | - A Bucci
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - G D'Angelo
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - P Cauchy
- Max Planck Institute of Immunobiology and Epigenetics, 79108, Freiburg, Germany
| | - A Radesco
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - A B Ventura
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - D S Walton
- Clent Life Sciences, DY84HD, Stourbridge, UK
| | - M Clarke
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, Birmingham, UK
| | - B Mandriani
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - S A Pappagallo
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - P Mondelli
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - K Liao
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
| | - G Gargano
- Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy
| | - G M Zaccaria
- Department of Electrical and Information Engineering, Polytechnic University of Bari, Bari, Italy
| | - L Viggiano
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy
| | - F M Lasorsa
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - A Ahmed
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - D Di Molfetta
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - G Fiermonte
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - M Cives
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - A Guarini
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - M C Vegliante
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - S Ciavarella
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - J Frampton
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, Birmingham, UK.
| | - G Volpe
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
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Hou J, Zhao R, Gronsbell J, Lin Y, Bonzel CL, Zeng Q, Zhang S, Beaulieu-Jones BK, Weber GM, Jemielita T, Wan SS, Hong C, Cai T, Wen J, Ayakulangara Panickan V, Liaw KL, Liao K, Cai T. Generate Analysis-Ready Data for Real-world Evidence: Tutorial for Harnessing Electronic Health Records With Advanced Informatic Technologies. J Med Internet Res 2023; 25:e45662. [PMID: 37227772 DOI: 10.2196/45662] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/26/2023] Open
Abstract
Although randomized controlled trials (RCTs) are the gold standard for establishing the efficacy and safety of a medical treatment, real-world evidence (RWE) generated from real-world data has been vital in postapproval monitoring and is being promoted for the regulatory process of experimental therapies. An emerging source of real-world data is electronic health records (EHRs), which contain detailed information on patient care in both structured (eg, diagnosis codes) and unstructured (eg, clinical notes and images) forms. Despite the granularity of the data available in EHRs, the critical variables required to reliably assess the relationship between a treatment and clinical outcome are challenging to extract. To address this fundamental challenge and accelerate the reliable use of EHRs for RWE, we introduce an integrated data curation and modeling pipeline consisting of 4 modules that leverage recent advances in natural language processing, computational phenotyping, and causal modeling techniques with noisy data. Module 1 consists of techniques for data harmonization. We use natural language processing to recognize clinical variables from RCT design documents and map the extracted variables to EHR features with description matching and knowledge networks. Module 2 then develops techniques for cohort construction using advanced phenotyping algorithms to both identify patients with diseases of interest and define the treatment arms. Module 3 introduces methods for variable curation, including a list of existing tools to extract baseline variables from different sources (eg, codified, free text, and medical imaging) and end points of various types (eg, death, binary, temporal, and numerical). Finally, module 4 presents validation and robust modeling methods, and we propose a strategy to create gold-standard labels for EHR variables of interest to validate data curation quality and perform subsequent causal modeling for RWE. In addition to the workflow proposed in our pipeline, we also develop a reporting guideline for RWE that covers the necessary information to facilitate transparent reporting and reproducibility of results. Moreover, our pipeline is highly data driven, enhancing study data with a rich variety of publicly available information and knowledge sources. We also showcase our pipeline and provide guidance on the deployment of relevant tools by revisiting the emulation of the Clinical Outcomes of Surgical Therapy Study Group Trial on laparoscopy-assisted colectomy versus open colectomy in patients with early-stage colon cancer. We also draw on existing literature on EHR emulation of RCTs together with our own studies with the Mass General Brigham EHR.
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Affiliation(s)
- Jue Hou
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Rachel Zhao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Gronsbell
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Yucong Lin
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, China
| | - Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Qingyi Zeng
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sinian Zhang
- School of Statistics, Renmin University of China, Bejing, China
| | | | - Griffin M Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | | | | | - Chuan Hong
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Tianrun Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Jun Wen
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | | | | | - Katherine Liao
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, United States
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5
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Lamba H, Ali H, Delgado M, Walther C, Nordick K, Shafii A, Chatterjee S, Nair A, Simpson L, Liao K, Civitello A. Extended Impella 5.0 and 5.5 Microaxillary Left Ventricular Mechanical Circulatory Support for Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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6
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Lamba H, Ali H, Delgado M, Shafii A, Chatterjee S, Walther C, Nair A, Simpson L, Liao K, Civitello A. Impact of Impella 5.0 and 5.5 Microaxillary Left Ventricular Mechanical Circulatory Support on Right Ventricular Hemodynamics. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Scott C, Posey J, Butac A, Lamba H, Oberton S, Shafii A, Liao K, Loor G, George J, Simpson L, Delgado R, Civitello A, Nair A. Investigating Genetic Variants in Patients with Left Ventricular Assist Devices for Nonischemic Cardiomyopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lamba H, Kherallah R, Kassi M, Delgado R, Mattar A, Nair A, Chatterjee S, Shafii A, Loor G, Rogers J, Civitello A, Liao K. Greater Burden of Biventricular Dysfunction in Female Recipients of Continuous-Flow Left Ventricular Devices. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Gauthier K, Piovesan D, Ramakirshnan S, Cho S, Lawson K, Liao K, Foster P, Cheng T, Shah Y, Walters M. 56P Inhibition of HIF-2α-dependent transcription with small molecule inhibitors may provide therapeutic benefit beyond renal cell carcinoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Giordano S, Liao K, Li L, Zorzi D, Holmes H, Chavez Mac Gregor M, Peterson S. 177P Health related quality of life in older breast cancer survivors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Cai T, He Z, Hong C, Zhang Y, Ho YL, Honerlaw J, Geva A, Ayakulangara Panickan V, King A, Gagnon DR, Gaziano M, Cho K, Liao K, Cai T. Scalable relevance ranking algorithm via semantic similarity assessment improves efficiency of medical chart review. J Biomed Inform 2022; 132:104109. [PMID: 35660521 DOI: 10.1016/j.jbi.2022.104109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/30/2022] [Accepted: 05/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Accurately assigning phenotype information to individual patients via computational phenotyping using Electronic Health Records (EHRs) has been seen as the first step towards enabling EHRs for precision medicine research. Chart review labels annotated by clinical experts, also known as "gold standard" labels, are essential for the development and validation of computational phenotyping algorithms. However, given the complexity of EHR systems, the process of chart review is both labor intensive and time consuming. We propose a fully automated algorithm, referred to as pGUESS, to rank EHR notes according to their relevance to a given phenotype. By identifying the most relevant notes, pGUESS can greatly improve the efficiency and accuracy of chart reviews. METHOD pGUESS uses prior guided semantic similarity to measure the informativeness of a clinical note to a given phenotype. We first select candidate clinical concepts from a pool of comprehensive medical concepts using public knowledge sources and then derive the semantic embedding vector (SEV) for a reference article (SEVref) and each note (SEVnote). The algorithm scores the relevance of a note as the cosine similarity between SEVnote and SEVref. RESULTS The algorithm was validated against four sets of 200 notes that were manually annotated by clinical experts to assess their informativeness to one of three disease phenotypes. pGUESS algorithm substantially outperforms existing unsupervised approaches for classifying the relevance status with respect to both accuracy and scalability across phenotypes. Averaging over the three phenotypes, the rank correlation between the algorithm ranking and gold standard label was 0.64 for pGUESS, but only 0.47 and 0.35 for the next two best performing algorithms. pGUESS is also much more computationally scalable compared to existing algorithms. CONCLUSION pGUESS algorithm can substantially reduce the burden of chart review and holds potential in improving the efficiency and accuracy of human annotation.
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Affiliation(s)
- Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA.
| | - Zeling He
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Chuan Hong
- Department of Biostatistics & Bioinformatics, Duke University, Duke University Medical Center 2424 Erwin Road, Suite 1102 Hock Plaza Box 2721, Durham, NC, USA
| | - Yichi Zhang
- Department of Computer Science and Statistics, University of Rhode Island, Tyler Hall, 9 Greenhouse Road, Suite 2, Kingston, RI, USA
| | - Yuk-Lam Ho
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA
| | | | - Alon Geva
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, USA; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Avenue, Bader, 6th Floor, Boston, MA, USA
| | | | - Amanda King
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - David R Gagnon
- VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA; Department of Biostatistics, Boston University, School of Public Health, 801 Massachusetts Ave Crosstown Center, Boston, MA, USA
| | - Michael Gaziano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA
| | - Kelly Cho
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA
| | - Katherine Liao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Suite 514, Boston, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
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Wallace Z, Weber B, Parks S, Cook C, Huck D, Brown J, Divakaran S, Hainer J, Bibbo C, Taqueti V, Dorbala S, Blankenstein R, Liao K, Aghayev A, Choi H, Di Carli M. AB0624 Patients with vasculitis have a high prevalence of coronary microvascular dysfunction. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundVasculitides are a heterogenous group of diseases characterized by intense vessel wall inflammation, endothelial injury, and systemic inflammation. Several vasculitides are associated with high risk of cardiovascular (CV) disease, an important source of morbidity and mortality in this population. This excess CV risk is attributed both to a high burden of traditional risk factors and to inflammation, but this remains poorly studied. Indeed, inflammation is a known risk factor for CV disease and implicated in coronary microvascular dysfunction (CMD) which may precede obstructive coronary artery disease (CAD).ObjectivesWe sought to assess whether vasculitis is associated with CMD in the absence of obstructive CAD.MethodsWe retrospectively identified subjects with systemic vasculitis who underwent symptom prompted rest/stress myocardial perfusion PET. Patients with an abnormal myocardial perfusion study (summed stress score ≥3) or LVEF<40% were excluded. Controls were identified from the same population and matched on age, gender and cardiovascular risk factors (CAD, hypertension, dyslipidemia, diabetes mellitus, and obesity). Coronary flow reserve (CFR), was calculated as the ratio of myocardial blood flow (ml/min/g) at peak stress compared to rest. CMD was defined as CFR <2.ResultsWe studied 26 vasculitis cases and 66 matched controls. The most common vasculitides were giant cell arteritis (38%), ANCA-associated vasculitis (31%), and Takayasu’s arteritis (12%). Median (IQR) time between diagnosis and PET was 6.5 (2.9, 14.2) years. Seven (27%) cases had active vascultis at the time of PET. Cases and controls were well-matched on age, sex, and CV risk factors (Table 1). Despite a similar prevalence of CV risk factors, coronary flow reserve (reflected by CMD) was abnormal in 38% of vasculitis cases compared to 15% of controls (p=0.004). The mean [SD] CFR was 19% lower in vasculitis cases vs controls (2.11 [0.5] versus 2.6 [0.7], p=0.003).Table 1.The presence of coronary microvasculature dysfunction in patients with systemic vasculitis without obstructive coronary artery diseaseCohort characteristicsVasculitis (n=26)Control (n=66)P-valueAge at PET, years62 (18)61 (17)0.24Time from Vasculitis Diagnosis to PET, years (median, IQR)6.5 (2.9, 14.2)n/aFemale, n (%)18 (72%)43 (65%)0.99Vasculitis CharacteristicsLarge Vessel (e.g., giant cell arteritis, Takayasu’s), n(%)13 (50%)n/an/aMedium Vessel (e.g., polyarteritis nodosa, Kawasaki’s arteritis), n(%)2 (8%)n/an/aSmall Vessel (e.g., ANCA-associated vasculitis, Henoch-Schonlein Purpura), n(%)11 (42%)n/an/aCardiovascular Risk FactorsAt DiagnosisAt PETAt PETHypertension, n (%)12 (46%)20 (71%)47 (80%)0.47Obesity, n (%)3 (12%)2 (32%)2 (32%)0.84Diabetes, n (%)3 (12%)5 (20%)13 (20%)0.99Dyslipidemia, n (%)4 (15%)15 (58%)40 (61%)0.99Known CAD, n (%)0 (0%)1 (4%)1 (2%)0.48Imaging FindingsRest myocardial blood flow, ml/min/g1.0 (0.3)1.0 (0.3)0.8Stress myocardial blood flow, ml/min/g2.1 (0.6)2.6 (1.0)0.008Coronary Flow Reserve, ml/min/g*2.1 (0.5)2.6 (0.7)0.003Coronary Microvasculature Dysfunction** (CMD), n (%)10 (38%)11 (15%)0.004ConclusionPatients with systemic vasculitis, even in the absence of obstructive CAD, have a high prevalence of CMD compared with non-vasculitis patients. These differences were observed despite matching cases and controls on traditional CV risk factors, highlighting the importance of other factors, such as inflammation and vasculitis treatments on CMD and CV disease in this population. CMD is a known independent risk factor for CV mortality. Future prospective studies are needed to understand the relationship between vasculitis, systemic inflammation, and CMD.Disclosure of InterestsNone declared
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Link NB, Huang S, Cai T, Sun J, Dahal K, Costa L, Cho K, Liao K, Cai T, Hong C. Binary acronym disambiguation in clinical notes from electronic health records with an application in computational phenotyping. Int J Med Inform 2022; 162:104753. [PMID: 35405530 DOI: 10.1016/j.ijmedinf.2022.104753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The use of electronic health records (EHR) systems has grown over the past decade, and with it, the need to extract information from unstructured clinical narratives. Clinical notes, however, frequently contain acronyms with several potential senses (meanings) and traditional natural language processing (NLP) techniques cannot differentiate between these senses. In this study we introduce a semi-supervised method for binary acronym disambiguation, the task of classifying a target sense for acronyms in the clinical EHR notes. METHODS We developed a semi-supervised ensemble machine learning (CASEml) algorithm to automatically identify when an acronym means a target sense by leveraging semantic embeddings, visit-level text and billing information. The algorithm was validated using note data from the Veterans Affairs hospital system to classify the meaning of three acronyms: RA, MS, and MI. We compared the performance of CASEml against another standard semi-supervised method and a baseline metric selecting the most frequent acronym sense. Along with evaluating the performance of these methods for specific instances of acronyms, we evaluated the impact of acronym disambiguation on NLP-driven phenotyping of rheumatoid arthritis. RESULTS CASEml achieved accuracies of 0.947, 0.911, and 0.706 for RA, MS, and MI, respectively, higher than a standard baseline metric and (on average) higher than a state-of-the-art semi-supervised method. As well, we demonstrated that applying CASEml to medical notes improves the AUC of a phenotype algorithm for rheumatoid arthritis. CONCLUSION CASEml is a novel method that accurately disambiguates acronyms in clinical notes and has advantages over commonly used supervised and semi-supervised machine learning approaches. In addition, CASEml improves the performance of NLP tasks that rely on ambiguous acronyms, such as phenotyping.
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Affiliation(s)
- Nicholas B Link
- VA Boston Healthcare System, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Sicong Huang
- VA Boston Healthcare System, Boston, MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, United States
| | - Tianrun Cai
- VA Boston Healthcare System, Boston, MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, United States
| | - Jiehuan Sun
- VA Boston Healthcare System, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kumar Dahal
- VA Boston Healthcare System, Boston, MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, United States
| | - Lauren Costa
- VA Boston Healthcare System, Boston, MA, United States
| | - Kelly Cho
- VA Boston Healthcare System, Boston, MA, United States
| | - Katherine Liao
- VA Boston Healthcare System, Boston, MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, United States
| | - Tianxi Cai
- VA Boston Healthcare System, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Chuan Hong
- VA Boston Healthcare System, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Schroder J, Shah A, Anyanwu A, D'Alessandro D, Streuber M, Mudy K, Shudo Y, Esmailian F, Liao K, Pagani F, Silvestry S, Wang I, Gananpathi A, Salerno C, Patel C, DeVore A, Koomalsingh K, Absi T, Khaghani A, Milano C, Smith J. Increasing Utilization of Extended Criteria Donor After Brain Death (DBD) Hearts Seldomly Used for Transplantation in the U.S. Due to Limitation of Ischemic Cold Storage - 2-Year Results of the OCS Heart EXPAND Prospective Multi-Center Trial (OCS Heart EXPAND). J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Weber B, Perez-Chada LM, Divakaran S, Brown JM, Taqueti V, Dorbala S, Blankstein R, Liao K, Merola JF, Di Carli M. Coronary microvascular dysfunction in patients with psoriasis. J Nucl Cardiol 2022; 29:37-42. [PMID: 32419071 PMCID: PMC9202505 DOI: 10.1007/s12350-020-02166-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Psoriasis is a common chronic inflammatory skin disorder that is associated with excess cardiovascular risk. Inflammation is a key mediator in the onset and progression of these cardiometabolic abnormalities; however, the excess cardiovascular risk conferred by psoriatic disease remains understudied. We investigated the prevalence and severity of CMD in patients with psoriasis and determined whether CMD is a result of CV risk factors and atherosclerotic burden. METHODS This was a consecutive retrospective cohort study of patients with psoriasis, normal myocardial perfusion, and LV ejection fraction (EF) > 50% (N = 62) and matched controls without psoriasis (N = 112). Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. Atherosclerotic burden was determined by semi-quantitative computed tomography (CT) coronary calcium assessment. RESULTS The prevalence of CMD (defined as MFR < 2) was 61.3% in patients with psoriatic disease, compared to 38.4% in a matched control population (P = .004). Furthermore, patients with psoriasis had a more severe reduction in adjusted MFR (2.3 ± .81 vs 1.92 ± .65, respectively, P = .001). The degree of atherosclerotic burden, as assessed by qualitative calcium score, was similar between psoriasis and controls. CONCLUSIONS Patients with psoriasis without overt CAD demonstrated a high prevalence of coronary vasomotor abnormalities that are not entirely accounted for by the commonly associated coronary risk factors or the burden of atherosclerosis.
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Affiliation(s)
- Brittany Weber
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, ASB-L1 037C, Boston, MA, 02115, USA
| | - Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Jenifer M Brown
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Viviany Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA
| | - Katherine Liao
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - Joseph F Merola
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, ASB-L1 037C, Boston, MA, 02115, USA
| | - Marcelo Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, USA.
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16
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Fandiño O, Cox JS, McGregor C, Conrad J, Liao K, Tremaine PR. Carbon Dioxide Contamination of Aqueous Morpholine Solutions and Effects on Secondary Coolant Chemistry Under CANDU Conditions. NUCL TECHNOL 2022. [DOI: 10.1080/00295450.2020.1862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- O. Fandiño
- University of Guelph, Department of Chemistry, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - J. S. Cox
- University of Guelph, Department of Chemistry, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - C. McGregor
- University of Guelph, Department of Chemistry, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - J. Conrad
- University of Guelph, Department of Chemistry, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - K. Liao
- Ontario Power Generation, Chemistry Department, 889 Brock Road, Pickering, Ontario, L1W 3J2, Canada
| | - P. R. Tremaine
- University of Guelph, Department of Chemistry, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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17
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Weber BN, Stevens E, Perez-Chada LM, Brown JM, Divakaran S, Bay C, Bibbo C, Hainer J, Dorbala S, Blankstein R, Taqueti VR, Merola JF, Massarotti E, Costenbader K, Liao K, Di Carli MF. Impaired Coronary Vasodilator Reserve and Adverse Prognosis in Patients With Systemic Inflammatory Disorders. JACC Cardiovasc Imaging 2021; 14:2212-2220. [PMID: 33744132 PMCID: PMC8429517 DOI: 10.1016/j.jcmg.2020.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the prognostic value of quantitative myocardial blood flow (MBF) and myocardial flow reserve (MFR), reflecting the integrated effects of diffuse atherosclerosis and microvascular dysfunction in patients with systemic inflammatory disorders. BACKGROUND Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. However, the prognostic significance of this vascular dysfunction is not known. METHODS This was a retrospective study of patients with RA, SLE, and PsO undergoing clinically indicated rest and stress myocardial perfusion positron emission tomography (PET). Patients with an abnormal myocardial perfusion study or left ventricular dysfunction were excluded. MFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to that at rest. RESULTS Among the 198 patients (median age: 65 years; 80% female), 20.7% had SLE, 31.8% had PsO, and 47.5% had RA. There were no differences in mean MFR between these conditions. Over a median follow-up of 7.8 years, there were 51 deaths and 63 major adverse cardiovascular events (MACE). Patients in the lowest tertile (MFR <1.65) had higher all-cause mortality than the highest tertile, which remained significant after adjusting for age, sex, and the pre-test clinical risk score (hazard ratio [HR]: 2.4; 95% confidence interval [CI]: 1.05 to 5.4; p = 0.038). Similarly, compared to the highest MFR tertile, those in the lowest tertile had a lower MACE-free survival after adjusting for age, sex, and the pre-test clinical risk score (HR: 3.6; 95% CI: 1.7 to 7.6; p = 0.001). CONCLUSIONS In patients with systemic inflammatory disorders, impaired coronary vasodilator reserve was associated with worse cardiovascular outcomes and all-cause mortality.
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Affiliation(s)
- Brittany N Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emma Stevens
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenifer M Brown
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Viviany R Taqueti
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Merola
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Costenbader
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Liao
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcelo F Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Verma A, Tsao N, Thomann L, Ho YL, Iyengar S, Luoh SW, Carr R, Crawford D, Efird JT, Huffman J, Hung A, Ivey K, Levin M, Lynch J, Natarajan P, Pyarajan S, Bick A, Costa L, Genovese G, Hauger R, Madduri R, Pathak G, Polimanti R, Voight B, Vujkovic M, Zekavat M, Zhao H, Ritchie MD, Chang KM, Cho K, Casas JP, Tsao PS, Gaziano JM, O'Donnell C, Damrauer S, Liao K. A Phenome-Wide Association Study of genes associated with COVID-19 severity reveals shared genetics with complex diseases in the Million Veteran Program. medRxiv 2021. [PMID: 34642702 PMCID: PMC8509103 DOI: 10.1101/2021.05.18.21257396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The study aims to determine the shared genetic architecture between COVID-19 severity with existing medical conditions using electronic health record (EHR) data. We conducted a Phenome-Wide Association Study (PheWAS) of genetic variants associated with critical illness (n=35) or hospitalization (n=42) due to severe COVID-19 using genome-wide association summary from the Host Genetics Initiative. PheWAS analysis was performed using genotype-phenotype data from the Veterans Affairs Million Veteran Program (MVP). Phenotypes were defined by International Classification of Diseases (ICD) codes mapped to clinically relevant groups using published PheWAS methods. Among 658,582 Veterans, variants associated with severe COVID-19 were tested for association across 1,559 phenotypes. Variants at the ABO locus (rs495828, rs505922) associated with the largest number of phenotypes (nrs495828=53 and nrs505922=59); strongest association with venous embolism, odds ratio (ORrs495828 1.33 (p=1.32 × 10-199), and thrombosis ORrs505922 1.33, p=2.2 × 10-265. Among 67 respiratory conditions tested, 11 had significant associations including MUC5B locus (rs35705950) with increased risk of idiopathic fibrosing alveolitis OR 2.83, p=4.12 × 10-191; CRHR1 (rs61667602) associated with reduced risk of pulmonary fibrosis, OR 0.84, p=2.26 × 10-12. The TYK2 locus (rs11085727) associated with reduced risk for autoimmune conditions, e.g., psoriasis OR 0.88, p=6.48 × 10-23, lupus OR 0.84, p=3.97 × 10-06. PheWAS stratified by genetic ancestry demonstrated differences in genotype-phenotype associations across ancestry. LMNA (rs581342) associated with neutropenia OR 1.29 p=4.1 × 10-13 among Veterans of African ancestry but not European. Overall, we observed a shared genetic architecture between COVID-19 severity and conditions related to underlying risk factors for severe and poor COVID-19 outcomes. Differing associations between genotype-phenotype across ancestries may inform heterogenous outcomes observed with COVID-19. Divergent associations between risk for severe COVID-19 with autoimmune inflammatory conditions both respiratory and non-respiratory highlights the shared pathways and fine balance of immune host response and autoimmunity and caution required when considering treatment targets.
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Affiliation(s)
- Anurag Verma
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noah Tsao
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sudha Iyengar
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shiuh-Wen Luoh
- VA Portland Health Care System, Portland OR, USA.,Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Rotonya Carr
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Washington, Division of Gastroenterology Seattle, WA USA
| | - Dana Crawford
- Cleveland Institute for Computational Biology, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jimmy T Efird
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Adriana Hung
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA.,Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS (Duke University Affiliate), Durham, North Carolina, USA
| | - Kerry Ivey
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Tennessee Valley Healthcare System (Nashville VA) & Vanderbilt University, Nashville, Tennessee, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael Levin
- VA Portland Health Care System, Portland OR, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Julie Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Pradeep Natarajan
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard & MIT, Cambridge, Massachusetts, USA
| | - Saiju Pyarajan
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Bick
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Vanderbilt University, Nashville, Tennessee, USA
| | - Lauren Costa
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Giulio Genovese
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard & MIT, Cambridge, Massachusetts, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Richard Hauger
- Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Ravi Madduri
- University of Chicago Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois, USA.,Data Science and Learning Division, Argonne National Laboratory, Lemont, Illinois
| | - Gita Pathak
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Connecticut, USA
| | - Renato Polimanti
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, Connecticut, USA
| | - Benjamin Voight
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marijana Vujkovic
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryam Zekavat
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Broad Institute of MIT & Harvard, Cambridge, MA, USA.,Yale School of Medicine New Haven, CT, USA
| | - Hongyu Zhao
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine New Haven, CT, USA.,Computational Biology and Bioinformatics Program, Yale University, New Haven, CT, USA
| | | | | | - Kyong-Mi Chang
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Philip S Tsao
- VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, Stanford, CA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher O'Donnell
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Philadelphia, USA.,Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Liao
- VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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19
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Weber BN, Stevens E, Barrett L, Bay C, Sinnette C, Brown JM, Divakaran S, Bibbo C, Hainer J, Dorbala S, Blankstein R, Liao K, Massarotti E, Costenbader K, Di Carli MF. Coronary Microvascular Dysfunction in Systemic Lupus Erythematosus. J Am Heart Assoc 2021; 10:e018555. [PMID: 34132099 PMCID: PMC8403317 DOI: 10.1161/jaha.120.018555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disorder associated with premature atherosclerosis and increased cardiovascular risk. Systemic inflammation is an emerging risk factor for coronary microvascular dysfunction (CMD). We aimed to test whether CMD, defined as abnormal myocardial flow reserve (MFR) by positron emission tomography‐computed tomography, would be independently associated with SLE after adjusting for nonobstructive atherosclerotic burden and common cardiovascular risk factors. Methods and Results Consecutive patients with SLE who underwent symptom‐prompted stress cardiac positron emission tomography‐computed tomography were included (n=42). Obstructive coronary artery disease and systolic dysfunction were excluded. MFR was quantified by positron emission tomography‐computed tomography, and CMD was defined as MFR <2. We frequency matched patients who did not have SLE and had symptom‐prompted positron emission tomography studies on age, sex, and key cardiovascular risk factors (n=69). The attenuation correction computed tomography scans were reviewed for qualitative assessment of coronary artery calcium. Patients with SLE had a more severe reduction in global MFR compared with controls and a higher prevalence of CMD, despite a similar degree of nonobstructive atherosclerotic burden (1.91±0.5 versus 2.4±0.7, respectively, P<0.0001; CMD, 57.1% versus 33.3%, respectively, P=0.017). Conclusions We demonstrated that patients with SLE with cardiac symptoms without obstructive coronary artery disease have a high prevalence of coronary vasomotor abnormalities. In comparison with symptomatic matched controls, patients with SLE have a more severe reduction in MFR that is not accounted for by common cardiovascular factors or atherosclerotic burden.
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Affiliation(s)
- Brittany N Weber
- Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.,Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Emma Stevens
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Leanne Barrett
- Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Camden Bay
- Department of Radiology Brigham and Women's HospitalHarvard Medical School Boston MA
| | - Corine Sinnette
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Jenifer M Brown
- Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.,Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Sanjay Divakaran
- Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.,Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Courtney Bibbo
- Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Jon Hainer
- Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Ron Blankstein
- Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.,Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
| | - Katherine Liao
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Karen Costenbader
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Marcelo F Di Carli
- Division of Cardiovascular Medicine Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston MA.,Cardiovascular Imaging Program Departments of Medicine and RadiologyBrigham and Women's HospitalHarvard Medical SchoolBoston MA
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20
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Lamba H, Mondal N, Chatterjee S, Civitello A, Nair A, Oberton S, Mattar A, Shafii A, Loor G, Liao K. Sex Specific Utilization and Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Weber B, Biery DW, Singh A, Divakaran S, Berman AN, Wu WY, Brown JM, Hainer J, Nasir K, Liao K, Bhatt DL, Di Carli MF, Blankstein R. Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Mass General Brigham YOUNG-MI Registry. Eur J Prev Cardiol 2021; 29:352-359. [PMID: 33784740 DOI: 10.1093/eurjpc/zwaa154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 01/30/2023]
Abstract
AIMS Autoimmune systemic inflammatory diseases (SIDs) are associated with an increased risk of cardiovascular (CV) disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of SID among adults who experience an MI at a young age. We sought to determine the prevalence and prognostic implications of SID among adults who experienced an MI at a young age. METHODS AND RESULTS The YOUNG-MI registry is a retrospective cohort study from two large academic centres, which includes patients who experienced a first MI at 50 years of age or younger. SID was ascertained through physician review of the electronic medical record (EMR). Incidence of death was ascertained through the EMR and national databases. The cohort consisted of 2097 individuals, with 53 (2.5%) possessing a diagnosis of SID. Patients with SID were more likely to be female (36% vs. 19%, P = 0.004) and have hypertension (62% vs. 46%, P = 0.025). Over a median follow-up of 11.2 years, patients with SID experienced an higher risk of all-cause mortality compared with either the full cohort of non-SID patients [hazard ratio (HR) = 1.95, 95% confidence interval (CI) (1.07-3.57), P = 0.030], or a matched cohort based on age, gender, and CV risk factors [HR = 2.68, 95% CI (1.18-6.07), P = 0.018]. CONCLUSIONS Among patients who experienced a first MI at a young age, 2.5% had evidence of SID, and these individuals had higher rates of long-term all-cause mortality. Our findings suggest that the presence of SID is associated with worse long-term survival after premature MI.
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Affiliation(s)
- Brittany Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - David W Biery
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Avinainder Singh
- Department of Medicine, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Adam N Berman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Wanda Y Wu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Jenifer M Brown
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, 6550 Fannin St, Houston, TX 77030, USA
| | - Katherine Liao
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Marcelo F Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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22
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Ahuja Y, Kim N, Liang L, Cai T, Dahal K, Seyok T, Lin C, Finan S, Liao K, Savovoa G, Chitnis T, Cai T, Xia Z. Leveraging electronic health records data to predict multiple sclerosis disease activity. Ann Clin Transl Neurol 2021; 8:800-810. [PMID: 33626237 PMCID: PMC8045951 DOI: 10.1002/acn3.51324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/26/2020] [Accepted: 02/01/2021] [Indexed: 12/26/2022] Open
Abstract
Objective No relapse risk prediction tool is currently available to guide treatment selection for multiple sclerosis (MS). Leveraging electronic health record (EHR) data readily available at the point of care, we developed a clinical tool for predicting MS relapse risk. Methods Using data from a clinic‐based research registry and linked EHR system between 2006 and 2016, we developed models predicting relapse events from the registry in a training set (n = 1435) and tested the model performance in an independent validation set of MS patients (n = 186). This iterative process identified prior 1‐year relapse history as a key predictor of future relapse but ascertaining relapse history through the labor‐intensive chart review is impractical. We pursued two‐stage algorithm development: (1) L1‐regularized logistic regression (LASSO) to phenotype past 1‐year relapse status from contemporaneous EHR data, (2) LASSO to predict future 1‐year relapse risk using imputed prior 1‐year relapse status and other algorithm‐selected features. Results The final model, comprising age, disease duration, and imputed prior 1‐year relapse history, achieved a predictive AUC and F score of 0.707 and 0.307, respectively. The performance was significantly better than the baseline model (age, sex, race/ethnicity, and disease duration) and noninferior to a model containing actual prior 1‐year relapse history. The predicted risk probability declined with disease duration and age. Conclusion Our novel machine‐learning algorithm predicts 1‐year MS relapse with accuracy comparable to other clinical prediction tools and has applicability at the point of care. This EHR‐based two‐stage approach of outcome prediction may have application to neurological disease beyond MS.
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Affiliation(s)
- Yuri Ahuja
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Nicole Kim
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Liang Liang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Tianrun Cai
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kumar Dahal
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thany Seyok
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chen Lin
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Sean Finan
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Katherine Liao
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savovoa
- Clinical Natural Language Processing Program, Boston Children's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Zongqi Xia
- Department of Neurology and Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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23
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Li SG, Liao K, Su DH, Zhuo C, Chu YZ, Hu ZD, Xu XL, Zhang R, Liu WE, Lu BH, Zeng J, Jin Y, Wang H. [Analysis of pathogen spectrum and antimicrobial resistance of pathogens associated with hospital-acquired infections collected from 11 teaching hospitals in 2018]. Zhonghua Yi Xue Za Zhi 2021; 100:3775-3783. [PMID: 33379842 DOI: 10.3760/cma.j.cn112137-20200430-01389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China, 2018. Methods: Non-duplicated nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 11 teaching hospitals across China were collected. The minimum inhibitory concentrations (MICs) of clinically significant strains were determined by agar dilution method or broth microdilution method. The Clinical and Laboratory Standards Institute (CLSI) M100-S29 criteria were used for interpretation, and the WHONET-5.6 software was used in data analysis. Results: A total of 1 590 cases were collected, including 831 cases from BSI, 450 cases from HAP and 309 cases from IAI. The most prevalent pathogens causing BSI were Escherichia coli (29.2%, 243/831), Klebsiella pneumoniae (16.2%, 135/831) and Staphylococcus aureus (10.1%, 84/831); the most prevalent pathogens causing IAI were E. coli (26.2%, 81/309), Enterococcus faecium (15.5%, 48/309) and K. pneumoniae (13.3%, 41/309); while Acinetobacter baumanii (24.7%, 111/450), Pseudomonas aeruginosa (20.7%, 93/450) and K. pneumoniae (16.2%, 73/450) were dominated in HAP. All S. aureus were susceptible to tigecycline, linezolid, daptomycin and glycopeptides; 77.8% (105/135) of S. aureus strains were susceptible to ceftaroline. Methicillin-resistant S. aureus (MRSA) accounted for 29.6% (40/135) of all the S. aureus, and was lower than the accounted rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) (83.7%, 41/49). One E. faecium strain (1.1%, 1/95) resistant to vacomycin and teicoplanin and one E. faecalis strain (2.3%, 1/43) resistant to linezolid was found. The prevalence of extended-spectrum β-lactamase (ESBL) was 56.1% (193/344) in E. coli and 22.1% (55/249) in K. pneumonia; the rate of carbapenem resistant E. coli and K. pneumonia was 4.1% (14/344) and 22.9% (57/249), respectively; the percentage of ceftazidime/avibactam resistant E. coli and K. pneumonia was 2.3% (8/344) and 2.0% (5/249), respectively; the percentage of colistin resistant E. coli and K. pneumonia was 1.5% (5/344) and 7.6% (19/249), respectively; no E. coli and K. pneumonia strains were found resistant to tigecycline. The rate of carbapenem resistant A. baumanii and P. aeruginosa were 78.9% (146/185) and 36.7% (66/180), respectively. A. baumanii showed low susceptibility to the antimicrobial agents except colistin (99.5%, 184/185) and tigecycline (91.4%, 169/185). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rate of 100% (180/180), 93.3% (168/180) and 85.6% (154/180), respectively. Conclusions: Nosocomial Gram-negative pathogens show high susceptibilities to tigecycline, colistin and ceftazidime/avibactam in vitro. Antimicrobial resistance in A. baumannii is a serious problem. The prevalence of carbapenem-resistant Enterobacteriaceae has increased, which should be monitored continuously in China.
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Affiliation(s)
- S G Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - K Liao
- Department of Clinical Laboratory, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - D H Su
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - C Zhuo
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Y Z Chu
- Department of Clinical Laboratory, the First Hospital of China Medical University, Shenyang 110001, China
| | - Z D Hu
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - X L Xu
- Department of Clinical Laboratory, Xijing Hospital of Air Force Military Medical University, Xi'an 710032, China
| | - R Zhang
- Department of Clinical Laboratory, the Second Affiliated Hospotal of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - W E Liu
- Department of Clinical Laboratory, Xiangya Hospital of Central South University, Changsha 410008, China
| | - B H Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J Zeng
- Department of Clinical Laboratory, Puai Hospital of Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430030, China
| | - Y Jin
- Department of Clinical Laboratory, Shandong Provincial Hospital, Jinan 250021, China
| | - H Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
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24
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Weber B, Biery D, Singh A, Divakaran S, Berman A, Wu W, Brown J, Liao K, Bhatt D, Di Carli M, Blankstein R. Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Partners YOUNG-MI registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1305] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Autoimmune systemic inflammatory diseases are associated with an increased risk of cardiovascular disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of inflammatory disease among U.S. adults who experience an MI at a young age.
Purpose
We sought to determine the prevalence and prognostic value of inflammatory disease in U.S. adults who experience an MI at a young age.
Methods
The YOUNG-MI registry is a retrospective cohort study of consecutive patients who experienced a Type 1 MI at or below the age of 50 years from 2000 to 2016 at two large medical centers. A diagnosis of rheumatoid arthritis (RA), psoriasis (PsO), systemic lupus erythematosus (SLE), or inflammatory arthritis was determined through physician review of electronic medical records (EMR). Demographic information, presence of cardiovascular (CV) risk-factors, medical procedures, and medications upon discharge were also ascertained from the EMR. Incidence of death was determined using a combination of EMR and national databases. Cox proportional hazard modeling was performed on a sub-sample following Mahalanobis Distance matching on age, sex, and CV risk factors.
Results
The cohort consisted of 2097 individuals (median age 45 years, 19% female, 53% ST-elevation MI). Among these, 53 (2.5%) individuals possessed a diagnosis of systemic inflammatory disease at or before their index MI (23% SLE, 9% RA, 64% PsO, 4% inflammatory arthritis). When compared to the remainder of the cohort, patients with a diagnosis of systemic inflammatory disease were more likely to be female (36% vs 19%, p=0.004) and be diagnosed with hypertension (62% vs 46%, p=0.025). There was, however, no significant difference in the prevalence of other CV risk factors – diabetes, smoking, dyslipidemia – or a family history of premature coronary artery disease. Despite these similarities, patients with inflammatory disease were less likely to be prescribed aspirin (88% vs 95%, p=0.049) or a statin (76% vs 89%, p=0.008) upon discharge. Over a median follow-up of 11.2 years, patients with inflammatory disease experienced an increased risk of all-cause mortality when compared with the full-cohort (Figure). Compared to the matched sample (n=138), patients with systemic inflammatory disease exhibited an increased risk of all-cause mortality (HR=2.68, CI [1.18 to 6.07], p=0.018), which remained significant after multivariable adjustment for length of stay and GFR (HR=2.38, CI [1.02 to 5.54], p=0.045).
Conclusions
Among individuals who experienced an MI at a young age, approximately 2.5% had evidence of a systemic inflammatory disease at or before their MI. When compared with a population of individuals with similar cardiovascular risk profiles, those with inflammatory disease had higher rates of all-cause mortality. Our findings suggest that the presence of a systemic inflammatory disorder is independently associated with worse long-term outcomes.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32 HL094301 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
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Affiliation(s)
- B Weber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - D.W Biery
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - A Singh
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Divakaran
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - A.N Berman
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - W Wu
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J.M Brown
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Liao
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - D.L Bhatt
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - M Di Carli
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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25
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Weber B, Brown J, Divakaran S, Stevens E, Hainer J, Bibbo C, Taqueti V, Blankstein R, Dorbala S, Massarotti E, Costenbader K, Liao K, Dicarli M. Coronary vasomotor dysfunction is associated with worse outcomes in patients with inflammatory disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions.
Purpose
We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes.
Methods
We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score >3) or left ventricular ejection fraction <40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure.
Results
Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR <2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction.
Conclusions
In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
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Affiliation(s)
- B Weber
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J.M Brown
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Divakaran
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Stevens
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - J Hainer
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - C Bibbo
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - V Taqueti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - S Dorbala
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - E Massarotti
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Costenbader
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - K Liao
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - M Dicarli
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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26
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Sparks J, Huang W, Lu B, Huang S, Cagan A, Gainer V, Finan S, Savova G, Solomon D, Karlson E, Liao K. OP0111 RHEUMATOID ARTHRITIS SEROLOGIC PHENOTYPE AT DIAGNOSIS AND SUBSEQUENT RISK FOR PNEUMONIA IDENTIFIED USING MACHINE LEARNING APPROACHES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) are at increased risk of serious infections, with considerable excess morbidity and mortality after pneumonia. RA-related autoantibodies such as anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) may be generated at inflamed pulmonary mucosa prior to clinical RA onset. Therefore, patients with seropositive RA may be at increased risk for pneumonia after RA diagnosis due to subclinical pulmonary injury.Objectives:We investigated whether seropositive RA was associated with increased pneumonia risk compared to seronegative RA.Methods:We performed a retrospective cohort study among RA patients seen at a health care system in Boston, MA. RA patients were identified using a previously validated electronic health record (EHR) algorithm incorporating billing codes, natural language processing (NLP) of notes, medications, and laboratory results at 97% specificity1. We constructed an incident RA cohort using NLP for the index date of initial mention of RA. All patients were required to have both CCP and RF data from clinical care to determine serologic RA phenotype. We used semi-supervised machine learning approaches to identify pneumonia using billing codes and terms extracted using NLP, with the Centers for Disease Control definition of pneumonia from medical record review as a gold standard. The area under the receiver operating curve (AUROC) for this billing code+NLP pneumonia algorithm was 0.94 compared to the standard rule-based pneumonia algorithm (billing code on inpatient discharge) AUROC of 0.86 (p<0.001). Smoking status was extracted using NLP methods. Other covariates, including a previous validated weighted RA multimorbidity score2, were determined using structured EHR data. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for pneumonia adjusting for potential confounders.Results:We analyzed a total of 4,110 patients with incident RA and both CCP/RF data available. Mean age at index date was 53.0 years (SD 14.8), 77.2% were female, and 79.8% were CCP+ or RF+. During 32,248 patient-years of follow-up (mean 7.8 years/patient), we identified 240 pneumonia cases. Patients with seropositive RA had a HR of 1.99 (95%CI 1.30-3.01, Table) for pneumonia compared to patients with seronegative RA, adjusted for age, sex, smoking, index year, ESR level, glucocorticoid use, DMARD use, and weighted RA multimorbidity score. While CCP+ RA (HR 1.91, 95%CI 1.23-2.97) and RF+ RA (HR 2.07, 95%CI 1.35-3.16) had increased pneumonia risk compared to seronegative RA, the CCP+RF- RA subgroup had no association with pneumonia (HR 0.67, 95%CI 0.23-1.93).Conclusion:Patients with incident seropositive RA, particularly RF+ RA, had increased risk for pneumonia throughout the RA disease course that was not explained by measured confounders including smoking status, multimorbidity, medications, and ESR level. Further studies should investigate how RF+ may predispose RA patients to later develop pneumonia after clinical RA diagnosis.References:[1]Liao KP, Cai T, Gainer V, et al. Electronic medical records for discovery research in rheumatoid arthritis. Arthritis Care Res. 2010;62(8):1120–1127.[2]Radner H, Yoshida K, Mjaavatten MD, et al. Development of a multimorbidity index: Impact on quality of life using a rheumatoid arthritis cohort. Semin Arthritis Rheum. 2015;45(2):167–173.Disclosure of Interests:Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Optum, Janssen, Gilead, Weixing Huang: None declared, Bing Lu: None declared, Sicong Huang: None declared, Andrew Cagan: None declared, Vivian Gainer: None declared, Sean Finan: None declared, Guergana Savova: None declared, Daniel Solomon Grant/research support from: Funding from Abbvie and Amgen unrelated to this work, Elizabeth Karlson: None declared, Katherine Liao: None declared
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Liu C, Huang H, Zhou Q, Liu B, Wang Y, Li P, Liao K, Su W. Pithecellobium clypearia extract enriched in gallic acid and luteolin has antibacterial activity against MRSA and reduces resistance to erythromycin, ceftriaxone sodium and levofloxacin. J Appl Microbiol 2020; 129:848-859. [PMID: 32301544 DOI: 10.1111/jam.14668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/06/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022]
Abstract
AIMS Antibiotic adjuvants can give a second life to the antibiotics to which bacteria are highly resistant. We evaluated the antimicrobial effects of extracts from Pithecellobium clypearia against methicillin-resistant Staphylococcus aureus (MRSA) and also the potential for synergy with several antibiotics. METHODS AND RESULTS For this study, four extracts from P. clypearia were tested on MRSA using the broth microdilution method for activity assessment. The ethyl acetate fraction (S20b) had the strongest antibacterial activity against MRSA among the fractions tested. In all, 14 compounds such as gallic acid and luteolin in S20b were analysed by UFLC-Q-TOF-MS/MS. S20b combined with erythromycin showed synergy effects against MRSA and combined with ceftriaxone sodium and levofloxacin showed additive effects against MRSA. Electron microscopy showed that extract S20b damaged the MRSA cell wall and K+ efflux measurements indicated that extract S20b increased cell membrane permeability. Moreover, S20b suppression of PBP2a expression was assessed by Western blot. Furthermore, an in vivo study was used to investigate the therapeutic potential of S20b based on a mouse pneumonia model. CONCLUSIONS The in vitro study results have shown that S20b not only inhibits MRSA growth directly but also reduces the resistance of MRSA to the evaluated antibacterial agents. Based on the in vivo study, it can be concluded that S20b can treat pneumonia in the mouse model. SIGNIFICANCE AND IMPACT OF THE STUDY This study is the first research to demonstrate that S20b can inhibit MRSA growth and reduce drug resistance of clinical isolates to antibiotics. S20b has the potential to be used as a therapeutic agent against MRSA and treatment for MRSA pneumonia.
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Affiliation(s)
- C Liu
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - H Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Q Zhou
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - B Liu
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Y Wang
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - P Li
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - K Liao
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - W Su
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Post-Market Traditional Chinese Medicine, Guangdong Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China
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Lamba H, Kherallah R, Hudson S, Mondal N, Chatterjee S, Civitello A, Nair A, George J, Shafii A, Loor G, Liao K. Do Women Have Inferior Outcomes to Men after LVAD Implantation- A Propensity-Matched Comparison. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cai T, Cai TT, Liao K, Liu W. Large-Scale Simultaneous Testing of Cross-Covariance Matrices with Applications to PheWAS. Stat Sin 2020; 29:983-1005. [PMID: 31889766 DOI: 10.5705/ss.202017.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Motivated by applications in phenome-wide association studies (PheWAS), we consider in this paper simultaneous testing of columns of high-dimensional cross-covariance matrices and develop a multiple testing procedure with theoretical guarantees. It is shown that the proposed testing procedure maintains a desired false discovery rate (FDR) and false discovery proportion (FDP) under mild regularity conditions. We also provide results on the magnitudes of the signals that can be detected with high power. Simulation studies demonstrate that the proposed procedure can be substantially more powerful than existing FDR controlling procedures in the presence of correlation of unknown structure. The proposed multiple testing procedure is applied to a PheWAS of two auto-immune genetic markers using a rheumatoid arthritis patient cohort constructed from the electronic medical records of Partners Healthcare System.
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Affiliation(s)
- Tianxi Cai
- Department of Biostatistics, Harvard T.H Chan School of Public Health
| | - T Tony Cai
- Department of Statistics, The Wharton School, University of Pennsylvania
| | | | - Weidong Liu
- Department of Mathematics, Institute of Natural Sciences and MOE-LSC, Shanghai Jiao Tong University
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Zhang L, Zhang Y, Cai T, Ahuja Y, He Z, Ho YL, Beam A, Cho K, Carroll R, Denny J, Kohane I, Liao K, Cai T. Automated grouping of medical codes via multiview banded spectral clustering. J Biomed Inform 2019; 100:103322. [PMID: 31672532 PMCID: PMC7261410 DOI: 10.1016/j.jbi.2019.103322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE With its increasingly widespread adoption, electronic health records (EHR) have enabled phenotypic information extraction at an unprecedented granularity and scale. However, often a medical concept (e.g. diagnosis, prescription, symptom) is described in various synonyms across different EHR systems, hindering data integration for signal enhancement and complicating dimensionality reduction for knowledge discovery. Despite existing ontologies and hierarchies, tremendous human effort is needed for curation and maintenance - a process that is both unscalable and susceptible to subjective biases. This paper aims to develop a data-driven approach to automate grouping medical terms into clinically relevant concepts by combining multiple up-to-date data sources in an unbiased manner. METHODS We present a novel data-driven grouping approach - multi-view banded spectral clustering (mvBSC) combining summary data from multiple healthcare systems. The proposed method consists of a banding step that leverages the prior knowledge from the existing coding hierarchy, and a combining step that performs spectral clustering on an optimally weighted matrix. RESULTS We apply the proposed method to group ICD-9 and ICD-10-CM codes together by integrating data from two healthcare systems. We show grouping results and hierarchies for 13 representative disease categories. Individual grouping qualities were evaluated using normalized mutual information, adjusted Rand index, and F1-measure, and were found to consistently exhibit great similarity to the existing manual grouping counterpart. The resulting ICD groupings also enjoy comparable interpretability and are well aligned with the current ICD hierarchy. CONCLUSION The proposed approach, by systematically leveraging multiple data sources, is able to overcome bias while maximizing consensus to achieve generalizability. It has the advantage of being efficient, scalable, and adaptive to the evolving human knowledge reflected in the data, showing a significant step toward automating medical knowledge integration.
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Affiliation(s)
- Luwan Zhang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Yichi Zhang
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, USA
| | - Tianrun Cai
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Yuri Ahuja
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zeling He
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Yuk-Lam Ho
- Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Andrew Beam
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Kelly Cho
- Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Joshua Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Isaac Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Katherine Liao
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Population Health and Data Sciences, MAVERIC, VA Boston Healthcare System, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Wallace ZS, Fu X, Liao K, Kallenberg CGM, Langford CA, Merkel PA, Monach P, Seo P, Specks U, Spiera R, St Clair EW, Zhang Y, Choi H, Stone JH. Disease Activity, Antineutrophil Cytoplasmic Antibody Type, and Lipid Levels in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Rheumatol 2019; 71:1879-1887. [PMID: 31162829 DOI: 10.1002/art.41006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/29/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population. METHODS Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial, which randomized patients to receive either rituximab or cyclophosphamide followed by azathioprine. Paired t-tests and multivariable linear regression were used to assess changes in lipid levels. RESULTS Of the 142 patients with serum samples available, the mean ± SD age was 52.3 ± 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)-ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low-density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3-ANCA-positive patients but not among those with relapsing disease or myeloperoxidase-ANCA-positive patients. There was no difference in change in lipid levels between rituximab-treated patients and cyclophosphamide-treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure. CONCLUSION Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3-ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.
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Affiliation(s)
| | | | | | | | | | | | - Paul Monach
- VA Boston Health Care System Boston Vet Center, Boston, Massachusetts
| | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Hyon Choi
- Massachusetts General Hospital, Boston
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Ludmir E, Liao K, Bishop A, Lin T, McAleer M, Woodhouse K, Paulino A, Yeboa D. Relationship between Treatment Center Case Volume and Outcomes for Ewing Sarcoma Patients: The Role of Local Therapy Timing. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gronsbell J, Minnier J, Yu S, Liao K, Cai T. Automated feature selection of predictors in electronic medical records data. Biometrics 2019; 75:268-277. [PMID: 30353541 DOI: 10.1111/biom.12987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/01/2018] [Indexed: 01/29/2023]
Abstract
The use of Electronic Health Records (EHR) for translational research can be challenging due to difficulty in extracting accurate disease phenotype data. Historically, EHR algorithms for annotating phenotypes have been either rule-based or trained with billing codes and gold standard labels curated via labor intensive medical chart review. These simplistic algorithms tend to have unpredictable portability across institutions and low accuracy for many disease phenotypes due to imprecise billing codes. Recently, more sophisticated machine learning algorithms have been developed to improve the robustness and accuracy of EHR phenotyping algorithms. These algorithms are typically trained via supervised learning, relating gold standard labels to a wide range of candidate features including billing codes, procedure codes, medication prescriptions and relevant clinical concepts extracted from narrative notes via Natural Language Processing (NLP). However, due to the time intensiveness of gold standard labeling, the size of the training set is often insufficient to build a generalizable algorithm with the large number of candidate features extracted from EHR. To reduce the number of candidate predictors and in turn improve model performance, we present an automated feature selection method based entirely on unlabeled observations. The proposed method generates a comprehensive surrogate for the underlying phenotype with an unsupervised clustering of disease status based on several highly predictive features such as diagnosis codes and mentions of the disease in text fields available in the entire set of EHR data. A sparse regression model is then built with the estimated outcomes and remaining covariates to identify those features most informative of the phenotype of interest. Relying on the results of Li and Duan (1989), we demonstrate that variable selection for the underlying phenotype model can be achieved by fitting the surrogate-based model. We explore the performance of our methods in numerical simulations and present the results of a prediction model for Rheumatoid Arthritis (RA) built on a large EHR data mart from the Partners Health System consisting of billing codes and NLP terms. Empirical results suggest that our procedure reduces the number of gold-standard labels necessary for phenotyping thereby harnessing the automated power of EHR data and improving efficiency.
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Affiliation(s)
- Jessica Gronsbell
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Jessica Minnier
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Sheng Yu
- Center for Statistical Science, Tsinghua University, Beijing, China
| | | | - Tianxi Cai
- Department of Biostatistics, Harvard University, Boston, Massachusetts
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Schroder J, D'Alessandro D, Esmailian F, Boeve T, Tang P, Liao K, Wang I, Anyanwu A, Shah A, Mudy K, Soltesz E, Smith J. Successful Utilization of Extended Criteria Donor (ECD) Hearts for Transplantation - Results of the OCS™ Heart EXPAND Trial to Evaluate the Effectiveness and Safety of the OCS Heart System to Preserve and Assess ECD Hearts for Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.088] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wallace Z, Fu S, Liao K, Zhang Y, Kallenberg CG, Langford CA, Merkel PA, Seo P, Specks U, Spiera R, St. Clair EW, Choi H, Stone JH. 172. THE ASSOCIATION OF DIFFERENCES IN LIPID PARAMETERS WITH DISEASE ACTIVITY IN ANCA-ASSOCIATED VASCULITIS (AAV). Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Serena Fu
- Massachusetts General Hospital, Boston, MA USA
| | | | | | - Cees G.M Kallenberg
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, MD USA
| | | | | | | | - Hyon Choi
- Massachusetts General Hospital, Boston, MA USA
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Ning W, Chan S, Beam A, Yu M, Geva A, Liao K, Mullen M, Mandl KD, Kohane I, Cai T, Yu S. Feature extraction for phenotyping from semantic and knowledge resources. J Biomed Inform 2019; 91:103122. [PMID: 30738949 PMCID: PMC6424621 DOI: 10.1016/j.jbi.2019.103122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Phenotyping algorithms can efficiently and accurately identify patients with a specific disease phenotype and construct electronic health records (EHR)-based cohorts for subsequent clinical or genomic studies. Previous studies have introduced unsupervised EHR-based feature selection methods that yielded algorithms with high accuracy. However, those selection methods still require expert intervention to tweak the parameter settings according to the EHR data distribution for each phenotype. To further accelerate the development of phenotyping algorithms, we propose a fully automated and robust unsupervised feature selection method that leverages only publicly available medical knowledge sources, instead of EHR data. METHODS SEmantics-Driven Feature Extraction (SEDFE) collects medical concepts from online knowledge sources as candidate features and gives them vector-form distributional semantic representations derived with neural word embedding and the Unified Medical Language System Metathesaurus. A number of features that are semantically closest and that sufficiently characterize the target phenotype are determined by a linear decomposition criterion and are selected for the final classification algorithm. RESULTS SEDFE was compared with the EHR-based SAFE algorithm and domain experts on feature selection for the classification of five phenotypes including coronary artery disease, rheumatoid arthritis, Crohn's disease, ulcerative colitis, and pediatric pulmonary arterial hypertension using both supervised and unsupervised approaches. Algorithms yielded by SEDFE achieved comparable accuracy to those yielded by SAFE and expert-curated features. SEDFE is also robust to the input semantic vectors. CONCLUSION SEDFE attains satisfying performance in unsupervised feature selection for EHR phenotyping. Both fully automated and EHR-independent, this method promises efficiency and accuracy in developing algorithms for high-throughput phenotyping.
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Affiliation(s)
- Wenxin Ning
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Stephanie Chan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrew Beam
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Alon Geva
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Katherine Liao
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mary Mullen
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Isaac Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Sheng Yu
- Center for Statistical Science, Tsinghua University, Beijing, China; Department of Industrial Engineering, Tsinghua University, Beijing, China; Institute for Data Science, Tsinghua University, Beijing, China.
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Shuai T, Deng L, Pan Y, Li W, Liao K, Li J, Peng L, Li Z. Free-breathing coronary CT angiography using 16-cm wide-detector for challenging patients: comparison with invasive coronary angiography. Clin Radiol 2018; 73:986.e1-986.e6. [DOI: 10.1016/j.crad.2018.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/20/2018] [Indexed: 12/01/2022]
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Schultz J, Cogswell R, Prtizker M, Missov E, Liao K, Misialek J, John R. Increased Pump Speed is Associated with Reduced Rates of Stroke on HeartMate II LVAD Support. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lin C, Lin C, Chen Y, Liao K, Wang G, Yu S. Development of a Localized Community-Based Integrated Home Care System: Model Swapping through an International Symposium. J Am Med Dir Assoc 2018. [DOI: 10.1016/j.jamda.2017.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sun LM, Liao K. Saccharomyces cerevisiae Hog1 MAP kinase pathway is activated in response to honokiol exposure. J Appl Microbiol 2018; 124:754-763. [PMID: 29165856 DOI: 10.1111/jam.13649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
Abstract
AIM The goal of the study was to investigate the cellular tolerance mechanism in response to honokiol exposure. METHODS AND RESULTS The broth microdilution method was employed to test the sensitivity of different Saccharomyces cerevisiae strains to honokiol. Intracellular levels of reactive oxygen species (ROSs) were determined by DCFH-DA staining. The phosphorylation of Hog1 was evaluated by Western blot analysis. The mRNA expressions of genes involved in the Ras-cyclic AMP (cAMP) pathway were analysed by real-time reverse transcription polymerase chain reaction. We found that the sod1▵ mutant was hypersensitive to honokiol and produced more ROS compared with wild-type and sod2▵ cells. Hog1 was phosphorylated in response to honokiol exposure and deletion of HOG1 increased the sensitivity to honokiol. The expressions of genes involved in the Ras-cAMP pathway were down-regulated after honokiol exposure; exogenous cAMP significantly reduced the phosphorylation of Hog1, although the level was higher than the control level. CONCLUSIONS In addition to SOD1, the Ras-cAMP cascade and Hog1 MAP kinase pathway is essential for protecting against honokiol-induced oxidative stress. SIGNIFICANCE AND IMPACT OF THE STUDY Our results provide insight into the understanding of the action mechanism of honokiol.
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Affiliation(s)
- L-M Sun
- Department of Pharmacology, Medical School of Southeast University, Nanjing, China
| | - K Liao
- Department of Pathology and Pathophysiology, Medical School of Southeast University, Nanjing, China
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Hamid O, Ros W, Thompson J, Hu-Lieskovan S, Eskens F, Diab A, Doi T, Wasser J, Spano JP, Rizvi N, Angevin E, Chiappori A, Ott P, Ganguly B, Fleener C, Dell V, Liao K, Joh T, Chou J, El-Khoueiry A. Safety, pharmacokinetics (PK) and pharmacodynamics (PD) data from a phase I dose-escalation study of OX40 agonistic monoclonal antibody (mAb) PF-04518600 (PF-8600) in combination with utomilumab, a 4-1BB agonistic mAb. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Cogswell R, Duval S, Schultz J, Martin C, Liao K, John R. Left Ventricular Assist Device Is Protective Against Cardiac Transplant Delisting for Medical Unsuitability. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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43
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Mazzulla F, Cogswell R, Schultz J, Walts A, Misialek J, Thenappan T, Pritzker M, Missov E, Martin C, Liao K, John R. Outcomes of Patients Who Require Temporary Mechanical Circulatory Support Prior to Left Ventricular Assist Device Placement. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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44
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Terao C, Kawaguchi T, Dieude P, Varga J, Kuwana M, Hudson M, Kawaguchi Y, Matucci-Cerinic M, Ohmura K, Riemekasten G, Kawasaki A, Airo P, Horita T, Oka A, Hachulla E, Yoshifuji H, Caramaschi P, Hunzelmann N, Baron M, Atsumi T, Hassoun P, Torii T, Takahashi M, Tabara Y, Shimizu M, Tochimoto A, Ayuzawa N, Yanagida H, Furukawa H, Tohma S, Hasegawa M, Fujimoto M, Ishikawa O, Yamamoto T, Goto D, Asano Y, Jinnin M, Endo H, Takahashi H, Takehara K, Sato S, Ihn H, Raychaudhuri S, Liao K, Gregersen P, Tsuchiya N, Riccieri V, Melchers I, Valentini G, Cauvet A, Martinez M, Mimori T, Matsuda F, Allanore Y. Transethnic meta-analysis identifies GSDMA and PRDM1 as susceptibility genes to systemic sclerosis. Ann Rheum Dis 2017; 76:1150-1158. [PMID: 28314753 DOI: 10.1136/annrheumdis-2016-210645] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/08/2017] [Accepted: 02/21/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is an autoimmune disease characterised by skin and systemic fibrosis culminating in organ damage. Previous genetic studies including genome-wide association studies (GWAS) have identified 12 susceptibility loci satisfying genome-wide significance. Transethnic meta-analyses have successfully expanded the list of susceptibility genes and deepened biological insights for other autoimmune diseases. METHODS We performed transethnic meta-analysis of GWAS in the Japanese and European populations, followed by a two-staged replication study comprising a total of 4436 cases and 14 751 controls. Associations between significant single nuclear polymorphisms (SNPs) and neighbouring genes were evaluated. Enrichment analysis of H3K4Me3, a representative histone mark for active promoter was conducted with an expanded list of SSc susceptibility genes. RESULTS We identified two significant SNP in two loci, GSDMA and PRDM1, both of which are related to immune functions and associated with other autoimmune diseases (p=1.4×10-10 and 6.6×10-10, respectively). GSDMA also showed a significant association with limited cutaneous SSc. We also replicated the associations of previously reported loci including a non-GWAS locus, TNFAIP3. PRDM1 encodes BLIMP1, a transcription factor regulating T-cell proliferation and plasma cell differentiation. The top SNP in GSDMA was a missense variant and correlated with gene expression of neighbouring genes, and this could explain the association in this locus. We found different human leukocyte antigen (HLA) association patterns between the two populations. Enrichment analysis suggested the importance of CD4-naïve primary T cell. CONCLUSIONS GSDMA and PRDM1 are associated with SSc. These findings provide enhanced insight into the genetic and biological basis of SSc.
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Affiliation(s)
- Chikashi Terao
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Takahisa Kawaguchi
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Philippe Dieude
- Rheumatology Bichat Hospital, Paris 7 University, Paris, France
| | - John Varga
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Masataka Kuwana
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Marie Hudson
- Jewish General Hospital and Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Marco Matucci-Cerinic
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, Department of Medical & Geriatrics Medicine, University of Florence, Firenze, Italy
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Gabriela Riemekasten
- Clinic for Rheumatology, University of Lübeck, Lübeck, Germany.,German Lung Center Borstel, Leibniz Institute, Germany
| | - Aya Kawasaki
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Paolo Airo
- Rheumatology Unit, Spedali Civili, Brescia, Italy
| | - Tetsuya Horita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Oka
- The Institute of Medical Science, Tokai University, Isehara, Japan
| | - Eric Hachulla
- Internal Medicine Department, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, Lille University, Lille, France
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Paola Caramaschi
- Rheumatology Department, University of Verona, Azienda Ospedaliera Universitaria Integrata, Italy
| | | | - Murray Baron
- Jewish General Hospital and Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Tatsuya Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Paul Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Meiko Takahashi
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Shimizu
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akiko Tochimoto
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naho Ayuzawa
- Department of Rheumatology, National Hospital Organization, Utano National Hospital, Kyoto, Japan
| | - Hidetoshi Yanagida
- Department of Rheumatology, National Hospital Organization, Utano National Hospital, Kyoto, Japan
| | - Hiroshi Furukawa
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
| | - Shigeto Tohma
- Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
| | - Minoru Hasegawa
- Division of Medicine, Faculty of Medical Sciences, Department of Dermatology, University of Fukui, Fukui, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Daisuke Goto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshihide Asano
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirahito Endo
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Toho University, Tokyo, Japan
| | - Hiroki Takahashi
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Soumya Raychaudhuri
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Katherine Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Naoyuki Tsuchiya
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | | | - Gabriele Valentini
- Department of Clinical and Experimental Medicine, Rheumatology Section, Second University of Naples, Naples, Italy
| | - Anne Cauvet
- INSERM U1016/UMR 8104, Cochin Institute, Paris Descartes University, Paris, France
| | - Maria Martinez
- INSERM U1220-IRSD-Batiment B Purpan Hospital Toulouse, Paris, France
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Department of Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yannick Allanore
- Rheumatology A Department, INSERM U1016/UMR 8104, Cochin Institute, Paris Descartes University, Paris, France
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Zheng Z, Zhang P, He G, Liao K, Wang Z, Pan J, Du K, Du J, Li BA. Simultaneous detection of 45 fusion genes in leukemia by dual-color fluorescence real-time PCR. Int J Lab Hematol 2017; 39:175-184. [PMID: 28133905 DOI: 10.1111/ijlh.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/03/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Detection of recurrent genetic abnormalities is of great significance for a refined diagnosis and assessment of prognosis in leukemia. Conventional nested reverse transcription PCR is labor intensive and time-consuming. METHODS We have developed a novel dual-color TaqMan probe-based real-time PCR method for the simultaneous screening of 45 fusion transcripts in 12 parallel reactions. The method was tested and validated with cell lines carrying known fusion transcripts and patient samples. RESULTS A multiplex real-time PCR method was successfully developed for rapid detection of 45 fusion genes and validated for 15 of the more commonly detected fusion genes. Intra-assay reproducibility assessed for the most frequent rearrangements ranged from 0.41% to 0.74% for the coefficient of variation (CV) of cycle threshold (Ct) and the interassay reproducibility ranged from 1.62% to 2.83% in five separate experiments. The lowest detection limit for the translocations tested ranged between 1 : 16 000 and 1 : 32 000. Validation of the method with 213 patient samples showed 100% specificity and excellent consistence with conventional nested RT-PCR. CONCLUSION Overall, we believe that this method is easily applicable, cost-effective, and clinically useful for a rapid screening of fusion genes in the initial diagnostic phase of leukemia. Its use can also be extended to the monitoring of minimal residual disease.
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Affiliation(s)
- Z Zheng
- School of Life Sciences, Xiamen University, Xiamen, China
| | - P Zhang
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - G He
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - K Liao
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - Z Wang
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - J Pan
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - K Du
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - J Du
- Shanghai Tissuebank Biotechnology Co., Ltd, Shanghai, China
| | - B-A Li
- School of Life Sciences, Xiamen University, Xiamen, China
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Shen H, Liao K, Wu HF, Lu HC, Li Y, Li Z, Zhang W. In utero exposure of high-dose di-n-butyl phthalate resulted in opposite effects on testicular cell apoptosis in late embryonic and pubertal male rat offspring. Hum Exp Toxicol 2017; 36:1236-1247. [DOI: 10.1177/0960327116685886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effects of in utero exposure to high-dose di- n-butyl phthalate (DBP) on testicular cell apoptosis in late embryonic and pubertal male rat offspring. Methods: Twenty pregnant Sprague-Dawley (SD) rats were divided into two groups. During gestation day (GD) 12 to GD 19, control group was given 1 ml day−1 of olive oil and experimental group was given DBP 500 mg kg−1 day−1 by gavage. On GD 19.5 and postnatal day (PND) 45, the testes were removed. Morphological analysis of the testes was observed by transmission electron microscopy and hematoxylin and eosin (H&E) staining. Testicular cell apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). The expression of Bcl-2, Bax, and p53 was presented by immunohistochemistry (IHC) and western blot. Data of the two groups was compared using independent samples t-test and Mann–Whitney test by SPSS 20.0. Results: H&E staining showed that spermatogenetic cells were significantly decreased in DBP exposed pubertal rat testis. The apoptosis index of testes in DBP-treated group was significantly lower on GD 19.5 but higher on PND 45 than that of the controls ( p < 0.01). IHC and western blot revealed significantly increased expression of Bcl-2 in GD 19.5 rat testis and Bax and p53 in PND 45 rat testis after DBP exposure, compared with the control ( p < 0.05). Conclusion: In utero exposure of high-dose DBP resulted in opposite effects on testicular cell apoptosis in late embryonic and pubertal rat offspring. The overexpression of Bcl-2, Bax, and p53 might be related to the occurrence of abnormal apoptosis and finally produce male infertility.
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Affiliation(s)
- H Shen
- Department of Urology, BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - K Liao
- Department of Urology, BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - H-F Wu
- Department of Urology, BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - H-C Lu
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Y Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Z Li
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - W Zhang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Long ZC, Gichira AW, Chen JM, Wang QF, Liao K. Development of EST-SSR markers in the relict tree Davidia involucrata (Davidiaceae) using transcriptome sequencing. Genet Mol Res 2016; 15:gmr-15-gmr15048539. [PMID: 27813565 DOI: 10.4238/gmr15048539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Davidia involucrata, reputed to be a "living fossil" in the plant kingdom, is a relict tree endemic to China. Extant natural populations are diminishing due to anthropogenic disturbance. In order to understand its ability to survive in a range of climatic conditions and to design conservation strategies for this endangered species, we developed genic simple sequence repeats (SSRs) from mRNA transcripts. In total, 142,950 contigs were assembled. Of these, 30,411 genic SSR loci were discovered and 12,208 primer pairs were designed. Dinucleotides were the most common (77.31%) followed by trinucleotides (16.44%). Thirteen randomly selected primers were synthesized and validated using 24 individuals of D. involucrata. The markers displayed high polymorphism with the number of alleles per locus ranging from 3 to 12 and the observed and expected heterozygosities ranging from 0.083 to 1.0 and 0.102 to 0.69, respectively. This large expressed sequence tag dataset and the novel SSR markers will be key tools in comparative studies that may reveal the adaptive evolution, population structure, and resolve the genetic diversity in this endangered species.
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Affiliation(s)
- Z C Long
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China.,Life Science College, University of Chinese Academy of Sciences, Beijing, China
| | - A W Gichira
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China.,Life Science College, University of Chinese Academy of Sciences, Beijing, China
| | - J M Chen
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
| | - Q F Wang
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
| | - K Liao
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
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Diab A, El-Khoueiry A, Eskens F, Ros W, Thompson J, Konto C, Bermingham C, Joh T, Liao K, Ganguly B, Hamid O. A first-in-human (FIH) study of PF-04518600 (PF-8600) OX40 agonist in adult patients (pts) with select advanced malignancies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Gichira AW, Long ZC, Wang QF, Chen JM, Liao K. Development of expressed sequence tag-based microsatellite markers for the critically endangered Isoëtes sinensis (Isoetaceae) based on transcriptome analysis. Genet Mol Res 2016; 15:gmr8497. [PMID: 27525847 DOI: 10.4238/gmr.15038497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Isoëtes sinensis is a critically endangered quillwort. To facilitate studies on the conservation genetics of this species, we developed expressed sequence tag-simple sequence repeat (EST-SSR) markers. A total of 50,063 unigenes were predicted by transcriptome sequencing, 5294 (10.6%) of which significantly matched 3011 Gene Ontology annotations and 2363 were assigned to Kyoto Encyclopedia of Genes and Genomes metabolic pathways. Most of these (2297) were involved in metabolism. A total of 1982 SSR motifs were identified, with trinucleotides being the dominant repeat motif, and 1438 (72.6%) SSR primers were designed. Eighteen randomly selected primer pairs were used to genotype 24 I. sinensis accessions, which confirmed the suitability of these novel markers for molecular studies of I. sinensis. The heterozygosity index value ranged between 0.0799 and 0.9106, while the Shannon-Wiener diversity index value ranged between 0.1732 and 2.5589. The EST-SSRs reported in this study are linked to genic sequences, and are therefore ideal for investigating the evolutionary history of I. sinensis. These markers, together with the large EST dataset generated in this study, will greatly facilitate conservation genetic studies of I. sinensis.
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Affiliation(s)
- A W Gichira
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Z C Long
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Q F Wang
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
| | - J M Chen
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
| | - K Liao
- Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
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50
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Escalante CP, Chang YC, Liao K, Rouleau T, Halm J, Bossi P, Bhadriraju S, Brito-Dellan N, Sahai S, Yusuf SW, Zalpour A, Elting LS. Meta-analysis of cardiovascular toxicity risks in cancer patients on selected targeted agents. Support Care Cancer 2016; 24:4057-74. [PMID: 27344327 DOI: 10.1007/s00520-016-3310-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/22/2016] [Accepted: 06/07/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents. METHODS We searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm. RESULTS Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN. CONCLUSIONS Several of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.
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Affiliation(s)
- C P Escalante
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Y C Chang
- Houston Independent School District, Houston, TX, USA
| | - K Liao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T Rouleau
- Carolinas Medical Center, Charlotte, NC, USA
| | - J Halm
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Bossi
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - S Bhadriraju
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Brito-Dellan
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Sahai
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S W Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Zalpour
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L S Elting
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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