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Lee JK, Jensen CD, Udaltsova N, Zheng Y, Levin TR, Chubak J, Kamineni A, Halm EA, Skinner CS, Schottinger JE, Ghai NR, Burnett-Hartman A, Issaka R, Corley DA. Predicting Risk of Colorectal Cancer After Adenoma Removal in a Large Community-Based Setting. Am J Gastroenterol 2024:00000434-990000000-01034. [PMID: 38354214 DOI: 10.14309/ajg.0000000000002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Colonoscopy surveillance guidelines categorize individuals as high or low risk for future colorectal cancer (CRC) based primarily on their prior polyp characteristics, but this approach is imprecise, and consideration of other risk factors may improve postpolypectomy risk stratification. METHODS Among patients who underwent a baseline colonoscopy with removal of a conventional adenoma in 2004-2016, we compared the performance for postpolypectomy CRC risk prediction (through 2020) of a comprehensive model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and prior polyp findings (i.e., adenoma with advanced histology, polyp size ≥10 mm, and sessile serrated adenoma or traditional serrated adenoma) with a polyp model featuring only polyp findings. Models were developed using Cox regression. Performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit test. RESULTS Among 95,001 patients randomly divided 70:30 into model development (n = 66,500) and internal validation cohorts (n = 28,501), 495 CRC were subsequently diagnosed; 354 in the development cohort and 141 in the validation cohort. Models demonstrated adequate calibration, and the comprehensive model demonstrated superior predictive performance to the polyp model in the development cohort (AUC 0.71, 95% confidence interval [CI] 0.68-0.74 vs AUC 0.61, 95% CI 0.58-0.64, respectively) and validation cohort (AUC 0.70, 95% CI 0.65-0.75 vs AUC 0.62, 95% CI 0.57-0.67, respectively). DISCUSSION A comprehensive CRC risk prediction model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and polyp findings was more accurate at predicting postpolypectomy CRC diagnosis than a model based on polyp findings alone.
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Affiliation(s)
- Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Christopher D Jensen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Theodore R Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Ethan A Halm
- Rutgers Biological Health Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Celette S Skinner
- Simmons Comprehensive Cancer Center and Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joanne E Schottinger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Nirupa R Ghai
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena, California, USA
| | | | - Rachel Issaka
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Sims AM, Bonsu KO, Urbonya R, Farooq F, Tavernier F, Yamamoto M, VanOmen S, Halford B, Gorodinsky P, Issaka R, Kpadenou T, Douglas R, Wilson S, Fu C, Canter D, Martin D, Novarra A, Graham L, Sey F, Antwi-Boasiako C, Segbefia C, Rodrigues O, Campbell A. Diagnosis patterns of sickle cell disease in Ghana: a secondary analysis. BMC Public Health 2021; 21:1719. [PMID: 34548040 PMCID: PMC8456625 DOI: 10.1186/s12889-021-11794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite having the highest prevalence of sickle cell disease (SCD) in the world, no country in Sub-Saharan Africa has a universal screening program for the disease. We sought to capture the diagnosis patterns of SCD (age at SCD diagnosis, method of SCD diagnosis, and age of first pain crisis) in Accra, Ghana. METHODS We administered an in-person, voluntary survey to parents of offspring with SCD between 2009 and 2013 in Accra as a part of a larger study and conducted a secondary data analysis to determine diagnosis patterns. This was conducted at a single site: a large academic medical center in the region. Univariate analyses were performed on diagnosis patterns; bivariate analyses were conducted to determine whether patterns differed by participant's age (children: those < 18 years old whose parents completed a survey about them, compared to adults: those > = 18 years old whose parents completed a survey about them), or their disease severity based on SCD genotype. Pearson's chi-squared were calculated. RESULTS Data was collected on 354 unique participants from parents. Few were diagnosed via SCD testing in the newborn period. Only 44% were diagnosed with SCD by age four; 46% had experienced a pain crisis by the same age. Most (66%) were diagnosed during pain crisis, either in acute (49%) or primary care (17%) settings. Children were diagnosed with SCD at an earlier age (74% by four years old); among the adults, parents reflected that 30% were diagnosed by four years old (p < 0.001). Half with severe forms of SCD were diagnosed by age four, compared to 31% with mild forms of the disease (p = 0.009). CONCLUSIONS The lack of a robust newborn screening program for SCD in Accra, Ghana, leaves children at risk for disease complications and death. People in our sample were diagnosed with SCD in the acute care setting, and in their toddler or school-age years or thereafter, meaning they are likely being excluded from important preventive care. Understanding current SCD diagnosis patterns in the region can inform efforts to improve the timeliness of SCD diagnosis, and improve the mortality and morbidity caused by the disease in this high prevalence population.
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Affiliation(s)
- Alexandra M Sims
- Children's National Hospital, Washington, DC, USA. .,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. .,Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave MLC 7035, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Kwaku Osei Bonsu
- University of Michigan Medical School, Ann Arbor, MI, USA.,Department of General Surgery, William Beaumont Hospital, Royal Oak, MI, USA
| | | | - Fatimah Farooq
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Fitz Tavernier
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Sheri VanOmen
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Rachel Issaka
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Rhonda Douglas
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samuel Wilson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Clementine Fu
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Duña Martin
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Austin Novarra
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lewis Graham
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Fredericka Sey
- Ghana Institute of Clinical Genetics, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Catherine Segbefia
- Department of Child Health, University of Ghana Medical School, Accra, Ghana.,Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Onike Rodrigues
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Andrew Campbell
- Children's National Hospital, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
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Provenzale D, Ness RM, Llor X, Weiss JM, Abbadessa B, Cooper G, Early DS, Friedman M, Giardiello FM, Glaser K, Gurudu S, Halverson AL, Issaka R, Jain R, Kanth P, Kidambi T, Lazenby AJ, Maguire L, Markowitz AJ, May FP, Mayer RJ, Mehta S, Patel S, Peter S, Stanich PP, Terdiman J, Keller J, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1312-1320. [PMID: 33022639 DOI: 10.6004/jnccn.2020.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel's recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.
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Affiliation(s)
| | | | | | | | | | - Gregory Cooper
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S Early
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Amy L Halverson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Rachel Issaka
- Fred Hutchinson Cancer Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Robert J Mayer
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Shivan Mehta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Peter P Stanich
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Alsayid M, Singh MH, Issaka R, Laleau V, Day L, Lee J, Allison J, Somsouk M. Yield of Colonoscopy After a Positive Result From a Fecal Immunochemical Test OC-Light. Clin Gastroenterol Hepatol 2018; 16:1593-1597.e1. [PMID: 29660528 PMCID: PMC6151285 DOI: 10.1016/j.cgh.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/20/2018] [Revised: 03/14/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about its ability to detect CRC in large average-risk populations. METHODS We performed a retrospective cohort study of patients (50-75 years old) in the San Francisco Health Network who were screened for CRC by OC-Light FIT from August 2010 through June 2015. Patients with a positive result were referred for colonoscopy. We used electronic health records to identify participants with positive FIT results, and collected results from subsequent colonoscopies and pathology analyses. The FIT positive rate was calculated by dividing the number of positive FIT results by the total number of FIT tests completed. The primary outcome was the positive rate from OC-Light FIT and yield of neoplasms at colonoscopy. Secondary outcomes were findings from first vs subsequent rounds of testing, and how these varied by sex and race. RESULTS We collected result from 35,318 FITs, performed on 20,886 patients; 2930 patients (8.3%) had a positive result, and 1558 patients completed the follow-up colonoscopy. A positive result from the FIT identified patients with CRC with a positive predictive value of 3.0%, and patients with advanced adenoma with a positive predictive value of 20.8%. The FIT positive rate was higher during the first round of testing (9.4%) compared to subsequent rounds (7.4%) (P < .01). The yield of CRC in patients with a positive result from the first round of the FIT was 3.7%, and decreased to 1.8% for subsequent rounds (P = .02). CONCLUSIONS In a retrospective analysis of patients in a diverse safety-net population who underwent OC-Light FIT for CRC screening, we found that approximately 3% of patients with a positive result from a FIT to have CRC and approximately 21% to have advanced adenoma.
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Affiliation(s)
- Muhammad Alsayid
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
| | | | - Rachel Issaka
- Clinical Research & Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, United States,Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States
| | - Victoria Laleau
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States
| | - Lukejohn Day
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey Lee
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States
| | - James Allison
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States
| | - Ma Somsouk
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, California.
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Ravi K, Friesen L, Issaka R, Kahrilas PJ, Pandolfino JE. Long-term Outcomes of Patients With Normal or Minor Motor Function Abnormalities Detected by High-resolution Esophageal Manometry. Clin Gastroenterol Hepatol 2015; 13:1416-23. [PMID: 25771245 PMCID: PMC4510014 DOI: 10.1016/j.cgh.2015.02.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS High-resolution manometry (HRM) expands recognition of minor esophageal motor abnormalities, but the clinical significance of these is unclear. We aimed to determine the outcomes of minor esophageal motor abnormalities. METHODS We reviewed HRM tracings from patients who underwent esophageal manometry at Northwestern Memorial Hospital from July 2004 through October 2005 by using the Chicago classification (version 2.0). We identified 301 patients with normal findings or minor manometric abnormalities (weak peristalsis, hypertensive peristalsis, frequent failed peristalsis, or rapid contractions with normal latency). Ninety-eight patients participated in a phone survey in which they were asked questions from the impact dysphagia questionnaire (mean follow-up period, 6 years 5 months). RESULTS Of 301 patients assessed, 166 had normal findings from HRM, 82 had weak peristalsis, 34 had hypertensive peristalsis, 17 had frequent failed peristalsis, and 2 had rapid contractions with normal latency. The primary indications for HRM of dysphagia (44%) and gastroesophageal reflux disease (63%) were unrelated to manometric findings. There were no endoscopic or videofluoroscopic differences between patients with minor manometric abnormalities. Of 98 patients with follow-up, findings from HRM were normal in 63, weak peristalsis was observed in 23, hypertensive peristalsis was observed in 10, and frequent failed peristalsis was observed in 2. No patients underwent surgical myotomy, pneumatic dilation, or botulinum toxin injection. Use of proton pump inhibitors and rates of fundoplication were similar, regardless of manometric findings. Sixteen patients (16%) had significant dysphagia at follow-up; hypertensive peristalsis was the most likely to be symptomatic. CONCLUSIONS Patients with normal and minor esophageal motor abnormalities report minimal symptoms and have few medical interventions related to esophageal dysfunction during long-term follow-up. Therefore, identification of normal and minor motor function is likely a good prognostic indicator.
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Affiliation(s)
- Karthik Ravi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Parikh ND, Issaka R, Lapin B, Komanduri S, Martin JA, Keswani RN. Inpatient weekend ERCP is associated with a reduction in patient length of stay. Am J Gastroenterol 2014; 109:465-70. [PMID: 24145679 DOI: 10.1038/ajg.2013.362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/16/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Endoscopic retrograde cholangiopancreatography (ERCP) performed on the weekend requires significant effort from the endoscopist, nursing staff, and anesthesia services. These factors often result in delaying the procedure until the following Monday. No data exist on whether performing weekend ERCP reduces length of stay (LOS) and total cost to justify the additional physician and nursing burden. METHODS In this single tertiary academic center, institutional review board-approved study, we retrospectively reviewed all hospitalized patients in whom an ERCP had been completed from May 2010 to September 2011. Demographic and clinical information, procedure details as well as total hospitalization charges (USD) were compared between patients who had an ERCP either on the weekend or weekday holiday (WE ERCP) or Monday (MON ERCP). Statistical comparisons were made using χ(2) and Fischer's exact test. A logistic regression model adjusted for propensity scores (PSs) was used to estimate the risk in prolonged LOS and high total charges associated with WE ERCPs vs. MON ERCPs. RESULTS A total of 1,114 ERCP's were performed during the time period, 123 of which met inclusion criteria (52 WE, 71 MON). Mean patient age was 56.3±16.7 years (54.5% female, 60.2% Caucasian). There were no significant demographic differences between the two groups. The most common procedure indications were choledocholithiasis (34.9%) and elevated liver enzymes after liver transplantation (25.2%). The analysis showed a significantly decreased LOS (P=0.010) and a trend towards decreased cost (P=0.050) associated with WE ERCP. In the multivariate analysis adjusted for PS, WE ERCP had a significantly decreased odds ratio of LOS>3 days (odds ratio: 0.37 (0.16-0.85); P=0.019). CONCLUSIONS We demonstrated a significant decrease in LOS and a trend towards decrease in charges in patients who underwent weekend ERCP compared with delaying ERCP until Monday. Thus, health-care organizations should consider removing barriers to weekend inpatient ERCPs.
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Affiliation(s)
- Neehar D Parikh
- 1] Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA [2] Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel Issaka
- Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brittany Lapin
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Srinadh Komanduri
- Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John A Martin
- Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Oestreich AJ, Aboian M, Lee J, Azmi I, Payne J, Issaka R, Davies BA, Katzmann DJ. Characterization of multiple multivesicular body sorting determinants within Sna3: a role for the ubiquitin ligase Rsp5. Mol Biol Cell 2006; 18:707-20. [PMID: 17182849 PMCID: PMC1783786 DOI: 10.1091/mbc.e06-08-0680] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [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] [Indexed: 11/11/2022] Open
Abstract
A subset of proteins that transit the endosomal system are directed into the intralumenal vesicles of multivesicular bodies (MVBs). MVB formation is critical for a variety of cellular functions including receptor down-regulation, viral budding, antigen presentation, and the generation of lysosome-related organelles. Entry of transmembrane proteins into the intralumenal vesicles of a MVB is a highly regulated process that is positively modulated by covalent modification of cargoes with ubiquitin. To identify additional MVB sorting signals, we examined the previously described ubiquitination-independent MVB cargo Sna3. Although Sna3 ubiquitination is not essential, Sna3 MVB sorting is positively modulated by its ubiquitination. Examination of MVB sorting determinants within a form of Sna3 lacking all lysine residues identified two critical regions: an amino-terminal tyrosine-containing region and a carboxyl-terminal PPAY motif. This PPAY motif interacts with the WW domains of the ubiquitin ligase Rsp5, and mutations in either the WW or, surprisingly, the HECT domains of Rsp5 negatively impacted MVB targeting of lysine-minus Sna3. These data indicate that Rsp5 function is required for MVB targeting of Sna3 in a capacity beyond cargo ubiquitination. These results uncover a series of determinants impacting Sna3 MVB sorting, including unexpected roles for Rsp5.
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Affiliation(s)
- Andrea J. Oestreich
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Mariam Aboian
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Jacqueline Lee
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Ishara Azmi
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Johanna Payne
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Rachel Issaka
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - Brian A. Davies
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
| | - David J. Katzmann
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905
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