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Brailsford C, Khamdan F, Dirr MA, Sagut P, Nietert PJ, Elston D. A study of collagen refractility in dermatofibroma and dermatofibrosarcoma protuberans using diffractive microscopy. J Cutan Pathol 2024; 51:306-310. [PMID: 38124386 PMCID: PMC10922144 DOI: 10.1111/cup.14577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Diffractive microscopy creates contrast within samples that are otherwise uniform under bright light. This technique can highlight subtle differences in refractive indices within birefringent samples containing varying amounts of mature collagen. Dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) possess differences in their mature collagen content and, therefore, may be distinguishable using diffractive microscopy. METHODS Two hundred forty-two DF and 85 DFSP hematoxylin-eosin (H&E)-stained specimens were analyzed using diffractive microscopy. Data regarding the distribution pattern and strength of refractility was recorded. RESULTS DFSP was more frequently found to be focally, weakly, or non-refractile (82.9%; n = 68) under diffractive microscopy, while DF more often showed diffusely bright refractility (52.9%; n = 128). DFSP samples with diffuse refractility in portions of the lesion (17.1%; n = 14) also exhibited a unique checkerboard pattern distinct from that which was seen in DF samples. CONCLUSIONS The absence of diffuse refractility was more closely associated with DFSP, as was the presence of a unique checkerboard diffraction pattern. Despite high sensitivity (Sn = 82.9%), absent refractility was not a specific test (Sp = 52.9%), with 47.1% (n = 114) of DF samples sharing this feature. The distinction between DF and DFSP is often diagnosed using H&E alone. In difficult cases, examination of collagen under diffractive microscopy may be useful in distinguishing DFSP from DF and provide an alternative cost-effective tool to immunohistochemical staining.
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Affiliation(s)
- Caroline Brailsford
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Fatema Khamdan
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - McKenzie A. Dirr
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Pelin Sagut
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina
| | - Dirk Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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Guille C, King C, King K, Kruis R, Ford D, Maldonado L, Nietert PJ, Brady KT, Newman RB. Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions. Health Aff (Millwood) 2024; 43:548-556. [PMID: 38560794 DOI: 10.1377/hlthaff.2023.01432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Effective screening and referral practices for perinatal mental health disorders, perinatal substance use disorders (SUDs), and intimate partner violence are greatly needed to reduce maternal morbidity and mortality. We conducted a randomized controlled trial from January 2021 to April 2023 comparing outcomes between Listening to Women and Pregnant and Postpartum People (LTWP), a text- and telephone-based screening and referral program, and usual care in-person screening and referral within the perinatal care setting. Participants assigned to LTWP were three times more likely to be screened compared with those assigned to usual care. Among participants completing a screen, those assigned to LTWP were 3.1 times more likely to screen positive, 4.4 times more likely to be referred to treatment, and 5.7 times more likely to attend treatment compared with those assigned to usual care. This study demonstrates that text- and telephone-based screening and referral systems may improve rates of screening, identification, and attendance to treatment for perinatal mental health disorders and perinatal SUDs compared with traditional in-person screening and referral systems. System-level changes and complementary policies and insurance payments to support adoption of effective text- and telephone-based screening and referral programs are needed.
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Affiliation(s)
- Constance Guille
- Constance Guille , Medical University of South Carolina, Charleston, South Carolina
| | | | - Kathryn King
- Kathryn King, Medical University of South Carolina
| | - Ryan Kruis
- Ryan Kruis, Medical University of South Carolina
| | - Dee Ford
- Dee Ford, Medical University of South Carolina
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3
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Voltin J, Nunn LM, Watson Z, Brasher ZE, Adisetiyo V, Hanlon CA, Nietert PJ, McRae-Clark AL, Jensen JH. Comparison of three magnetic resonance imaging measures of brain iron in healthy and cocaine use disorder participants. NMR Biomed 2024; 37:e5072. [PMID: 38009303 PMCID: PMC10922943 DOI: 10.1002/nbm.5072] [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: 06/29/2023] [Revised: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023]
Abstract
Several magnetic resonance imaging (MRI) measures for quantifying endogenous nonheme brain iron have been proposed. These correspond to distinct physical properties with varying sensitivities and specificities to iron. Moreover, they may depend not only on tissue iron concentration, but also on the intravoxel spatial pattern of iron deposition, which is complex in many brain regions. Here, the three MRI brain iron measures of R 2 * , magnetic field correlation (MFC), and magnetic susceptibility are compared in several deep gray matter regions for both healthy participants (HPs) and individuals with cocaine use disorder (CUD). Their concordance is assessed from their correlations with each other and their relative dependencies on age. In addition, associations between the iron measures and microstructure in adjacent white matter regions are investigated by calculating their correlations with diffusion MRI measures from the internal capsule, and associations with cognition are determined by using results from a battery of standardized tests relevant to CUD. It is found that all three iron measures are strongly correlated with each other for the considered gray matter regions, but with correlation coefficients substantially less than one indicating important differences. The age dependencies of all three measures are qualitatively similar in most regions, except for the red nucleus, where the susceptibility has a significantly stronger correlation with age than R 2 * . Weak to moderate correlations are seen for the iron measures with several of the diffusion and cognitive measures, with the strongest correlations being obtained for R 2 * . The iron measures differ little between the HP and CUD groups, although susceptibility is significantly lower in the red nucleus for the CUD group. For the comparisons made, the iron measures behave similarly in most respects, but with notable quantitative differences. It is suggested that these differences may be, in part, attributable to a higher sensitivity to the spatial pattern of iron deposition for R 2 * and MFC than for susceptibility. This is supported most strongly by a sharp contrast between the values of the iron measures in the globus pallidus relative to those in the red nucleus. The observed correlations of the iron measures with diffusion and cognitive scores point to possible connections between gray matter iron, white matter microstructure, and cognition.
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Affiliation(s)
- Joshua Voltin
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa M. Nunn
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | - Zoe Watson
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | - Zoe E. Brasher
- Department of Behavioral Science and Neuroscience, Duke University Medical Center, Durham, North Carolina
| | - Vitria Adisetiyo
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Colleen A. Hanlon
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Aimee L. McRae-Clark
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina
| | - Jens H. Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
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Allen CG, Neil G, Halbert CH, Sterba KR, Nietert PJ, Welch B, Lenert L. Barriers and facilitators to the implementation of family cancer history collection tools in oncology clinical practices. J Am Med Inform Assoc 2024; 31:631-639. [PMID: 38164994 PMCID: PMC10873828 DOI: 10.1093/jamia/ocad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION This study aimed to identify barriers and facilitators to the implementation of family cancer history (FCH) collection tools in clinical practices and community settings by assessing clinicians' perceptions of implementing a chatbot interface to collect FCH information and provide personalized results to patients and providers. OBJECTIVES By identifying design and implementation features that facilitate tool adoption and integration into clinical workflows, this study can inform future FCH tool development and adoption in healthcare settings. MATERIALS AND METHODS Quantitative data were collected using survey to evaluate the implementation outcomes of acceptability, adoption, appropriateness, feasibility, and sustainability of the chatbot tool for collecting FCH. Semistructured interviews were conducted to gather qualitative data on respondents' experiences using the tool and recommendations for enhancements. RESULTS We completed data collection with 19 providers (n = 9, 47%), clinical staff (n = 5, 26%), administrators (n = 4, 21%), and other staff (n = 1, 5%) affiliated with the NCI Community Oncology Research Program. FCH was systematically collected using a wide range of tools at sites, with information being inserted into the patient's medical record. Participants found the chatbot tool to be highly acceptable, with the tool aligning with existing workflows, and were open to adopting the tool into their practice. DISCUSSION AND CONCLUSIONS We further the evidence base about the appropriateness of scripted chatbots to support FCH collection. Although the tool had strong support, the varying clinical workflows across clinic sites necessitate that future FCH tool development accommodates customizable implementation strategies. Implementation support is necessary to overcome technical and logistical barriers to enhance the uptake of FCH tools in clinical practices and community settings.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Grace Neil
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Leslie Lenert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Bonilha HS, Reedy EL, Wilmskoetter J, Nietert PJ, Martin-Harris B. Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies. Dysphagia 2024:10.1007/s00455-023-10643-5. [PMID: 38265506 DOI: 10.1007/s00455-023-10643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Abstract
Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.
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Affiliation(s)
- Heather Shaw Bonilha
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA.
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Room 202B, Columbia, SC, 29208, USA.
| | - Erin L Reedy
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
| | - Janina Wilmskoetter
- Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425-2503, USA
- College of Medicine, Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 606, Charleston, SC, 29425-2503, USA
| | - Paul J Nietert
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC, 29425-2503, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL, 60208, USA
- Feinberg School of Medicine, Otolaryngology - Head & Neck Surgery, Radiation Oncology, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA
- Edward J. Hines Veteran's Affairs Medical Center, 5000 5th Avenue, Hines, IL, 60141-3030, USA
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Xu JX, Coker A, Dulaney Z, Furbish A, Xu FZ, Helke KL, Woster PM, Nietert PJ, Braxton AM. Establishing New Isosexual Pairs in Adult Male Guinea Pigs ( Cavia porcellus) to Facilitate Social Housing. J Am Assoc Lab Anim Sci 2024; 63. [PMID: 38262624 PMCID: PMC11022948 DOI: 10.30802/aalas-jaalas-23-000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/06/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
Guinea pigs (Cavia porcellus) are a commonly used species in biomedical research. As social creatures, compatible guinea pigs should be housed together unless scientific objectives or veterinary care require otherwise. Extensive literature suggests that adult male guinea pigs are highly aggressive in the presence of females, but data are lacking regarding the compatibility of cohoused adult males in the absence of females. Most studies that use adult males do not report housing densities. We used serial wound scoring and observations of behavior to determine whether unfamiliar adult male guinea pigs will develop stable, prosocial isosexual pairs. Wound scoring was performed before and 24 h after pairing. Serial behavioral observations assessed affiliative and agonistic behaviors at 0.5, 2, 24, and 48 h after pairing. Wound scoring and behavioral observations continued weekly for 1 mo and monthly thereafter. Wound scores were significantly higher at 24 h after pairing as compared with baseline and all other time points. Wounding was rare after week 2, indicating reduced aggression. Furthermore, affiliative behaviors significantly increased over time while agonistic behaviors were rare. Together, these data suggest that unfamiliar adult male guinea pigs establish stable prosocial pairs after an acclimation period. As was done in the present study, providing ample space, separate shelters for each animal, and the absence of female guinea pigs will likely facilitate successful pairing. We recommend consideration of a social housing program for adult male guinea pigs to provide companionship and enrich their housing environment.
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Affiliation(s)
- Jen X Xu
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Ashton Coker
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Zadie Dulaney
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Amelia Furbish
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Frank Z Xu
- Department of Biomedical Science, The University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Kristi L Helke
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Patrick M Woster
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Alicia M Braxton
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina
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Young LEA, Nietert PJ, Stubler R, Kittrell CG, Grimsley G, Lewin DN, Mehta AS, Hajar C, Wang K, O’Quinn EC, Angel PM, Wallace K, Drake RR. Utilizing multimodal mass spectrometry imaging for profiling immune cell composition and N-glycosylation across colorectal carcinoma disease progression. Front Pharmacol 2024; 14:1337319. [PMID: 38273829 PMCID: PMC10808565 DOI: 10.3389/fphar.2023.1337319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Colorectal cancer (CRC) stands as a leading cause of death worldwide, often arising from specific genetic mutations, progressing from pre-cancerous adenomas to adenocarcinomas. Early detection through regular screening can result in a 90% 5-year survival rate for patients. However, unfortunately, only a fraction of CRC cases are identified at pre-invasive stages, allowing progression to occur silently over 10-15 years. The intricate interplay between the immune system and tumor cells within the tumor microenvironment plays a pivotal role in the progression of CRC. Immune cell clusters can either inhibit or facilitate tumor initiation, growth, and metastasis. To gain a better understanding of this relationship, we conducted N-glycomic profiling using matrix-assisted laser desorption-ionization mass spectrometry imaging (MALDI-MSI). We detected nearly 100 N-glycan species across all samples, revealing a shift in N-glycome profiles from normal to cancerous tissues, marked by a decrease in high mannose N-glycans. Further analysis of precancerous to invasive carcinomas showed an increase in pauci-mannose biantennary, and tetraantennary N-glycans with disease progression. Moreover, a distinct stratification in the N-glycome profile was observed between non-mucinous and mucinous CRC tissues, driven by pauci-mannose, high mannose, and bisecting N-glycans. Notably, we identified immune clusters of CD20+ B cells and CD3/CD44+ T cells distinctive and predictive with signature profiles of bisecting and branched N-glycans. These spatial N-glycan profiles offer potential biomarkers and therapeutic targets throughout the progression of CRC.
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Affiliation(s)
- Lyndsay E. A. Young
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Paul J. Nietert
- Translational Science Laboratory, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Rachel Stubler
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Caroline G. Kittrell
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Grace Grimsley
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - David N. Lewin
- Department of Regenerative Medicine and Cell Biology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Anand S. Mehta
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Chadi Hajar
- Department of Regenerative Medicine and Cell Biology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Katherine Wang
- Department of Regenerative Medicine and Cell Biology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth C. O’Quinn
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
- Department of Regenerative Medicine and Cell Biology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Peggi M. Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Kristin Wallace
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
- Translational Science Laboratory, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Richard R. Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Wang H, Gou W, Nietert PJ, Hirsch J, Wang J, Allawi A, Mortadha AS, Cook K, Overstreet M, Wei H, Adams D, Lancaster WP, Morgan KA, Strange C. Alpha-1 Antitrypsin Augmentation Therapy in Chronic Pancreatitis Patients Undergoing Total Pancreatectomy and Islet Autotransplantation: A Randomized, Controlled Study. Cell Transplant 2024; 33:9636897241243014. [PMID: 38659255 PMCID: PMC11044796 DOI: 10.1177/09636897241243014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Stress-induced islet graft loss during the peri-transplantation period reduces the efficacy of islet transplantation. In this prospective, randomized, double-blind clinical trial, we evaluated the safety and efficacy of 60 mg/kg human alpha-1 antitrypsin (AAT) or placebo infusion weekly for four doses beginning before surgery in chronic pancreatitis (CP) patients undergoing total pancreatectomy and islet autotransplantation (TP-IAT). Subjects were followed for 12 months post-TP-IAT. The dose of AAT was safe, as there was no difference in the types and severity of adverse events in participants from both groups. There were some biochemical signals of treatment effect with a higher oxygen consumption rate in AAT islets before transplantation and a lower serum C-peptide (an indicator of islet death) in the AAT group at 15 min after islet infusion. Findings per the statistical analysis plan using a modified intention to treat analysis showed no difference in the C-peptide area under the curve (AUC) following a mixed meal tolerance test at 12 months post-TP-IAT. There was no difference in the secondary and exploratory outcomes. Although AAT therapy did not show improvement in C-peptide AUC in this study, AAT therapy is safe in CP patients and there are experiences gained on optimal clinical trial design in this challenging disease.
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Affiliation(s)
- Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Wenyu Gou
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J. Nietert
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jason Hirsch
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jingjing Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ahmed Allawi
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Abd S. Mortadha
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kelsey Cook
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Morgan Overstreet
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Hua Wei
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David Adams
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - William P. Lancaster
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine A. Morgan
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Charlie Strange
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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9
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Khamdan F, Dirr MA, Sagut P, Brailsford CJ, Williams JA, Nietert PJ, Elston DM. Cytologic atypia of benign inflammatory versus neoplastic cutaneous squamous lesions. J Cutan Pathol 2023; 50:1070-1077. [PMID: 37730204 PMCID: PMC10685324 DOI: 10.1111/cup.14536] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/22/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Cytologic atypia encompasses several features of abnormal cellular morphology. We sought to quantify these features in benign and premalignant/malignant squamous cell lesions to better characterize criteria for malignancy. METHODS We conducted a rater-blinded observational study in which histopathology slides were evaluated under light microscopy, and the presence and relative quantity of 24 distinct cytological features were recorded, along with respective diagnoses. Each slide was evaluated, and the ratings were recorded and analyzed. RESULTS The most helpful findings, whose presence in high numbers indicates an increased likelihood that the tissue sample is premalignant/malignant, were: (1) pleomorphic parakeratosis; (2) pleomorphic nuclei in the epithelium; (3) irregular nuclei; (4) thick refractile nuclear envelope; (5) presence of nuclear hyperchromasia (dark gray); (6) peripheral nucleoli; and (7) nucleolar stems. Higher values of round or oval nuclear shape and vesicular nuclei increase the likelihood that the tissue sample is benign. CONCLUSIONS Certain nuclear features have a higher association with premalignancy/malignancy and may guide histologic evaluation of a given lesion. These findings can be used in combination with architectural features and clinical history to add to a complete diagnostic picture.
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Affiliation(s)
- Fatema Khamdan
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - McKenzie A. Dirr
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Pelin Sagut
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Jacob A. Williams
- Department of Public Health Sciences, Medical University of South Carolina
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina
| | - Dirk M. Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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11
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Kwon JY, Nietert PJ, Rockey DC. Hyperbilirubinemia in hospitalized patients: Etiology and outcomes. J Investig Med 2023; 71:773-781. [PMID: 37386866 PMCID: PMC10824167 DOI: 10.1177/10815589231180498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
There is little information on the differential diagnosis and prognosis of hospitalized patients with hyperbilirubinemia. Here, we hypothesized that hyperbilirubinemia in hospitalized patients is associated with specific diseases and outcomes. This retrospective cohort analysis included patients admitted to the Medical University of South Carolina with a total bilirubin >3 mg/dL from January 9, 2015 to August 25, 2017. Collected clinical data included demographics, primary diagnosis, Charlson Comorbidity Index (CCI), laboratory data, and clinical outcomes. We separated and analyzed the cohort into seven primary diagnostic groups. We identified 1693 patients with a bilirubin level >3 mg/dL. The cohort was 42% female, had an average age of 54, average CCI of 4.8, and average length of stay of 13 days. The causes of hyperbilirubinemia included the following: primary liver disease (868/1693; 51%) with cirrhosis being most common (385/1693; 23%), benign biliary obstruction (252/1693; 15%), hemolytic anemia (149/1693; 9%), malignant biliary obstruction (121/1693; 7%), unknown etiology (108/1693; 6%), primary liver cancer (74/1693; 4%), and metastatic cancer to the liver (57/1693; 3%). Overall, the mortality/discharge to hospice rate in patients with a bilirubin >3 mg/dL was 30%, and was proportional to the severity of hyperbilirubinemia, including when controlling for the underlying severity of illness. Mortality was highest in patients with primary liver disease and malignancy and was lowest in patients with non-cancerous obstruction or hemolytic jaundice. Hyperbilirubinemia in hospitalized patients is most often due to primary liver disease, and identifies patients with a poor prognosis, particularly when caused by primary liver disease or cancer.
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Affiliation(s)
- Joshua Y Kwon
- Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, USA
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12
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Srivastava RP, Nietert PJ, Bobo JFG, Haj M, Forbes N, Elmunzer BJ. Serum Amylase as a Biomarker for Proof-of-Concept Studies in Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis Prevention. Clin Gastroenterol Hepatol 2023; 21:2676-2678.e2. [PMID: 36029968 PMCID: PMC9958270 DOI: 10.1016/j.cgh.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Romik P Srivastava
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - John F G Bobo
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mona Haj
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Nauzer Forbes
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
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13
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Khamdan F, Brailsford C, Dirr MA, Sagut P, Nietert PJ, Elston D. Dermatofibroma Versus Dermatofibrosarcoma Protuberans: A Nuclear Morphology Study. Am J Dermatopathol 2023; 45:631-634. [PMID: 37625803 PMCID: PMC10463235 DOI: 10.1097/dad.0000000000002526] [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: 08/27/2023]
Abstract
ABSTRACT The locally invasive soft-tissue sarcoma, dermatofibrosarcoma protuberans (DFSPs), shares certain histologic features of the much more common and benign dermatofibroma (DF). While immunohistochemical stains, specifically cluster of differentiation 34 and Factor XIIIa, can be used to distinguish the 2 entities using microscopy, these markers are not entirely sensitive nor specific. Three-dimensionally, DFSP nuclei resemble a "puck" or "coin"-like shape. As hematoxylin/eosin-stained slides are prepared, these "puck" nuclei are fixed in an infinite number of orientations depending on their current position in rotation about their axes within the tumor cells. Under histological examination, this random nuclear positioning produces the appearance of 2 predominate morphologies: an ovoid "disk" shape (en face) and a narrow spindled shape (side view), which distribute in a roughly 50:50 ratio throughout the tumor sample slide. Nuclear morphology was analyzed in 324 DFSP and DF samples at high magnification (×400) to determine the presence or absence of a predominant morphology in which nuclei appear to alternate between an ovoid (en face) and spindled (side view) throughout most of the tumor sample. An alternating ovoid-spindled nuclear morphology was the predominant cytology in 98% of DFSP and was not predominant in 100% of DF samples (P < 0.001). This morphology was found to be highly specific (Sp = 1) and sensitive (Sn = 0.98) for DFSP. This unique nuclear morphology may be a more sensitive and specific diagnostic tool in identifying DFSP from DF in comparison with costly immunohistochemical stains.
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Affiliation(s)
- Fatema Khamdan
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Caroline Brailsford
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - McKenzie A. Dirr
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Pelin Sagut
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina
| | - Dirk Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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14
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Jungbauer WN, Zhang K, Melvin CL, Nietert PJ, Ford ME, Pecha PP. Identifying barriers to obstructive sleep-disordered breathing care: Parental perspectives. Int J Pediatr Otorhinolaryngol 2023; 171:111621. [PMID: 37300964 PMCID: PMC10526645 DOI: 10.1016/j.ijporl.2023.111621] [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: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Despite established clinical practice guidelines for pediatric obstructive sleep-disordered breathing (SDB), disparities persist for this common condition. Few studies have investigated parental experiences about challenges faced in obtaining SDB evaluation and tonsillectomy for their children. To better understand parent-perceived barriers to treatment of childhood SDB, we administered a survey to assess parental knowledge of this condition. MATERIALS & METHODS A cross-sectional survey was designed to be completed by parents of children diagnosed with SDB. Two validated surveys were administered: 1) Barriers to Care Questionnaire and 2) Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. Logistic regression modeling was performed to assess for predictors of parental barriers to SDB care and knowledge. RESULTS Eighty parents completed the survey. Mean patient age was 7.4 ± 4.6 years, and 48 (60%) patients were male. The survey response rate was 51%. Patient racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, and 14 (17.5%) Other. Parents reported challenges in the 'Pragmatic' domain, including appointment availability and cost of healthcare, as the most frequently described barrier to care. Adjusting for age, sex, race, and education, parents in the middle-income bracket ($26,500 - $79,500) had higher odds of reporting greater barriers to care than parents in the highest (>$79,500) income tier (OR 5.536, 95% CI 1.312-23.359, P = 0.020) and lowest income tier (<$26,500) (OR 3.920, 95% CI 1.096-14.020). Parents whose children had tonsillectomy (n = 40) answered only a mean 55.7% ± 13.3% of questions correctly on the knowledge scale. CONCLUSION Pragmatic challenges were the most encountered barrier that parents reported in accessing SDB care. Families in the middle-income tier experienced the greatest barriers to SDB care compared to lower and higher income families. In general, parental knowledge of SDB and tonsillectomy was relatively low. These findings represent potential areas of improvement to target interventions to promote equitable care for SDB.
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Affiliation(s)
- W Nicholas Jungbauer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kathy Zhang
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
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15
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Allen CG, Judge DP, Nietert PJ, Hunt KJ, Jackson A, Gallegos S, Sterba KR, Ramos PS, Melvin CL, Wager K, Catchpole K, Ford M, McMahon L, Lenert L. Anticipating adaptation: tracking the impact of planned and unplanned adaptations during the implementation of a complex population-based genomic screening program. Transl Behav Med 2023; 13:381-387. [PMID: 37084411 PMCID: PMC10255754 DOI: 10.1093/tbm/ibad006] [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: 04/23/2023] Open
Abstract
In 2021, the Medical University of South Carolina (MUSC) launched In Our DNA SC. This large-scale initiative will screen 100,000 individuals in South Carolina for three preventable hereditary conditions that impact approximately two million people in the USA but often go undetected. In anticipation of inevitable changes to the delivery of this complex initiative, we developed an approach to track and assess the impact of evaluate adaptations made during the pilot phase of program implementation. We used a modified version of the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) and Adaptations to code adaptations made during the 3-month pilot phase of In Our DNA SC. Adaptations were documented in real-time using a REDCap database. We used segmented linear regression models to independently test three hypotheses about the impact of adaptations on program reach (rate of enrollment in the program, rate of messages viewed) and implementation (rate of samples collected) 7 days pre- and post-adaptation. Effectiveness was assessed using qualitative observations. Ten adaptations occurred during the pilot phase of program implementation. Most adaptations (60%) were designed to increase the number and type of patient contacted (reach). Adaptations were primarily made based on knowledge and experience (40%) or from quality improvement data (30%). Of the three adaptations designed to increase reach, shortening the recruitment message potential patients received significantly increased the average rate of invitations viewed by 7.3% (p = 0.0106). There was no effect of adaptations on implementation (number of DNA samples collected). Qualitative findings support improvement in effectiveness of the intervention after shortening the consent form and short-term positive impact on uptake of the intervention as measured by team member's participation. Our approach to tracking adaptations of In Our DNA SC allowed our team to quantify the utility of modifications, make decisions about pursuing the adaptation, and understand consequences of the change. Streamlining tools for tracking and responding to adaptations can help monitor the incremental impact of interventions to support continued learning and problem solving for complex interventions being delivered in health systems based on real-time data.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Daniel P Judge
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paul J Nietert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Kelly J Hunt
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Amy Jackson
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Sam Gallegos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Katherine R Sterba
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paula S Ramos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Cathy L Melvin
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Karen Wager
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Ken Catchpole
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Marvella Ford
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Lori McMahon
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Leslie Lenert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
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Atherton KM, Poupore NS, Clemmens CS, Nietert PJ, Pecha PP. Sociodemographic Factors Affecting Loss to Follow-Up After Newborn Hearing Screening: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:1289-1300. [PMID: 36939626 PMCID: PMC10773460 DOI: 10.1002/ohn.221] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Universal newborn hearing screening (NBHS) has been widely implemented as a part of early hearing detection and intervention (EHDI) programs worldwide. Even with excellent provider knowledge and screening rates, many infants do not receive definitive hearing testing or intervention after initial screening. The objective of this study was to identify sociodemographic factors contributing to loss of follow-up. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases were searched from the date of inception through December 28, 2021. Studies containing sociodemographic information on patients who were referred to NBHS were included. Meta-analysis of odds ratios (ORs) was performed comparing rates of sociodemographic variables between patients adherent and nonadherent to follow-up. RESULTS A total of 169,238 infants from 19 studies were included. Low birth weight (OR 1.6 [95% confidence interval, CI 1.2-2.2, p < .001), racial minority (OR 1.4 [95% CI 1.2-1.6], p < .001), rural residence (OR 1.5 [95% CI 1.1-1.9], p = .005), lack of insurance (OR 1 [95% CI 1.4-2.5], p < .001), and public or state insurance (OR 1.7 [95% CI 1.2-4.2], p = .008) were associated with missed follow-up after referred NBHS. Associated maternal factors included low maternal education (OR 1.8 [95% CI 1.6-2.0], p < .001), young maternal age (OR 1.5 [95% CI 1.5-1.6], p < .001), unmarried maternal status (OR 1.5 [95% CI 1.1-1.9], p = .003), and current or former maternal smoking status (OR 1.8 [95% CI 1.4-2.2], p < .001). CONCLUSION Both infant and maternal sociodemographic factors influence follow-up compliance after referred NBHS. Focused efforts should be made by medical providers and policymakers to address these factors to ensure appropriate newborn hearing care and interventions are achieved.
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Affiliation(s)
- Kelly M. Atherton
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, South Carolina, Charleston, USA
| | - Nicolas S. Poupore
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Clarice S. Clemmens
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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17
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Nadig TR, Thomas N, Nietert PJ, Lozier J, Tanner NT, Wang Memoli JS, Pastis NJ, Silvestri GA. Guided Bronchoscopy for the Evaluation of Pulmonary Lesions: An Updated Meta-analysis. Chest 2023; 163:1589-1598. [PMID: 36640994 PMCID: PMC10925546 DOI: 10.1016/j.chest.2022.12.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Guided bronchoscopy is increasingly used to diagnose peripheral pulmonary lesions (PPLs). A meta-analysis published in 2012 demonstrated a pooled diagnostic yield of 70%; however, recent publications have documented yields as low as 40% and as high as 90%. RESEARCH QUESTION Has the diagnostic yield of guided bronchoscopy in patients with PPLs improved over the past decade? STUDY DESIGN AND METHODS A comprehensive search was performed of studies evaluating the diagnostic yield of differing bronchoscopic technologies used to reach PPLs. Study quality was assessed using the Quality assessment of diagnostic accuracy of studies (QUADAS-2) assessment tool. Number of lesions, type of technology used, overall diagnostic yield, and yield by size were extracted. Adverse events were recorded. Meta-analytic techniques were used to summarize findings across all studies. RESULTS A total of 16,389 lesions from 126 studies were included. There was no significant difference in diagnostic yield prior to 2012 (39 studies; 3,052 lesions; yield 70.5%) vs after 2012 (87 studies; 13,535 lesions; yield 69.2%) (P > .05). Additionally, there was no significant difference in yield when comparing different technologies. Studies with low risk of overall bias had a lower diagnostic yield than those with high risk of bias (66% vs 71%, respectively; P = .018). Lesion size > 2 cm, presence of bronchus sign, and reports with a high prevalence of malignancy in the study population were associated with significantly higher diagnostic yield. Significant (P < .0001) between-study heterogeneity was also noted. INTERPRETATION Despite the reported advances in bronchoscopic technology to diagnose PPLs, the diagnostic yield of guided bronchoscopy has not improved.
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Affiliation(s)
- Tejaswi R Nadig
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC
| | - Nina Thomas
- Division of Pulmonary Disease & Critical Care, University of Colorado, Aurora, CO
| | - Paul J Nietert
- Department of Public Health Sciences, MUSC, Charleston, SC
| | - Jessica Lozier
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC
| | - Nichole T Tanner
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC
| | - Jessica S Wang Memoli
- Division of Pulmonary, Critical Care and Respiratory Services, Medstar Washington Hospital Center, Washington, DC
| | - Nicholas J Pastis
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, MUSC, Charleston, SC.
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18
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Back SE, Flanagan JC, Killeen T, Saraiya TC, Brown DG, Jarnecke AM, Rothbaum AO, Joseph J, Ana ES, de Arellano A, Shoemaker HL, Dixon RA, Nietert PJ, Brady KT. COPE and oxytocin for the treatment of co-occurring PTSD and alcohol use disorder: Design and methodology of a randomized controlled trial in U.S. military veterans. Contemp Clin Trials 2023; 126:107084. [PMID: 36646315 PMCID: PMC9998357 DOI: 10.1016/j.cct.2023.107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND A significant proportion of individuals with alcohol use disorder (AUD) also meet criteria for posttraumatic stress disorder (PTSD). Military veterans are at increased risk for developing co-occurring AUD/PTSD, with prevalence rates 2-4 times higher than the general population. Research is needed to develop more effective treatments for this common comorbidity. The current investigation addresses this need by examining the synergistic effects of a novel pharmacotherapy combined with psychotherapy for co-occurring AUD/PTSD among veterans. Accumulating evidence suggests that the neuropeptide oxytocin (OT) is a promising pharmacotherapy to augment psychotherapy for AUD/PTSD. OT targets neurobiological and behavioral dysregulation common to both AUD and PTSD, in particular, corticolimbic connectivity. Human and animal studies show OT reduces alcohol self-administration, tolerance, and withdrawal; enhances fear extinction; and promotes prosocial behaviors. The current study builds on previous work by examining OT among veterans with AUD/PTSD receiving Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE), an evidence-based integrated treatment. METHODS This paper describes the rationale, design, and methodology of a Stage II, 12-week, double-blind, randomized clinical trial of intranasal OT (40 IU) versus placebo combined with COPE among veterans (N = 180) with current AUD/PTSD. In addition, the effects of treatment on corticolimbic connectivity will be examined using functional magnetic resonance imaging (fMRI) at pre- and post-treatment. CONCLUSIONS The proposed study will provide new knowledge and mechanistic insights to accelerate research in this understudied area and may lead to improved treatment outcomes for co-occurring AUD/PTSD. CLINICALTRIALS gov: NCT04523922.
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Affiliation(s)
- Sudie E Back
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | - Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Tanya C Saraiya
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Delisa G Brown
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amber M Jarnecke
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Alex O Rothbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jane Joseph
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Santa Ana
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Abigail de Arellano
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah L Shoemaker
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Reagan Ashley Dixon
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Falangola MF, Nie X, Voltin J, Ward R, Dhiman S, Nietert PJ, Jensen JH. Brain microstructure abnormalities in the 3xTg-AD mouse - A diffusion MRI and morphology correlation study. Magn Reson Imaging 2022; 94:48-55. [PMID: 36116712 PMCID: PMC9695071 DOI: 10.1016/j.mri.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
The widely studied triple transgenic (3xTg-AD) mouse provides a robust model of Alzheimer's disease (AD) with region dependent patterns of progressive amyloid-β (Aß) and tau pathology. Using diffusion MRI (dMRI), we investigated the sensitivity of dMRI measures in capturing AD pathology associated microstructure alterations in older 3xTg-AD mice, and the degree to which dMRI changes correlate with measurements of Aβ and tau pathology. 3xTg-AD and normal control (NC) mice, 15 to 21 months of age, were used in this study. In vivo dMRI data were acquired for the generation of diffusion tensor (DT) and diffusional kurtosis (DK) measures within the hippocampus and fimbria (Fi). For these same brain regions, Aβ and tau pathology were quantified by morphological analysis of Aß1-42 and AT8 immunoreactivity. Two-tailed, two-sample t-tests were performed to assess group differences in each brain region of interest (ROI), with the Benjamini-Hochberg false discovery rate (FDR) method being applied to adjust for multiple comparisons. Spearman correlation coefficients were calculated to investigate associations between diffusion and morphological measures. Our results revealed, depending on the brain region, DT and DK measures were able to detect group differences. In the dorsal hippocampus (HD), fractional anisotropy (FA) was significantly higher in the 3xTg-AD mice compared with NC mice. In the subiculum (SUB), FA, axial diffusivity (D||) and radial kurtosis (K┴) were significantly higher in 3xTg-AD mice compared with NC mice. Morphological quantification of Aß1-42 and AT8 immunoreactivity showed elevated Aß and tau in the Fi, ventral hippocampus (HV) and SUB of 3xTg-AD mice. The presence of Aβ and tau was significantly correlated with several DT and DK measures, particularly in the SUB, where an increase in tau correlated with an increase in mean kurtosis (MK) and K┴. This work demonstrates significant dMRI differences between older 3xTg-AD and NC mice in the hippocampus and Fi. Significant correlations were found between dMRI and morphological measures of Aβ and tau pathology. These results support the potential of dMRI-derived parameters as biomarkers of AD pathology. Since the imaging methods employed here are easily translatable to clinical MRI, our results are also relevant for human AD patients.
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Affiliation(s)
- Maria Fatima Falangola
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.
| | - Xingju Nie
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Voltin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Ralph Ward
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Siddhartha Dhiman
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Dooley MJ, Simpson KN, Simpson AN, Nietert PJ, Williams JD, King K, McElligott JT. A Modification of Time-Driven Activity-Based Costing for Comparing Cost of Telehealth and In-Person Visits. Telemed J E Health 2022; 28:1525-1533. [PMID: 35263178 PMCID: PMC9587787 DOI: 10.1089/tmj.2021.0338] [Citation(s) in RCA: 7] [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: 06/30/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Cost studies of telehealth (TH) and virtual visits are few and report mixed results of the economic impact of virtual care and TH. Largely missing from the literature are studies that identify the cost of delivering TH versus in-person care. The objective was to demonstrate a modified time-driven activity-based costing (TDABC) approach to compare weighted labor cost of an in-person pediatric clinic sick visit before COVID-19 to the same virtual and in-person sick-visit during COVID-19. Methods: We examined visits before and during COVID-19 using: (1) recorded structured interviews with providers; (2) iterative workflow mapping; (3) electronic health records time stamps for validation; (4) standard cost weights for wages; and (5) clinic CPT billing code mix for complexity weighs. We examined the variability in estimated time using a decision tree model and Monte Carlo simulations. Results: Workflow charts were created for the clinic before COVID-19 and during COVID-19. Using TDABC and simulations for varying time, the weighted cost of clinic labor for sick visit before COVID-19 was $54.47 versus $51.55 during COVID-19. Discussion: The estimated mean labor cost for care during the pandemic has not changed from the pre-COVID period; however, this lack of a difference is largely because of the increased use of TH. Conclusions: Our TDABC approach is feasible to use under virtual working conditions; requires minimal provider time for execution; and generates detailed cost estimates that have "face validity" with providers and are relevant for economic evaluation.
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Affiliation(s)
- Mary J. Dooley
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kit N. Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Annie N. Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - J. Duncan Williams
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn King
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James T. McElligott
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
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21
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Flanagan JC, Nietert PJ, Sippel L, Jarnecke AM, Kirby C, Hogan JN, Massa AA, Brower J, Back SE, Parrott D. A randomized controlled trial examining the effects of intranasal oxytocin on alcohol craving and intimate partner aggression among couples. J Psychiatr Res 2022; 152:14-24. [PMID: 35709548 PMCID: PMC9308670 DOI: 10.1016/j.jpsychires.2022.06.011] [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: 01/17/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND While alcohol use disorder (AUD) is a well-established risk factor for intimate partner aggression (IPA), effective treatments for co-occurring AUD and IPA (AUD/IPA) are lacking. Oxytocin is one promising pharmacological candidate for AUD/IPA given its potential to modulate social behavior and attenuate alcohol use. However, emerging data suggests that oxytocin's prosocial effects are inconsistent, and a small number of studies have also found that oxytocin might have the potential to be aggressogenic. No studies have directly examined the impact of oxytocin on alcohol- or IPA-related outcomes in a dyadic context. METHODS The goal of this double-blind, randomized, and placebo-controlled trial was to examine the effects of a single dose of intranasal oxytocin (40 international units) on cue-induced alcohol craving, subjective aggression, laboratory task-based IPA, and cortisol reactivity in a sample of 100 couples (N = 200 individuals) with AUD and physical IPA in their current relationship. RESULTS There were no statistically significant differences between the oxytocin and placebo conditions for any of the primary outcomes. CONCLUSIONS Findings suggest that a single dose of intranasal oxytocin was not efficacious in mitigating alcohol craving or aggression in this sample. Although hypotheses were not supported, the findings provide important evidence that oxytocin was not aggressogenic in this high-risk sample. Future research investigating dispositional and contextual moderators of oxytocin response in addition to the therapeutic effects of more intensive oxytocin dosing or administration strategies on alcohol craving and aggression is warranted.
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Affiliation(s)
- Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Sippel
- VA Northeast Program Evaluation Center, West Haven, CT, USA,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,National Center for PTSD Evaluation Division, West Haven, CT, USA
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Charli Kirby
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jasara N. Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea A. Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Jessica Brower
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Dominic Parrott
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
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22
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Kamen DL, Wallace C, Li Z, Wyatt M, Paulos C, Wei C, Wang H, Wolf BJ, Nietert PJ, Gilkeson G. Safety, immunological effects and clinical response in a phase I trial of umbilical cord mesenchymal stromal cells in patients with treatment refractory SLE. Lupus Sci Med 2022; 9:9/1/e000704. [PMID: 35820718 PMCID: PMC9277402 DOI: 10.1136/lupus-2022-000704] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reports of clinical improvement following mesenchymal stromal cell (MSC) infusions in refractory lupus patients at a single centre in China led us to perform an explorative phase I trial of umbilical cord derived MSCs in patients refractory to 6 months of immunosuppressive therapy. METHODS Six women with a SLEDAI >6, having failed standard of care therapy, received one intravenous infusion of 1×106 MSCs/kg of body weight. They maintained their current immunosuppressives, but their physician was allowed to adjust corticosteroids initially for symptom management. The clinical endpoint was an SRI of 4 with no new British Isles Lupus Activity Guide (BILAG) As and no increase in Physician Global Assessment score of >0.3 with tapering of prednisone to 10 mg or less by 20 weeks. RESULTS Of six patients, five (83.3%; 95% CI 35.9% to 99.6%) achieved the clinical endpoint of an SRI of 4. Adverse events were minimal. Mechanistic studies revealed significant reductions in CD27IgD double negative B cells, switched memory B cells and activated naïve B cells, with increased transitional B cells in the five patients who met the endpoint. There was a trend towards decreased autoantibody levels in specific patients. Two patients had increases in their Helios+Treg cells, but no other significant T cell changes were noted. GARP-TGFβ complexes were significantly increased following the MSC infusions. The B cell changes and the GARP-TGFβ increases significantly correlated with changes in SLEDAI scores. CONCLUSION This phase 1 trial suggests that umbilical cord (UC) MSC infusions are very safe and may have efficacy in lupus. The B cell and GARP-TGFβ changes provide novel insight into mechanisms by which MSCs may impact disease. TRIAL REGISTRATION NUMBER NCT03171194.
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Affiliation(s)
- Diane L Kamen
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Caroline Wallace
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zihai Li
- Department of Medicine, Division of Hematology/Oncology, Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Megan Wyatt
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Crystal Paulos
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chungwen Wei
- University of Rochester Medical Center, Rochester, New York, USA
| | - Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gary Gilkeson
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Benitez A, Jensen JH, Thorn K, Dhiman S, Fountain-Zaragoza S, Rieter WJ, Spampinato MV, Hamlett ED, Nietert PJ, Falangola MDF, Helpern JA. Greater diffusion restriction in white matter in Preclinical Alzheimer's disease. Ann Neurol 2022; 91:864-877. [PMID: 35285067 DOI: 10.1002/ana.26353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Alzheimer's Continuum is biologically defined by beta-amyloid deposition which, at the earliest stages, is superimposed upon white matter degeneration in aging. However, the extent to which these co-occurring changes are characterized is relatively under-explored. The goal of this study was to use Diffusional Kurtosis Imaging (DKI) and biophysical modeling to detect and describe amyloid-related white matter changes in preclinical Alzheimer's disease (AD). METHODS Cognitively unimpaired participants ages 45-85 completed brain MRI, amyloid PET (florbetapir), neuropsychological testing, and other clinical measures at baseline in a cohort study. We tested whether beta amyloid-negative (AB-) and -positive (AB+) participants differed on DKI-based conventional (i.e. Fractional Anisotropy [FA], Mean Diffusivity [MD], Mean Kurtosis [MK]) and modeling (i.e. Axonal Water Fraction [AWF], extra-axonal radial diffusivity [De,⊥ ]) metrics, and whether these metrics were associated with other biomarkers. RESULTS We found significantly greater diffusion restriction (higher FA/AWF, lower MD/ De,⊥ ) in white matter in AB+ than AB- (partial η2 = 0.08-0.19), more notably in the extra-axonal space within primarily late-myelinating tracts. Diffusion metrics predicted amyloid status incrementally over age (AUC=0.84) with modest yet selective associations, where AWF (a marker of axonal density) correlated with speed/executive functions and neurodegeneration, whereas De,⊥ (a marker of gliosis/myelin repair) correlated with amyloid deposition and white matter hyperintensity volume. INTERPRETATION These results support prior evidence of a non-monotonic change in diffusion behavior, where an early increase in diffusion restriction is hypothesized to reflect inflammation and myelin repair prior to an ensuing decrease in diffusion restriction, indicating glial and neuronal degeneration. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andreana Benitez
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn Thorn
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Siddhartha Dhiman
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanie Fountain-Zaragoza
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - William J Rieter
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Vittoria Spampinato
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Eric D Hamlett
- Department of Pathology and Laboratory Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Maria de Fatima Falangola
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph A Helpern
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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Yan F, Pearce JL, Ford ME, Nietert PJ, Pecha PP. Examining Associations Between Neighborhood-Level Social Vulnerability and Care for Children With Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2022; 166:1118-1126. [PMID: 35259035 DOI: 10.1177/01945998221084203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aim to investigate the impact of neighborhood-level social vulnerability on otolaryngology care for children with obstructive sleep-disordered breathing (SDB). STUDY DESIGN Retrospective cohort study. SETTING A tertiary children's hospital. METHODS Children aged 2 to 17 years with SDB were included. Residential addresses were geocoded with geographic information systems, and spatial overlays were used to assign census tract-level social vulnerability index (SVI) scores to each participant. Multivariable logistic regression models were used to estimate associations of neighborhood SVI scores and individual factors with attendance of otolaryngology referral appointment and interventions. RESULTS The study included 397 patients (mean ± SD age, 5.9 ± 3.7 years; 51% male, n = 203). After adjustment for age and sex, children with higher overall SVI scores (odds ratio [OR], 0.40; 95% CI, 0.16-0.92) and higher socioeconomic vulnerability scores (OR, 0.34; 95% CI, 0.14-0.86) were less likely to attend their referral appointments. The odds of attending referrals were 83% lower (OR, 0.17; 95% CI, 0.09-0.34) for Black children and 73% lower (OR, 0.27; 95% CI, 0.11-0.65) for Hispanic children than for non-Hispanic White children. Medicaid beneficiaries had lower odds of attending their referrals (OR, 0.20; 95% CI, 0.08-0.48) than privately insured children. Overall SVI score was not associated with receiving recommended polysomnography or tonsillectomy. CONCLUSION In our study, children living in areas of greater social vulnerability were less likely to attend their otolaryngology referral appointments for SDB evaluation, as were children of Black race, Hispanic ethnicity, and Medicaid beneficiaries. These results suggest that neighborhood conditions, as well as patient-level factors, influence patient access to SDB care.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - John L Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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25
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Card L, Litwin CM, Curry S, Mack EH, Nietert PJ, Meissner EG. Self-Administered, Remote Assessment of SARS-CoV-2 Seroprevalence in Health Care Workers. Am J Med Sci 2022; 364:281-288. [PMID: 35278364 PMCID: PMC8906004 DOI: 10.1016/j.amjms.2022.01.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/19/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
Background Our objective was to safely and remotely assess longitudinal SARS-CoV-2 seroprevalence in at-risk health care workers at the onset of the epidemic. Methods Self-administered serologic testing was performed every 30 days up to 5 times using a point-of-care, lateral flow SARS-CoV-2 nucleocapsid IgG immunoassay in a cohort of at-risk health care workers (n = 339) and lower-risk controls (n = 100). Results Subjects were enrolled between 4/14/20–5/6/20 and most were clinicians (41%) or nurses (27%). Of 20 subjects who reported confirmed SARS-CoV-2 infection prior to (n = 5, 1%) or during the study (n = 15, 3%), half (10/20) were seropositive. Five additional subjects were seropositive and did not report documented infection. Estimated infection rates in health care workers did not differ from concurrent community rates. Conclusions This remotely conducted, contact-free study did not identify serologic evidence of widespread occupational SARS-CoV-2 infection in health care workers.
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Affiliation(s)
- Lauren Card
- South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Christine M Litwin
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Scott Curry
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth H Mack
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Eric G Meissner
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA; Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA.
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26
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Lauzon SD, Zhao W, Nietert PJ, Ciolino JD, Hill MD, Ramakrishnan V. Impact of minimal sufficient balance, minimization, and stratified permuted blocks on bias and power in the estimation of treatment effect in sequential clinical trials with a binary endpoint. Stat Methods Med Res 2022; 31:184-204. [PMID: 34841963 PMCID: PMC9026574 DOI: 10.1177/09622802211055856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Minimization is among the most common methods for controlling baseline covariate imbalance at the randomization phase of clinical trials. Previous studies have found that minimization does not preserve allocation randomness as well as other methods, such as minimal sufficient balance, making it more vulnerable to allocation predictability and selection bias. Additionally, minimization has been shown in simulation studies to inadequately control serious covariate imbalances when modest biased coin probabilities (≤0.65) are used. This current study extends the investigation of randomization methods to the analysis phase, comparing the impact of treatment allocation methods on power and bias in estimating treatment effects on a binary outcome using logistic regression. Power and bias in the estimation of treatment effect was found to be comparable across complete randomization, minimization, and minimal sufficient balance in unadjusted analyses. Further, minimal sufficient balance was found to have the most modest impact on power and the least bias in covariate-adjusted analyses. The minimal sufficient balance method is recommended for use in clinical trials as an alternative to minimization when covariate-adaptive subject randomization takes place.
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Affiliation(s)
| | - Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Michael D Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
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Dhiman S, Fountain-Zaragoza S, Jensen JH, Falangola MF, McKinnon ET, Moss HG, Thorn KE, Rieter WJ, Spampinato MV, Nietert PJ, Helpern JA, Benitez A. Fiber Ball White Matter Modeling Reveals Microstructural Alterations in Healthy Brain Aging. Aging Brain 2022; 2:100037. [PMID: 36324695 PMCID: PMC9624504 DOI: 10.1016/j.nbas.2022.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Age-related white matter degeneration is characterized by myelin breakdown and neuronal fiber loss that preferentially occur in regions that myelinate later in development. Conventional diffusion MRI (dMRI) has demonstrated age-related increases in diffusivity but provide limited information regarding the tissue-specific changes driving these effects. A recently developed dMRI biophysical modeling technique, Fiber Ball White Matter (FBWM) modeling, offers enhanced biological interpretability by estimating microstructural properties specific to the intra-axonal and extra-axonal spaces. We used FBWM to illustrate the biological mechanisms underlying changes throughout white matter in healthy aging using data from 63 cognitively unimpaired adults ages 45-85 with no radiological evidence of neurodegeneration or incipient Alzheimer's disease. Conventional dMRI and FBWM metrics were computed for two late-myelinating (genu of the corpus callosum and association tracts) and two early-myelinating regions (splenium of the corpus callosum and projection tracts). We examined the associations between age and these metrics in each region and tested whether age was differentially associated with these metrics in late- vs. early-myelinating regions. We found that conventional metrics replicated patterns of age-related increases in diffusivity in late-myelinating regions. FBWM additionally revealed specific intra- and extra-axonal changes suggestive of myelin breakdown and preferential loss of smaller-diameter axons, yielding in vivo corroboration of findings from histopathological studies of aged brains. These results demonstrate that advanced biophysical modeling approaches, such as FBWM, offer novel information about the microstructure-specific alterations contributing to white matter changes in healthy aging. These tools hold promise as sensitive indicators of early pathological changes related to neurodegenerative disease.
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Affiliation(s)
- Siddhartha Dhiman
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanie Fountain-Zaragoza
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Fatima Falangola
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Emilie T McKinnon
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Hunter G Moss
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn E Thorn
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - William J Rieter
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Maria Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph A Helpern
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Andreana Benitez
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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28
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Benitez A, Jensen JH, Falangola MF, Spampinato MV, Rieter WJ, Nietert PJ, Fountain‐Zaragoza S, Keith K, Dhiman S, Helpern JA. Greater diffusion restriction in white matter tracts in preclinical AD. Alzheimers Dement 2021. [DOI: 10.1002/alz.054942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Kahtryn Keith
- Medical University of South Carolina Charleston SC USA
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29
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Pandey JP, Namboodiri AM, Nietert PJ, Barnes LL, Bennett DA. Inhibitory Fcγ Receptor and Paired Immunoglobulin Type 2 Receptor Alpha Genotypes in Alzheimer's Disease. J Alzheimers Dis 2021; 84:965-968. [PMID: 34602489 DOI: 10.3233/jad-215174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated whether FCGRIIB (rs1050501 C/T) and PILRA (rs1859788 A/G) genotypes contributed to the development of Alzheimer's disease (AD). We genotyped 209 African American (AA) and 638 European American (EA) participants for the FCGRIIB and PILRA alleles. In the AA cohort, subjects homozygous for the C allele of FCGRIIB were more than 4 times as likely to develop AD as those homozygous for the alternative T allele. This SNP also interacted with PILRA: participants who were the carriers of the FCGRIIB C allele and PILRA A allele were 3 times as likely to develop AD as those who lacked these alleles.
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Affiliation(s)
- Janardan P Pandey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Aryan M Namboodiri
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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30
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El-Amin N, Lauzon SD, Nietert PJ, Kanter J. Which adults with sickle cell disease need an evaluation for pulmonary embolism? Br J Haematol 2021; 195:447-455. [PMID: 34472094 DOI: 10.1111/bjh.17552] [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: 11/10/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
Individuals living with sickle cell disease (SCD) are at an increased risk of venous thrombo-embolism (VTE) including pulmonary embolisms (PEs). There is a high mortality associated with PE in individuals with SCD. It can be difficult to diagnose PE since presenting symptoms of PE often mimic those of other forms of vaso-occlusive crisis in SCD. Currently, there are no validated models for predicting PEs in patients with sickle cell disease, which often leads to frequent CT scans and exposure to harmful radiation and intravenous contrast. The aim of this study was to evaluate different host variables and potential clinical biomarkers of patients with SCD including those used in the Wells score to assess predictability for PE in order to create a more accurate diagnostic algorithm to predict PE. A retrospective chart review was performed on 349 patients with SCD who underwent testing for a PE with a CT scan of the chest. Forward and backward stepwise model selection was performed to obtain a parsimonious model of the predictors of PEs. The incidence of PE in this population was 9·7%. Of the factors evaluated for this study, the Wells score was the only one with clinical significance. A Wells score greater than 4 had a sensitivity and specificity of 72·5% and 70·1%, respectively, and a score greater than 6 had a sensitivity and specificity of 50% and 87%, respectively. The Wells score is an acceptable clinical tool which may prove useful in individuals with SCD to predict who is most likely to have a PE and therefore should undergo a CT scan. A prospective study is needed to further confirm these findings.
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Affiliation(s)
- Nadirah El-Amin
- Division of Pediatric Hematology-Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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31
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Gilbert M, Goilav B, Hsu JJ, Nietert PJ, Meidan E, Chua A, Ardoin SP, Wenderfer SE, von Scheven E, Ruth NM. Differences in rituximab use between pediatric rheumatologists and nephrologists for the treatment of refractory lupus nephritis and renal flare in childhood-onset SLE. Pediatr Rheumatol Online J 2021; 19:137. [PMID: 34461932 PMCID: PMC8404338 DOI: 10.1186/s12969-021-00627-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Consensus treatment plans have been developed for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in childhood-onset systemic lupus erythematosus. However, patients who do not respond to initial therapy, or who develop renal flare after remission, warrant escalation of treatment. Our objective was to assess current practices of pediatric nephrologists and rheumatologists in North America in treatment of refractory proliferative LN and flare. METHODS Members of Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the American Society for Pediatric Nephrology (ASPN) were surveyed in November 2015 to assess therapy choices (other than modifying steroid dosing) and level of agreement between rheumatologists and nephrologists for proliferative LN patients. Two cases were presented: (1) refractory disease after induction treatment with corticosteroid and cyclophosphamide (CYC) and (2) nephritis flare after initial response to treatment. Survey respondents chose treatments for three follow up scenarios for each case that varied by severity of presentation. Treatment options included CYC, mycophenolate mofetil (MMF), rituximab (RTX), and others, alone or in combination. RESULTS Seventy-six respondents from ASPN and foty-one respondents from CARRA represented approximately 15 % of the eligible members from each organization. Treatment choices between nephrologists and rheumatologists were highly variable and received greater than 50 % agreement for an individual treatment choice in only the following 2 of 6 follow up scenarios: 59 % of nephrologists, but only 38 % of rheumatologists, chose increasing dose of MMF in the case of LN refractory to induction therapy with proteinuria, hematuria, and improved serum creatinine. In a follow up scenario showing severe renal flare after achieving remission with induction therapy, 58 % of rheumatologists chose CYC and RTX combination therapy, whereas the top choice for nephrologists (43 %) was CYC alone. Rheumatologists in comparison to nephrologists chose more therapy options that contained RTX in all follow up scenarios except one (p < 0.05). CONCLUSIONS Therapy choices for pediatric rheumatologists and nephrologists in the treatment of refractory LN or LN flare were highly variable with rheumatologists more often choosing rituximab. Further investigation is necessary to delineate the reasons behind this finding. This study highlights the importance of collaborative efforts in developing consensus treatment plans for pediatric LN.
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Affiliation(s)
- Mileka Gilbert
- Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC, 29425, USA.
| | - Beatrice Goilav
- grid.414114.50000 0004 0566 7955The Children’s Hospital at Montefiore, 111 East 210th Street, Bronx, NY 10467 USA
| | - Joyce J. Hsu
- grid.168010.e0000000419368956Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305 USA
| | - Paul J. Nietert
- grid.259828.c0000 0001 2189 3475Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC 29425 USA
| | - Esra Meidan
- grid.38142.3c000000041936754XHarvard Medical School, 300 Longwood Ave, Boston, MA 02115 USA
| | - Annabelle Chua
- grid.26009.3d0000 0004 1936 7961Duke University, Box 3959, 2301 Erwin Road, Durham, NC 27710 USA
| | - Stacy P. Ardoin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43221 USA
| | - Scott E. Wenderfer
- grid.39382.330000 0001 2160 926XBaylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Emily von Scheven
- grid.266102.10000 0001 2297 6811University of California San Francisco, 550 16th Street, 4th floor, San Francisco, CA 94158 USA
| | - Natasha M. Ruth
- grid.259828.c0000 0001 2189 3475Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC 29425 USA
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32
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Hammad SM, Harden OC, Wilson DA, Twal WO, Nietert PJ, Oates JC. Plasma Sphingolipid Profile Associated With Subclinical Atherosclerosis and Clinical Disease Markers of Systemic Lupus Erythematosus: Potential Predictive Value. Front Immunol 2021; 12:694318. [PMID: 34367153 PMCID: PMC8335560 DOI: 10.3389/fimmu.2021.694318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects females more than males, with African Americans developing more severe manifestation of the disease. SLE patients are at increased risk for cardiovascular disease (CVD), and SLE women 35-44 years old have 50 fold the incidence rate of CVD. Because SLE patients do not follow the typical age and gender pattern for CVD, but instead an accelerated disease course, the traditional biomarkers of elevated LDL and total cholesterol levels do not accurately assess their CVD risk. Recently, we have reported that African American SLE patients had higher ceramide, hexosylceramide, sphingosine and dihydrosphingosine 1-phosphate levels compared to their healthy controls, and those with atherosclerosis had higher sphingomyelin and sphingoid bases levels than those without (PLoS One. 2019; e0224496). In the current study, we sought to identify sphingolipid species that correlate with and pose the potential to predict atherosclerosis severity in African American SLE patients. Plasma samples from a group of African American predominantly female SLE patients with well-defined carotid atherosclerotic plaque burden were analyzed for sphingolipidomics using targeted mass spectroscopy. The data demonstrated that at baseline, plaque area and C3 values correlated inversely with most lactoceramide species. After one-year follow-up visit, values of the change of plaque area correlated positively with the lactoceramide species. There was no correlation between LDL-C concentrations and lactoceramide species. Taken together, lactocylcermide levels may have a ‘predictive’ value and sphingolipidomics have an added benefit to currently available tools in early diagnosis and prognosis of African American SLE patients with CVD.
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Affiliation(s)
- Samar M Hammad
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, SC, United States
| | - Olivia C Harden
- Medical University of South Carolina, Charleston, SC, United States
| | - Dulaney A Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Waleed O Twal
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, SC, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jim C Oates
- Department of Medicine, Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, United States.,Medical Service, Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
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33
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Ciolino JD, Spino C, Ambrosius WT, Khalatbari S, Cayetano SM, Lapidus JA, Nietert PJ, Oster RA, Perkins SM, Pollock BH, Pomann GM, Price LL, Rice TW, Tosteson TD, Lindsell CJ, Spratt H. Guidance for biostatisticians on their essential contributions to clinical and translational research protocol review. J Clin Transl Sci 2021; 5:e161. [PMID: 34527300 PMCID: PMC8427547 DOI: 10.1017/cts.2021.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022] Open
Abstract
Rigorous scientific review of research protocols is critical to making funding decisions, and to the protection of both human and non-human research participants. Given the increasing complexity of research designs and data analysis methods, quantitative experts, such as biostatisticians, play an essential role in evaluating the rigor and reproducibility of proposed methods. However, there is a common misconception that a statistician's input is relevant only to sample size/power and statistical analysis sections of a protocol. The comprehensive nature of a biostatistical review coupled with limited guidance on key components of protocol review motived this work. Members of the Biostatistics, Epidemiology, and Research Design Special Interest Group of the Association for Clinical and Translational Science used a consensus approach to identify the elements of research protocols that a biostatistician should consider in a review, and provide specific guidance on how each element should be reviewed. We present the resulting review framework as an educational tool and guideline for biostatisticians navigating review boards and panels. We briefly describe the approach to developing the framework, and we provide a comprehensive checklist and guidance on review of each protocol element. We posit that the biostatistical reviewer, through their breadth of engagement across multiple disciplines and experience with a range of research designs, can and should contribute significantly beyond review of the statistical analysis plan and sample size justification. Through careful scientific review, we hope to prevent excess resource expenditure and risk to humans and animals on poorly planned studies.
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Affiliation(s)
- Jody D. Ciolino
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cathie Spino
- Department of Biostatistics, University of Michigan, Washington Heights, Ann Arbor, MI, USA
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Shokoufeh Khalatbari
- Michigan Institute for Clinical & Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | | | - Jodi A. Lapidus
- School of Public Health, Oregon Health & Sciences University, Portland, OR, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, UK
| | - Susan M. Perkins
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA
| | - Gina-Maria Pomann
- Duke Biostatistics, Epidemiology and Research Design (BERD) Methods Core, Duke University, Durham, NC, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Todd W. Rice
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Medical Director, Vanderbilt Human Research Protections Program, Vice-President for Clinical Trials Innovation and Operations, Nashville, TN, USA
| | - Tor D. Tosteson
- Department of Biomedical Data Science, Division of Biostatistics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Heidi Spratt
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Pandey JP, Namboodiri AM, Nietert PJ, Knowles MR, Pace RG, Pier GB. Immunoglobulin GM and KM allotypes are associated with antibody responses to Pseudomonas aeruginosa antigens in chronically infected cystic fibrosis patients. J Cyst Fibros 2021; 20:1080-1084. [PMID: 34246573 DOI: 10.1016/j.jcf.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/25/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chronic infection with Pseudomonas aeruginosa (P. aeruginosa) is a leading cause of death in patients with cystic fibrosis (CF). Immunobiology of P. aeruginosa infection is complex and not well understood. Chronically infected CF patients generate high levels of antibodies to P. aeruginosa, but this response does not lead to clinical improvement. Therefore, additional studies aimed at identification and understanding of the host factors that influence naturally occurring immune responses to P. aeruginosa are needed. In this investigation, we evaluated the contribution of immunoglobulin GM (γ marker) and KM (κ marker) allotypes to the antibody responses to P. aeruginosa lipopolysaccharide (LPS) O1, O6, O11, and alginate antigens and the broadly-conserved surface polysaccharide expressed by many microbial pathogens, poly-N-acetyl-D-glucosamine (PNAG), in 58 chronically infected CF patients. METHODS IgG1 markers GM 3 and 17 and IgG2 markers GM 23- and 23+ were determined by a pre-designed TaqMan® genotyping assay. The κ chain determinants KM 1 and 3 were characterized by PCR-RFLP. Antibodies to the LPS O antigens, alginate, and PNAG were measured by an ELISA. RESULTS Several significant associations were noted with KM alleles. Particular KM 1/3 genotypes were individually and epistatically (with GM 3/17) associated with the level of IgG antibodies to O1, O11, alginate, and PNAG antigens. CONCLUSIONS Immunoglobulin GM and KM genotypes influence the magnitude of humoral immunity to LPS O, alginate, and PNAG antigens. These results, if confirmed in a larger study population, will be helpful in devising novel immunotherapeutic approaches against P. aeruginosa.
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Affiliation(s)
- Janardan P Pandey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States.
| | - Aryan M Namboodiri
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute and Cystic Fibrosis Research Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Rhonda G Pace
- Department of Medicine, Marsico Lung Institute and Cystic Fibrosis Research Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Gerald B Pier
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, United States
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35
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Falangola MF, Nie X, Ward R, Dhiman S, Voltin J, Nietert PJ, Jensen JH. Diffusion MRI detects basal forebrain cholinergic abnormalities in the 3xTg-AD mouse model of Alzheimer's disease. Magn Reson Imaging 2021; 83:1-13. [PMID: 34229088 DOI: 10.1016/j.mri.2021.06.022] [Citation(s) in RCA: 4] [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: 03/16/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
Degeneration of the basal forebrain (BF) is detected early in the course of Alzheimer's disease (AD). Reduction in the number of BF cholinergic (ChAT) neurons associated with age-related hippocampal cholinergic neuritic dystrophy is described in the 3xTg-AD mouse model; however, no prior diffusion MRI (dMRI) study has explored the presence of BF alterations in this model. Here we investigated the ability of diffusion MRI (dMRI) to detect abnormalities in BF microstructure for the 3xTg-AD mouse model, along with related pathology in the hippocampus (HP) and white matter (WM) tracks comprising the septo-hippocampal pathway. 3xTg-AD and normal control (NC) mice were imaged in vivo using the specific dMRI technique known as diffusional kurtosis imaging (DKI) at 2, 8, and 15 months of age, and 8 dMRI parameters were measured at each time point. Our results revealed significant lower dMRI values in the BF of 2 months-old 3xTg-AD mice compared with NC mice, most likely related to the increased number of ChAT neurons seen in this AD mouse model at this age. They also showed significant age-related dMRI changes in the BF of both groups between 2 and 8 months of age, mainly a decrease in fractional anisotropy and axial diffusivity, and an increase in radial kurtosis. These dMRI changes in the BF may be reflecting the complex aging and pathological microstructural changes described in this region. Group differences and age-related changes were also observed in the HP, fimbria (Fi) and fornix (Fx). In the HP, diffusivity values were significantly higher in the 2 months-old 3xTg-AD mice, and the HP of NC mice showed a significant increase in axial kurtosis after 8 months, reflecting a normal pattern of increased fiber density complexity, which was not seen in the 3xTg-AD mice. In the Fi, mean and radial diffusivity values were significantly higher, and fractional anisotropy, radial kurtosis and kurtosis fractional anisotropy were significantly lower in the 2 months-old 3xTg-AD mice. The age trajectories for both NC and TG mice in the Fi and Fx were similar between 2 and 8 months, but after 8 months there was a significant decrease in diffusivity metrics associated with an increase in kurtosis metrics in the 3xTg-AD mice. These later HP, Fi and Fx dMRI changes probably reflect the growing number of dystrophic neurites and AD pathology progression in the HP, accompanied by WM disruption in the septo-hippocampal pathway. Our results demonstrate that dMRI can detect early cytoarchitectural abnormalities in the BF, as well as related aging and neurodegenerative changes in the HP, Fi and Fx of the 3xTg-AD mice. Since DKI is widely available on clinical scanners, these results also support the potential of the considered dMRI parameters as in vivo biomarkers for AD disease progression.
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Affiliation(s)
- Maria Fatima Falangola
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA.
| | - Xingju Nie
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Ralph Ward
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Siddhartha Dhiman
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua Voltin
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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36
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Pandey JP, Nietert PJ, Kothera RT, Barnes LL, Bennett DA. Interactive Effects of HLA and GM Alleles on the Development of Alzheimer Disease. Neurol Genet 2021; 7:e565. [PMID: 33898740 PMCID: PMC8063623 DOI: 10.1212/nxg.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated whether particular immunoglobulin GM (γ marker) alleles-individually or epistatically with a known human leukocyte antigen (HLA) risk allele-were associated with the development of Alzheimer disease (AD). METHODS Using a prospective cohort study design, we genotyped DNA samples from 209 African American (AA) and 638 European American (EA) participants for IgG1 (GM 3 and GM 17), IgG2 (GM 23+ and GM 23-), and HLA-DRB1 rs9271192 (A/C) alleles by TaqMan and rhAMP genotyping assays. RESULTS In EA subjects, none of the GM or HLA alleles-individually or epistatically-were associated with time to development of AD. In AA subjects, GM and HLA alleles individually were not associated with time to development of AD. However, there was a significant interaction: In the presence of GM 3 (i.e., GM 3/3 and GM 3/17 subjects), the presence of the HLA-C allele was associated with a 4-fold increase in the likelihood of developing AD compared with its absence (hazard ratio [HR] 4.17, 95% CI, 1.28-13.58). In the absence of GM 3 (GM 17/17 subjects), however, the presence of the HLA-C allele was not associated with time to development of AD (HR 1.10, 95% CI, 0.50-2.41). CONCLUSIONS These results show that particular GM and HLA alleles epistatically contribute to the development of AD.
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Affiliation(s)
- Janardan P. Pandey
- From the Department of Microbiology and Immunology (J.P.P., R.T.K.) and Department of Public Health, Sciences (P.J.N.), Medical University of South Carolina, Charleston; and Rush Alzheimer's Disease Center (L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL
| | - Paul J. Nietert
- From the Department of Microbiology and Immunology (J.P.P., R.T.K.) and Department of Public Health, Sciences (P.J.N.), Medical University of South Carolina, Charleston; and Rush Alzheimer's Disease Center (L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL
| | - Ronald T. Kothera
- From the Department of Microbiology and Immunology (J.P.P., R.T.K.) and Department of Public Health, Sciences (P.J.N.), Medical University of South Carolina, Charleston; and Rush Alzheimer's Disease Center (L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL
| | - Lisa L. Barnes
- From the Department of Microbiology and Immunology (J.P.P., R.T.K.) and Department of Public Health, Sciences (P.J.N.), Medical University of South Carolina, Charleston; and Rush Alzheimer's Disease Center (L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL
| | - David A. Bennett
- From the Department of Microbiology and Immunology (J.P.P., R.T.K.) and Department of Public Health, Sciences (P.J.N.), Medical University of South Carolina, Charleston; and Rush Alzheimer's Disease Center (L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL
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Yan F, Levy DA, Wen CC, Melvin CL, Ford ME, Nietert PJ, Pecha PP. Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2021; 166:1127-1133. [PMID: 33648386 DOI: 10.1177/0194599821993383] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). STUDY DESIGN Retrospective cohort study. SETTING Tertiary children's hospital. METHODS A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. RESULTS In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance (P < .001) and had a median driving distance of 74.8 vs 16.8 miles (P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). CONCLUSION Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dylan A Levy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Davis ML, Neelon B, Nietert PJ, Burgette LF, Hunt KJ, Lawson AB, Egede LE. Propensity score matching for multilevel spatial data: accounting for geographic confounding in health disparity studies. Int J Health Geogr 2021; 20:10. [PMID: 33639940 PMCID: PMC7913404 DOI: 10.1186/s12942-021-00265-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes is a public health burden that disproportionately affects military veterans and racial minorities. Studies of racial disparities are inherently observational, and thus may require the use of methods such as Propensity Score Analysis (PSA). While traditional PSA accounts for patient-level factors, this may not be sufficient when patients are clustered at the geographic level and thus important confounders, whether observed or unobserved, vary by geographic location. METHODS We employ a spatial propensity score matching method to account for "geographic confounding", which occurs when the confounding factors, whether observed or unobserved, vary by geographic region. We augment the propensity score and outcome models with spatial random effects, which are assigned scaled Besag-York-Mollié priors to address spatial clustering and improve inferences by borrowing information across neighboring geographic regions. We apply this approach to a study exploring racial disparities in diabetes specialty care between non-Hispanic black and non-Hispanic white veterans. We construct multiple global estimates of the risk difference in diabetes care: a crude unadjusted estimate, an estimate based solely on patient-level matching, and an estimate that incorporates both patient and spatial information. RESULTS In simulation we show that in the presence of an unmeasured geographic confounder, ignoring spatial heterogeneity results in increased relative bias and mean squared error, whereas incorporating spatial random effects improves inferences. In our study of racial disparities in diabetes specialty care, the crude unadjusted estimate suggests that specialty care is more prevalent among non-Hispanic blacks, while patient-level matching indicates that it is less prevalent. Hierarchical spatial matching supports the latter conclusion, with a further increase in the magnitude of the disparity. CONCLUSIONS These results highlight the importance of accounting for spatial heterogeneity in propensity score analysis, and suggest the need for clinical care and management strategies that are culturally sensitive and racially inclusive.
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Affiliation(s)
- Melanie L. Davis
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
| | - Brian Neelon
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | | | - Kelly J. Hunt
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, US
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Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, Shaffer JA, Bolton T, Spackman S, Wassertheil-Smoller S, Kee F, Amouyel P, Shea SJ, Kuller LH, Kauhanen J, van Zutphen EM, Blazer DG, Krumholz H, Nietert PJ, Kromhout D, Laughlin G, Berkman L, Wallace RB, Simons LA, Dennison EM, Barr ELM, Meyer HE, Wood AM, Danesh J, Di Angelantonio E, Davidson KW. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA 2020; 324:2396-2405. [PMID: 33320224 PMCID: PMC7739139 DOI: 10.1001/jama.2020.23068] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
Importance It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs). Objective To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood. Design, Setting, and Participants A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline. Exposures Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder). Main Outcomes and Measures Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported. Results Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors. Conclusions and Relevance In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.
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Affiliation(s)
- Eric L. Harshfield
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York
- Applied Behavioral Medicine Research Institute, Stony Brook University, Stony Brook, New York
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Thomas Bolton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Spackman
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Frank Kee
- Centre for Public Health, Queens University, Belfast, United Kingdom
| | | | - Steven J. Shea
- Columbia Field Center, Columbia University, New York, New York
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - E. M. van Zutphen
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC at VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC at VU University Medical Center, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Dan G. Blazer
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | | | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina
| | - Daan Kromhout
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Gail Laughlin
- Family Medicine & Public Health, University of California, San Diego
| | - Lisa Berkman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health
| | | | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | | | - Angela M. Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Karina W. Davidson
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
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Awe O, Sinkway JM, Chow RP, Wagener Q, Schulz EV, Yu JY, Nietert PJ, Wagner CL, Lee KH. Differential regulation of a placental SAM68 and sFLT1 gene pathway and the relevance to maternal vitamin D sufficiency. Pregnancy Hypertens 2020; 22:196-203. [PMID: 33068876 PMCID: PMC7688503 DOI: 10.1016/j.preghy.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine if an axis of placental gene expression associated with early onset and severe preeclampsia (EOSPE) was operative in term pregnancy and correlated with vitamin D sufficiency. METHODS qPCR analysis of NKX2-5, SAM68, sFLT1 and membrane bound VEGFR1/FLT1 mRNA expression was conducted in placentas from 43 subjects enrolled in a vitamin D3 pregnancy supplementation trial. Pair-wise rank order correlations between patient-specific gene expression levels were calculated, and their relationship to maternal 25(OH)D status was assessed by a two-sample Wilcoxon test. Additionally, we probed the mechanistic link between SAM68 and sFLT1 using siRNA depletion in a human trophoblast cell line model. RESULTS Positive and highly significant correlations were found between SAM68 vs. sFLT1 and SAM68 vs. FLT1 expression levels, as were significant and differential correlations between the expression of these genes and perinatal 25(OH)D status. The variability when stratified by race/ethnicity was qualitatively distinct from those previously observed in EOSPE. Mechanistic studies confirmed a functional role for SAM68 protein in the regulation of sFLT1 expression. NKX2-5 expression was not significantly correlated with sFLT1 or SAM68 expression in these samples, suggesting that its expression may be significant at earlier stages of pregnancy or be restricted to pathological settings. CONCLUSIONS These data further support our overarching hypothesis that SAM68 expression is a key determinant of VEGFR1 isoform expression in the placenta, and provide additional insights into how this gene pathway may be differentially deployed or modified in normal and pathological pregnancies.
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Affiliation(s)
- Oyindamola Awe
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - James M Sinkway
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Rebecca P Chow
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Quentell Wagener
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Elizabeth V Schulz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Jeremy Y Yu
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Kyu-Ho Lee
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States; Regenerative Medicine and Cell Biology Department, Medical University of South Carolina, Charleston, SC 29425, United States; Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Falangola MF, Nie X, Ward R, McKinnon ET, Dhiman S, Nietert PJ, Helpern JA, Jensen JH. Diffusion MRI detects early brain microstructure abnormalities in 2-month-old 3×Tg-AD mice. NMR Biomed 2020; 33:e4346. [PMID: 32557874 PMCID: PMC7683375 DOI: 10.1002/nbm.4346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
The 3×Tg-AD mouse is one of the most studied animal models of Alzheimer's disease (AD), and develops both amyloid beta deposits and neurofibrillary tangles in a temporal and spatial pattern that is similar to human AD pathology. Additionally, abnormal myelination patterns with changes in oligodendrocyte and myelin marker expression are reported to be an early pathological feature in this model. Only few diffusion MRI (dMRI) studies have investigated white matter abnormalities in 3×Tg-AD mice, with inconsistent results. Thus, the goal of this study was to investigate the sensitivity of dMRI to capture brain microstructural alterations in 2-month-old 3×Tg-AD mice. In the fimbria, the fractional anisotropy (FA), kurtosis fractional anisotropy (KFA), and radial kurtosis (K┴ ) were found to be significantly lower in 3×Tg-AD mice than in controls, while the mean diffusivity (MD) and radial diffusivity (D┴ ) were found to be elevated. In the fornix, K┴ was lower for 3×Tg-AD mice; in the dorsal hippocampus MD and D┴ were elevated, as were FA, MD, and D┴ in the ventral hippocampus. These results indicate, for the first time, dMRI changes associated with myelin abnormalities in young 3×Tg-AD mice, before they develop AD pathology. Morphological quantification of myelin basic protein immunoreactivity in the fimbria was significantly lower in the 3×Tg-AD mice compared with the age-matched controls. Our results demonstrate that dMRI is able to detect widespread, significant early brain morphological abnormalities in 2-month-old 3×Tg-AD mice.
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Affiliation(s)
- Maria Fatima Falangola
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, US
| | - Xingju Nie
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, US
| | - Ralph Ward
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, US
| | - Emilie T McKinnon
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Siddhartha Dhiman
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, US
| | - Joseph A Helpern
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, US
| | - Jens H Jensen
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina, US
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, US
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, US
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Oster RA, Devick KL, Thurston SW, Larson JJ, Welty LJ, Nietert PJ, Pollock BH, Pomann GM, Spratt H, Lindsell CJ, Enders FT. Learning gaps among statistical competencies for clinical and translational science learners. J Clin Transl Sci 2020; 5:e12. [PMID: 33948238 PMCID: PMC8057376 DOI: 10.1017/cts.2020.498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Statistical literacy is essential in clinical and translational science (CTS). Statistical competencies have been published to guide coursework design and selection for graduate students in CTS. Here, we describe common elements of graduate curricula for CTS and identify gaps in the statistical competencies. METHODS We surveyed statistics educators using e-mail solicitation sent through four professional organizations. Respondents rated the degree to which 24 educational statistical competencies were included in required and elective coursework in doctoral-level and master's-level programs for CTS learners. We report competency results from institutions with Clinical and Translational Science Awards (CTSAs), reflecting institutions that have invested in CTS training. RESULTS There were 24 CTSA-funded respondents representing 13 doctoral-level programs and 23 master's-level programs. For doctoral-level programs, competencies covered extensively in required coursework for all doctoral-level programs were basic principles of probability and hypothesis testing, understanding the implications of selecting appropriate statistical methods, and computing appropriate descriptive statistics. The only competency extensively covered in required coursework for all master's-level programs was understanding the implications of selecting appropriate statistical methods. The least covered competencies included understanding the purpose of meta-analysis and the uses of early stopping rules in clinical trials. Competencies considered to be less fundamental and more specialized tended to be covered less frequently in graduate courses. CONCLUSION While graduate courses in CTS tend to cover many statistical fundamentals, learning gaps exist, particularly for more specialized competencies. Educational material to fill these gaps is necessary for learners pursuing these activities.
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Affiliation(s)
- Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katrina L. Devick
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Sally W. Thurston
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Joseph J. Larson
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Leah J. Welty
- Department of Preventive Medicine – Biostatistics, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Heidi Spratt
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Felicity T. Enders
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Lauzon SD, Ramakrishnan V, Nietert PJ, Ciolino JD, Hill MD, Zhao W. Statistical properties of minimal sufficient balance and minimization as methods for controlling baseline covariate imbalance at the design stage of sequential clinical trials. Stat Med 2020; 39:2506-2517. [PMID: 32363614 DOI: 10.1002/sim.8552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 01/21/2023]
Abstract
When the number of baseline covariates whose imbalance needs to be controlled in a sequential randomized controlled trial is large, minimization is the most commonly used method for randomizing treatment assignments. The lack of allocation randomness associated with the minimization method has been the source of controversy, and the need to reduce even minor imbalances inherent in the minimization method has been challenged. The minimal sufficient balance (MSB) method is an alternative to the minimization method. It prevents serious imbalance from a large number of covariates while maintaining a high level of allocation randomness. In this study, the two treatment allocation methods are compared with regards to the effectiveness of balancing covariates across treatment arms and allocation randomness in equal allocation clinical trials. The MSB method proves to be equal or superior in both respects. In addition, type I error rate is preserved in analyses for both balancing methods, when using a binary endpoint.
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Affiliation(s)
- Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael D Hill
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Wenle Zhao
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Litvin CB, Nietert PJ, Jenkins RG, Wessell AM, Nemeth LS, Ornstein SM. Translating CKD Research into Primary Care Practice: a Group-Randomized Study. J Gen Intern Med 2020; 35:1435-1443. [PMID: 31823314 PMCID: PMC7210359 DOI: 10.1007/s11606-019-05353-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed. OBJECTIVE To assess whether implementation of a primary care improvement model results in improved identification and management of CKD DESIGN: 18-month group-randomized study PARTICIPANTS: 21 primary care practices in 13 US states caring for 107,094 patients INTERVENTIONS: To promote implementation of CKD improvement strategies, intervention practices received clinical quality measure (CQM) reports at least quarterly, hosted an on-site visit and 2 webinars, and sent clinician/staff representatives to a "best practice" meeting. Control practices received CQM reports at least quarterly. MAIN MEASURES Changes in practice adherence to a set of 11 CKD CQMs KEY RESULTS: We observed significantly greater improvements among intervention practices for annual screening for albuminuria in patients with diabetes or hypertension (absolute change 22% in the intervention group vs. - 2.6% in the control group, p < 0.0001) and annual monitoring for albuminuria in patients with CKD (absolute change 21% in the intervention group vs. - 2.0% in the control group, p < 0.0001). Avoidance of NSAIDs in patients with CKD declined in both intervention and control groups, with a significantly greater decline in the control practices (absolute change - 5.0% in the intervention group vs. - 10% in the control group, p < 0.0001). There were no other significant changes found for the other CQMs. Variable implementation of CKD improvement strategies was noted across the intervention practices. CONCLUSIONS Implementation of a primary care improvement model designed to improve CKD identification and management resulted in significantly improved care on 3 out of 11 CQMs. Incomplete adoption of improvement strategies may have limited further improvement. Improving CKD identification and management likely requires a longer and more intensive intervention.
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Affiliation(s)
- Cara B Litvin
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ruth G Jenkins
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea M Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Steven M Ornstein
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
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Affiliation(s)
- D R Roberts
- Department of Radiology and Radiological Science
| | - D Asemani
- Department of Radiology and Radiological Science
| | | | - M A Eckert
- Department of Otolaryngology-Head and Neck Surgery
| | - D C Inglesby
- Department of Radiology and Radiological ScienceMedical University of South CarolinaCharleston, South Carolina
| | - J J Bloomberg
- Neurosciences LaboratoryNASA Johnson Space CenterHouston, Texas
| | - M S George
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaRalph H. Johnson VA Medical CenterCharleston, South Carolina
| | - T R Brown
- Department of Radiology and Radiological ScienceMedical University of South CarolinaCharleston, South Carolina
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Roberts DR, Asemani D, Nietert PJ, Eckert MA, Inglesby DC, Bloomberg JJ, George MS, Brown TR. Reply. AJNR Am J Neuroradiol 2020; 41:E8. [PMID: 31948950 DOI: 10.3174/ajnr.a6400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D R Roberts
- Department of Radiology and Radiological Science
| | - D Asemani
- Department of Radiology and Radiological Science
| | | | - M A Eckert
- Department of Otolaryngology - Head and Neck Surgery
| | - D C Inglesby
- Department of Radiology and Radiological ScienceMedical University of South CarolinaCharleston, South Carolina
| | - J J Bloomberg
- Neurosciences LaboratoryNASA Johnson Space CenterHouston, Texas
| | - M S George
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharleston, South CarolinaRalph H. Johnson VA Medical CenterCharleston, South Carolina
| | - T R Brown
- Department of Radiology and Radiological ScienceMedical University of South CarolinaCharleston, South Carolina
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Wang H, Gou W, Strange C, Wang J, Nietert PJ, Cloud C, Owzarski S, Shuford B, Duke T, Luttrell L, Lesher A, Papas KK, Herold KC, Clark P, Usmani-Brown S, Kitzmann J, Crosson C, Adams DB, Morgan KA. Islet Harvest in Carbon Monoxide-Saturated Medium for Chronic Pancreatitis Patients Undergoing Islet Autotransplantation. Cell Transplant 2019; 28:25S-36S. [PMID: 31885286 PMCID: PMC7016471 DOI: 10.1177/0963689719890596] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Stresses encountered during human islet isolation lead to unavoidable β-cell death after transplantation. This reduces the chance of insulin independence in chronic pancreatitis patients undergoing total pancreatectomy and islet autotransplantation. We tested whether harvesting islets in carbon monoxide-saturated solutions is safe and can enhance islet survival and insulin independence after total pancreatectomy and islet autotransplantation. Chronic pancreatitis patients who consented to the study were randomized into carbon monoxide (islets harvested in a carbon monoxide-saturated medium) or control (islets harvested in a normal medium) groups. Islet yield, viability, oxygen consumption rate, β-cell death (measured by unmethylated insulin DNA), and serum cytokine levels were measured during the peri-transplantation period. Adverse events, metabolic phenotypes, and islet function were measured prior and at 6 months post-transplantation. No adverse events directly related to the infusion of carbon monoxide islets were observed. Carbon monoxide islets showed significantly higher viability before transplantation. Subjects receiving carbon monoxide islets had less β-cell death, decreased CCL23, and increased CXCL12 levels at 1 or 3 days post transplantation compared with controls. Three in 10 (30%) of the carbon monoxide subjects and none of the control subjects were insulin independent. This pilot trial showed for the first time that harvesting human islets in carbon monoxide-saturated solutions is safe for total pancreatectomy and islet autotransplantation patients.
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Affiliation(s)
- Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Wenyu Gou
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Charlie Strange
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jingjing Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Colleen Cloud
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Stefanie Owzarski
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Betsy Shuford
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Tara Duke
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Louis Luttrell
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kevan C. Herold
- Department of Immunology, Yale University, New Haven, CT, USA
| | - Pamela Clark
- Department of Immunology, Yale University, New Haven, CT, USA
| | | | | | - Craig Crosson
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David B. Adams
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine A. Morgan
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Hammad SM, Hardin JR, Wilson DA, Twal WO, Nietert PJ, Oates JC. Race disparity in blood sphingolipidomics associated with lupus cardiovascular comorbidity. PLoS One 2019; 14:e0224496. [PMID: 31747417 PMCID: PMC6867606 DOI: 10.1371/journal.pone.0224496] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
Systemic lupus erythematous (SLE) is a chronic multi-organ autoimmune disease. Genetic and environmental factors contribute to disease onset and severity. Sphingolipids are signaling molecules involved in regulating cell functions and have been associated with multiple genetic disease processes. African-Americans are more likely to suffer from SLE morbidity than Whites. The Medical University of South Carolina has banked plasma samples from a well-characterized lupus cohort that includes African-Americans and Whites. This study examined the influence of race on plasma sphingolipid profiles in SLE patients and association of sphingolipid levels with comorbid atherosclerosis and SLE disease activity. Mass spectrometry revealed that healthy African-Americans had higher sphingomyelin levels and lower lactosylcermide levels compared to healthy Whites. SLE patients, irrespective of race, had higher levels of ceramides, and sphingoid bases (sphingosine and dihydrosphingosine) and their phosphates compared to healthy subjects. Compared to African-American controls, African-American SLE patients had higher levels of ceramides, hexosylceramides, sphingosine and dihydrosphingosine 1-phosphate. Compared to White controls, White SLE patients exhibited higher levels of sphingoid bases and their phosphates, but lower ratios of C16:0 ceramide/sphingosine 1-phosphate and C24:1 ceramide/sphingosine 1-phosphate. White SLE patients with atherosclerosis exhibited lower levels of sphingoid bases compared to White SLE patients without atherosclerosis. In contrast, African-American SLE patients with atherosclerosis had higher levels of sphingoid bases and sphingomyelins compared to African-American SLE patients without atherosclerosis. Compared to White SLE patients with atherosclerosis, African-American SLE patients with atherosclerosis had higher levels of select sphingolipids. Plasma levels of sphingosine, C16:0 ceramide/sphingosine 1-phosphate ratio and C24:1 ceramide/sphingosine 1-phosphate ratio significantly correlated with SLEDAI in the African-American but not White SLE patients. The C16:0 ceramide/sphingosine 1-phosphate ratio in SLE patients, and levels of C18:1 and C26:1 lactosylcermides, C20:0 hexosylceramide, and sphingoid bases in SLE patients with atherosclerosis could be dependent on race. Further ethnic studies in SLE cohorts are necessary to verify use of sphingolipidomics as complementary diagnostic tool.
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Affiliation(s)
- Samar M. Hammad
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jasmyn R. Hardin
- College of Graduate Studies/Summer Undergraduate Research Program, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Waleed O. Twal
- Department of Regenerative Medicine & Cell Biology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - James C. Oates
- Department of Medicine, Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
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Roberts DR, Asemani D, Nietert PJ, Eckert MA, Inglesby DC, Bloomberg JJ, George MS, Brown TR. Prolonged Microgravity Affects Human Brain Structure and Function. AJNR Am J Neuroradiol 2019; 40:1878-1885. [PMID: 31624117 PMCID: PMC6975111 DOI: 10.3174/ajnr.a6249] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 06/02/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Widespread brain structural changes are seen following extended spaceflight missions. The purpose of this study was to investigate whether these structural changes are associated with alterations in motor or cognitive function. MATERIALS AND METHODS Brain MR imaging scans of National Aeronautics and Space Administration astronauts were retrospectively analyzed to quantify pre- to postflight changes in brain structure. Local structural changes were assessed using the Jacobian determinant. Structural changes were compared with clinical findings and cognitive and motor function. RESULTS Long-duration spaceflights aboard the International Space Station, but not short-duration Space Shuttle flights, resulted in a significant increase in total ventricular volume (10.7% versus 0%, P < .001, n = 12 versus n = 7). Total ventricular volume change was significantly associated with mission duration (r = 0.72, P = .001, n = 19) but negatively associated with age (r = -0.48, P = .048, n = 19). Long-duration spaceflights resulted in significant crowding of brain parenchyma at the vertex. Pre- to postflight structural changes of the left caudate correlated significantly with poor postural control; and the right primary motor area/midcingulate correlated significantly with a complex motor task completion time. Change in volume of 3 white matter regions significantly correlated with altered reaction times on a cognitive performance task (bilateral optic radiations, splenium of the corpus callosum). In a post hoc finding, astronauts who developed spaceflight-associated neuro-ocular syndrome demonstrated smaller changes in total ventricular volume than those who did not (12.8% versus 6.5%, n = 8 versus n = 4). CONCLUSIONS While cautious interpretation is appropriate given the small sample size and number of comparisons, these findings suggest that brain structural changes are associated with changes in cognitive and motor test scores and with the development of spaceflight-associated neuro-optic syndrome.
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Affiliation(s)
- D R Roberts
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
- Department of Neurosciences (D.R.R.)
| | - D Asemani
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
| | | | - M A Eckert
- Otolaryngology-Head and Neck Surgery (M.A.E.)
| | - D C Inglesby
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
| | - J J Bloomberg
- Neurosciences Laboratory (J.J.B.), NASA Johnson Space Center, Houston, Texas
| | - M S George
- Psychiatry and Behavioral Sciences (M.S.G.), Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson VA Medical Center (M.S.G.), Charleston, South Carolina
| | - T R Brown
- From the Departments of Radiology and Radiological Science (D.R.R., D.A., D.I., T.R.B.)
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Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, Riley LM, Savin S, Khan T, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens JW, Björkelund C, Blaha M, Blazer DG, Bolton T, Bonita Beaglehole R, Brenner H, Brunner EJ, Casiglia E, Chamnan P, Choi YH, Chowdry R, Coady S, Crespo CJ, Cushman M, Dagenais GR, D'Agostino Sr RB, Daimon M, Davidson KW, Engström G, Ford I, Gallacher J, Gansevoort RT, Gaziano TA, Giampaoli S, Grandits G, Grimsgaard S, Grobbee DE, Gudnason V, Guo Q, Tolonen H, Humphries S, Iso H, Jukema JW, Kauhanen J, Kengne AP, Khalili D, Koenig W, Kromhout D, Krumholz H, Lam TH, Laughlin G, Marín Ibañez A, Meade TW, Moons KGM, Nietert PJ, Ninomiya T, Nordestgaard BG, O'Donnell C, Palmieri L, Patel A, Perel P, Price JF, Providencia R, Ridker PM, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schöttker B, Shara N, Shaw JE, Shin HC, Simons LA, Sofianopoulou E, Sundström J, Völzke H, Wallace RB, Wareham NJ, Willeit P, Wood D, Wood A, Zhao D, Woodward M, Danaei G, Roth G, Mendis S, Onuma O, Varghese C, Ezzati M, Graham I, Jackson R, Danesh J, Di Angelantonio E. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health 2019; 7:e1332-e1345. [PMID: 31488387 PMCID: PMC7025029 DOI: 10.1016/s2214-109x(19)30318-3] [Citation(s) in RCA: 449] [Impact Index Per Article: 89.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 07/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.
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