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Graur A, Saenger JA, Mercaldo ND, Simon J, Abston ED, Price MC, Lanciotti K, Swisher LA, Colson YL, Willers H, Lanuti M, Fintelmann FJ. Multimodality Management of Thoracic Tumors: Initial Experience With a Multidisciplinary Thoracic Ablation Conference. Ann Surg Oncol 2024; 31:3426-3436. [PMID: 38270827 DOI: 10.1245/s10434-024-14910-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND This study aimed to describe lesion-specific management of thoracic tumors referred for consideration of image-guided thermal ablation (IGTA) at a newly established multidisciplinary ablation conference. METHODS This retrospective single-center cohort study included consecutive patients with non-small cell lung cancer (NSCLC) or thoracic metastases evaluated from June 2020 to January 2022 in a multidisciplinary conference. Outcomes included the management recommendation, treatments received (IGTA, surgical resection, stereotactic body radiation therapy [SBRT], multimodality management), and number of tumors treated per patient. Pearson's chi-square test was used to assess for a change in management, and Poisson regression was used to compare the number of tumors by treatment received. RESULTS The study included 172 patients (58 % female; median age, 69 years; 56 % thoracic metastases; 27 % multifocal primary lung cancer; 59 % ECOG 0 [range, 0-3]) assessed in 206 evaluations. For the patients with NSCLC, IGTA was considered the most appropriate local therapy in 12 %, equal to SBRT in 22 %, and equal to lung resection in 3 % of evaluations. For the patients with thoracic metastases, IGTA was considered the most appropriate local therapy in 22 %, equal to SBRT in 12 %, and equal to lung resection in 3 % of evaluations. Although all patients were referred for consideration of IGTA, less than one third of patients with NSCLC or thoracic metastases underwent IGTA (p < 0.001). Multimodality management allowed for treatment of more tumors per patient than single-modality management (p < 0.01). CONCLUSIONS Multidisciplinary evaluation of patients with thoracic tumors referred for consideration of IGTA significantly changed patient management and facilitated lesion-specific multimodality management.
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Affiliation(s)
- Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Jonathan A Saenger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | | | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Eric D Abston
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa C Price
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Kori Lanciotti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren A Swisher
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yolonda L Colson
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Lanuti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.
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Sandström A, Torrado-Carvajal A, Morrissey EJ, Kim M, Alshelh Z, Zhu Y, Li MD, Chang CY, Jarraya M, Akeju O, Schrepf A, Harris RE, Kwon YM, Bedair H, Chen AF, Mercaldo ND, Kettner N, Napadow V, Toschi N, Edwards RR, Loggia ML. [ 11 C]-PBR28 positron emission tomography signal as an imaging marker of joint inflammation in knee osteoarthritis. Pain 2024; 165:1121-1130. [PMID: 38015622 DOI: 10.1097/j.pain.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Although inflammation is known to play a role in knee osteoarthritis (KOA), inflammation-specific imaging is not routinely performed. In this article, we evaluate the role of joint inflammation, measured using [ 11 C]-PBR28, a radioligand for the inflammatory marker 18-kDa translocator protein (TSPO), in KOA. Twenty-one KOA patients and 11 healthy controls (HC) underwent positron emission tomography/magnetic resonance imaging (PET/MRI) knee imaging with the TSPO ligand [ 11 C]-PBR28. Standardized uptake values were extracted from regions-of-interest (ROIs) semiautomatically segmented from MRI data, and compared across groups (HC, KOA) and subgroups (unilateral/bilateral KOA symptoms), across knees (most vs least painful), and against clinical variables (eg, pain and Kellgren-Lawrence [KL] grades). Overall, KOA patients demonstrated elevated [ 11 C]-PBR28 binding across all knee ROIs, compared with HC (all P 's < 0.005). Specifically, PET signal was significantly elevated in both knees in patients with bilateral KOA symptoms (both P 's < 0.01), and in the symptomatic knee ( P < 0.05), but not the asymptomatic knee ( P = 0.95) of patients with unilateral KOA symptoms. Positron emission tomography signal was higher in the most vs least painful knee ( P < 0.001), and the difference in pain ratings across knees was proportional to the difference in PET signal ( r = 0.74, P < 0.001). Kellgren-Lawrence grades neither correlated with PET signal (left knee r = 0.32, P = 0.19; right knee r = 0.18, P = 0.45) nor pain ( r = 0.39, P = 0.07). The current results support further exploration of [ 11 C]-PBR28 PET signal as an imaging marker candidate for KOA and a link between joint inflammation and osteoarthritis-related pain severity.
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Affiliation(s)
- Angelica Sandström
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Erin J Morrissey
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Minhae Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Zeynab Alshelh
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Yehui Zhu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew D Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Connie Y Chang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Richard E Harris
- Susan Samueli Integrative Health Institute, School of Medicine, University of California at Irvine, Irvine CA, United States
- Department of Anesthesiology and Perioperative Care, School of Medicine, University of California at Irvine, Irvine CA, United States
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hany Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Nathaniel D Mercaldo
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Norman Kettner
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Nicola Toschi
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Biomedicine and Prevention, University of Rome, "Tor Vergata," Rome, Italy
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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3
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Graur A, Mercaldo ND, Simon J, Alici C, Saenger JA, Cahalane AM, Vazquez R, Fintelmann FJ. High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency. AJR Am J Roentgenol 2024; 222:e2330557. [PMID: 38264999 DOI: 10.2214/ajr.23.30557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.
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Affiliation(s)
- Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Cagatay Alici
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Jonathan A Saenger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexis M Cahalane
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Rafael Vazquez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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Tonnesen PE, Mercaldo ND, Tahir I, Dietrich ASW, Amayri W, Graur A, Allaire B, Bouxsein ML, Samelson EJ, Kiel DP, Fintelmann FJ. Muscle Reference Values From Thoracic and Abdominal CT for Sarcopenia Assessment: The Framingham Heart Study. Invest Radiol 2024; 59:259-270. [PMID: 37725490 PMCID: PMC10920396 DOI: 10.1097/rli.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Loss of muscle mass is a known feature of sarcopenia and predicts poor clinical outcomes. Although muscle metrics can be derived from routine computed tomography (CT) images, sex-specific reference values at multiple vertebral levels over a wide age range are lacking. OBJECTIVE The aim of this study was to provide reference values for skeletal muscle mass and attenuation on thoracic and abdominal CT scans in the community-based Framingham Heart Study cohort to aid in the identification of sarcopenia. MATERIALS AND METHODS This secondary analysis of a prospective trial describes muscle metrics by age and sex for participants from the Framingham Heart Study without prior history of cancer who underwent at least 1 CT scan between 2002 and 2011. Using 2 previously validated machine learning algorithms followed by human quality assurance, skeletal muscle was analyzed on a single axial CT image per level at the 5th, 8th, 10th thoracic, and 3rd lumbar vertebral body (T5, T8, T10, L3). Cross-sectional muscle area (cm 2 ), mean skeletal muscle radioattenuation (SMRA, in Hounsfield units), skeletal muscle index (SMI, in cm 2 /m 2 ), and skeletal muscle gauge (SMRA·SMI) were calculated. Measurements were summarized by age group (<45, 45-54, 55-64, 65-74, ≥75 years), sex, and vertebral level. Models enabling the calculation of age-, sex-, and vertebral-level-specific reference values were created and embedded into an open access online Web application. RESULTS The cohort consisted of 3804 participants (1917 [50.4%] males; mean age, 55.6 ± 11.8 years; range, 33-92 years) and 7162 CT scans. Muscle metrics qualitatively decreased with increasing age and female sex. CONCLUSIONS This study established age- and sex-specific reference values for CT-based muscle metrics at thoracic and lumbar vertebral levels. These values may be used in future research investigating the role of muscle mass and attenuation in health and disease, and to identify sarcopenia.
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Affiliation(s)
- P. Erik Tonnesen
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Nathaniel D. Mercaldo
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ismail Tahir
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
| | - Anna-Sophia W. Dietrich
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
| | - Wael Amayri
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
| | - Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
| | - Brett Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mary L. Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
- Endocrine Division, Massachusetts General Hospital, Boston, MA
| | - Elizabeth J. Samelson
- Harvard Medical School, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Douglas P. Kiel
- Harvard Medical School, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Florian J. Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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5
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Graur A, Saenger JA, Mercaldo ND, Simon J, Abston ED, Price MC, Lanciotti K, Swisher LA, Colson YL, Willers H, Lanuti M, Fintelmann FJ. ASO Visual Abstract: Multimodality Management of Thoracic Tumors-Initial Experience with a Multidisciplinary Thoracic Ablation Conference. Ann Surg Oncol 2024:10.1245/s10434-024-15045-x. [PMID: 38372862 DOI: 10.1245/s10434-024-15045-x] [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: 02/20/2024]
Affiliation(s)
- Alexander Graur
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Jonathan A Saenger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
- Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | | | - Judit Simon
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Eric D Abston
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa C Price
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Kori Lanciotti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren A Swisher
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yolonda L Colson
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Lanuti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA.
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Hasubek AL, Wang X, Zhang E, Kobus M, Chen J, Vandergrift LA, Kurreck A, Ehret F, Dinges S, Hohm A, Tilgner M, Buko A, Habbel P, Nowak J, Mercaldo ND, Gusev A, Feldman AS, Cheng LL. Differentiation of patients with and without prostate cancer using urine 1 H NMR metabolomics. Magn Reson Chem 2023; 61:740-747. [PMID: 37654196 DOI: 10.1002/mrc.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. For its detection, serum prostate-specific antigen (PSA) screening is commonly used, despite its lack of specificity, high false positive rate, and inability to discriminate indolent from aggressive PCa. Following increases in serum PSA levels, clinicians often conduct prostate biopsies with or without advanced imaging. Nuclear magnetic resonance (NMR)-based metabolomics has proven to be promising for advancing early-detection and elucidation of disease progression, through the discovery and characterization of novel biomarkers. This retrospective study of urine-NMR samples, from prostate biopsy patients with and without PCa, identified several metabolites involved in energy metabolism, amino acid metabolism, and the hippuric acid pathway. Of note, lactate and hippurate-key metabolites involved in cellular proliferation and microbiome effects, respectively-were significantly altered, unveiling widespread metabolomic modifications associated with PCa development. These findings support urine metabolomics profiling as a promising strategy to identify new clinical biomarkers for PCa detection and diagnosis.
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Affiliation(s)
- Anna-Laura Hasubek
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaoyu Wang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ella Zhang
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marta Kobus
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jiashang Chen
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsey A Vandergrift
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Annika Kurreck
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Felix Ehret
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Dinges
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Annika Hohm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marlon Tilgner
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Buko
- Human Metabolome Technologies, Boston, Massachusetts, USA
| | - Piet Habbel
- Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - Johannes Nowak
- SRH Poliklinik Gera GmbH, Radiology Gotha, Gotha, Germany
- SRH University of Applied Health Sciences, Gera, Germany
| | - Nathaniel D Mercaldo
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Gusev
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Feldman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Leo L Cheng
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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7
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Dichtel LE, Tabari A, Mercaldo ND, Corey KE, Husseini J, Osganian SA, Chicote ML, Rao EM, Miller KK, Bredella MA. CT Texture Analysis in Nonalcoholic Fatty Liver Disease (NAFLD). J Clin Exp Hepatol 2023; 13:760-766. [PMID: 37693260 PMCID: PMC10483004 DOI: 10.1016/j.jceh.2023.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease worldwide. There are limited biomarkers that can detect progression from simple steatosis to nonalcoholic steatohepatitis (NASH). The purpose of our study was to utilize CT texture analysis to distinguish steatosis from NASH. Methods 16 patients with NAFLD (38% male, median (interquartile range): age 57 (48-64) years, BMI 37.5 (35.0-46.8) kg/m2) underwent liver biopsy and abdominal non-contrast CT. CT texture analysis was performed to quantify gray-level tissue summaries (e.g., entropy, kurtosis, skewness, and attenuation) using commercially available software (TexRad, Cambridge England). Logistic regression analyses were performed to quantify the association between steatosis/NASH status and CT texture. ROC curve analysis was performed to determine sensitivity, specificity, AUC, 95% CIs, and cutoff values of texture parameters to differentiate steatosis from NASH. Results By histology, 6/16 (37%) of patients had simple steatosis and 10/16 (63%) had NASH. Patients with NASH had lower entropy (median, interquartile range (IQR): 4.3 (4.1, 4.8) vs. 5.0 (4.9, 5.2), P = 0.013) and lower mean value of positive pixels (MPP) (34.4 (21.8, 52.2) vs. 66.5 (57.0, 70.7), P = 0.009) than those with simple steatosis. Entropy values below 4.73 predict NASH with 100% (95%CI: 67-100%) specificity and 80% (50-100%) sensitivity, AUC: 0.88. MPP values below 54.0 predict NASH with 100% (67-100%) specificity and 100% (50-100%) sensitivity, AUC 0.90. Conclusion Our study provides preliminary evidence that CT texture analysis may serve as a novel imaging biomarker for disease activity in NAFLD and the discrimination of steatosis and NASH.
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Affiliation(s)
- Laura E. Dichtel
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nathaniel D. Mercaldo
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen E. Corey
- Harvard Medical School, Boston, MA, USA
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Jad Husseini
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mark L. Chicote
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth M. Rao
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Karen K. Miller
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Miriam A. Bredella
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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8
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Tahir I, Cahalane AM, Saenger JA, Leppelmann KS, Abrishami Kashani M, Marquardt JP, Silverman SG, Shyn PB, Mercaldo ND, Fintelmann FJ. Factors Associated with Hospital Length of Stay and Adverse Events following Percutaneous Ablation of Lung Tumors. J Vasc Interv Radiol 2023; 34:759-767.e2. [PMID: 36521793 DOI: 10.1016/j.jvir.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation of lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 men [51%]; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation and 57 microwave ablation) from 2006 to 2019. Age-adjusted Charlson Comorbidity Index, sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery-to-aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using univariable and multivariable generalized linear models. RESULTS In univariable analysis, HLOS was associated with current smoking (incidence rate ratio [IRR], 4.54 [1.23-16.8]; P = .02), COPD (IRR, 3.56 [1.40-9.04]; P = .01), cryoablations with ≥3 pleural punctures (IRR, 3.13 [1.07-9.14]; P = .04), general anesthesia (IRR, 10.8 [4.18-27.8]; P < .001), and sarcopenia (IRR, 2.66 [1.10-6.44]; P = .03). After multivariable adjustment, COPD (IRR, 3.56 [1.57-8.11]; P = .003) and general anesthesia (IRR, 12.1 [4.39-33.5]; P < .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (P = .03). CONCLUSIONS Identified preprocedural risk factors from the surgical literature may aid in risk stratification for HLOS after percutaneous ablation of lung tumors, but were not associated with adverse events.
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Affiliation(s)
- Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexis M Cahalane
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Sigmund Freud University, Vienna, Austria
| | - Konstantin S Leppelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Peter Marquardt
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Rosas HD, Lewis L, Connors N, Mercaldo ND, Nasr S. Are you angry? Neural basis of impaired facial expression recognition in pre-manifest Huntington's. Parkinsonism Relat Disord 2023; 109:105289. [PMID: 36948112 PMCID: PMC11017071 DOI: 10.1016/j.parkreldis.2023.105289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Early non-motor symptoms in Huntington's disease (HD), including visual perceptual difficulties, can have profound negative impacts on quality of life. In particular, deficits in emotion recognition may contribute to misinterpretation of social cues, and may adversely affect interpersonal relationships, work relationships and/or general well-being. This may be particularly salient during the pre-manifest period, a period prior to the onset of motor symptoms. We sought to evaluate impairments in emotion recognition in gene-positive individuals who did not meet criterial for a diagnosis of HD; we also sought to determine associations between emotion recognition processing and altered cortico-striatal circuitry. METHODS We used a standardized battery to evaluate performance on a facial expression recognition task in a cohort of motor pre-manifest HD (Pre-HD) individuals (N = 21). Functional MRI (fMRI) was then used to assess the face processing network in a subset (N = 15). RESULTS We found significantly decreased response accuracy to certain facial expressions, particularly of negative emotions (p < 0.001) in Pre-HDs. When Pre-HDs viewed faces with different emotions, activation within the Superior Temporal Sulcus (fSTS) was reduced compared to controls; in contrast, the level of evoked response within other face-selective cortical regions was comparable. CONCLUSION Early deficits in emotion recognition in Pre-HD appear to be associated with alterations in the fSTS response, a distinctly different pathway from that involved in face perception and provide support for early cognitive and behavioral interventions.
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Affiliation(s)
- H Diana Rosas
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA; Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA, 02115, USA; Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Charlestown, MA, 02129, USA.
| | - Lydia Lewis
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA; Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA, 02115, USA; Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Natalie Connors
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA; Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA, 02115, USA; Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, 02129, USA; Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA; Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Charlestown, MA, 02129, USA
| | - Shahin Nasr
- Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA; Center for Neuroimaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Charlestown, MA, 02129, USA
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10
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Furtado FS, Mercaldo ND, Vahle T, Benkert T, Bradley WR, Ratanaprasatporn L, Seethamraju RT, Harisinghani MG, Lee S, Suarez-Weiss K, Umutlu L, Catana C, Pomykala KL, Domachevsky L, Bernstine H, Groshar D, Rosen BR, Catalano OA. Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI. Eur Radiol 2023; 33:2536-2547. [PMID: 36460925 DOI: 10.1007/s00330-022-09275-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. METHODS Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. RESULTS The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038). CONCLUSIONS In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. KEY POINTS • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Thomas Vahle
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa Ratanaprasatporn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ravi Teja Seethamraju
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- MR Collaborations, Siemens Medical Solutions USA, Inc., 30 Jonathan Ln, Malden, MA, 02148, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Krista Suarez-Weiss
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Lale Umutlu
- Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ciprian Catana
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | | | - Liran Domachevsky
- Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
| | - Hanna Bernstine
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - David Groshar
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - Bruse R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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Muti IH, Gonzalez Sanchez-Dahl M, Zhong AB, Weng J, Füzesi MV, Kivisäkk P, Hyman BT, Arnold SE, Feldman AS, Mercaldo ND, Cheng LL. Designing a quality assurance process for quality control of nuclear magnetic resonance metabolomics studies of human blood. NMR Biomed 2023; 36:e4868. [PMID: 36330660 PMCID: PMC9992016 DOI: 10.1002/nbm.4868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
High-resolution magic angle spinning (HRMAS) nuclear magnetic resonance (NMR)-based metabolomics has demonstrated its utility in studies of biofluids for various diseases. HRMAS NMR spectroscopy is uniquely well suited for analyzing human blood samples because of the small quantity of samples and minimal preparation required. To develop this methodology into standardized clinical protocols, establishment of the method's quality assurance (QA) and evaluations of its quality control (QC) are critical. This study aims to assess the QA/QC measured from human blood specimens in the form of serum and plasma through within-subject and between-subject comparisons, as well as stability and consistency comparisons over several freezing-thawing cycles of sample storage conditions, and most importantly, the agreement of pooled control samples against individual samples.
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Affiliation(s)
- Isabella H Muti
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anya B Zhong
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - JianXiang Weng
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark V Füzesi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pia Kivisäkk
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bradley T Hyman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven E Arnold
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Feldman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel D Mercaldo
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo L Cheng
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Polyakov NJ, Som A, Mercaldo ND, Di Capua J, Little BP, Flores EJ. Rate of True-Positive Findings of COVID-19 Typical Appearance at Chest CT per RSNA Consensus Guidelines in an Increasingly Vaccinated Population. Radiology 2023; 306:e220680. [PMID: 36066367 PMCID: PMC9462593 DOI: 10.1148/radiol.220680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background RSNA consensus guidelines for COVID-19-related chest CT are widely used but, to the knowledge of the authors, their rate of true-positive findings for COVID-19 pneumonia in vaccinated patients has not been assessed. Purpose To assess the rate of true-positive findings of typical appearance for COVID-19 at chest CT by using RSNA guidelines in fully vaccinated patients with polymerase chain reaction (PCR)-confirmed COVID-19 infection compared with unvaccinated patients. Materials and Methods Included were patients with COVID-19 who had typical appearance on chest CT images and one PCR test for COVID-19 with a positive result or two tests with negative results within 7 days of undergoing chest CT between January 2021 and January 2022 at a quaternary academic medical center. True-positive findings were defined as chest CT images interpreted as COVID-19 typical appearance and PCR-confirmed COVID-19 infection within 7 days. Logistic regression models were constructed to quantify the association between PCR results and vaccination status, vaccination status and COVID-19 variants, and vaccination status and number of months. Results Included were 652 patients (median age, 59 years; IQR, 48-72 years; 371 men [57%]) with CT scans classified as typical appearance. Of those patients, 483 (74%) were unvaccinated and 169 (26%) were fully vaccinated. The overall rate of true-positive findings on CT images rated as typical appearance was lower in vaccinated versus unvaccinated patients (70 of 169 [41%; 95% CI: 34, 49] vs 352 of 483 [73%; 95% CI: 69, 77]; odds ratio [OR], 3.8 [95% CI: 2.6, 5.5]; P < .001). Unvaccinated patients were more likely to have true-positive findings on CT images compared with fully vaccinated patients during the peaks of COVID-19 variants Alpha (OR, 16; 95% CI: 6, 42; P < .001) and Delta (OR, 8; 95% CI: 4, 16; P < .001), but no statistical differences were found during the peak of the Omicron variant (OR, 1.7; 95% CI: 0.3, 11; P = .56). Conclusion Fully vaccinated patients with confirmed COVID-19 breakthrough infections had lower rates of true-positive findings of COVID-19 typical appearance at chest CT. © RSNA, 2022 Supplemental material is available for this article.
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Affiliation(s)
- Nicole J Polyakov
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Avik Som
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Nathaniel D Mercaldo
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - John Di Capua
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Brent P Little
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Efrén J Flores
- From the Department of Scholarly Engagement, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 (N.J.P., E.J.F.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S., N.D.M., J.D.C., E.J.F.); and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
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13
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Yoon BC, Pomerantz SR, Mercaldo ND, Goyal S, L’Italien EM, Lev MH, Buch KA, Buchbinder BR, Chen JW, Conklin J, Gupta R, Hunter GJ, Kamalian SC, Kelly HR, Rapalino O, Rincon SP, Romero JM, He J, Schaefer PW, Do S, González RG. Incorporating algorithmic uncertainty into a clinical machine deep learning algorithm for urgent head CTs. PLoS One 2023; 18:e0281900. [PMID: 36913348 PMCID: PMC10010506 DOI: 10.1371/journal.pone.0281900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Machine learning (ML) algorithms to detect critical findings on head CTs may expedite patient management. Most ML algorithms for diagnostic imaging analysis utilize dichotomous classifications to determine whether a specific abnormality is present. However, imaging findings may be indeterminate, and algorithmic inferences may have substantial uncertainty. We incorporated awareness of uncertainty into an ML algorithm that detects intracranial hemorrhage or other urgent intracranial abnormalities and evaluated prospectively identified, 1000 consecutive noncontrast head CTs assigned to Emergency Department Neuroradiology for interpretation. The algorithm classified the scans into high (IC+) and low (IC-) probabilities for intracranial hemorrhage or other urgent abnormalities. All other cases were designated as No Prediction (NP) by the algorithm. The positive predictive value for IC+ cases (N = 103) was 0.91 (CI: 0.84-0.96), and the negative predictive value for IC- cases (N = 729) was 0.94 (0.91-0.96). Admission, neurosurgical intervention, and 30-day mortality rates for IC+ was 75% (63-84), 35% (24-47), and 10% (4-20), compared to 43% (40-47), 4% (3-6), and 3% (2-5) for IC-. There were 168 NP cases, of which 32% had intracranial hemorrhage or other urgent abnormalities, 31% had artifacts and postoperative changes, and 29% had no abnormalities. An ML algorithm incorporating uncertainty classified most head CTs into clinically relevant groups with high predictive values and may help accelerate the management of patients with intracranial hemorrhage or other urgent intracranial abnormalities.
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Affiliation(s)
- Byung C. Yoon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Stuart R. Pomerantz
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Nathaniel D. Mercaldo
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, United States of America
| | - Swati Goyal
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Eric M. L’Italien
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael H. Lev
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Karen A. Buch
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Bradley R. Buchbinder
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John W. Chen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Center for Systems Biology (CSB), Boston, MA, United States of America
| | - John Conklin
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Rajiv Gupta
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Consortia for Integration of Medicine and Innovative Technologies (CIMIT), Boston, MA, United States of America
- Massachusetts General Hospital CT Innovation and Advanced X-ray Imaging Science (AXIS) Center, Boston, MA, United States of America
| | - George J. Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Shahmir C. Kamalian
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hillary R. Kelly
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, United States of America
| | - Otto Rapalino
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sandra P. Rincon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Javier M. Romero
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Julian He
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pamela W. Schaefer
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Enterprise Radiology, Boston, MA, United States of America
| | - Synho Do
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Ramon Gilberto González
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Massachusetts General Hospital Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States of America
- * E-mail:
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Rajakumar T, Horos R, Kittner P, Kahraman M, Sikosek T, Hinkfoth F, Tikk K, Mercaldo ND, Stenzinger A, Rabe KF, Reck M, Thomas M, Christopoulos P, Steinkraus BR. Brief Report: A Blood-Based MicroRNA Complementary Diagnostic Predicts Immunotherapy Efficacy in Advanced-Stage NSCLC With High Programmed Death-Ligand 1 Expression. JTO Clin Res Rep 2022; 3:100369. [PMID: 35880086 PMCID: PMC9307680 DOI: 10.1016/j.jtocrr.2022.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
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15
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O'Shea A, Li MD, Mercaldo ND, Balthazar P, Som A, Yeung T, Succi MD, Little BP, Kalpathy-Cramer J, Lee SI. Intubation and mortality prediction in hospitalized COVID-19 patients using a combination of convolutional neural network-based scoring of chest radiographs and clinical data. BJR Open 2022; 4:20210062. [PMID: 36105420 PMCID: PMC9459864 DOI: 10.1259/bjro.20210062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To predict short-term outcomes in hospitalized COVID-19 patients using a model incorporating clinical variables with automated convolutional neural network (CNN) chest radiograph analysis. Methods A retrospective single center study was performed on patients consecutively admitted with COVID-19 between March 14 and April 21 2020. Demographic, clinical and laboratory data were collected, and automated CNN scoring of the admission chest radiograph was performed. The two outcomes of disease progression were intubation or death within 7 days and death within 14 days following admission. Multiple imputation was performed for missing predictor variables and, for each imputed data set, a penalized logistic regression model was constructed to identify predictors and their functional relationship to each outcome. Cross-validated area under the characteristic (AUC) curves were estimated to quantify the discriminative ability of each model. Results 801 patients (median age 59; interquartile range 46-73 years, 469 men) were evaluated. 36 patients were deceased and 207 were intubated at 7 days and 65 were deceased at 14 days. Cross-validated AUC values for predictive models were 0.82 (95% CI, 0.79-0.86) for death or intubation within 7 days and 0.82 (0.78-0.87) for death within 14 days. Automated CNN chest radiograph score was an important variable in predicting both outcomes. Conclusion Automated CNN chest radiograph analysis, in combination with clinical variables, predicts short-term intubation and death in patients hospitalized for COVID-19 infection. Chest radiograph scoring of more severe disease was associated with a greater probability of adverse short-term outcome. Advances in knowledge Model-based predictions of intubation and death in COVID-19 can be performed with high discriminative performance using admission clinical data and convolutional neural network-based scoring of chest radiograph severity.
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Affiliation(s)
- Aileen O'Shea
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew D Li
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, United States
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Patricia Balthazar
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, MGH and BWH Center for Clinical Data Science, Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
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16
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Weinstein DF, Choi JG, Mercaldo ND, Stump NN, Paras ML, Berube RA, Hur C. Is Resident-Driven Inpatient Care More Expensive? Challenging a Long-Held Assumption. Acad Med 2021; 96:1205-1212. [PMID: 33496432 DOI: 10.1097/acm.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The financial impact of graduate medical education (GME) on teaching hospitals remains poorly understood, while calls for increased federal support continue alongside legislative threats to reduce funding. Despite studies suggesting that residents are more "economical" than alternative providers, GME is widely believed to be an expensive investment. Assumptions that residents increase the cost of patient care have persisted in the absence of convincing evidence to the contrary. Thus, the authors sought to examine resident influence on patient care costs by comparing costs between a resident-driven service (RS) and a nonresident-covered service (NRS), with attention to clinical outcomes and how potential cost differences relate to the utilization of resources, length of stay (LOS), and other factors. METHOD This prospective study compared costs and clinical outcomes of internal medicine patients admitted to an RS versus an NRS at Massachusetts General Hospital (July 1, 2016-June 30, 2017). Total variable direct costs of inpatient admission was the primary outcome measure. LOS; 30-day readmission rate; utilization related to diagnostic radiology, pharmaceuticals, and clinical labs; and other outcome measures were also compared. Linear regression models quantified the relationship between log-transformed variable direct costs and service. RESULTS Baseline characteristics of 5,448 patients on the 2 services (3,250 on an RS and 2,198 on an NRS) were similar. On an RS, patient care costs were slightly less and LOS was slightly shorter than on an NRS, with no significant differences in hospital mortality or 30-day readmission rate detected. Resource utilization was comparable between the services. CONCLUSIONS These findings undermine long-held assumptions that residents increase the cost of patient care. Though not generalizable to ambulatory settings or other specialties, this study can help inform hospital decision making around sponsorship of GME programs, especially if federal funding for GME remains capped or is subject to additional reductions.
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Affiliation(s)
- Debra F Weinstein
- D.F. Weinstein is vice president, Graduate Medical Education, Mass General Brigham, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Jin G Choi
- J.G. Choi is a second-year medical student, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-8517-8374
| | - Nathaniel D Mercaldo
- N.D. Mercaldo is statistician, Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, and instructor of radiology, Harvard Medical School, Boston, Massachusetts
| | - Natalie N Stump
- N.N. Stump is a fourth-year medical student, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Molly L Paras
- M.L. Paras is infectious disease fellowship director, Mass General Brigham, and instructor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Rhodes A Berube
- R.A. Berube is senior administrative director for clinical operations, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Hur
- C. Hur is director, Healthcare Innovations Research and Evaluation, and professor of medicine, Columbia University, New York, New York
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17
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Chan ST, Mercaldo ND, Kwong KK, Hersch SM, Rosas HD. Impaired Cerebrovascular Reactivity in Huntington's Disease. Front Physiol 2021; 12:663898. [PMID: 34366879 PMCID: PMC8334185 DOI: 10.3389/fphys.2021.663898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
There is increasing evidence that impairments of cerebrovascular function and/or abnormalities of the cerebral vasculature might contribute to early neuronal cell loss in Huntington's disease (HD). Studies in both healthy individuals as well as in patients with other neurodegenerative disorders have used an exogenous carbon dioxide (CO2) challenge in conjunction with functional magnetic resonance imaging (fMRI) to assess regional cerebrovascular reactivity (CVR). In this study, we explored potential impairments of CVR in HD. Twelve gene expanded HD individuals, including both pre-symptomatic and early symptomatic HD and eleven healthy controls were administered a gas mixture targeting a 4-8 mmHg increase in CO2 relative to the end-tidal partial pressure of CO2 (P ET CO2) at rest. A Hilbert Transform analysis was used to compute the cross-correlation between the time series of regional BOLD signal changes (ΔBOLD) and increased P ET CO2, and to estimate the response delay of ΔBOLD relative to P ET CO2. After correcting for age, we found that the cross-correlation between the time series for regional ΔBOLD and for P ET CO2 was weaker in HD subjects than in controls in several subcortical white matter regions, including the corpus callosum, subcortical white matter adjacent to rostral and caudal anterior cingulate, rostral and caudal middle frontal, insular, middle temporal, and posterior cingulate areas. In addition, greater volume of dilated perivascular space (PVS) was observed to overlap, primarily along the periphery, with the areas that showed greater ΔBOLD response delay. Our preliminary findings support that alterations in cerebrovascular function occur in HD and may be an important, not as yet considered, contributor to early neuropathology in HD.
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Affiliation(s)
- Suk Tak Chan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Nathaniel D Mercaldo
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Kenneth K Kwong
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Steven M Hersch
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Herminia D Rosas
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Mitani AA, Mercaldo ND, Haneuse S, Schildcrout JS. Survey design and analysis considerations when utilizing misclassified sampling strata. BMC Med Res Methodol 2021; 21:145. [PMID: 34247586 PMCID: PMC8273975 DOI: 10.1186/s12874-021-01332-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A large multi-center survey was conducted to understand patients' perspectives on biobank study participation with particular focus on racial and ethnic minorities. In order to enrich the study sample with racial and ethnic minorities, disproportionate stratified sampling was implemented with strata defined by electronic health records (EHR) that are known to be inaccurate. We investigate the effect of sampling strata misclassification in complex survey design. METHODS Under non-differential and differential misclassification in the sampling strata, we compare the validity and precision of three simple and common analysis approaches for settings in which the primary exposure is used to define the sampling strata. We also compare the precision gains/losses observed from using a disproportionate stratified sampling scheme compared to using a simple random sample under varying degrees of strata misclassification. RESULTS Disproportionate stratified sampling can result in more efficient parameter estimates of the rare subgroups (race/ethnic minorities) in the sampling strata compared to simple random sampling. When sampling strata misclassification is non-differential with respect to the outcome, a design-agnostic analysis was preferred over model-based and design-based analyses. All methods yielded unbiased parameter estimates but standard error estimates were lowest from the design-agnostic analysis. However, when misclassification is differential, only the design-based method produced valid parameter estimates of the variables included in the sampling strata. CONCLUSIONS In complex survey design, when the interest is in making inference on rare subgroups, we recommend implementing disproportionate stratified sampling over simple random sampling even if the sampling strata are misclassified. If the misclassification is non-differential, we recommend a design-agnostic analysis. However, if the misclassification is differential, we recommend using design-based analyses.
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Affiliation(s)
- Aya A Mitani
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Canada.
| | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
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19
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Rosas HD, Lewis LR, Mercaldo ND, Nasr S, Brickman AM, Siless V, Yassa M, Sathishkumar M, Lott I, Schupf N, Silverman W, Lai F. Altered connectivity of the default mode network in cognitively stable adults with Down syndrome: "Accelerated aging" or a prelude to Alzheimer's disease? Alzheimers Dement (Amst) 2021; 13:e12105. [PMID: 34027014 PMCID: PMC8136300 DOI: 10.1002/dad2.12105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Most individuals with Down syndrome (DS) have the neuropathological changes of Alzheimer's disease (AD) by age 40 and will have developed dementia by age 60. Alterations of the intrinsic connectivity of the default mode network (DMN) are associated with AD in the neurotypical population. In this study, we sought to determine whether, and how, connectivity between the hubs of the DMN were altered in cognitively stable adults with DS who did not have evidence of either mild cognitive impairment or AD. METHODS Resting state functional MRI scans were collected from 26 healthy adults with DS and 26 healthy age-matched non-DS controls. Nodes comprising the DMN were generated as ROI's (regions of interest) and inter-nodal correlations estimated. RESULTS Analysis of intra-network connectivity of the DMN revealed anterior-posterior DMN dissociation and hyper- and hypo-connectivity, suggesting "accelerated aging" in DS. DISCUSSION Disruption of the DMN may serve as a prelude for AD in DS.
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Affiliation(s)
- H. Diana Rosas
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Lydia R. Lewis
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Nathaniel D. Mercaldo
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Shahin Nasr
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Adam M. Brickman
- G. H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging BrainCollege of Physicians and SurgeonsColumbia UniversityNew YorkUSA
- Department of NeurologyColumbia UniversityNew YorkUSA
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkUSA
| | - Viviana Siless
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Michael Yassa
- Center for the Neurobiology of Learning and Memory and Department of Neurobiology and BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
| | - Mithra Sathishkumar
- Center for the Neurobiology of Learning and Memory and Department of Neurobiology and BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ira Lott
- Department of NeurologyUniversity of CaliforniaIrvineCaliforniaUSA
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Nicole Schupf
- G. H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging BrainCollege of Physicians and SurgeonsColumbia UniversityNew YorkUSA
- Department of NeurologyColumbia UniversityNew YorkUSA
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkUSA
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkUSA
| | - Wayne Silverman
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Florence Lai
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Tao R, Mercaldo ND, Haneuse S, Maronge JM, Rathouz PJ, Heagerty PJ, Schildcrout JS. Two-wave two-phase outcome-dependent sampling designs, with applications to longitudinal binary data. Stat Med 2021; 40:1863-1876. [PMID: 33442883 DOI: 10.1002/sim.8876] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 12/26/2022]
Abstract
Two-phase outcome-dependent sampling (ODS) designs are useful when resource constraints prohibit expensive exposure ascertainment on all study subjects. One class of ODS designs for longitudinal binary data stratifies subjects into three strata according to those who experience the event at none, some, or all follow-up times. For time-varying covariate effects, exclusively selecting subjects with response variation can yield highly efficient estimates. However, if interest lies in the association of a time-invariant covariate, or the joint associations of time-varying and time-invariant covariates with the outcome, then the optimal design is unknown. Therefore, we propose a class of two-wave two-phase ODS designs for longitudinal binary data. We split the second-phase sample selection into two waves, between which an interim design evaluation analysis is conducted. The interim design evaluation analysis uses first-wave data to conduct a simulation-based search for the optimal second-wave design that will improve the likelihood of study success. Although we focus on longitudinal binary response data, the proposed design is general and can be applied to other response distributions. We believe that the proposed designs can be useful in settings where (1) the expected second-phase sample size is fixed and one must tailor stratum-specific sampling probabilities to maximize estimation efficiency, or (2) relative sampling probabilities are fixed across sampling strata and one must tailor sample size to achieve a desired precision. We describe the class of designs, examine finite sampling operating characteristics, and apply the designs to an exemplar longitudinal cohort study, the Lung Health Study.
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Affiliation(s)
- Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathaniel D Mercaldo
- Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard University, Boston, Massachusetts, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard University, Boston, Massachusetts, USA
| | - Jacob M Maronge
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul J Rathouz
- Department of Population Health, University of Texas, Austin, Texas, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Rosas HD, Hsu E, Mercaldo ND, Lai F, Pulsifer M, Keator D, Brickman AM, Price J, Yassa M, Hom C, Krinsky‐McHale SJ, Silverman W, Lott I, Schupf N. Alzheimer-related altered white matter microstructural integrity in Down syndrome: A model for sporadic AD? Alzheimers Dement (Amst) 2020; 12:e12040. [PMID: 33204811 PMCID: PMC7648416 DOI: 10.1002/dad2.12040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Virtually all adults with Down syndrome (DS) develop Alzheimer's disease (AD)-associated neuropathology by the age of 40, with risk for dementia increasing from the early 50s. White matter (WM) pathology has been reported in sporadic AD, including early demyelination, microglial activation, loss of oligodendrocytes and reactive astrocytes but has not been extensively studied in the at-risk DS population. METHODS Fifty-six adults with DS (35 cognitively stable adults, 11 with mild cognitive impairment, 10 with dementia) underwent diffusion-weighted magnetic resonance imaging (MRI), amyloid imaging, and had assessments of cognition and functional abilities using tasks appropriate for persons with intellectual disability. RESULTS Early changes in late-myelinating and relative sparing of early-myelinating pathways, consistent with the retrogenesis model proposed for sporadic AD, were associated with AD-related cognitive deficits and with regional amyloid deposition. DISCUSSION Our findings suggest that quantification of WM changes in DS could provide a promising and clinically relevant biomarker for AD clinical onset and progression.
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Affiliation(s)
- H. Diana Rosas
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Eugene Hsu
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Nathaniel D. Mercaldo
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Florence Lai
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Margaret Pulsifer
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - David Keator
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
| | - Adam M. Brickman
- G. H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging BrainCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Julie Price
- Department of RadiologyAthinoula Martinos CenterMassachusetts General HospitalHarvard Medical SchoolCharlestownMassachusettsUSA
| | - Michael Yassa
- Department of Neurobiology and BehaviorUniversity of CaliforniaCalifornia, USAIrvine
| | - Christy Hom
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
| | | | - Wayne Silverman
- Kennedy Krieger InstituteJohns Hopkins University School of Medicine, BaltimoreMarylandUSA
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Ira Lott
- Department of PediatricsIrvine Medical CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Nicole Schupf
- G. H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging BrainCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyCollege of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
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22
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Chan ST, Mercaldo ND, Ravina B, Hersch SM, Rosas HD. Association of Dilated Perivascular Spaces and Disease Severity in Patients With Huntington Disease. Neurology 2020; 96:e890-e894. [PMID: 33106388 PMCID: PMC8105900 DOI: 10.1212/wnl.0000000000011121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/21/2019] [Accepted: 10/08/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To quantify the percent volume of dilated perivascular space (PVS) in the subcortical forebrain in patients with early Huntington disease (HD) and to explore the relationship between PVS and disease severity. Methods MRI scans were performed on 25 patients with HD and 23 healthy age-matched controls at Massachusetts General Hospital. The imaging data were analyzed with a novel algorithm to determine regional PVS volume. A fractional logistic regression analysis was used to quantify the association between regional percent PVS volume and (1) disease designation (HD or control) and (2) disease severity as assessed by normalized caudate volume. Results Patients with HD had the greatest percent volume of dilated PVS in the putamen (left putamen: odds ratio 2.06 [95% confidence interval (CI) 1.62–2.62], HD 3.27% [95% CI 2.83–3.78] vs controls 1.62% [95% CI 1.32–1.97], pfdr < 0.001; right putamen: odds ratio 1.66 [95% CI 1.33–2.08], HD 3.43% [95% CI 2.94–4.01] vs controls 2.09% [95% CI 1.79–2.45], pfdr < 0.001) and several subcortical white matter regions compared to controls. Dilated PVS increased with disease severity. Conclusions The objective quantification of dilated PVS suggests that PVS burden is high, is associated with disease severity, and may affect the distribution and success of treatments administered either intrathecally such as antisense oligonucleotides or by intraparenchymal administration such as cell and gene therapies. Classification of Evidence This study provides Class II evidence that increased dilated PVS is associated with worse HD severity. The study is rated Class II because of the cross-sectional design.
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Affiliation(s)
- Suk Tak Chan
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C., H.D.R.), Department of Radiology, and Department of Neurology (N.D.M., S.M.H., H.D.R.), Massachusetts General Hospital, Boston; Voyager Therapeutics (S.M.H.); and Praxis Medicines (B.R.), Cambridge, MA
| | - Nathaniel D Mercaldo
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C., H.D.R.), Department of Radiology, and Department of Neurology (N.D.M., S.M.H., H.D.R.), Massachusetts General Hospital, Boston; Voyager Therapeutics (S.M.H.); and Praxis Medicines (B.R.), Cambridge, MA
| | - Bernard Ravina
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C., H.D.R.), Department of Radiology, and Department of Neurology (N.D.M., S.M.H., H.D.R.), Massachusetts General Hospital, Boston; Voyager Therapeutics (S.M.H.); and Praxis Medicines (B.R.), Cambridge, MA
| | - Steven M Hersch
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C., H.D.R.), Department of Radiology, and Department of Neurology (N.D.M., S.M.H., H.D.R.), Massachusetts General Hospital, Boston; Voyager Therapeutics (S.M.H.); and Praxis Medicines (B.R.), Cambridge, MA
| | - Herminia D Rosas
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C., H.D.R.), Department of Radiology, and Department of Neurology (N.D.M., S.M.H., H.D.R.), Massachusetts General Hospital, Boston; Voyager Therapeutics (S.M.H.); and Praxis Medicines (B.R.), Cambridge, MA.
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Awadalla M, Mahmood SS, Groarke JD, Hassan MZO, Nohria A, Rokicki A, Murphy SP, Mercaldo ND, Zhang L, Zlotoff DA, Reynolds KL, Alvi RM, Banerji D, Liu S, Heinzerling LM, Jones-O'Connor M, Bakar RB, Cohen JV, Kirchberger MC, Sullivan RJ, Gupta D, Mulligan CP, Shah SP, Ganatra S, Rizvi MA, Sahni G, Tocchetti CG, Lawrence DP, Mahmoudi M, Devereux RB, Forrestal BJ, Mandawat A, Lyon AR, Chen CL, Barac A, Hung J, Thavendiranathan P, Picard MH, Thuny F, Ederhy S, Fradley MG, Neilan TG. Global Longitudinal Strain and Cardiac Events in Patients With Immune Checkpoint Inhibitor-Related Myocarditis. J Am Coll Cardiol 2020; 75:467-478. [PMID: 32029128 DOI: 10.1016/j.jacc.2019.11.049] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/03/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a need for improved methods for detection and risk stratification of myocarditis associated with immune checkpoint inhibitors (ICIs). Global longitudinal strain (GLS) is a sensitive marker of cardiac toxicity among patients receiving standard chemotherapy. There are no data on the use of GLS in ICI myocarditis. OBJECTIVES This study sought to evaluate the role of GLS and assess its association with cardiac events among patients with ICI myocarditis. METHODS This study retrospectively compared echocardiographic GLS by speckle tracking at presentation with ICI myocarditis (cases, n = 101) to that from patients receiving an ICI who did not develop myocarditis (control subjects, n = 92). Where available, GLS was also measured pre-ICI in both groups. Major adverse cardiac events (MACE) were defined as a composite of cardiogenic shock, arrest, complete heart block, and cardiac death. RESULTS Cases and control subjects were similar in age, sex, and cancer type. At presentation with myocarditis, 61 cases (60%) had a normal ejection fraction (EF). Pre-ICI, GLS was similar between cases and control subjects (20.3 ± 2.6% vs. 20.6 ± 2.0%; p = 0.60). There was no change in GLS among control subjects on an ICI without myocarditis (pre-ICI vs. on ICI, 20.6 ± 2.0% vs. 20.5 ± 1.9%; p = 0.41); in contrast, among cases, GLS decreased to 14.1 ± 2.8% (p < 0.001). The GLS at presentation with myocarditis was lower among cases presenting with either a reduced (12.3 ± 2.7%) or preserved EF (15.3 ± 2.0%; p < 0.001). Over a median follow-up of 162 days, 51 (51%) experienced MACE. The risk of MACE was higher with a lower GLS among patients with either a reduced or preserved EF. After adjustment for EF, each percent reduction in GLS was associated with a 1.5-fold increase in MACE among patients with a reduced EF (hazard ratio: 1.5; 95% confidence interval: 1.2 to 1.8) and a 4.4-fold increase with a preserved EF (hazard ratio: 4.4; 95% confidence interval: 2.4 to 7.8). CONCLUSIONS GLS decreases with ICI myocarditis and, compared with control subjects, was lower among cases presenting with either a preserved or reduced EF. Lower GLS was strongly associated with MACE in ICI myocarditis presenting with either a preserved or reduced EF.
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Affiliation(s)
- Magid Awadalla
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Syed S Mahmood
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - John D Groarke
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Malek Z O Hassan
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam Rokicki
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean P Murphy
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nathaniel D Mercaldo
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lili Zhang
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel A Zlotoff
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Raza M Alvi
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dahlia Banerji
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shiying Liu
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lucie M Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen and Nurnberg, Germany
| | - Maeve Jones-O'Connor
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rula B Bakar
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Justine V Cohen
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen and Nurnberg, Germany
| | - Ryan J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Dipti Gupta
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Connor P Mulligan
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sachin P Shah
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Sarju Ganatra
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Gagan Sahni
- Cardiovascular Institute, School of Medicine, The Mount Sinai Hospital, New York, New York
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy
| | - Donald P Lawrence
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Mahmoudi
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Richard B Devereux
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Brian J Forrestal
- Cardio-Oncology Program, Department of Cardiology, Medstar Washington Hospital Center, Medstar Heart and Vascular institute, Washington, DC
| | - Anant Mandawat
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander R Lyon
- Cardio-Oncology Program, Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Carol L Chen
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Ana Barac
- Cardio-Oncology Program, Department of Cardiology, Medstar Washington Hospital Center, Medstar Heart and Vascular institute, Washington, DC
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Franck Thuny
- Cardiology Division, Cardiovascular Division, Department of Medicine, Aix-Marseille Universite, Marseille, France
| | - Stephane Ederhy
- UNICO-GRECO, Cardio-Oncology Program, Department of Cardiology, Assistance Publique-Hopitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - Michael G Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, Florida
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center (CIRC), Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Lee SMC, Martin DS, Miller CA, Scott JM, Laurie SS, Macias BR, Mercaldo ND, Ploutz-Snyder L, Stenger MB. Venous and Arterial Responses to Partial Gravity. Front Physiol 2020; 11:863. [PMID: 32848835 PMCID: PMC7399573 DOI: 10.3389/fphys.2020.00863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction: Chronic exposure to the weightlessness-induced cephalad fluid shift is hypothesized to be a primary contributor to the development of spaceflight-associated neuro-ocular syndrome (SANS) and may be associated with an increased risk of venous thrombosis in the jugular vein. This study characterized the relationship between gravitational level (Gz-level) and acute vascular changes. Methods: Internal jugular vein (IJV) cross-sectional area, inferior vena cava (IVC) diameter, and common carotid artery (CCA) flow were measured using ultrasound in nine subjects (5F, 4M) while seated when exposed to 1.00-Gz, 0.75-Gz, 0.50-Gz, and 0.25-Gz during parabolic flight and while supine before flight (0-G analog). Additionally, IJV flow patterns were characterized. Results: IJV cross-sectional area progressively increased from 12 (95% CI: 9–16) mm2 during 1.00-Gz seated to 24 (13–35), 34 (21–46), 68 (40–97), and 103 (75–131) mm2 during 0.75-Gz, 0.50-Gz, and 0.25-Gz seated and 1.00-Gz supine, respectively. Also, IJV flow pattern shifted from the continuous forward flow observed during 1.00-Gz and 0.75-Gz seated to pulsatile flow during 0.50-Gz seated, 0.25-Gz seated, and 1.00-Gz supine. In contrast, we were unable to detect differences in IVC diameter measured during 1.00-G seated and any level of partial gravity or during 1.00-Gz supine. CCA blood flow during 1.00-G seated was significantly less than 0.75-Gz and 1.00-Gz supine but differences were not detected at partial gravity levels 0.50-Gz and 0.25-Gz. Conclusions: Acute exposure to decreasing Gz-levels is associated with an expansion of the IJV and flow patterns that become similar to those observed in supine subjects and in astronauts during spaceflight. These data suggest that Gz-levels greater than 0.50-Gz may be required to reduce the weightlessness-induced headward fluid shift that may contribute to the risks of SANS and venous thrombosis during spaceflight.
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Affiliation(s)
| | | | | | - Jessica M Scott
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | | | - Lori Ploutz-Snyder
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael B Stenger
- Lyndon B. Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
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25
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Schildcrout JS, Haneuse S, Tao R, Zelnick LR, Schisterman EF, Garbett SP, Mercaldo ND, Rathouz PJ, Heagerty PJ. Two-Phase, Generalized Case-Control Designs for the Study of Quantitative Longitudinal Outcomes. Am J Epidemiol 2020; 189:81-90. [PMID: 31165875 DOI: 10.1093/aje/kwz127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 01/30/2023] Open
Abstract
We propose a general class of 2-phase epidemiologic study designs for quantitative, longitudinal data that are useful when phase 1 longitudinal outcome and covariate data are available but data on the exposure (e.g., a biomarker) can only be collected on a subset of subjects during phase 2. To conduct a study using a design in the class, one first summarizes the longitudinal outcomes by fitting a simple linear regression of the response on a time-varying covariate for each subject. Sampling strata are defined by splitting the estimated regression intercept or slope distributions into distinct (low, medium, and high) regions. Stratified sampling is then conducted from strata defined by the intercepts, by the slopes, or from a mixture. In general, samples selected with extreme intercept values will yield low variances for associations of time-fixed exposures with the outcome and samples enriched with extreme slope values will yield low variances for associations of time-varying exposures with the outcome (including interactions with time-varying exposures). We describe ascertainment-corrected maximum likelihood and multiple-imputation estimation procedures that permit valid and efficient inferences. We embed all methodological developments within the framework of conducting a substudy that seeks to examine genetic associations with lung function among continuous smokers in the Lung Health Study (United States and Canada, 1986-1994).
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Affiliation(s)
| | - Sebastien Haneuse
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leila R Zelnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Enrique F Schisterman
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Shawn P Garbett
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Paul J Rathouz
- Department of Population Health, Dell Medical School, University of Texas, Austin, Texas
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
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Chen Y, Criss SD, Watson TR, Eckel A, Palazzo L, Tramontano AC, Wang Y, Mercaldo ND, Kong CY. Cost and Utilization of Lung Cancer End-of-Life Care Among Racial-Ethnic Minority Groups in the United States. Oncologist 2020; 25:e120-e129. [PMID: 31501272 PMCID: PMC6964141 DOI: 10.1634/theoncologist.2019-0303] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/17/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The end-of-life period is a crucial time in lung cancer care. To have a better understanding of the racial-ethnic disparities in health care expenditures, access, and quality, we evaluated these disparities specifically in the end-of-life period for patients with lung cancer in the U.S. MATERIALS AND METHODS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to analyze characteristics of lung cancer care among those diagnosed between the years 2000 and 2011. Linear and logistic regression models were constructed to measure racial-ethnic disparities in end-of-life care cost and utilization among non-Hispanic (NH) Asian, NH black, Hispanic, and NH white patients while controlling for other risk factors such as age, sex, and SEER geographic region. RESULTS Total costs and hospital utilization were, on average, greater among racial-ethnic minorities compared with NH white patients in the last month of life. Among patients with NSCLC, the relative total costs were 1.27 (95% confidence interval [CI], 1.21-1.33) for NH black patients, 1.36 (95% CI, 1.25-1.49) for NH Asian patients, and 1.21 (95% CI, 1.07-1.38) for Hispanic patients. Additionally, the odds of being admitted to a hospital for NH black, NH Asian, and Hispanic patients were 1.22 (95% CI, 1.15-1.30), 1.47 (95% CI, 1.32-1.63), and 1.18 (95% CI, 1.01-1.38) times that of NH white patients, respectively. Similar results were found for patients with SCLC. CONCLUSION Minority patients with lung cancer have significantly higher end-of-life medical expenditures than NH white patients, which may be explained by a greater intensity of care in the end-of-life period. IMPLICATIONS FOR PRACTICE This study investigated racial-ethnic disparities in the cost and utilization of medical care among lung cancer patients during the end-of-life period. Compared with non-Hispanic white patients, racial-ethnic minority patients were more likely to receive intensive care in their final month of life and had statistically significantly higher end-of-life care costs. The findings of this study may lead to a better understanding of the racial-ethnic disparities in end-of-life care, which can better inform future end-of-life interventions and help health care providers develop less intensive and more equitable care, such as culturally competent advanced care planning programs, for all patients.
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Affiliation(s)
- Yufan Chen
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Steven D. Criss
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Tina R. Watson
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Andrew Eckel
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Lauren Palazzo
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Angela C. Tramontano
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
| | - Ying Wang
- BC Cancer VancouverVancouverBritish ColumbiaCanada
| | - Nathaniel D. Mercaldo
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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27
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Mercaldo ND, Brothers KB, Carrell DS, Clayton EW, Connolly JJ, Holm IA, Horowitz CR, Jarvik GP, Kitchner TE, Li R, McCarty CA, McCormick JB, McManus VD, Myers MF, Pankratz JJ, Shrubsole MJ, Smith ME, Stallings SC, Williams JL, Schildcrout JS. Enrichment sampling for a multi-site patient survey using electronic health records and census data. J Am Med Inform Assoc 2019; 26:219-227. [PMID: 30590688 DOI: 10.1093/jamia/ocy164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/15/2018] [Indexed: 11/14/2022] Open
Abstract
Objective We describe a stratified sampling design that combines electronic health records (EHRs) and United States Census (USC) data to construct the sampling frame and an algorithm to enrich the sample with individuals belonging to rarer strata. Materials and Methods This design was developed for a multi-site survey that sought to examine patient concerns about and barriers to participating in research studies, especially among under-studied populations (eg, minorities, low educational attainment). We defined sampling strata by cross-tabulating several socio-demographic variables obtained from EHR and augmented with census-block-level USC data. We oversampled rarer and historically underrepresented subpopulations. Results The sampling strategy, which included USC-supplemented EHR data, led to a far more diverse sample than would have been expected under random sampling (eg, 3-, 8-, 7-, and 12-fold increase in African Americans, Asians, Hispanics and those with less than a high school degree, respectively). We observed that our EHR data tended to misclassify minority races more often than majority races, and that non-majority races, Latino ethnicity, younger adult age, lower education, and urban/suburban living were each associated with lower response rates to the mailed surveys. Discussion We observed substantial enrichment from rarer subpopulations. The magnitude of the enrichment depends on the accuracy of the variables that define the sampling strata and the overall response rate. Conclusion EHR and USC data may be used to define sampling strata that in turn may be used to enrich the final study sample. This design may be of particular interest for studies of rarer and understudied populations.
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Affiliation(s)
- Nathaniel D Mercaldo
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - John J Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Ichan School of Medicine at Mt. Sinai, New York, New York, USA
| | - Gail P Jarvik
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Terrie E Kitchner
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Catherine A McCarty
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA
| | | | - Valerie D McManus
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Melanie F Myers
- Division of Human Genetics, Cincinnati Children's Hospital, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joshua J Pankratz
- Department of Information Technology, Mayo Clinic, Rochester, Minnesota, USA
| | - Martha J Shrubsole
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah C Stallings
- Division of Geriatric Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Janet L Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
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28
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Scholtz JE, Baliyan V, Hedgire S, Mercaldo ND, Pierce TT, Missine GZS, Meyersohn NM, Stockton K, Redel TL, McNulty F, Savage C, Roberts RJ, Foldyna B, Takx RA, Dushyant S, Lu MT, Hoffmann U, Ghoshhajra BB. Randomized Trial Comparing Transdermal With Sublingual Nitroglycerin Administration for Coronary Vasodilation in CTA. JACC Cardiovasc Imaging 2019; 12:1890-1893. [DOI: 10.1016/j.jcmg.2019.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/29/2019] [Accepted: 02/28/2019] [Indexed: 10/26/2022]
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Glover M, Mercaldo ND, Blumenthal DM, Ferris TG, Wasfy JH. Differences in Medicare Beneficiary Risk Scores by Physician's International Medical Graduate Status. J Gen Intern Med 2019; 34:1110-1112. [PMID: 30737681 PMCID: PMC6614298 DOI: 10.1007/s11606-019-04830-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Massachusetts General Physicians Organization, Boston, MA, USA.
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel M Blumenthal
- Harvard Medical School, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Devoted Health, Waltham, MA, USA
| | - Timothy G Ferris
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Physicians Organization, Boston, MA, USA
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jason H Wasfy
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Physicians Organization, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
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30
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Awadalla M, Golden DLA, Mahmood SS, Alvi RM, Mercaldo ND, Hassan MZO, Banerji D, Rokicki A, Mulligan C, Murphy SPT, Jones-O'Connor M, Cohen JV, Heinzerling LM, Armanious M, Sullivan RJ, Damrongwatanasuk R, Chen CL, Gupta D, Kirchberger MC, Moslehi JJ, Shah SP, Ganatra S, Thavendiranathan P, Rizvi MA, Sahni G, Lyon AR, Tocchetti CG, Mercurio V, Thuny F, Ederhy S, Mahmoudi M, Lawrence DP, Groarke JD, Nohria A, Fradley MG, Reynolds KL, Neilan TG. Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors. J Immunother Cancer 2019; 7:53. [PMID: 30795818 PMCID: PMC6387531 DOI: 10.1186/s40425-019-0535-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background Influenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs. Methods Patients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death. Results The FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002). Conclusion The rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV. Electronic supplementary material The online version of this article (10.1186/s40425-019-0535-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magid Awadalla
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Doll Lauren Alexandra Golden
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Syed S Mahmood
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Raza M Alvi
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Nathaniel D Mercaldo
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Malek Z O Hassan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Dahlia Banerji
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Adam Rokicki
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Connor Mulligan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Sean P T Murphy
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Maeve Jones-O'Connor
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Justine V Cohen
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucie M Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany
| | - Merna Armanious
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Ryan J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rongras Damrongwatanasuk
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Carol L Chen
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Dipti Gupta
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany
| | - Javid J Moslehi
- Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sachin P Shah
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Sarju Ganatra
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA
| | | | | | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Franck Thuny
- Cardiovascular Division, Department of Medicine, Aix-Marseille Universite, Marseille, France
| | - Stephane Ederhy
- Cardio-Oncology Program, Division of Cardiology, Hopitaux Universitaires est Paris, Paris, France
| | - Michael Mahmoudi
- Division of Cardiology, Department of Medicine, Southampton General Hospital, Southampton, UK
| | - Donald P Lawrence
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John D Groarke
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael G Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.,Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Tramontano AC, Nipp R, Mercaldo ND, Kong CY, Schrag D, Hur C. Survival Disparities by Race and Ethnicity in Early Esophageal Cancer. Dig Dis Sci 2018; 63:2880-2888. [PMID: 30109578 PMCID: PMC6738563 DOI: 10.1007/s10620-018-5238-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/01/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Survival outcome disparities among esophageal cancer patients exist, but are not fully understood. AIMS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival differences among racial/ethnic patient populations persist after adjusting for demographic and clinical characteristics. METHODS Our study included T1-3N0M0 adenocarcinoma and squamous cell cancer patients diagnosed between 2003 and 2011. We compared survival among two racial/ethnic patient subgroups using Cox proportional hazards methods, adjusting for age, sex, histology, marital status, socioeconomics, SEER region, comorbidities, T stage, tumor location, diagnosis year, and treatment received. RESULTS Among 2025 patients, 87.9% were White and 12.1% were Nonwhite. Median survival was 18.7 months for Whites vs 13.8 months for Nonwhites (p = 0.01). In the unadjusted model, Nonwhite patients had higher risk of mortality (HR = 1.29, 95% CI 1.11-1.49, p < 0.0001) when compared to White patients; however, in the Cox regression adjusted model there was no significant difference (HR = 0.94, 95% CI 0.80-1.10, p = 0.44). Surgery, chemotherapy, younger age, lower T stage, and lower Charlson comorbidity score were significant predictors in the full adjusted model. CONCLUSIONS Differences in mortality risk by race/ethnicity appear to be largely explained by additional factors. In particular, associations were seen in surgery and T stage. Further research is needed to understand potential mechanisms underlying the differences and to better target patients who can benefit from treatment options.
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Affiliation(s)
- Angela C. Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - Nathaniel D. Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA,Department of Radiology, Massachusetts General Hospital Cancer Center, Boston, USA
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA
| | - Deborah Schrag
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, USA,Gastrointestinal Division, Harvard Medical School, Boston, USA
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Antommaria AHM, Brothers KB, Myers JA, Feygin YB, Aufox SA, Brilliant MH, Conway P, Fullerton SM, Garrison NA, Horowitz CR, Jarvik GP, Li R, Ludman EJ, McCarty CA, McCormick JB, Mercaldo ND, Myers MF, Sanderson SC, Shrubsole MJ, Schildcrout JS, Williams JL, Smith ME, Clayton EW, Holm IA. Parents' attitudes toward consent and data sharing in biobanks: A multisite experimental survey. AJOB Empir Bioeth 2018; 9:128-142. [PMID: 30240342 DOI: 10.1080/23294515.2018.1505783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The factors influencing parents' willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents' willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. METHODS This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of three consent and data-sharing scenarios. RESULTS In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50-59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one's child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. CONCLUSIONS Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks.
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Affiliation(s)
- Armand H Matheny Antommaria
- a Ethics Center , Cincinnati Children's Hospital Medical Center.,b Department of Pediatrics , University of Cincinnati College of Medicine
| | | | - John A Myers
- c Department of Pediatrics , University of Louisville
| | - Yana B Feygin
- c Department of Pediatrics , University of Louisville
| | | | | | | | | | - Nanibaa' A Garrison
- h Treuman Katz Center for Pediatric Bioethics , Seattle Children's Hospital and Research Institute.,i Department of Pediatrics (Bioethics) , University of Washington
| | - Carol R Horowitz
- j Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai
| | - Gail P Jarvik
- k Departments of Medicine (Medical Genetics) and Genome Sciences , University of Washington
| | - Rongling Li
- l Division of Genomic Medicine , National Human Genome Research Institute
| | | | | | | | | | - Melanie F Myers
- b Department of Pediatrics , University of Cincinnati College of Medicine.,q Division of Human Genetics , Cincinnati Children's Hospital Medical Center
| | - Saskia C Sanderson
- r Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai
| | | | | | | | | | - Ellen Wright Clayton
- w Center for Biomedical Ethics and Society, Vanderbilt University Medical Center
| | - Ingrid A Holm
- x Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research , Boston Children's Hospital.,y Department of Pediatrics , Harvard Medical School
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Rosas HD, Wilkens P, Salat DH, Mercaldo ND, Vangel M, Yendiki AY, Hersch SM. Complex spatial and temporally defined myelin and axonal degeneration in Huntington disease. Neuroimage Clin 2018; 20:236-242. [PMID: 30090698 PMCID: PMC6078048 DOI: 10.1016/j.nicl.2018.01.029] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/04/2018] [Accepted: 01/23/2018] [Indexed: 01/10/2023]
Abstract
Although much prior work has focused on the basal ganglia and cortical pathology that defines Huntington's disease (HD), recent studies have also begun to characterize cerebral white matter damage (Rosas et al., 2006; Dumas et al., 2012; Poudel et al., 2014). In this study, we investigated differences in the large fascicular bundles of the cerebral white matter of gene-positive HD carriers, including pre-manifest individuals and early symptomatic patients, using recently developed diffusion tractography procedures. We examined eighteen major fiber bundles in 37 patients with early HD (average age 55.2 ± 11.5, 14 male, 23 female), 31 gene-positive, motor negative pre-symptomatic HD (PHD) (average age 48.1 ± 11.5, 13 male, 18 female), and 38 healthy age-matched controls (average age 55.7 ± 8.6, 14 male, 24 female), using the TRActs Constrained by UnderLying Anatomy (TRACULA) procedure available as part of the FreeSurfer image processing software package. We calculated the mean fractional anisotropy (FA) and the mean radial (RD) and axial diffusivities (AD) for each fiber bundle. We also evaluated the relationships between diffusion measures, cognition and regional cortical thinning. We found that early changes in RD of select tracts in PHD subjects were associated with impaired performance on neuropsychological tests, suggesting that early changes in myelin might underlie early cognitive dysfunction. Finally, we found that increases in AD of select tracts were associated with regionally select cortical thinning of areas known to atrophy in HD, including the sensorimotor, supramarginal and fusiform gyrus, suggesting that AD may be reflecting pyramidal cell degeneration in HD. Together, these results suggest that white matter microstructural changes in HD reflect a complex, clinically relevant and dynamic process. In our study, we found evidence of a temporally specific and regionally selective degeneration of white matter (WM) bundles. Early changes in myelin integrity were found in pre-manifest HD; these correlated with cognitive scores but not with atrophy. In contrast, changes in axonal integrity were found later, in early HD; these correlated closely with cortical atrophy. These findings bring new insights into WM degeneration in HD, its clinical significance and suggest novel therapeutic targets.
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Affiliation(s)
- H D Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Neuro-imaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - P Wilkens
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Neuro-imaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D H Salat
- Center for Neuro-imaging of Aging and Neurodegenerative Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
| | - N D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Vangel
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - A Y Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA
| | - S M Hersch
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sanderson SC, Brothers KB, Mercaldo ND, Clayton EW, Antommaria AHM, Aufox SA, Brilliant MH, Campos D, Carrell DS, Connolly J, Conway P, Fullerton SM, Garrison NA, Horowitz CR, Jarvik GP, Kaufman D, Kitchner TE, Li R, Ludman EJ, McCarty CA, McCormick JB, McManus VD, Myers MF, Scrol A, Williams JL, Shrubsole MJ, Schildcrout JS, Smith ME, Holm IA. Public Attitudes toward Consent and Data Sharing in Biobank Research: A Large Multi-site Experimental Survey in the US. Am J Hum Genet 2017; 100:414-427. [PMID: 28190457 DOI: 10.1016/j.ajhg.2017.01.021] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [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: 09/23/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022] Open
Abstract
Individuals participating in biobanks and other large research projects are increasingly asked to provide broad consent for open-ended research use and widespread sharing of their biosamples and data. We assessed willingness to participate in a biobank using different consent and data sharing models, hypothesizing that willingness would be higher under more restrictive scenarios. Perceived benefits, concerns, and information needs were also assessed. In this experimental survey, individuals from 11 US healthcare systems in the Electronic Medical Records and Genomics (eMERGE) Network were randomly allocated to one of three hypothetical scenarios: tiered consent and controlled data sharing; broad consent and controlled data sharing; or broad consent and open data sharing. Of 82,328 eligible individuals, exactly 13,000 (15.8%) completed the survey. Overall, 66% (95% CI: 63%-69%) of population-weighted respondents stated they would be willing to participate in a biobank; willingness and attitudes did not differ between respondents in the three scenarios. Willingness to participate was associated with self-identified white race, higher educational attainment, lower religiosity, perceiving more research benefits, fewer concerns, and fewer information needs. Most (86%, CI: 84%-87%) participants would want to know what would happen if a researcher misused their health information; fewer (51%, CI: 47%-55%) would worry about their privacy. The concern that the use of broad consent and open data sharing could adversely affect participant recruitment is not supported by these findings. Addressing potential participants' concerns and information needs and building trust and relationships with communities may increase acceptance of broad consent and wide data sharing in biobank research.
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Affiliation(s)
- Saskia C Sanderson
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Great Ormond Street Hospital, London WC1N 3JH, UK; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA.
| | | | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN 37203, USA
| | | | - Sharon A Aufox
- Center for Genetic Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Diego Campos
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - John Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Pat Conway
- Essentia Institute of Rural Health, Duluth, MN 55805, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Nanibaa' A Garrison
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics, University of Washington, Seattle, WA 98101, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gail P Jarvik
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - David Kaufman
- Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Terrie E Kitchner
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD 20892, USA
| | | | | | | | - Valerie D McManus
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Melanie F Myers
- Genetic Counseling Graduate Program, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH 45229, USA
| | - Aaron Scrol
- Group Health Research Institute, Seattle, WA 98101, USA
| | - Janet L Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA
| | - Martha J Shrubsole
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - Maureen E Smith
- Center for Genetic Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA 02115, USA
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Smith ME, Sanderson SC, Brothers KB, Myers MF, McCormick J, Aufox S, Shrubsole MJ, Garrison NA, Mercaldo ND, Schildcrout JS, Clayton EW, Antommaria AHM, Basford M, Brilliant M, Connolly JJ, Fullerton SM, Horowitz CR, Jarvik GP, Kaufman D, Kitchner T, Li R, Ludman EJ, McCarty C, McManus V, Stallings S, Williams JL, Holm IA. Conducting a large, multi-site survey about patients' views on broad consent: challenges and solutions. BMC Med Res Methodol 2016; 16:162. [PMID: 27881091 PMCID: PMC5122167 DOI: 10.1186/s12874-016-0263-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022] Open
Abstract
Background As biobanks play an increasing role in the genomic research that will lead to precision medicine, input from diverse and large populations of patients in a variety of health care settings will be important in order to successfully carry out such studies. One important topic is participants’ views towards consent and data sharing, especially since the 2011 Advanced Notice of Proposed Rulemaking (ANPRM), and subsequently the 2015 Notice of Proposed Rulemaking (NPRM) were issued by the Department of Health and Human Services (HHS) and Office of Science and Technology Policy (OSTP). These notices required that participants consent to research uses of their de-identified tissue samples and most clinical data, and allowing such consent be obtained in a one-time, open-ended or “broad” fashion. Conducting a survey across multiple sites provides clear advantages to either a single site survey or using a large online database, and is a potentially powerful way of understanding the views of diverse populations on this topic. Methods A workgroup of the Electronic Medical Records and Genomics (eMERGE) Network, a national consortium of 9 sites (13 separate institutions, 11 clinical centers) supported by the National Human Genome Research Institute (NHGRI) that combines DNA biorepositories with electronic medical record (EMR) systems for large-scale genetic research, conducted a survey to understand patients’ views on consent, sample and data sharing for future research, biobank governance, data protection, and return of research results. Results Working across 9 sites to design and conduct a national survey presented challenges in organization, meeting human subjects guidelines at each institution, and survey development and implementation. The challenges were met through a committee structure to address each aspect of the project with representatives from all sites. Each committee’s output was integrated into the overall survey plan. A number of site-specific issues were successfully managed allowing the survey to be developed and implemented uniformly across 11 clinical centers. Conclusions Conducting a survey across a number of institutions with different cultures and practices is a methodological and logistical challenge. With a clear infrastructure, collaborative attitudes, excellent lines of communication, and the right expertise, this can be accomplished successfully.
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Affiliation(s)
- Maureen E Smith
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Chicago, IL, 60611, USA.
| | - Saskia C Sanderson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,University College London, London, UK
| | - Kyle B Brothers
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Melanie F Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sharon Aufox
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Avenue, Chicago, IL, 60611, USA
| | - Martha J Shrubsole
- Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | | | - Nathaniel D Mercaldo
- Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | | | - Ellen Wright Clayton
- Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | | | - Melissa Basford
- Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | | | - John J Connolly
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Dave Kaufman
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri Kitchner
- Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - Rongling Li
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Sarah Stallings
- Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | | | - Ingrid A Holm
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Banerjee A, Slagle JM, Mercaldo ND, Booker R, Miller A, France DJ, Rawn L, Weinger MB. A simulation-based curriculum to introduce key teamwork principles to entering medical students. BMC Med Educ 2016; 16:295. [PMID: 27852293 PMCID: PMC5112730 DOI: 10.1186/s12909-016-0808-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/27/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Failures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams. METHODS As part of a new "Foundations" core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students' anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students' course evaluations, faculty reflection, and debriefing, the course changed and matured. RESULTS Four hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their "Decision Making Abilities" (OR 1.69, 95% CI 1.07-2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28-3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises. CONCLUSIONS This curriculum could be valuable to other medical schools seeking to inculcate teamwork foundations in their medical school's preclinical curricula. Moreover, this curriculum can be used to facilitate teamwork principles important to inter-disciplinary, as well as uni-disciplinary, collaboration.
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Affiliation(s)
- Arna Banerjee
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue S, 526 MAB, Nashville, TN 37212 USA
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jason M. Slagle
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Nathaniel D. Mercaldo
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Ray Booker
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
| | - Anne Miller
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN USA
- Present Address: Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Daniel J. France
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Lisa Rawn
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
- Present Address: Baptist Health Neurosurgery Arkansas, Little Rock, AR USA
| | - Matthew B. Weinger
- Department of Medical Education, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center, Nashville, TN USA
- Center for Research and Innovation in Systems Safety (CRISS), Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
- Health Services Research Division and the Geriatrics Research Education and Clinical Center, Veterans Affairs (VA) Tennessee Valley Healthcare System – Nashville Campus, Nashville, TN USA
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Weinger MB, Slagle JM, Kuntz AH, Schildcrout JS, Banerjee A, Mercaldo ND, Bills JL, Wallston KA, Speroff T, Patterson ES, France DJ. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers. Anesth Analg 2015; 121:957-971. [DOI: 10.1213/ane.0000000000000670] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Maddox RA, Blase JL, Mercaldo ND, Harvey AR, Schonberger LB, Kukull WA, Belay ED. Clinically Unsuspected Prion Disease Among Patients With Dementia Diagnoses in an Alzheimer's Disease Database. Am J Alzheimers Dis Other Demen 2015; 30:752-5. [PMID: 26320231 DOI: 10.1177/1533317515602218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
BACKGROUND Brain tissue analysis is necessary to confirm prion diseases. Clinically unsuspected cases may be identified through neuropathologic testing. METHODS National Alzheimer's Coordinating Center (NACC) Minimum and Neuropathologic Data Set for 1984 to 2005 were reviewed. Eligible patients had dementia, underwent autopsy, had available neuropathologic data, belonged to a currently funded Alzheimer's Disease Center (ADC), and were coded as having an Alzheimer's disease clinical diagnosis or a nonprion disease etiology. For the eligible patients with neuropathology indicating prion disease, further clinical information, collected from the reporting ADC, determined whether prion disease was considered before autopsy. RESULTS Of 6000 eligible patients in the NACC database, 7 (0.12%) were clinically unsuspected but autopsy-confirmed prion disease cases. CONCLUSION The proportion of patients with dementia with clinically unrecognized but autopsy-confirmed prion disease was small. Besides confirming clinically suspected cases, neuropathology is useful to identify unsuspected clinically atypical cases of prion disease.
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Affiliation(s)
- Ryan A Maddox
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J L Blase
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N D Mercaldo
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - A R Harvey
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L B Schonberger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W A Kukull
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - E D Belay
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rasmussen SB, Saied NN, Bowens C, Mercaldo ND, Schildcrout JS, Malchow RJ. Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis. Pain Med 2013; 14:1239-47. [PMID: 23755801 DOI: 10.1111/pme.12150] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dexamethasone, when added to local anesthetics, has been shown to prolong the duration of peripheral nerve blocks; however, there are limited studies utilizing large numbers of patients. The purpose of this study was to examine the effect of adding dexamethasone to ropivacaine on duration of nerve blocks of the upper and lower extremity. METHODS We reviewed 1,040 patient records collected in an orthopedic outpatient surgery center that had received an upper or lower extremity peripheral nerve block with ropivacaine 0.5% with or without dexamethasone and/or epinephrine. The primary outcome was duration of analgesia in upper or lower extremity blocks containing dexamethasone as an adjunct. Secondary outcomes included postoperative patient pain scores, satisfaction, and the incidence of block related complications. Linear and ordinal logistic regression models were used to examine the independent effect of dexamethasone on outcomes. RESULTS Dexamethasone was observed to increase median block duration by 37% (95% confidence interval: 31-43%). The increased block duration persisted within body regions (upper and lower) and across a range of block types. Dexamethasone was also observed to reduce pain scores on the day of surgery (P = 0.001) and postoperative day 1 (P < 0.001). There was no significant difference in duration of nerve blocks when epinephrine (1:400,000) was added to 0.5% ropivacaine with or without dexamethasone. CONCLUSION The addition of dexamethasone to 0.5% ropivacaine prolongs the duration of peripheral nerve blocks of both the upper and lower extremity.
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Affiliation(s)
- Stephanie B Rasmussen
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-5614, USA.
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Barocas DA, Gray DT, Fowke JH, Mercaldo ND, Blume JD, Chang SS, Cookson MS, Smith JA, Penson DF. Racial variation in the quality of surgical care for prostate cancer. J Urol 2012; 188:1279-85. [PMID: 22902011 DOI: 10.1016/j.juro.2012.06.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Difference in the quality of care may contribute to the less optimal prostate cancer treatment outcomes among black men compared with white men. We determined whether a racial quality of care gap exists in surgical care for prostate cancer, as evidenced by racial variation in the use of high volume surgeons and facilities, and in the quality of certain outcome measures of care. MATERIALS AND METHODS We performed cross-sectional and cohort analyses of administrative data from the Healthcare Cost and Utilization Project all-payer State Inpatient Databases, encompassing all nonfederal hospitals in Florida, Maryland and New York State from 1996 to 2007. Included in analysis were men 18 years old or older with a diagnosis of prostate cancer who underwent radical prostatectomy. We compared the use of surgeons and/or hospitals in the top quartile of annual volume for this procedure, inpatient blood transfusion, complications, mortality and length of stay between black and white patients. RESULTS Of 105,972 patients 81,112 (76.5%) were white, 14,006 (13.2%) were black, 6,999 (6.6%) were Hispanic and 3,855 (3.6%) were all other. In mixed effects multivariate models, black men had markedly lower use of high volume hospitals (OR 0.73, 95% CI 0.70-0.76) and surgeons (OR 0.67, 95% CI 0.64-0.70) compared to white men. Black men also had higher odds of blood transfusion (OR 1.08, 95% CI 1.01-1.14), longer length of stay (OR 1.07, 95% CI 1.06-1.07) and inpatient mortality (OR 1.73, 95% CI 1.02-2.92). CONCLUSIONS Using an all-payer data set, we identified concerning potential quality of care gaps between black and white men undergoing radical prostatectomy for prostate cancer.
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Affiliation(s)
- Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA.
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Lenart MJ, Wong K, Gupta RK, Mercaldo ND, Schildcrout JS, Michaels D, Malchow RJ. The Impact of Peripheral Nerve Techniques on Hospital Stay Following Major Orthopedic Surgery. Pain Med 2012; 13:828-34. [DOI: 10.1111/j.1526-4637.2012.01363.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Billings FT, Pretorius M, Schildcrout JS, Mercaldo ND, Byrne JG, Ikizler TA, Brown NJ. Obesity and oxidative stress predict AKI after cardiac surgery. J Am Soc Nephrol 2012; 23:1221-8. [PMID: 22626819 DOI: 10.1681/asn.2011090940] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obesity increases oxidative stress, endothelial dysfunction, and inflammation, but the effect of obesity on postoperative AKI is not known. We examined the relationship between body mass index (BMI) and AKI in 445 patients undergoing cardiac surgery and whether oxidative stress (F(2)-isoprostanes), inflammation (IL-6), or antifibrinolysis (plasminogen activator inhibitor-1 [PAI-1]) contribute to any identified relationship. Overall, 112 (25%) of the 445 patients developed AKI. Higher BMI was independently associated with increased odds of AKI (26.5% increase per 5 kg/m(2) [95% confidence interval, 4.3%-53.4%]; P=0.02). Baseline F(2)-isoprostane (P=0.04), intraoperative F(2)-isoprostane (P=0.003), and intraoperative PAI-1 (P=0.04) concentrations also independently predicted AKI. BMI no longer predicted AKI after adjustment for the effect of F(2)-isoprostanes, suggesting that obesity may affect AKI via effects on oxidative stress. In contrast, adjustment for IL-6 or PAI-1 did not substantially alter the association between BMI and AKI. Further, deconstruction of the obesity-AKI relationship into direct (i.e., independent of candidate pathways) and indirect (i.e., effect of BMI on AKI via each candidate pathway) effects indicated that F(2)-isoprostanes, but not IL-6 or PAI-1, partially mediate the relationship between obesity and AKI (P=0.001). In conclusion, obesity independently predicts AKI after cardiac surgery, and oxidative stress may partially mediate this association.
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Affiliation(s)
- Frederic T Billings
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Muscarella P, Wilfong LS, Ross SB, Richards DA, Raynov J, Fisher WE, Flynn PJ, Whiting SH, Rosemurgy A, Harrell FE, Mercaldo ND, Kosten S, Quiring J, Speyer S, Richman J, Ferraro J, Coeshott C, Cohn A, Rodell TC, Apelian D. A randomized, placebo-controlled, double blind, multicenter phase II adjuvant trial of the efficacy, immunogenicity, and safety of GI-4000 plus gem versus gem alone in patients with resected pancreas cancer with activating RAS mutations/survival and immunology analysis of the R1 subgroup. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14501 Background: Patients with resected pancreas cancer treated with standard of care Gem have a median overall survival of 22 months (vs 20 months w/ observation). Activating mutations in ras occur in > 90% of pancreas cancer cases. GI-4000 is whole, heat-killed recombinant S. cerevisiae yeast that expresses mutated Ras proteins. This trial is designed to evaluate the efficacy, immunogenicity, and safety of GI-4000 plus Gem in patients with Ras mutant + resected pancreas cancer. Methods: The study enrolled 176 Ras mutant + pancreas cancer subjects post resection randomized 1:1 to GI-4000 plus Gem or placebo plus Gem (stratified by resection status; R0 or R1). Three weekly injections of GI-4000 or placebo were followed by 6 cycles of Gem 1000 mg/m2 iv (day 1, 8, 15 every 28 days). Monthly GI-4000 or placebo were administered on the Gem off-weeks and continued monthly until intolerance, disease recurrence, or death. The primary endpoint is RFS. Data for the 39 R1 subjects (GI-4000 n=19, Placebo n=20) have been unblinded and analyzed. Results: The GI-4000 group had an 11.4 week advantage in median overall survival (524 Days vs 444 Days), 16% advantage in 1 year survival (72% vs 56%), and a 4.6 week advantage in median RFS (287 Days vs 255 days). The GI-4000 group showed a significantly higher rate of mutation specific T cell response to Ras by ELISpot assay; 7/15 (47%) vs 1/12 (8%), p=0.032,with a more pronounced survival benefit in GI-4000 treated immune responders; 21.7 week advantage in median survival (596 Days vs 444 Days) compared to placebo. No significant novel toxicities have been observed to date. Conclusions: GI-4000 in combination with adjuvant Gem showed a clinically meaningful point estimate for the treatment effect on survival in R1 subjects with Ras mutant + pancreas cancer. GI-4000 was immunogenic and well tolerated. Ras specific immune response was associated with a more pronounced benefit in median survival. These data warrant further study in a definitively powered clinical trial for GI-4000 in the adjuvant setting in R1 subjects.
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Affiliation(s)
- Peter Muscarella
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | | | | | | | - Frank E Harrell
- Vanderbilt University School of Medicine Department of Biostatistics, Nashville, TN
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Lau DT, Mercaldo ND, Shega JW, Rademaker A, Weintraub S. Functional decline associated with polypharmacy and potentially inappropriate medications in community-dwelling older adults with dementia. Am J Alzheimers Dis Other Demen 2011; 26:606-15. [PMID: 22207646 PMCID: PMC3298080 DOI: 10.1177/1533317511432734] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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] [Indexed: 11/16/2022]
Abstract
This study provides empirical evidence on whether polypharmacy and potentially inappropriate prescription medications (PIRx, as defined by the 2003 Beers criteria) increase the likelihood of functional decline among community-dwelling older adults with dementia. Data were from the National Alzheimer's Coordinating Center, Uniform Data Set (9/2005-9/2009). Study sample included 1994 community-dwelling participants aged ≥65 with dementia at baseline. Results showed that participants having ≥5 medications were more likely to have functional decline than participants having <5 medications. However, the increased likelihood was only apparent in participants who did not have PIRx. Instead of magnifying the associated risk as hypothesized, PIRx appeared to have a protective effect albeit marginally statistically significant. Therefore, increased medication burden may be associated with functional decline in community-dwelling older adults with dementia who are not prescribed with PIRx. More research is needed to understand which classes of medications have the most deleterious effect on this population.
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Affiliation(s)
- Denys T Lau
- Department of Pharmacy Administration, University of Illinois at Chicago, College of Pharmacy, 60612, USA.
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Ehrenfeld JM, Cassedy EA, Forbes VE, Mercaldo ND, Sandberg WS. Modified rapid sequence induction and intubation: a survey of United States current practice. Anesth Analg 2011; 115:95-101. [PMID: 22025487 DOI: 10.1213/ane.0b013e31822dac35] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. A modification of this technique is implemented in certain clinical circumstances. However, there is currently no standard definition for a modified RSII. Therefore, we surveyed clinicians at academic centers across the United States to establish a working definition of a modified RSII as well as the clinical scenarios in which it is being used. METHODS A survey was created that queried the use and definition of modified RSII, and validated with test respondents. We then mailed the survey to all 131 anesthesia residency training programs across the United States. Logistic regression models were created to estimate the percentage of affirmative responses among respondents that performed modified RSII procedures and answered survey items in a consistent manner. Similar quantities were calculated by physician status (resident and attending). RESULTS Four hundred ninety surveys were received from 58 institutions (44% institution response rate); 93% of respondents reported using a modified RSII, and of those 85% consistently completed the survey instrument. A majority of respondents (71%, CI: 63%-77%) reported administering oxygen before anesthesia induction, applying cricoid pressure, and attempting to ventilate the lungs via a facemask before securing the airway. Respondents noted that they would use a modified RSII procedure if the patient were either moderately or morbidly obese (each ∼59%, 53%-64%), had a history but no current symptoms of gastroesophageal reflux disease (52%, 46%-57%), had a hiatal hernia (42%, 36%-48%) or were a trauma patient who had been NPO for at least 8 h (39%, 33%-45%). Similar RSII results were obtained when repeating the analysis on the subset that did not enforce the consistency requirements. CONCLUSIONS Based on our survey we have established three defining features of a modified RSII: (1) oxygen administration before induction; (2) the use of cricoid pressure; and (3) an attempt to ventilate the patient's lungs before securing the airway. Although this definition seems intuitively obvious, no previous work has tested whether it is commonly accepted.
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Affiliation(s)
- Jesse M Ehrenfeld
- Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University, 1301 Medical Center Drive, TVC 4648 Nashville TN 37232, USA.
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Jeskey M, Card E, Nelson D, Mercaldo ND, Sanders N, Higgins MS, Shi Y, Michaels D, Miller A. Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation. J Nurs Manag 2011; 19:863-75. [PMID: 21988434 DOI: 10.1111/j.1365-2834.2011.01295.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. BACKGROUND Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. METHOD Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. RESULTS Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise. CONCLUSIONS Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. IMPLICATIONS FOR NURSING MANAGEMENT It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units.
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Affiliation(s)
- Mary Jeskey
- Department of Anesthesiology, Center for Interdisciplinary Health Workforce Studies, USA
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Baysinger CL, Pope JE, Lockhart EM, Mercaldo ND. The management of accidental dural puncture and postdural puncture headache: a North American survey. J Clin Anesth 2011; 23:349-60. [PMID: 21696932 DOI: 10.1016/j.jclinane.2011.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/21/2011] [Accepted: 04/20/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Curtis L Baysinger
- Division of Obstetric Anesthesia, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Bliwise DL, Mercaldo ND, Avidan AY, Boeve BF, Greer SA, Kukull WA. Sleep disturbance in dementia with Lewy bodies and Alzheimer's disease: a multicenter analysis. Dement Geriatr Cogn Disord 2011; 31:239-46. [PMID: 21474933 PMCID: PMC3085031 DOI: 10.1159/000326238] [Citation(s) in RCA: 61] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Evidence suggests that patients with dementia with Lewy bodies (DLB) may have more nocturnal sleep disturbance than patients with Alzheimer's disease (AD). We sought to confirm such observations using a large, prospectively collected, standardized, multicenter-derived database, i.e. the National Alzheimer's Coordinating Center Uniform Data Set. METHODS Nocturnal sleep disturbance (NSD) data, as characterized by the Neuropsychiatric Inventory Questionnaire (NPI-Q), were derived from 4,531 patients collected between September 2005 and November 2008 from 32 National Institute on Aging participating AD centers. Patient and informant characteristics were compared between those with and without NSD by dementia diagnosis (DLB and probable AD). Finally, a logistic regression model was created to quantify the association between NSD status and diagnosis while adjusting for these patient/informant characteristics, as well as center. RESULTS NSD was more frequent in clinically diagnosed DLB relative to clinically diagnosed AD (odds ratio = 2.93, 95% confidence interval = 2.22-3.86). These results were independent from the gender of the patient or informant, whether the informant lived with the patient, and other patient characteristics, such as dementia severity, depressive symptoms, and NPI-Q-derived measures of hallucinations, delusions, agitation and apathy. In AD, but not DLB, patients, NSD was associated with more advanced disease. Comorbidity of NSD with hallucinations, agitation and apathy was higher in DLB than in AD. There was also evidence that the percentage of DLB cases with NSD showed wide variation across centers. CONCLUSION As defined by the NPI-Q, endorsement of the nocturnal behavior item by informants is more likely in patients with DLB when compared to AD, even after the adjustment of key patient/informant characteristics.
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Affiliation(s)
- Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA,*Donald L. Bliwise, PhD, Department of Neurology, Emory University School of Medicine, Wesley Woods Health Center, 1841 Clifton Road, Room 509, Atlanta, GA 30329 (USA), Tel. +1 404 728 4751, E-Mail
| | - Nathaniel D. Mercaldo
- National Alzheimer's Coordinating Center, University of Washington, Seattle, Wash., USA,Department of Biostatistics, Vanderbilt University Nashville, Tenn., USA
| | - Alon Y. Avidan
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, Calif., USA
| | - Bradley F. Boeve
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn., USA
| | - Sophia A. Greer
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA
| | - Walter A. Kukull
- National Alzheimer's Coordinating Center, University of Washington, Seattle, Wash., USA
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Weinger MB, Slagle JM, Kuntz A, Banerjee A, Schildcrout JS, Mercaldo ND, France D, Speroff T, Bills J, Wallston K. Improving actual handover behavior with a simulation-based training intervention. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/154193121005401233] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
A simulation-based training intervention to improve patient handovers between anesthesia providers (APs) and Post-Anesthesia Care Unit (PACU) nurses (RNs) in adult (VUH) and pediatric (VCH) PACUs, was developed, implemented, and evaluated. The intervention included didactic webinars, an electronic handover report tool, a 2-hour simulation-based training session and a 1-hr “refresher” course several months later. Training focused on interpersonal skills and overcoming obstacles to effective handovers. Trained nurses observed and evaluated 981 actual PACU handovers over 12 months using a standardized rating tool. A different blinded observer scored pre- and post-training simulated handovers. A culture survey was administered before and after the intervention. After training, handover quality improved significantly with more than 70% of handovers rated as “effective” in both PACUs (P<0.001). The training status of the handover giver (AP) was the critical determinant of handover effectiveness. Following full implementation, new (untrained) clinicians performed effective handovers suggesting culture change and/or implicit training.
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Affiliation(s)
- Matthew B. Weinger
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Jason M. Slagle
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Audrey Kuntz
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Arna Banerjee
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Jonathan S. Schildcrout
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Nathaniel D. Mercaldo
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Dan France
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Theodore Speroff
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Jim Bills
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
| | - Ken Wallston
- Center for Perioperative Research in Quality, Depts. of Anesthesiology, Medicine, Biomedical Informatics, Biostatistics, Medical Education and Nursing, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Care Center, Veterans Affairs Tennessee Valley Healthcare System
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Hughes CG, Weavind L, Banerjee A, Mercaldo ND, Schildcrout JS, Pandharipande PP. Intraoperative Risk Factors for Acute Respiratory Distress Syndrome in Critically Ill Patients. Anesth Analg 2010; 111:464-7. [DOI: 10.1213/ane.0b013e3181d8a16a] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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