1
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Eisenberg E, Miller RJH, Hu LH, Rios R, Betancur J, Azadani P, Han D, Sharir T, Einstein AJ, Bokhari S, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Liang JX, Otaki Y, Tamarappoo BK, Dey D, Berman DS, Slomka PJ. Diagnostic safety of a machine learning-based automatic patient selection algorithm for stress-only myocardial perfusion SPECT. J Nucl Cardiol 2022; 29:2295-2307. [PMID: 34228341 PMCID: PMC9020793 DOI: 10.1007/s12350-021-02698-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stress-only myocardial perfusion imaging (MPI) markedly reduces radiation dose, scanning time, and cost. We developed an automated clinical algorithm to safely cancel unnecessary rest imaging with high sensitivity for obstructive coronary artery disease (CAD). METHODS AND RESULTS Patients without known CAD undergoing both MPI and invasive coronary angiography from REFINE SPECT were studied. A machine learning score (MLS) for prediction of obstructive CAD was generated using stress-only MPI and pre-test clinical variables. An MLS threshold with a pre-defined sensitivity of 95% was applied to the automated patient selection algorithm. Obstructive CAD was present in 1309/2079 (63%) patients. MLS had higher area under the receiver operator characteristic curve (AUC) for prediction of CAD than reader diagnosis and TPD (0.84 vs 0.70 vs 0.78, P < .01). An MLS threshold of 0.29 had superior sensitivity than reader diagnosis and TPD for obstructive CAD (95% vs 87% vs 87%, P < .01) and high-risk CAD, defined as stenosis of the left main, proximal left anterior descending, or triple-vessel CAD (sensitivity 96% vs 89% vs 90%, P < .01). CONCLUSIONS The MLS is highly sensitive for prediction of both obstructive and high-risk CAD from stress-only MPI and can be applied to a stress-first protocol for automatic cancellation of unnecessary rest imaging.
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Affiliation(s)
- Evann Eisenberg
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Robert J H Miller
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- University of Calgary, Calgary, AB, Canada
| | - Lien-Hsin Hu
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Richard Rios
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Julian Betancur
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Peyman Azadani
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Donghee Han
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | | | - Andrew J Einstein
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Sabahat Bokhari
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Joanna X Liang
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Yuka Otaki
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Balaji K Tamarappoo
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA.
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2
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Lin A, van Diemen PA, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen RS, Berman DS, Nørgaard BL, Slomka PJ, Knaapen P, Dey D. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Fractional Flow Reserve-Defined Ischemia and Impaired Myocardial Blood Flow. Circ Cardiovasc Imaging 2022; 15:e014369. [PMID: 36252116 PMCID: PMC10085569 DOI: 10.1161/circimaging.122.014369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A pathophysiological interplay exists between plaque morphology and coronary physiology. Machine learning (ML) is increasingly being applied to coronary computed tomography angiography (CCTA) for cardiovascular risk stratification. We sought to assess the performance of a ML score integrating CCTA-based quantitative plaque features for predicting vessel-specific ischemia by invasive fractional flow reserve (FFR) and impaired myocardial blood flow (MBF) by positron emission tomography (PET). METHODS This post-hoc analysis of the PACIFIC trial (Prospective Comparison of Cardiac Positron Emission Tomography/Computed Tomography [CT]' Single Photon Emission Computed Tomography/CT Perfusion Imaging and CT Coronary Angiography with Invasive Coronary Angiography) included 208 patients with suspected coronary artery disease who prospectively underwent CCTA' [15O]H2O PET, and invasive FFR. Plaque quantification from CCTA was performed using semiautomated software. An ML algorithm trained on the prospective NXT trial (484 vessels) was used to develop a ML score for the prediction of ischemia (FFR≤0.80), which was then evaluated in 581 vessels from the PACIFIC trial. Thereafter, the ML score was applied for predicting impaired hyperemic MBF (≤2.30 mL/min per g) from corresponding PET scans. The performance of the ML score was compared with CCTA reads and noninvasive FFR derived from CCTA (FFRCT). RESULTS One hundred thirty-nine (23.9%) vessels had FFR-defined ischemia, and 195 (33.6%) vessels had impaired hyperemic MBF. For the prediction of FFR-defined ischemia, the ML score yielded an area under the receiver-operating characteristic curve of 0.92, which was significantly higher than that of visual stenosis grade (0.84; P<0.001) and comparable with that of FFRCT (0.93; P=0.34). Quantitative percent diameter stenosis and low-density noncalcified plaque volume had the greatest ML feature importance for predicting FFR-defined ischemia. When applied for impaired MBF prediction, the ML score exhibited an area under the receiver-operating characteristic curve of 0.80; significantly higher than visual stenosis grade (area under the receiver-operating characteristic curve 0.74; P=0.02) and comparable with FFRCT (area under the receiver-operating characteristic curve 0.77; P=0.16). CONCLUSIONS An externally validated ML score integrating CCTA-based quantitative plaque features accurately predicts FFR-defined ischemia and impaired MBF by PET, performing superiorly to standard CCTA stenosis evaluation and comparably to FFRCT.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pepijn A. van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Rios
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S. Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Daniel S. Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bjarne L. Nørgaard
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Piotr J. Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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3
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Rios R, Miller RJH, Hu LH, Otaki Y, Singh A, Diniz M, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, DiCarli M, Van Kriekinge S, Kavanagh P, Parekh T, Liang JX, Dey D, Berman DS, Slomka P. Determining a minimum set of variables for machine learning cardiovascular event prediction: results from REFINE SPECT registry. Cardiovasc Res 2022; 118:2152-2164. [PMID: 34259870 PMCID: PMC9302886 DOI: 10.1093/cvr/cvab236] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 04/16/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Optimal risk stratification with machine learning (ML) from myocardial perfusion imaging (MPI) includes both clinical and imaging data. While most imaging variables can be derived automatically, clinical variables require manual collection, which is time-consuming and prone to error. We determined the fewest manually input and imaging variables required to maintain the prognostic accuracy for major adverse cardiac events (MACE) in patients undergoing a single-photon emission computed tomography (SPECT) MPI. METHODS AND RESULTS This study included 20 414 patients from the multicentre REFINE SPECT registry and 2984 from the University of Calgary for training and external testing of the ML models, respectively. ML models were trained using all variables (ML-All) and all image-derived variables (including age and sex, ML-Image). Next, ML models were sequentially trained by incrementally adding manually input and imaging variables to baseline ML models based on their importance ranking. The fewest variables were determined as the ML models (ML-Reduced, ML-Minimum, and ML-Image-Reduced) that achieved comparable prognostic performance to ML-All and ML-Image. Prognostic accuracy of the ML models was compared with visual diagnosis, stress total perfusion deficit (TPD), and traditional multivariable models using area under the receiver-operating characteristic curve (AUC). ML-Minimum (AUC 0.798) obtained comparable prognostic accuracy to ML-All (AUC 0.799, P = 0.19) by including 12 of 40 manually input variables and 11 of 58 imaging variables. ML-Reduced achieved comparable accuracy (AUC 0.796) with a reduced set of manually input variables and all imaging variables. In external validation, the ML models also obtained comparable or higher prognostic accuracy than traditional multivariable models. CONCLUSION Reduced ML models, including a minimum set of manually collected or imaging variables, achieved slightly lower accuracy compared to a full ML model but outperformed standard interpretation methods and risk models. ML models with fewer collected variables may be more practical for clinical implementation.
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Affiliation(s)
- Richard Rios
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Lien Hsin Hu
- Department of Nuclear Medicine, Taipei, Veterans General Hospital, Taipei, Taiwan
| | - Yuka Otaki
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ananya Singh
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Marcio Diniz
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo DiCarli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Serge Van Kriekinge
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paul Kavanagh
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Tejas Parekh
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Piotr Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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4
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Rios R, Miller RJH, Manral N, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Van Kriekinge SD, Kavanagh PB, Parekh T, Liang JX, Dey D, Berman DS, Slomka PJ. Handling missing values in machine learning to predict patient-specific risk of adverse cardiac events: Insights from REFINE SPECT registry. Comput Biol Med 2022; 145:105449. [PMID: 35381453 PMCID: PMC9117456 DOI: 10.1016/j.compbiomed.2022.105449] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/08/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Machine learning (ML) models can improve prediction of major adverse cardiovascular events (MACE), but in clinical practice some values may be missing. We evaluated the influence of missing values in ML models for patient-specific prediction of MACE risk. METHODS We included 20,179 patients from the multicenter REFINE SPECT registry with MACE follow-up data. We evaluated seven methods for handling missing values: 1) removal of variables with missing values (ML-Remove), 2) imputation with median and unique category for continuous and categorical variables, respectively (ML-Traditional), 3) unique category for missing variables (ML-Unique), 4) cluster-based imputation (ML-Cluster), 5) regression-based imputation (ML-Regression), 6) missRanger imputation (ML-MR), and 7) multiple imputation (ML-MICE). We trained ML models with full data and simulated missing values in testing patients. Prediction performance was evaluated using area under the receiver-operating characteristic curve (AUC) and compared with a model without missing values (ML-All), expert visual diagnosis and total perfusion deficit (TPD). RESULTS During mean follow-up of 4.7 ± 1.5 years, 3,541 patients experienced at least one MACE (3.7% annualized risk). ML-All (reference model-no missing values) had AUC 0.799 for MACE risk prediction. All seven models with missing values had lower AUC (ML-Remove: 0.778, ML-MICE: 0.774, ML-Cluster: 0.771, ML-Traditional: 0.771, ML-Regression: 0.770, ML-MR: 0.766, and ML-Unique: 0.766; p < 0.01 for ML-Remove vs remaining methods). Stress TPD (AUC 0.698) and visual diagnosis (0.681) had the lowest AUCs. CONCLUSION Missing values reduce the accuracy of ML models when predicting MACE risk. Removing variables with missing values and retraining the model may yield superior patient-level prediction performance.
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Affiliation(s)
- Richard Rios
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Universidad Nacional de Colombia, Sede de La Paz, GAUNAL, La Paz, Colombia
| | - Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Nipun Manral
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA; Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Edward J Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tejas Parekh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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5
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Kuronuma K, Van Diemen P, Han D, Lin A, McElhinney P, Tomasino GF, Park C, Otaki Y, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen R, Berman DS, Slomka P, Dey D, Knaapen P. ASSOCIATION BETWEEN VASCULAR INFLAMMATION BY PERICORONARY ADIPOSETISSUE ATTENUATION FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY AND MYOCARDIAL BLOOD FLOW USING POSITRON EMISSION TOMOGRAPHY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Han D, Van Diemen P, Kuronuma K, Lin A, McElhinney P, Tomasino GF, Park C, Otaki Y, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen R, Berman DS, Slomka P, Dey D, Knaapen P. SEX DIFFERENCES IN QUANTITATIVE COMPUTED TOMOGRAPHY CORONARY PLAQUE CHARACTERIZATION AND FRACTIONAL FLOW RESERVE: SUBSTUDY OF THE PACIFIC TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dočekal V, Koberová T, Hrabovský J, Vopálenská A, Gyepes R, Císařová I, Rios R, Veselý J. Stereoselective Cyclopropanation of Boron Dipyrromethene (BODIPY) Derivatives by an Organocascade Reaction. Adv Synth Catal 2022. [DOI: 10.1002/adsc.202200013] [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: 11/11/2022]
Affiliation(s)
- V. Dočekal
- Department of Organic Chemistry Faculty of Science Charles University Hlavova 2030/8 128 43 Prague 2 Czech Republic
| | - T. Koberová
- Department of Organic Chemistry Faculty of Science Charles University Hlavova 2030/8 128 43 Prague 2 Czech Republic
| | - J. Hrabovský
- Faculty of Mathematics and Physics Charles University in Prague Prague Czech Republic
- HiLASE Centre Institute of Physics of the Czech Academy of Sciences Dolní Břežany Czech Republic
| | - A. Vopálenská
- Department of Organic Chemistry Faculty of Science Charles University Hlavova 2030/8 128 43 Prague 2 Czech Republic
| | - R. Gyepes
- J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences Dolejškova 3 182 23 Prague 8 Czech Republic
| | - I. Císařová
- Department of Inorganic Chemistry Faculty of Science Charles University Hlavova 2030/8 128 43 Prague 2 Czech Republic
| | - R. Rios
- School of Chemistry University of Southampton Highfield Campus SO17 1BJ Southampton UK
| | - J. Veselý
- Department of Organic Chemistry Faculty of Science Charles University Hlavova 2030/8 128 43 Prague 2 Czech Republic
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8
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Hu LH, Miller RJH, Sharir T, Commandeur F, Rios R, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Liang JX, Eisenberg E, Dey D, Berman DS, Slomka PJ. Prognostically safe stress-only single-photon emission computed tomography myocardial perfusion imaging guided by machine learning: report from REFINE SPECT. Eur Heart J Cardiovasc Imaging 2021; 22:705-714. [PMID: 32533137 DOI: 10.1093/ehjci/jeaa134] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) stress-only protocols reduce radiation exposure and cost but require clinicians to make immediate decisions regarding rest scan cancellation. We developed a machine learning (ML) approach for automatic rest scan cancellation and evaluated its prognostic safety. METHODS AND RESULTS In total, 20 414 patients from a solid-state SPECT MPI international multicentre registry with clinical data and follow-up for major adverse cardiac events (MACE) were used to train ML for MACE prediction as a continuous probability (ML score), using 10-fold repeated hold-out testing to separate test from training data. Three ML score thresholds (ML1, ML2, and ML3) were derived by matching the cancellation rates achieved by physician interpretation and two clinical selection rules. Annual MACE rates were compared in patients selected for rest scan cancellation between approaches. Patients selected for rest scan cancellation with ML had lower annualized MACE rates than those selected by physician interpretation or clinical selection rules (ML1 vs. physician interpretation: 1.4 ± 0.1% vs. 2.1 ± 0.1%; ML2 vs. clinical selection: 1.5 ± 0.1% vs. 2.0 ± 0.1%; ML3 vs. stringent clinical selection: 0.6 ± 0.1% vs. 1.7 ± 0.1%, all P < 0.0001) at matched cancellation rates (60 ± 0.7, 64 ± 0.7, and 30 ± 0.6%). Annualized all-cause mortality rates in populations recommended for rest cancellation by physician interpretation, clinical selection approaches were higher (1.3%, 1.2%, and 1.0%, respectively) compared with corresponding ML thresholds (0.6%, 0.6%, and 0.2%). CONCLUSION ML, using clinical and stress imaging data, can be used to automatically recommend cancellation of rest SPECT MPI scans, while ensuring higher prognostic safety than current clinical approaches.
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Affiliation(s)
- Lien-Hsin Hu
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.,Department of Nuclear Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shipai Road, Beitou District, Taipei 112, Taiwan
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.,Department of Cardiac Sciences, University of Calgary, 24 Ave NW, Calgary, AB, Canada
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, HaBarzel St 20, Tel Aviv, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Rager Blvd, 84105 Be'er Sheva,, Israel
| | - Frederic Commandeur
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Richard Rios
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 W 168th St, New York, NY 10032, USA.,Department of Radiology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Mathews B Fish
- Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, 3333 Riverbend Dr, Springfield, OR 97477, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Albert J Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA
| | - Edward J Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA
| | - Timothy M Bateman
- Cardiovascular Imaging Technologies LLC, 4320 Wormhall Rd, Kansas City, 64111 MO, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Evann Eisenberg
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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9
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Nakanishi R, Slomka PJ, Rios R, Betancur J, Blaha MJ, Nasir K, Miedema MD, Rumberger JA, Gransar H, Shaw LJ, Rozanski A, Budoff MJ, Berman DS. Machine Learning Adds to Clinical and CAC Assessments in Predicting 10-Year CHD and CVD Deaths. JACC Cardiovasc Imaging 2020; 14:615-625. [PMID: 33129741 DOI: 10.1016/j.jcmg.2020.08.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 03/03/2020] [Revised: 07/01/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether machine learning (ML) of noncontrast computed tomographic (CT) and clinical variables improves the prediction of atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) deaths compared with coronary artery calcium (CAC) Agatston scoring and clinical data. BACKGROUND The CAC score provides a measure of the global burden of coronary atherosclerosis, and its long-term prognostic utility has been consistently shown to have incremental value over clinical risk assessment. However, current approaches fail to integrate all available CT and clinical variables for comprehensive risk assessment. METHODS The study included data from 66,636 asymptomatic subjects (mean age 54 ± 11 years, 67% men) without established ASCVD undergoing CAC scanning and followed for cardiovascular disease (CVD) and CHD deaths at 10 years. Clinical risk assessment incorporated the ASCVD risk score. For ML, an ensemble boosting approach was used to fit a predictive classifier for outcomes, followed by automated feature selection using information gain ratio. The model-building process incorporated all available clinical and CT data, including the CAC score; the number, volume, and density of CAC plaques; and extracoronary scores; comprising a total of 77 variables. The overall proposed model (ML all) was evaluated using a 10-fold cross-validation framework on the population data and area under the curve (AUC) as metrics. The prediction performance was also compared with 2 traditional scores (ASCVD risk and CAC score) and 2 additional models that were trained using all the clinical data (ML clinical) and CT variables (ML CT). RESULTS The AUC by ML all (0.845) for predicting CVD death was superior compared with those obtained by ASCVD risk alone (0.821), CAC score alone (0.781), and ML CT alone (0.804) (p < 0.001 for all). Similarly, for predicting CHD death, AUC by ML all (0.860) was superior to the other analyses (0.835 for ASCVD risk, 0.816 for CAC, and 0.827 for ML CT; p < 0.001). CONCLUSIONS The comprehensive ML model was superior to ASCVD risk, CAC score, and an ML model fitted using CT variables alone in the prediction of both CVD and CHD death.
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Affiliation(s)
- Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan; Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Richard Rios
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Julian Betancur
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Blaha
- Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center, Baltimore, Maryland, USA
| | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, USA
| | | | - John A Rumberger
- Department of Cardiac Imaging, The Princeton Longevity Center, Princeton, New Jersey, USA
| | - Heidi Gransar
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslee J Shaw
- Weill Cornell Medical College, New York, New York, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew J Budoff
- Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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10
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Plaster B, Adamek E, Allgeier B, Anaya J, Back H, Bagdasarova Y, Berguno D, Blatnik M, Boissevain J, Bowles T, Broussard L, Brown MP, Carr R, Clark D, Clayton S, Cude-Woods C, Currie S, Dees E, Ding X, Du S, Filippone B, García A, Geltenbort P, Hasan S, Hawari A, Hickerson K, Hill R, Hino M, Hoagland J, Hoedl S, Hogan G, Hona B, Hong R, Holley A, Ito T, Kawai T, Kirch K, Kitagaki S, Knecht A, Lamoreaux S, Liu CY, Liu J, Makela M, Mammei R, Martin J, Meier N, Melconian D, Mendenhall M, Moore S, Morris C, Mortensen R, Nepal S, Nouri N, Pattie R, Pérez Galván A, Phillips II D, Pichlmaier A, Picker R, Pitt M, Ramsey J, Rios R, Russell R, Sabourov K, Sallaska A, Salvat D, Saunders A, Schmid R, Seestrom S, Servicky C, Sharapov E, Sjue S, Slutsky S, Smith D, Sondheim W, Sun X, Swank C, Swift G, Tatar E, Teasdale W, Terai C, Tipton B, Utsuro M, Vogelaar R, VornDick B, Wang Z, Wehring B, Wexler J, Womack T, Wrede C, Xu Y, Yan H, Young A, Yuan J, Zeck B. Final results for the neutron β-asymmetry parameter A0 from the UCNA experiment. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921904004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The UCNA experiment was designed to measure the neutron β-asymmetry parameter A0 using polarized ultracold neutrons (UCN). UCN produced via downscattering in solid deuterium were polarized via transport through a 7 T magnetic field, and then directed to a 1 T solenoidal electron spectrometer, where the decay electrons were detected in electron detector packages located on the two ends of the spectrometer. A value for A0 was then extracted from the asymmetry in the numbers of counts in the two detector packages. We summarize all of the results from the UCNA experiment, obtained during run periods in 2007, 2008–2009, 2010, and 2011–2013, which ultimately culminated in a 0.67% precision result for A0.
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11
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Ruiz TR, Ramírez AL, Duran MO, Jimenez IP, Espinosa MC, Rios R. Optimizing response assessment to anti-multiple myeloma treatment by using the hevylite assay: A multicentric study. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Roque A, Pizzi MN, Fernandez-Hidalgo N, Cuellar-Calabria H, Rios R, Ferreria N, Almirante B, Castell-Conesa J, Escobar M, Aguade-Bruix S. 3118F-FDG-PET/CTA of prosthetic heart valves: Postsurgical inflammatory patterns and its temporal evolution. Can we question the 3-month limit of the current guidelines? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez142.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Roque
- University Hospital Vall d"Hebron, Radiology, Barcelona, Spain
| | - M N Pizzi
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | | | | | - R Rios
- University Hospital Vall d"Hebron, Cardiac Surgery, Barcelona, Spain
| | - N Ferreria
- University Hospital Vall d"Hebron, Cardiology, Barcelona, Spain
| | - B Almirante
- University Hospital Vall d"Hebron, Infectious Diseases, Barcelona, Spain
| | - J Castell-Conesa
- University Hospital Vall d"Hebron, Nuclear Medicine, Barcelona, Spain
| | - M Escobar
- University Hospital Vall d"Hebron, Radiology, Barcelona, Spain
| | - S Aguade-Bruix
- University Hospital Vall d"Hebron, Nuclear Medicine, Barcelona, Spain
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13
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Sun X, Adamek E, Allgeier B, Blatnik M, Bowles T, Broussard L, Brown MP, Carr R, Clayton S, Cude-Woods C, Currie S, Dees E, Ding X, Filippone B, García A, Geltenbort P, Hasan S, Hickerson K, Hoagland J, Hong R, Hogan G, Holley A, Ito T, Kneckt A, Liu CY, Liu J, Makela M, Mammei R, Martin J, Melconian D, Mendenhall M, Moore S, Morris C, Nepal S, Nouri N, Pattie R, Galván A, Phillips II D, Picker R, Pitt M, Plaster B, Ramsey J, Rios R, Salvat D, Saunders A, Sondheim W, Sjue S, Slutsky S, Swank C, Swift G, Tatar E, Vogelaar R, VornDick B, Wanchun W, Wang Z, Wexler J, Womack T, Wrede C, Young A, Zeck B. Search for neutron dark decay: n → χ + e+e−. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921905008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In January, 2018, Fornal and Grinstein proposed that a previously unobserved neutron decay branch to a dark matter particle (χ) could account for the discrepancy in the neutron lifetime observed in two different types of experiments. One of the possible final states discussed includes a single χ along with an e+e− pair. We use data from the UCNA (Ultracold Neutron Asymmetry) experiment to set limits on this decay channel. Coincident electron-like events are detected with ∼ 4π acceptance using a pair of detectors that observe a volume of stored Ultracold Neutrons (UCNs). We use the timing information of coincidence events to select candidate dark sector particle decays by applying a timing calibration and selecting events within a physically-forbidden timing region for conventional n → p + e- + ν̅e decays. The summed kinetic energy (Ee+e−) from such events is reconstructed and used to set limits, as a function of the χ mass, on the branching fraction for this decay channel.
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14
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Roque A, Pizzi MN, Fernandez-Hidalgo N, Cuellar-Calabria H, Rios R, Ferreira N, Sambola A, Almirante B, Garcia-Dorado D, Castell J, Escobar M, Tornos P, Aguade-Bruix S. 524918F-FDG-PET/CTA of prosthetic cardiac valves: postsurgical inflammatory patterns and its temporal evolution. Can we question the 3-month limit of the current guidelines? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Roque
- University Hospital Vall d'Hebron, Radiology, Barcelona, Spain
| | - M N Pizzi
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | | | - R Rios
- University Hospital Vall d'Hebron, Cardiac Surgery, Barcelona, Spain
| | - N Ferreira
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - A Sambola
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - B Almirante
- University Hospital Vall d'Hebron, Infectious Diseases, Barcelona, Spain
| | - D Garcia-Dorado
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - J Castell
- University Hospital Vall d'Hebron, Nuclear Medicine, Barcelona, Spain
| | - M Escobar
- University Hospital Vall d'Hebron, Radiology, Barcelona, Spain
| | - P Tornos
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - S Aguade-Bruix
- University Hospital Vall d'Hebron, Nuclear Medicine, Barcelona, Spain
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15
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Pizzi MN, Fernandez-Hidalgo N, Cuellar-Calabria H, Gonzalez-Alujas MT, Ferreira-Gonzalez I, Maisterra-Santos O, Rios R, Sambolla-Ayala A, Garcia-Dorado D, Almirante B, Tornos P, Aguade-Bruix S, Castell-Conesa J, Roque A. P2274First assessment of the clinical impact and confirmation of the diagnostic ability of the 18F-FDG-PET/CTA prosthetic valve endocarditis. New data supports initial results. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M N Pizzi
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | - N Fernandez-Hidalgo
- University Hospital Vall d'Hebron, Infectious Diseases Department, Barcelona, Spain
| | - H Cuellar-Calabria
- University Hospital Vall d'Hebron, Radiology Department, Barcelona, Spain
| | - M T Gonzalez-Alujas
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | - I Ferreira-Gonzalez
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | | | - R Rios
- University Hospital Vall d'Hebron, Cardiovascular Surgery, Barcelona, Spain
| | - A Sambolla-Ayala
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | - D Garcia-Dorado
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | - B Almirante
- University Hospital Vall d'Hebron, Infectious Diseases Department, Barcelona, Spain
| | - P Tornos
- Hospital Vall d'Hebron, Cardiology Department, Epidemiology Unit, Barcelona, Spain
| | - S Aguade-Bruix
- Universitary Hospital Vall d'Hebron, Nuclear Medicine Department, Barcelona, Spain
| | - J Castell-Conesa
- Universitary Hospital Vall d'Hebron, Nuclear Medicine Department, Barcelona, Spain
| | - A Roque
- University Hospital Vall d'Hebron, Radiology Department, Barcelona, Spain
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16
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Rios R, De Crevoisier R, Ospina JD, Commandeur F, Lafond C, Simon A, Haigron P, Espinosa J, Acosta O. Population model of bladder motion and deformation based on dominant eigenmodes and mixed-effects models in prostate cancer radiotherapy. Med Image Anal 2017; 38:133-149. [PMID: 28343079 DOI: 10.1016/j.media.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
In radiotherapy for prostate cancer irradiation of neighboring organs at risk may lead to undesirable side-effects. Given this setting, the bladder presents the largest inter-fraction shape variations hampering the computation of the actual delivered dose vs. planned dose. This paper proposes a population model, based on longitudinal data, able to estimate the probability of bladder presence during treatment, using only the planning computed tomography (CT) scan as input information. As in previously-proposed principal component analysis (PCA) population-based models, we have used the data to obtain the dominant eigenmodes that describe bladder geometric variations between fractions. However, we have used a longitudinal analysis along each mode in order to properly characterize patient's variance from the total population variance. We have proposed is a mixed-effects (ME) model in order to separate intra- and inter-patient variability, in an effort to control confounding cohort effects. Other than using PCA, bladder shapes are represented by using spherical harmonics (SPHARM) that additionally enables data compression without information lost. Based on training data from repeated CT scans, the ME model was thus implemented following dimensionality reduction by means of SPHARM and PCA. We have evaluated the model in a leave-one-out cross validation framework on the training data but also using independent data. Probability maps (PMs) were thus generated with several draws from the learnt model as predicted regions where the bladder will likely move and deform. These PMs were compared with the actual regions using metrics based on mutual information distance and misestimated voxels. The prediction was also compared with two previous population PCA-based models. The proposed model was able to reduce the uncertainties in the estimation of the probable region of bladder motion and deformation. This model can thus be used for tailoring radiotherapy treatments.
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Affiliation(s)
- Richard Rios
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France; Universidad Nacional de Colombia, Facultad de Minas, GAUNAL, Medellín, Colombia.
| | - Renaud De Crevoisier
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France; CRLCC Eugène Marquis, Département de Radiothérapie, F-35000 Rennes, France
| | - Juan D Ospina
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Frederic Commandeur
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Caroline Lafond
- CRLCC Eugène Marquis, Département de Radiothérapie, F-35000 Rennes, France
| | - Antoine Simon
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Pascal Haigron
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Jairo Espinosa
- Universidad Nacional de Colombia, Facultad de Minas, GAUNAL, Medellín, Colombia
| | - Oscar Acosta
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
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17
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Rios R, Ospina J, Lafond C, Acosta O, Espinosa J, de Crevoisier R. Characterization of Bladder Motion and Deformation in Prostate Cancer Radiotherapy. Ing Rech Biomed 2016. [DOI: 10.1016/j.irbm.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Qazilbash MH, Wieder E, Thall PF, Wang X, Rios R, Lu S, Kanodia S, Ruisaard KE, Giralt SA, Estey EH, Cortes J, Komanduri KV, Clise-Dwyer K, Alatrash G, Ma Q, Champlin RE, Molldrem JJ. PR1 peptide vaccine induces specific immunity with clinical responses in myeloid malignancies. Leukemia 2016; 31:697-704. [PMID: 27654852 PMCID: PMC5332281 DOI: 10.1038/leu.2016.254] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/27/2016] [Accepted: 07/12/2016] [Indexed: 01/29/2023]
Abstract
PR1, an HLA-A2-restricted peptide derived from both proteinase 3 and neutrophil elastase, is recognized on myeloid leukemia cells by cytotoxic T lymphocytes (CTL) that preferentially kill leukemia and contribute to cytogenetic remission. To evaluate safety, immunogenicity and clinical activity of PR1 vaccination, a phase I/II trial was conducted. Sixty-six HLA-A2+ patients with acute myeloid leukemia (AML: 42), chronic myeloid leukemia (CML: 13) or myelodysplastic syndrome (MDS: 11) received three to six PR1 peptide vaccinations, administered subcutaneously every 3 weeks at dose levels of 0.25, 0.5 or 1.0 mg. Patients were randomized to the 3 dose levels after establishing the safety of the highest dose level. Primary endpoints were safety and immune response, assessed by doubling of PR1/HLA-A2 tetramer-specific CTL, and the secondary endpoint was clinical response. Immune responses were noted in 35 of 66 (53%) patients. Of the 53 evaluable patients with active disease, 12 (24%) had objective clinical responses (complete: 8, partial: 1 and hematological improvement: 3). PR1-specific immune response was seen in 9 of 25 clinical responders vs. 3 of 28 clinical non-responders (p=0.03). In conclusion, PR1 peptide vaccine induces specific immunity that correlates with clinical responses, including molecular remission, in AML, CML and MDS patients.
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Affiliation(s)
- M H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Wieder
- Adult Stem Cell Transplant Program and Department of Medicine, University of Miami Sylvester Cancer Center, Miami, FL, USA
| | - P F Thall
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Wang
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rios
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Lu
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Kanodia
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K E Ruisaard
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S A Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - E H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Cortes
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K V Komanduri
- Adult Stem Cell Transplant Program and Department of Medicine, University of Miami Sylvester Cancer Center, Miami, FL, USA
| | - K Clise-Dwyer
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Q Ma
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J J Molldrem
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rodríguez Carballeira M, Espinosa G, Mejía J, Solans R, Larrañaga J, Castillo M, Rios R, Nieto J, Solanich X, Fonseca E, Muñoz F, Fraile G, Boldava R, Hurtado R. SAT0534 Thrombosis and Re-Thrombosis Manifestations in Patients with Behçet Disease. Descriptive Analysis from Regeb Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Rios R, Estapé E, Díaz C, Segarra B, Martin MS. EVALUATION RETREAT: A SENSIBLE METHOD FOR PROGRAM'S ASSESSMENT. INTED Proc 2015; 2015:7577-7584. [PMID: 26985449 PMCID: PMC4791064] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The University of Puerto Rico (UPR), Medical Sciences Campus (MSC) post-doctoral Master of Science in Clinical and Translational Research (MSc) program aims to train Hispanic post-doctoral candidates to advance their careers and become successful clinical and translational researchers geared to help eliminate health disparities. Its curriculum highlights the use of technology and online resources to maximize time use of time and efforts. As part of the assessment efforts, the program's Evaluation Committee leads an annual activity, Evaluation Retreat (ER), to evaluate the program's curriculum, research component, and mentoring experience according to Scholars' perspective. Results are used by the Program Executive committee for further planning and improvement. This analysis presents the most relevant results from these activities. DESIGN METHODS Data collection (from last 5 years), include quantitative (online surveys) and qualitative approaches (a group meeting with Scholars.) Questionnaires request Scholars to rate specific features of the program's research component, mentoring experience and curriculum. It also includes questions about the program in general (major strengths and challenges, and recommendations for improvement. During the group meeting, Scholars discuss these results and present consensus in a plenary session. Quantitative data are managed and analyzed using the statistical software SPSS. Qualitative data are examined using content analysis. RESULTS Scholars identified as program's strengths the networking opportunities (local and with U.S. experts), the diversity of peers and faculty, the faculty support, the technical and audiovisual support, the physical facilities and resources, the guest speakers and consultants, and the quality of the curriculum. Challenges vary as cohorts change, but time limitations and the need for technical/statistical support are always highlighted. Recommendations for improvement emphasize the need for a greater pool of experienced mentors, and more hands-on approaches to address particular skills such as, manuscript development, institutional and federal guidelines for proposal submission, and issues related to the research project management. DISCUSSION Evaluation Retreats provide a valuable input to improve a program geared to develop competent clinical researchers. Findings evidence the program's commitment with providing the foundation for an enhanced mass of clinical researchers.
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Affiliation(s)
- R Rios
- University of Puerto Rico, School of Public Health (PUERTO RICO)
| | - E Estapé
- University of Puerto Rico-School of Health Professions (PUERTO RICO)
| | - C Díaz
- University of Puerto Rico-School of Medicine (PUERTO RICO)
| | - B Segarra
- University of Puerto Rico-School of Health Professions (PUERTO RICO)
| | - M San Martin
- University of Puerto Rico-School of Health Professions (PUERTO RICO)
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Vethe H, Finne K, Skogstrand T, Vaudel M, Vikse BE, Hultstrom M, Placier S, Scherer A, Tenstad O, Marti HPP, Milanesi S, Rocca C, Gregorini M, Corradetti V, Pattonieri EF, Cannone M, Maggi N, Bosio F, Esposito P, Bianco C, Benzoni I, Maestri M, Avanzini MA, Rampino T, Dal Canton A, Kadoya H, Satoh M, Sasaki T, Kashihara N, Pongsakul N, Thongboonkerd V, Hsu HH, Chen KH, Tian YC, Chen YC, Hung CC, Yang CW, Yamamoto Y, Iyoda M, Wada Y, Suzuki T, Matsumoto K, Shindo-Hirai Y, Kuno Y, Saito T, Iseri K, Shibata T, Da Silva AF, Teixeira VC, Schor N, Paterno J, Naves MA, Visiona I, Schor N, Teixeira VP, Borda B, Lengyel C, Varkonyi T, Ivanyi B, Keresztes C, Lazar G, Edamatsu T, Fujieda A, Ezawa A, Itoh Y, Detsika MG, Duann P, Carvalho FF, Teixeira VP, Almeida WS, Schor N, Wagner S, Schnorr J, Glaser J, Gemeinhardt I, Ebert M, Klopfleisch R, Taupitz M, Frangou EA, Rizou M, Prakoura N, Zoidakis J, Vlahou A, Gakiopoulou H, Liapis G, Charonis A, Kayukov I, Parastaeva M, Beresneva O, Ivanova G, Kucher A, Karunnaya H, Zarayski M, Smirnov A, Chandak PG, Smirnov A, Sipovski V, Beresneva O, Parastaeva M, Ivanova G, Kucher A, Sipovski E, Zarayski M, Karunnaya H, Dobronravov V, Kayukov I, Masola V, Zaza G, Granata S, Secchi MF, Onisto M, Lupo A, Gambaro G, Kim JI, Jang HS, Han SJ, Park KM, Grchevska L, Paterno JC, Ramos MDFP, Razvickas CV, Rehder VL, Schor N, Teixeira VP, Raya AI, Pineda CM, Guerrero F, Rios R, Aguilera E, Peralta A, Lopez I, Parastaeva M, Beresneva O, Kucher A, Ivanova G, Kayukov I, Smirnov A, Takenaka T, Inoue T, Miyazaki T, Hayashi M, Suzuki H, Garrido P, Fernandes J, Ribeiro S, Vala H, Belo L, Costa E, Santos-Silva A, Reis F, Shi Y, Tsuboi N, Maruyama S, Matsuo S, Piecha D, Koch S, Steppan S, Loser K. EXPERIMENTAL PATHOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Costa RS, Marques CR, Rios R, Silva HBF, Carneiro NVQ, Cana B, Cerqueira-Lima AT, Campos KM, Oliveira TT, Silva VLN, Mota LA, Suzarth SS, Figueiredo CA. Are TGF-β gene polymorphisms associated to asthma risk? ACTA ACUST UNITED AC 2013. [DOI: 10.13172/2052-9295-1-1-904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rodríguez Carballeira M, Solans R, Martínez F, Larrañaga J, Rios R, Ortego N, Callejas J, Castillo M, Martínez-Berriotxoa A, Trapiella L, Solanich X, Muñoz-Rodríguez F, Espinosa G. FRI0234 BehÇet’s disease: Clinical and immunologic manifestations in a cohort of 377 patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Saunders A, Makela M, Bagdasarova Y, Back HO, Boissevain J, Broussard LJ, Bowles TJ, Carr R, Currie SA, Filippone B, García A, Geltenbort P, Hickerson KP, Hill RE, Hoagland J, Hoedl S, Holley AT, Hogan G, Ito TM, Lamoreaux S, Liu CY, Liu J, Mammei RR, Martin J, Melconian D, Mendenhall MP, Morris CL, Mortensen RN, Pattie RW, Pitt M, Plaster B, Ramsey J, Rios R, Sallaska A, Seestrom SJ, Sharapov EI, Sjue S, Sondheim WE, Teasdale W, Young AR, VornDick B, Vogelaar RB, Wang Z, Xu Y. Performance of the Los Alamos National Laboratory spallation-driven solid-deuterium ultra-cold neutron source. Rev Sci Instrum 2013; 84:013304. [PMID: 23387639 DOI: 10.1063/1.4770063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this paper, we describe the performance of the Los Alamos spallation-driven solid-deuterium ultra-cold neutron (UCN) source. Measurements of the cold neutron flux, the very low energy neutron production rate, and the UCN rates and density at the exit from the biological shield are presented and compared to Monte Carlo predictions. The cold neutron rates compare well with predictions from the Monte Carlo code MCNPX and the UCN rates agree with our custom UCN Monte Carlo code. The source is shown to perform as modeled. The maximum delivered UCN density at the exit from the biological shield is 52(9) UCN/cc with a solid deuterium volume of ~1500 cm(3).
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Affiliation(s)
- A Saunders
- Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
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Holley AT, Broussard LJ, Davis JL, Hickerson K, Ito TM, Liu CY, Lyles JTM, Makela M, Mammei RR, Mendenhall MP, Morris CL, Mortensen R, Pattie RW, Rios R, Saunders A, Young AR. A high-field adiabatic fast passage ultracold neutron spin flipper for the UCNA experiment. Rev Sci Instrum 2012; 83:073505. [PMID: 22852693 DOI: 10.1063/1.4732822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The UCNA collaboration is making a precision measurement of the β asymmetry (A) in free neutron decay using polarized ultracold neutrons (UCN). A critical component of this experiment is an adiabatic fast passage neutron spin flipper capable of efficient operation in ambient magnetic fields on the order of 1 T. The requirement that it operate in a high field necessitated the construction of a free neutron spin flipper based, for the first time, on a birdcage resonator. The design, construction, and initial testing of this spin flipper prior to its use in the first measurement of A with UCN during the 2007 run cycle of the Los Alamos Neutron Science Center's 800 MeV proton accelerator is detailed. These studies determined the flipping efficiency of the device, averaged over the UCN spectrum present at the location of the spin flipper, to be ̅ε=0.9985(4).
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Affiliation(s)
- A T Holley
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
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Liu J, Mendenhall MP, Holley AT, Back HO, Bowles TJ, Broussard LJ, Carr R, Clayton S, Currie S, Filippone BW, García A, Geltenbort P, Hickerson KP, Hoagland J, Hogan GE, Hona B, Ito TM, Liu CY, Makela M, Mammei RR, Martin JW, Melconian D, Morris CL, Pattie RW, Pérez Galván A, Pitt ML, Plaster B, Ramsey JC, Rios R, Russell R, Saunders A, Seestrom SJ, Sondheim WE, Tatar E, Vogelaar RB, VornDick B, Wrede C, Yan H, Young AR. Determination of the axial-vector weak coupling constant with ultracold neutrons. Phys Rev Lett 2010; 105:181803. [PMID: 21231098 DOI: 10.1103/physrevlett.105.181803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Indexed: 05/30/2023]
Abstract
A precise measurement of the neutron decay β asymmetry A₀ has been carried out using polarized ultracold neutrons from the pulsed spallation ultracold neutron source at the Los Alamos Neutron Science Center. Combining data obtained in 2008 and 2009, we report A₀ = -0.119 66±0.000 89{-0.001 40}{+0.001 23}, from which we determine the ratio of the axial-vector to vector weak coupling of the nucleon g{A}/g{V}=-1.275 90{-0.004 45}{+0.004 09}.
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Affiliation(s)
- J Liu
- Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, CA 91125, USA
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Mika V, Hurd TC, Sunil T, Morning Star L, Moore F, Garcia O, Lopez L, Martinez M, Rios R, Welsh R. Lessons learned engaging Hispanic communities in cancer research. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1551 Background: Community involvement is critical to advance cancer education and prevention in minority communities. Researchers must be knowledgeable of the target community's basic cultural beliefs and linguistic needs. This study sought to identify the best approach for conducting community based cancer research in South Texas Hispanic communities. We report our experiences and lessons learned with participants and site recruitment and retention. Methods: We introduced a community based, culturally relevant breast and cervical cancer screening and early detection program, Esperanza y Vida, to address barriers and disparities in four border communities (urban, rural, colonia, and small border town). These areas represent the diverse South Texas Mexican American population in terms of language use, immigration status, and length of time in the US. Within these communities we recruited a grassroots community organization, faith-based health center, rural hospital district, and federally qualified health center. Results: Focus groups were conducted with women and men to assess knowledge, attitudes, and beliefs about women's cancers. To successfully recruit participants, we implemented various techniques to engage the community and establish sustainable relationships. These included community health worker recruitment of community members, traditional recruitment (flyers, posters, word of mouth), key community and cultural leader support, and discussions with local groups and health organizations. We and our community partners identified and overcame investigator/community barriers (lack of community knowledge, community integration into the research process, community understanding of research methods, reluctance to develop innovative approaches). Consequently, participants are eager to remain with the program and are individually and collectively mobilizing others to create a sustainable and durable program. Conclusions: 1. Cultural leader engagement worked best for participant recruitment in the small border town and colonia settings, while key community leader engagement was most effective in the small city urban and rural settings. 2. Research/community partners must identify and discuss project barriers regardless of the fear of creating discordance to reach solutions. No significant financial relationships to disclose.
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Affiliation(s)
- V. Mika
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - T. C. Hurd
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - T. Sunil
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - L. Morning Star
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - F. Moore
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - O. Garcia
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - L. Lopez
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - M. Martinez
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - R. Rios
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
| | - R. Welsh
- University Health System, San Antonio, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Texas at San Antonio, San Antonio, TX; University of Texas Health Science Center Houston, San Antonio, TX; Gateway Community Health Center, Laredo, TX; South Texas Colonia Initiatives, Inc., Corpus Christi, TX; Mercy Ministries, Laredo, TX; Winter Garden Border AHEC, Eagle Pass, TX
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Pattie RW, Anaya J, Back HO, Boissevain JG, Bowles TJ, Broussard LJ, Carr R, Clark DJ, Currie S, Du S, Filippone BW, Geltenbort P, García A, Hawari A, Hickerson KP, Hill R, Hino M, Hoedl SA, Hogan GE, Holley AT, Ito TM, Kawai T, Kirch K, Kitagaki S, Lamoreaux SK, Liu CY, Liu J, Makela M, Mammei RR, Martin JW, Melconian D, Meier N, Mendenhall MP, Morris CL, Mortensen R, Pichlmaier A, Pitt ML, Plaster B, Ramsey JC, Rios R, Sabourov K, Sallaska AL, Saunders A, Schmid R, Seestrom S, Servicky C, Sjue SKL, Smith D, Sondheim WE, Tatar E, Teasdale W, Terai C, Tipton B, Utsuro M, Vogelaar RB, Wehring BW, Xu YP, Young AR, Yuan J. First measurement of the neutron beta asymmetry with ultracold neutrons. Phys Rev Lett 2009; 102:012301. [PMID: 19257182 DOI: 10.1103/physrevlett.102.012301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Indexed: 05/27/2023]
Abstract
We report the first measurement of an angular correlation parameter in neutron beta decay using polarized ultracold neutrons (UCN). We utilize UCN with energies below about 200 neV, which we guide and store for approximately 30 s in a Cu decay volume. The interaction of the neutron magnetic dipole moment with a static 7 T field external to the decay volume provides a 420 neV potential energy barrier to the spin state parallel to the field, polarizing the UCN before they pass through an adiabatic fast passage spin flipper and enter a decay volume, situated within a 1 T field in a 2x2pi solenoidal spectrometer. We determine a value for the beta-asymmetry parameter A_{0}=-0.1138+/-0.0046+/-0.0021.
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Affiliation(s)
- R W Pattie
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
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Villarreal A, Stoecker BJ, Garcia C, Garcia K, Rios R, Gonzales C, Mandadi K, Faraji B, Patil BS, Deyhim F. Cranberry juice improved antioxidant status without affecting bone quality in orchidectomized male rats. Phytomedicine 2007; 14:815-20. [PMID: 17481874 DOI: 10.1016/j.phymed.2007.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND We reported that drinking citrus juice improves bone quality in orchidectomized senescent male rats. Because cranberry juice, like citrus, is rich in nutrients and phenolic compounds, beneficial effects of citrus juice might also be seen with cranberry juice. An experiment evaluated effect of drinking cranberry juice on bone quality in orchidectomized rats. METHODS Thirty-two 1-year-old male rats were randomized to two groups: a sham-control group (n=8) and an orchidectomized group (n=24). The treatments for the 4 months duration of the study were SHAM, orchidectomy (ORX), ORX+drinking either 27% or 45% cranberry juice concentrate added to drinking water. At the termination of the study, the rats were euthanized, blood was collected for plasma antioxidant status and IGF-I. The femur, tibia and the 4th lumbar were evaluated for bone quality. Total calcium and magnesium concentration in the femurs were also evaluated. RESULTS ORX did not affect red blood cell (RBC)-induced hemolysis despite lowering (p<0.05) plasma antioxidant capacity; reduced (p<0.05) plasma IGF-I, femoral density, femoral strength, time-induced femoral fracture, bone mineral content, bone mineral area; numerically (p=0.07) lowered 4th lumbar density; decreased (p<0.05) trabecular connectivity, trabecular number, femoral ash; increased (p<0.05) trabecular separation in comparison to the SHAM group. Drinking cranberry juice increased (p<0.05) plasma antioxidant status, protected RBC against hemolysis, but had no positive effect on bone quality or bone mineral status. CONCLUSIONS Cranberry juice increases plasma antioxidant status without affecting bone quality.
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Affiliation(s)
- A Villarreal
- Department of Human Sciences, MSC 168, Texas A&M University-Kingsville, Kingsville, TX 78363, USA
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Marzoa R, Crespo-Leiro MG, Paniagua MJ, Bendayán I, Rios R, Franco R, Rodriguez JA, Barge E, Naya C, Gómez M, Cuenca JJ, Juffé A, Castro-Beiras A. Late noncardiac surgery in heart transplant patients. Transplant Proc 2007; 39:2382-4. [PMID: 17889197 DOI: 10.1016/j.transproceed.2007.07.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/26/2022]
Abstract
OBJECTIVE Because of improved long-term survival of heart transplants (HT), patients often need noncardiac surgery (NCS). Immunosuppression may increase the infection rate. Inadequate management may increase the risk of dysfunction or acute rejection episodes (ARE). Long-term outcomes of NCS and optimal immunosuppressive management in the perioperative period are not well known. The objective of this study was to analyze the incidence, morbidity, and mortality of late NCS after HT. METHODS We retrospectively evaluated the incidence and type of late NCS as well as the risk factors for complications and the mortality among 207 HT patients. Immunosuppression and ARE rates were also analyzed. RESULTS One hundred and sixteen late NCS (84.5% elective) were performed in 72 HT patients (34.8%). Interventions were: 35 urologic (30.2%), 29 abdominal (25%), 14 vascular (12.1%), 13 ENT (11.2%), 11 skin and soft tissue (9.5%), and 7 orthopedic (6%). Malignancy was the main indication for NCS (33.6%). Only 4 patients (5.6%) died preoperatively. Mortality was higher among emergent vs elective procedures (16.6% vs 1%; P = .012) and among patients with preoperative high vs middle/low risk (26.6% vs 0%). Postsurgical infection was the most frequent complication (6.9%). However, there were no relevant complications in 82.8% of HT patients. Hospitalization time was <15 days in two thirds of patients. Immunosuppression was modified in 33 patients (28.4%), especially when the surgical indication was neoplasia (P < .001). None of the patients with NCS displayed allograft dysfunction or an ARE. CONCLUSIONS More than one-third of HT patients needed a late NCS. In our experience, elective surgical procedures with middle/low preoperative cardiovascular risk are safe. In this context, the risk of rejection was low when immunosuppression was carefully monitored to reduce the risk of infection.
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Affiliation(s)
- R Marzoa
- Area del Corazón, Complejo Hospitalario Juan Canalejo, La Coruña, Spain.
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Crespo-Leiro MG, Paniagua MJ, Franco R, Marzoa R, Grille Z, Naya C, Barge E, Rios R, Rodríguez JA, Calviño R, Cuenca JJ, Castro-Beiras A. Late Steroid Withdrawal After Heart Transplantation and Incidence of Acute Rejection. Transplant Proc 2007; 39:2372-4. [PMID: 17889193 DOI: 10.1016/j.transproceed.2007.07.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/23/2022]
Abstract
BACKGROUND Steroid withdrawal (SW) after heart transplantation (HT) reduces steroid-associated side effects, although it can increase acute rejection episodes (ARE). Patient selection criteria for SW and the time elapsed after HT for this maneuver are controversial issues. The objective of this study was to assess the safety of late SW after HT with regard to the occurrence of ARE and to analyze risk factors resulting in a poor evolution. METHODS We studied a cohort of 24 patients who underwent SW late after HT. All of them had gone at least 4 years without any ARE. Independent variables were time after HT, general recipient and donor data, risk factors for ARE, and immunosuppression. The dependent variables were occurrence of ARE (proven or not proven with endomyocardial biopsy) and time and severity of ARE. RESULTS Among 24 HT patients including 96% men with an overall mean age of 57 years who underwent SW, the mean follow-up was 2.32 +/- 0.86 years. Six patients (25%) displayed an ARE >or=2R according to the International Society for Heart and Lung Transplantation (ISHLT) at 5 +/- 3 months after SW. There were no deaths. Time from the last rejection episode to SW was 6.6 +/- 2 years. All ARE were treated with steroid boluses (mean total dose 1583 +/- 1044 mg). Among the HT patients with ARE, 5 (85%) had never experienced ARE after HT. Upon long-term follow-up, there were 2 deaths: 1 sudden death at 30 months after SW and 1 due to allograft vasculopathy at 20 months post-SW. Currently 92% are New York Heart Association (NYHA) functional class I with a mean left ventricular ejection fraction of 67% +/- 10%. CONCLUSIONS In our series of HT with late SW after HT (even among an HT population with a low risk of rejection), there was a 25% rate of ARE. This study did not allow us to identify risk factors for ARE after SW. We believe that based upon these observations SW should be implemented with caution.
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Affiliation(s)
- M G Crespo-Leiro
- Area del Corazón, Complejo Hospitalario Juan Canalejo, La Coruña, Spain.
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Qazilbash MH, Thall PF, Wang X, Wieder E, Rios R, Kant S, Estey EH, Cortes JE, Komanduri K, Champlin RE, Molldrem JJ. PR1 peptide vaccination for patients with myeloid leukemias. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7017 Background: PR1 is a nanomeric HLA-A2-restricted peptide derived from the myeloid leukemia-associated antigens proteinase 3 and neutrophil elastase. Methods: Sixty-six HLA-A2+ patients with acute myeloid leukemia (42), chronic myeloid leukemia (13) or myelodysplastic syndrome (11) were treated with PR1 peptide vaccine. The first 54 patient received three vaccinations, and the last 12 patients were given six vaccinations. The vaccine was injected subcutaneously, at 3 week intervals at one of three dose levels: 0.25, 0.5 or 1.0 mg per vaccination. Immune response to the vaccine was defined as a ≥ 2-fold increase in PR1-specific cytotoxic T lymphocytes. Results: Fifty-three patients had measurable disease (MD) and 13 were in complete remission. The vaccine was well tolerated, with toxicity limited to grade I and II injection site reactions. Forty-four of the 53 patients with MD were evaluable for both immune and clinical responses. PR1-specific immune response was observed in 35/44 (57%) of the evaluable patients. Clinical responses were observed in 10 of the 25 immune responders versus 2 of the 19 immune non-responders (p=0.04). PR1 vaccine-induced immune response was associated with a longer event-free survival, 8.7 months vs. 4.1 months in immune non-responders (p = 0.17). Older age and high blast count were associated with short event-free survival (p=0.01 and <0.001). Conclusion: PR1 peptide vaccine-induced immune response is associated with a superior overall clinical response and a trend towards longer event-free survival in patients with persistent myeloid leukemia. [Table: see text]
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Affiliation(s)
| | | | - X. Wang
- UT MD Anderson Cancer Center, Houston, TX
| | - E. Wieder
- UT MD Anderson Cancer Center, Houston, TX
| | - R. Rios
- UT MD Anderson Cancer Center, Houston, TX
| | - S. Kant
- UT MD Anderson Cancer Center, Houston, TX
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Qazilbash M, Rios R, Thall P, Wang X, Wieder E, Lu S, Kant S, Giralt S, Estey E, Cortes J, Champlin R, Komanduri K, Molldrem J. PR1 vaccine after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Smith R, Kaune H, Parodi D, Madariaga M, Rios R, Morales I, Castro A. Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress. Hum Reprod 2005; 21:986-93. [PMID: 16361286 DOI: 10.1093/humrep/dei429] [Citation(s) in RCA: 224] [Impact Index Per Article: 11.8] [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: 12/31/2022] Open
Abstract
BACKGROUND The pathophysiology of the testicular damage in varicocele has not been completely understood. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. The current study was designed to determine the extent of sperm nuclear DNA damage in patients with varicocele and to examine its relationship with oxidative stress. METHODS Semen samples from 55 patients with clinical varicocele and 25 normozoospermic donors were examined. Varicocele sperm samples were classified as normal or abnormal according to World Health Organization guidelines. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry and by the terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity were assessed by a chemiluminescence assay. RESULTS DNA fragmentation index (DFI) (percentage of sperm with denatured DNA) values and the percentage of TUNEL-positive cells were significantly greater in patients with varicocele, either with normal (DFI, 20.7 +/- 4.0; TUNEL positive, 26.1 +/- 3.2) or with abnormal (DFI, 35.5 +/- 9.0; TUNEL positive, 32.2 +/- 4.1) semen profile, compared with controls (DFI, 7.1 +/- 0.9; TUNEL positive, 14.2 +/- 1.2). Similarly, ROS levels were significantly higher (P < 0.01) in both groups of patients with varicocele. CONCLUSIONS The presence of a varicocele is associated with high levels of DNA-damage spermatozoa even in the presence of normal semen profile. The results also indicate that oxidative damage is associated with sperm DNA damage in these patients.
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Affiliation(s)
- R Smith
- Institute of Maternal and Child Research, School of Medicine, University of Chile and San Borja-Arriarán Clinical Hospital, Santiago, Chile.
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Winthrop KL, Scott J, Brown D, Jay MT, Rios R, Mase S, Richardson D, Edmonson A, MacLean M, Flood J. Investigation of human contacts: a Mycobacterium bovis outbreak among cattle at a California dairy. Int J Tuberc Lung Dis 2005; 9:809-13. [PMID: 16013779] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND In May 2002, a Mycobacterium bovis outbreak occurred among cattle at a California dairy. We investigated to determine whether persons were infected after working with the cattle or drinking their raw milk. METHODS We identified persons with potential contact with infected cattle, including dairy workers, their family members, and slaughterhouse workers. Persons were given a tuberculin skin test (TST), and their occupational and milk-drinking habits were recorded. RESULTS Of 88 potential contacts, 78 (90%) were given a TST; 33 (43%) had positive TST results, of whom 32 were Mexican-born (RR 15.8, 95%CI 2.3-108.8). No persons had active tuberculosis. Eighteen (72%) dairy workers, 11 (27%) family members, and four (33%) slaughterhouse workers had positive TST results. After adjusting for Mexican-birth and age, dairy workers were no more likely to have positive TST results than others (adjusted RR 1.2, 95%CI 0.6-2.1). Forty-one (62%) dairy staff and their family members drank raw milk from the dairy; 21 (51%) had positive TST results and were Mexican-born. All 13 US-born raw milk drinkers had negative TST results. CONCLUSION A high prevalence of positive TST results was documented among workers at the affected dairy, although results were not independently associated with contact with infected cattle or milk products. Further assessment of California dairy workers should be considered.
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Affiliation(s)
- K L Winthrop
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Molldrem J, Akande O, Estey E, Rios R. O-34 Immunosuppressive therapy withATG in low-risk patients with myelodysplastic syndrome. Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jay MT, Garrett V, Mohle-Boetani JC, Barros M, Farrar JA, Rios R, Abbott S, Sowadsky R, Komatsu K, Mandrell R, Sobel J, Werner SB. A Multistate Outbreak of Escherichia coli O157:H7 Infection Linked to Consumption of Beef Tacos at a Fast-Food Restaurant Chain. Clin Infect Dis 2004; 39:1-7. [PMID: 15206044 DOI: 10.1086/421088] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Accepted: 12/22/2003] [Indexed: 11/03/2022] Open
Abstract
We investigated a multistate outbreak of Escherichia coli O157:H7 infections. Isolates from 13 case patients from California, Nevada, and Arizona were matched by pulsed-field gel electrophoresis subtyping. Five case patients (38%) were hospitalized, and 3 (23%) developed hemolytic uremic syndrome; none died. The median age was 12 years (range, 2-75 years), and 10 (77%) were female. Case-control studies found an association between illness and eating beef tacos at a national Mexican-style fast-food restaurant chain (88% of cases versus 38% of controls; matched OR, undefined; 95% confidence interval, 1.49 to infinity; P=.009). A trace-back investigation implicated an upstream supplier of beef, but a farm investigation was not possible. This outbreak illustrates the value of employing hospital laboratory-based surveillance to detect local clusters of infections and the effectiveness of using molecular subtyping to identify geographically dispersed outbreaks. The outbreak investigation also highlights the need for a more efficient tracking system for food products.
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Affiliation(s)
- Michele T Jay
- California Department of Health Services, Sacramento, USA.
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Riedemann S, Reinhardt G, Jara J, Rios R, Wenzel MS, Willems P, Bock HL. Immunogenicity and reactogenicity of combined versus separately administered DTPw-HBV and Hib vaccines given to healthy infants at 2, 4 and 6 months of age, with a booster at 18 months. Int J Infect Dis 2002; 6:215-22. [PMID: 12718838 DOI: 10.1016/s1201-9712(02)90114-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/23/2022] Open
Abstract
OBJECTIVES To determine the immunogenicity and reactogenicity of a combined DTPw-HBV/Hib vaccine, in comparison with DTPw-HBV and Hib vaccines given as separate concomitant injections. METHODS In an open, randomized study, healthy infants were injected with either DTPw-HBV/Hib vaccine or separate DTPw-HBV and Hib vaccines at 2, 4 and 6 months of age, with a booster at 18 months. RESULTS Both vaccination regimens were immunogenic, with seropositivity rates of 100% after the booster vaccination for all vaccine components. Even as early as 2 months after the second dose of the primary vaccination, most patients had seroprotective antibody titers, the proportion of seropositive subjects approaching 100% for tetanus, hepatitis B, and Hib. Post-primary and post-booster geometric mean titers (GMTs) were well above seroprotective thresholds for each vaccine antigen in both groups, with no clinically relevant differences in the groups. The separate and combined administrations showed comparable reactogenicity profiles, and neither showed a significant increase in reactogenicity with successive doses. CONCLUSIONS The results of this study support the combination of Hib and DTPw-HBV vaccination in routine infant immunization at 2, 4 and 6 months of age with a booster at 18 months. Maximum benefit is obtained from compliance with the full course, but substantial benefit is likely to be achieved even in partially compliant patients, provided they receive at least two doses. Furthermore, these results demonstrate the tolerability of a fourth (booster) administration, where the addition of the Hib vaccine to DTPw-HBV did not lead to an increase in the overall reactogenicity.
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Buchholz U, Mermin J, Rios R, Casagrande TL, Galey F, Lee M, Quattrone A, Farrar J, Nagelkerke N, Werner SB. An outbreak of food-borne illness associated with methomyl-contaminated salt. JAMA 2002; 288:604-10. [PMID: 12150672 DOI: 10.1001/jama.288.5.604] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT On January 5, 1999, the California Department of Health Services was notified of the repeated occurrence (December 21, 1998, and January 2, 1999) of gastrointestinal tract illness among patrons at a Thai restaurant in central California. OBJECTIVE To identify the source of the outbreak. DESIGN Case-control study; microbiological and toxicological laboratory testing of samples of food, stool, and vomitus. SETTING Thai food restaurant in central California. PARTICIPANTS Patrons of the restaurant. A case (n = 107) was defined as dizziness, nausea, or vomiting occurring in a person who ate at the restaurant between December 20, 1998, and January 2, 1999, with onset of symptoms within 2 hours of eating. A control (n = 169) was a person who ate at the restaurant during the same period but reported no symptoms. MAIN OUTCOME MEASURES Odds ratios (ORs) of illness associated with food exposures; ORs of shifts during which illness occurred associated with certain cooks; laboratory results. RESULTS The median latency period was 40 minutes from beginning eating to first symptom and was 2 hours to onset of diarrhea. The median duration of symptoms was 6 hours. Twenty-six persons (24%) visited the emergency department or were treated by a physician; no person required hospitalization. Patients reported nausea (95%), dizziness (72%), abdominal cramps (58%), headache (52%), vomiting (51%), chills (48%), and diarrhea (46%). Fifty-one cases (48%) included dizziness, lightheadedness, or a feeling of disequilibrium as the initial symptom. Illness was statistically associated with several foods and ingredients, but no single dish or ingredient explained a substantial number of cases. The analysis of food exposures included salt added by cooks, as estimated by using the amount of salt in the recipe for each dish and the amount of each dish eaten by respondents. This association was stronger with increasing levels of salt: ORs for illness among persons who consumed more than 0.42 to 0.84, more than 0.84 to 1.25, and more than 1.25 tsp of salt added to foods in the kitchen were 1.9 (95% confidence interval [CI], 0.6-5.7), 3.0 (95% CI, 1.0-8.8), and 4.0 (95% CI, 1.3-13.5) compared with persons who consumed less than 0.42 tsp (P value for trend =.004). Methomyl, a highly toxic carbamate pesticide, was identified in a sample of vomitus (20 ppm) and in salt taken from containers in the storeroom (mean, 5600 ppm) and the stovetop (mean, 1425 ppm). The oral toxic dose causing illness in 50% of those exposed to methomyl was estimated to be 0.15 mg/kg of body weight (estimated range, 0.09-0.31 mg/kg of body weight). The presence of cook A was associated with shifts during which cases of illness occurred (OR, 10.4; 95% CI, 1.2-157.4). CONCLUSION This outbreak of gastrointestinal illness was associated with the consumption of food seasoned with methomyl-contaminated salt. To allow rapid assessment for further investigational and control measures by health officials, physicians should report suspected outbreaks of illness to public health departments, however trivial the symptoms or cause may seem.
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Affiliation(s)
- Udo Buchholz
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Rios R, Herrero JI, Quiroga J, Sangro B, Sola I, Pardo F, Cienfuegos JA, Herraiz M, Prieto J. Idiopathic adulthood ductopenia: long-term follow-up after liver transplantation. Dig Dis Sci 2001; 46:1420-3. [PMID: 11478493 DOI: 10.1023/a:1010679502324] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- R Rios
- Department of Internal Medicine, Clinca Universitaria, Pamplona, Spain
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Safgren SL, Reid JM, Rios R, Ames MM. Validated high-performance liquid chromatographic assay for simultaneous determination of dacarbazine and the plasma metabolites 5-(3-hydroxymethyl-3-methyl-1-triazeno)imidazole-4-carboxamide and 5-(3-methyl-1-triazeno)imidazole-4-carboxamide. J Chromatogr B Biomed Sci Appl 2001; 754:91-6. [PMID: 11318431 DOI: 10.1016/s0378-4347(00)00586-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dacarbazine (DTIC) is a prodrug that is clinically effective in the treatment of Hodgkin's disease, melanoma and soft tissue sarcoma. To better characterize the clinical pharmacology of parent drug and reactive metabolites, a reversed-phase HPLC method with UV detection was developed for simultaneous determination of dacarbazine and the metabolites 5-(3-hydroxymethyl-3-methyl-1-triazeno)imidazole-4-carboxamide (HMMTIC) and 5-(3-methyl-1-triazeno)imidazole-4-carboxamide (MTIC). Chromatographic separation was achieved with a Zorbax SB-CN column and with a mobile phase of 80% 50 mM ammonium phosphate, pH 6.5, 20% methanol and 0.1% triethylamine. HMMTIC, MTIC and DTIC were extracted from plasma with methanol precipitation of the proteins. Recovery of DTIC and the metabolites from whole blood was greater than 92%. Rapid processing of whole blood, methanol extraction and storage at -70 degrees C substantially increased the stability of HMMTIC and MTIC from less than 15 min to 3 days. Precision for HMMTIC, MTIC and DTIC ranged from 3.7 to 16.3% relative standard deviation. The accuracy ranged from 101 to 114% for all three analytes. The validated assay was used to determine the pharmacokinetic data for dacarbazine and its active metabolites for human patients with recurrent glioma receiving DTIC intravenously.
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Affiliation(s)
- S L Safgren
- Department of Oncology, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Nielsen PV, Rios R. Inhibition of fungal growth on bread by volatile components from spices and herbs, and the possible application in active packaging, with special emphasis on mustard essential oil. Int J Food Microbiol 2000; 60:219-29. [PMID: 11016611 DOI: 10.1016/s0168-1605(00)00343-3] [Citation(s) in RCA: 218] [Impact Index Per Article: 9.1] [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: 11/19/2022]
Abstract
The effect of modified atmosphere packaging (MAP) on the most important spoilage fungi of bread was investigated. Penicillium commune, P. roqueforti, Aspergillus flavus and Endomyces fibuliger were able to grow at oxygen levels down to 0.03%, while the chalk mould E. fibuliger was capable of growing even in the presence of an oxygen absorber. High levels of carbon dioxide retarded growth but not completely. As an alternative to MAP active packaging (AP) using volatile essential oils (EO) and oleoresins (OL) from spices and herbs were tested against a range of fungi commonly found on bread. Concentrations of 1, 10 or 100 microl EO or OL were added to a filter paper placed in the lid of a Petri dish inoculated with one of the test fungi. The Petri dish was sealed hermetically to avoid the exchange of gases. Mustard essential oil showed the strongest effect. Cinnamon, garlic and clove also had high activity, while oregano oleoresin only inhibited growth weakly. Vanilla showed no inhibitory effect towards the tested microorganisms at the applied concentrations. A. flavus was more resistant than the other microorganisms while P. roqueforti was the most sensitive. Mustard essential oil was investigated in greater detail. The minimal inhibitory concentration (MIC) for the active component, allyl isothiocyanate (AITC), was determined for the same species and an additional three moulds and one yeast. MIC values ranged from 1.8 to 3.5 microg/ml gas phase. Results showed that whether AITC was fungistatic or fungicidal depended on its concentration, and the concentration of spores. When the gas phase contained at least 3.5 microg/ml, AITC was fungicidal to all tested fungi. Results of sensory evaluation showed, that hot-dog bread was more sensitive to AITC than rye bread. The minimal recognisable concentration of AITC was 2.4 microg/ml gas phase for rye bread and between 1.8 and 3.5 microg/ml gas phase for hot-dog bread. These findings showed that the required shelf-life of rye bread could be achieved by active packaging with AITC. Active packaging of hot-dog bread, may nevertheless require the additional effect of other preserving factors to avoid off-flavour formation
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Affiliation(s)
- P V Nielsen
- Department of Biotechnology,Technical University of Denmark.
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Budihardjo II, Boerner SA, Eckdahl S, Svingen PA, Rios R, Ames MM, Kaufmann SH. Effect of 6-aminonicotinamide and other protein synthesis inhibitors on formation of platinum-DNA adducts and cisplatin sensitivity. Mol Pharmacol 2000; 57:529-38. [PMID: 10692493 DOI: 10.1124/mol.57.3.529] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 01/03/2023] Open
Abstract
The present study was undertaken to examine the mechanistic basis for the recent observation that the pyridine nucleotide derivative 6-aminonicotinamide (6AN, NSC 21206) enhances the accumulation and resulting cytotoxicity of cisplatin in a variety of tumor cell lines. When A549 lung cancer cells or K562 leukemia cells were treated with 62.5 microM 6AN for 21 h and then pulse-labeled with [(35)S]methionine for 1 h, increased labeling of five polypeptides, one of which corresponded to a M(r) approximately 78,000 glucose-regulated protein (GRP78), was observed. Two subsequent observations, however, suggested that up-regulation of these polypeptides was unlikely to explain the interaction between 6AN and cisplatin: 1) the concentration of 6AN required to induce GRP78 was 4-fold higher than the dose required to sensitize cells to cisplatin; and 2) simultaneous treatment of cells with 6AN and cycloheximide prevented the increase in GRP78 but not the sensitizing effect of 6AN. On the contrary, treatment with the protein synthesis inhibitors cycloheximide, anisomycin, or puromycin as well as prolonged exposure to the RNA synthesis inhibitor actinomycin D mimicked the biochemical modulating effects of 6AN on cisplatin action. Conversely, 6AN inhibited protein synthesis, whereas 18 6AN analogs that failed to enhance Pt-DNA adducts and cisplatin cytotoxicity failed to inhibit protein synthesis. These observations are consistent with a model in which 6AN and other inhibitors of protein synthesis act as modulating agents by increasing cisplatin accumulation, thereby enhancing the formation of Pt-DNA adducts and subsequent cisplatin-induced cell death.
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Affiliation(s)
- I I Budihardjo
- Division of Oncology Research, Mayo Medical School, Rochester, Minnesota, USA
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Abstract
We report a case of the 5q- syndrome with simultaneous occurrence of multiple myeloma, characterized by a very complicated course. To the best of our knowledge, this is the first report of such an association.
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Affiliation(s)
- R Rios
- Servicio de Hematología, Hospital 'Valle de los Pedroches', Pozoblanco, Córdoba, Spain
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Walker DL, Reid JM, Svingen PA, Rios R, Covey JM, Alley MC, Hollingshead MG, Budihardjo II, Eckdahl S, Boerner SA, Kaufmann SH, Ames MM. Murine pharmacokinetics of 6-aminonicotinamide (NSC 21206), a novel biochemical modulating agent. Biochem Pharmacol 1999; 58:1057-66. [PMID: 10509758 DOI: 10.1016/s0006-2952(99)00179-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
The pyridine nucleotide 6-aminonicotinamide (6AN) was shown recently to sensitize a number of human tumor cell lines to cisplatin in vitro. The present studies were undertaken to compare the drug concentrations and length of exposure required for this sensitization in vitro with the drug exposure that could be achieved in mice in vivo. Human K562 leukemia cells and A549 lung cancer cells were incubated with 6AN for various lengths of time, exposed to cisplatin for 1-2 hr, and assayed for Pt-DNA adducts as well as the ability to form colonies. K562 cells displayed progressive increases in Pt-DNA adducts and cisplatin sensitivity during the first 10 hr of 6AN exposure. An 18-hr 6AN exposure was likewise more effective than a 6-hr 6AN exposure in sensitizing A549 cells to cisplatin. HPLC analysis of 6AN and its metabolite, 6-amino-NAD+, permitted assessment of exposures achieved in vivo after i.v. administration of 10 mg/kg of 6AN to CD2F1 mice. 6AN reached peak serum concentrations of 80-90 microM and was cleared rapidly, with T1/2alpha and T1/2beta values of 7.4 and 31.3 min, respectively. Bioavailability was 80-100% with identical plasma pharmacokinetics after i.p. administration. At least 25% of the 6AN was excreted unchanged in the urine. The metabolite 6-amino-NAD+ was detected in perchloric acid extracts of brain, liver, kidney, and spleen, but not in serum. Efforts to prolong systemic 6AN exposure by administering multiple i.p. doses or using osmotic pumps resulted in lethal toxicity. These results demonstrated that 6AN exposures required to sensitize tumor cells to cisplatin in vitro are difficult to achieve in vivo.
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Affiliation(s)
- D L Walker
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Reid JM, Kuffel MJ, Miller JK, Rios R, Ames MM. Metabolic activation of dacarbazine by human cytochromes P450: the role of CYP1A1, CYP1A2, and CYP2E1. Clin Cancer Res 1999; 5:2192-7. [PMID: 10473105] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Dacarbazine (DTIC), a widely used anticancer agent, is inactive until metabolized in the liver by cytochromes P450 to form the reactive N-demethylated species 5-[3-hydroxymethyl-3-methyl-triazen-1-yl]-imidazole-4-carboxamide (HMMTIC) and 5-[3-methyl-triazen-1-yl]-imidazole-4-carboxamide (MTIC). The modest activity of DTIC in the treatment of cancer patients has been attributed in part to lower activity of cytochromes P450 (P450) in humans when compared with rodents. Importantly, the particular P450 isoforms involved in the activation pathway have not been reported. We now report that the DTIC N-demethylation involved in MTIC formation by human liver microsomes is catalyzed by CYP1A1, CYP1A2, and CYP2E1. The most potent inhibitors of DTIC N-demethylation were alpha-naphthoflavone (CYP1A1 and CYP1A2), quercetin (CYP1A2), chlorzoxazone (CYP1A2 and CYP2E1), and di-sulfiram (CYP2E1). Antihuman CYP1A2 antiserum also inhibited DTIC N-demethylation. DTIC N-demethylation in a panel of 10 human liver microsome preparations was correlated with the catalytic activities for CYP1A2 (ethoxyresorufin O-deethylation and caffeine N3-demethylation) in the absence of alpha-naphthoflavone and with the catalytic activities for CYP2E1 (chlorzoxazone 6-hydroxylations) in the presence of alpha-naphthoflavone. DTIC metabolism was catalyzed by recombinant human CYP1A1, CYP1A2, and CYP2E1. The Km (Vmax) values for metabolism of DTIC by recombinant human CYP1A1 and CYP1A2 were 595 microM (0.684 nmol/min/mg protein) and 659 microM (1.74 nmol/min/mg protein), respectively. The CYP2E1 Km value exceeded 2.8 mM. Thus, we conclude that (a) CYP1A2 is the predominant P450 that catalyzes DTIC hepatic metabolism; (b) CYP2E1 contributes to hepatic DTIC metabolism at higher substrate concentrations; and (c) CYP1A1 catalyzes extrahepatic metabolism of DTIC.
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Affiliation(s)
- J M Reid
- Department of Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Gellan gum beads of propranolol hydrochloride, a hydrophilic model drug, were prepared by solubilising the drug in a dispersion of gellan gum and then dropping the dispersion into calcium chloride solution. The droplets formed gelled beads instantaneously by ionotropic gelation. Major formulation and process variables which might influence the preparation of the beads and the drug release from gellan gum beads were studied. Very high entrapment efficiencies were obtained (92%) after modifying the pH of both the gellan gum dispersion and the calcium chloride solution. The beads could be stored for 3 weeks in a wet or dried state without modification of the drug release. Oven-dried beads released the drug somewhat more slowly than the wet or freeze-dried beads. The drug release from oven-dried beads was slightly affected by the pH of the dissolution medium. Gellan gum could be a useful carrier for the encapsulation of fragile drugs and provides new opportunities in the field of bioencapsulation.
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Affiliation(s)
- F Kedzierewicz
- Laboratoire de Pharmacie Galénique, Faculté de Pharmacie, Université Henri Poincaré, Nancy, France.
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Rios R, Stolfi A, Campbell PH, Pickoff AS. Postnatal development of the putative neuropeptide-Y-mediated sympathetic-parasympathetic autonomic interaction. Cardiovasc Res 1996. [DOI: 10.1016/s0008-6363(95)00100-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rios R, Stolfi A, Campbell PH, Pickoff AS. Postnatal development of the putative neuropeptide-Y-mediated sympathetic--parasympathetic autonomic interaction. Cardiovasc Res 1996; 31 Spec No:E96-103. [PMID: 8681351] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Intense stellate ganglion stimulation causes a long-lasting inhibition of cardiac vagal responses in adult dogs. This inhibition is thought to result from the release of neuropeptide Y from sympathetic nerve terminals, which, in turn, blocks the release of acetylcholine from parasympathetic neurons. The purpose of this study was to characterize the developmental expression of this autonomic interaction in the dog. METHODS We studied and compared the effects of 5-min trains of right stellate ganglion stimulation on cardiac chronotropic responses to supramaximal vagal stimulation trains in 10 neonatal dogs, 8 one-month-old puppies, 8 two-month-old puppies and 8 adult dogs. RESULTS In the adult group, after 5 min of stellate stimulation, inhibition of the vagal chronotropic response was observed in 7 of 8 (87.5%). Inhibition was observed in 100% of the one-month-olds and in 87.5% of the two-month-olds. In contrast, in the neonates, inhibition was observed in only 4 of 10 (40%) (P < 0.05). The maximum percent inhibition of the cardiac vagal response was significantly less in the neonates than in the older puppies (P < 0.001) and adults (P < 0.01), and the summated inhibition also tended to be less in the neonates (P < 0.05 compared to one- and two-month-old puppies). Finally, in 60% of the neonates and 37.5% of all other animals vagal responses after stellate stimulation were facilitated, i.e. at least 20% greater than the pre-stellate stimulation values. CONCLUSION The putative neuropeptide-Y-mediated, sympathetic-parasympathetic interaction is not fully expressed in the canine neonate. It appears to develop quite rapidly postnatally, being fully expressed by 1 month of age. We hypothesize that this developmental change is likely the result of maturation of sympathetic nervous system function after birth. The facilitation of the vagal chronotropic response, observed in some animals after stellate stimulation, is a new finding, and may represent yet another type of autonomic interaction.
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Affiliation(s)
- R Rios
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA
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