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Avecilla V, Doke M, Das M, Alcazar O, Appunni S, Rech Tondin A, Watts B, Ramamoorthy V, Rubens M, Das JK. Integrative Bioinformatics-Gene Network Approach Reveals Linkage between Estrogenic Endocrine Disruptors and Vascular Remodeling in Peripheral Arterial Disease. Int J Mol Sci 2024; 25:4502. [PMID: 38674087 PMCID: PMC11049860 DOI: 10.3390/ijms25084502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Vascular diseases, including peripheral arterial disease (PAD), pulmonary arterial hypertension, and atherosclerosis, significantly impact global health due to their intricate relationship with vascular remodeling. This process, characterized by structural alterations in resistance vessels, is a hallmark of heightened vascular resistance seen in these disorders. The influence of environmental estrogenic endocrine disruptors (EEDs) on the vasculature suggests a potential exacerbation of these alterations. Our study employs an integrative approach, combining data mining with bioinformatics, to unravel the interactions between EEDs and vascular remodeling genes in the context of PAD. We explore the molecular dynamics by which EED exposure may alter vascular function in PAD patients. The investigation highlights the profound effect of EEDs on pivotal genes such as ID3, LY6E, FOS, PTP4A1, NAMPT, GADD45A, PDGF-BB, and NFKB, all of which play significant roles in PAD pathophysiology. The insights gained from our study enhance the understanding of genomic alterations induced by EEDs in vascular remodeling processes. Such knowledge is invaluable for developing strategies to prevent and manage vascular diseases, potentially mitigating the impact of harmful environmental pollutants like EEDs on conditions such as PAD.
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Affiliation(s)
- Vincent Avecilla
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA;
| | - Mayur Doke
- Diabetes Research Institute, University of Miami, Miami, FL 33136, USA; (M.D.); (O.A.); (A.R.T.); (B.W.)
| | - Madhumita Das
- Department of Biology, Miami Dade College, Miami, FL 33132, USA;
| | - Oscar Alcazar
- Diabetes Research Institute, University of Miami, Miami, FL 33136, USA; (M.D.); (O.A.); (A.R.T.); (B.W.)
| | - Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode 673008, Kerala, India;
| | - Arthur Rech Tondin
- Diabetes Research Institute, University of Miami, Miami, FL 33136, USA; (M.D.); (O.A.); (A.R.T.); (B.W.)
| | - Brandon Watts
- Diabetes Research Institute, University of Miami, Miami, FL 33136, USA; (M.D.); (O.A.); (A.R.T.); (B.W.)
| | | | - Muni Rubens
- Baptist Health South Florida, Miami Gardens, FL 33176, USA; (V.R.); (M.R.)
| | - Jayanta Kumar Das
- Department of Health and Natural Sciences, Florida Memorial University, Miami Gardens, FL 33054, USA
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Appunni S, Rubens M, Ramamoorthy V, Saxena A, Doke M, Roy M, Ruiz-Pelaez JG, Zhang Y, Ahmed MA, Zhang Z, McGranaghan P, Chaparro S, Jimenez J. Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations. South Med J 2024; 117:75-79. [PMID: 38307502 DOI: 10.14423/smj.0000000000001654] [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: 02/04/2024]
Abstract
OBJECTIVES Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database. METHODS We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission. RESULTS There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38-1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31-1.39), vasopressor use (OR 1.59, 95% CI 1.51-1.66), mechanical ventilation (OR 1.62, 95% CI 1.47-1.78), and ICU admission rates (OR 1.58, 95% CI 1.51-1.66) were significantly higher among male hospitalizations. CONCLUSION Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.
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Affiliation(s)
- Sandeep Appunni
- From the Government Medical College, Kozhikode, Kerala, India
| | | | | | | | - Mayur Doke
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Mukesh Roy
- Office of Clinical Research, Baptist Health South Florida, Miami
| | | | - Yanjia Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami
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Doke M, Appunni S, Rubens M, Alcazar O, Ramamoorthy V, Saxena A, Roy M, Khosla A, Chaparro S, Jimenez J. Genomic Alterations and Aberrant Molecular Pathways in Arrhythmogenic Cardiomyopathy. Am J Cardiol 2024; 211:160-162. [PMID: 37890566 DOI: 10.1016/j.amjcard.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Mayur Doke
- Robert Stempel College of Public Health, Florida International University, Miami, Florida
| | | | - Muni Rubens
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Office of Clinical Research, Baptist Health South Florida, Miami, Florida; Universidad Espíritu Santo, Samborondón, Ecuador
| | - Oscar Alcazar
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Anshul Saxena
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Mukesh Roy
- Office of Clinical Research, Baptist Health South Florida, Miami, Florida
| | - Atulya Khosla
- William Beaumont University Hospital, Royal Oak, Michigan
| | - Sandra Chaparro
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Javier Jimenez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida.
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Chan K, Conroy A, Khosla A, Rubens M, Saxena A, Ramamoorthy V, Roy M, Appunni S, Doke M, Ahmed MA, Zhang Z, McGranaghan P, Chaparro S, Jimenez J. Prevalence and effects of acute myocardial infarction on hospital outcomes among COVID-19 patients. Coron Artery Dis 2024; 35:38-43. [PMID: 37876241 DOI: 10.1097/mca.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is one of the most lethal complications of COVID-19 hospitalization. In this study, we looked for the occurrence of AMI and its effects on hospital outcomes among COVID-19 patients. METHODS Data from the 2020 California State Inpatient Database was used retrospectively. All COVID-19 hospitalizations with age ≥ 18 years were included in the analyses. Adverse hospital outcomes included in-hospital mortality, prolonged length of stay (LOS), vasopressor use, mechanical ventilation, and ICU admission. Prolonged LOS was defined as any hospital LOS ≥ 75th percentile. Multivariate logistic regression analyses were used to understand the strength of associations after adjusting for cofactors. RESULTS Our analysis had 94 114 COVID-19 hospitalizations, and 1548 (1.6%) had AMI. Mortality (43.2% vs. 10.8%, P < 0.001), prolonged LOS (39.9% vs. 28.2%, P < 0.001), vasopressor use (7.8% vs. 2.1%, P < 0.001), mechanical ventilation (35.0% vs. 9.7%, P < 0.001), and ICU admission (33.0% vs. 9.4%, P < 0.001) were significantly higher among COVID-19 hospitalizations with AMI. The odds of adverse outcomes such as mortality (aOR 3.90, 95% CI: 3.48-4.36), prolonged LOS (aOR 1.23, 95% CI: 1.10-1.37), vasopressor use (aOR 3.71, 95% CI: 3.30-4.17), mechanical ventilation (aOR 2.71, 95% CI: 2.21-3.32), and ICU admission (aOR 3.51, 95% CI: 3.12-3.96) were significantly more among COVID-19 hospitalizations with AMI. CONCLUSION Despite the very low prevalence of AMI among COVID-19 hospitalizations, the study showed a substantially greater risk of adverse hospital outcomes and mortality. COVID-19 patients with AMI should be aggressively treated to improve hospital outcomes.
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Affiliation(s)
- Kelvin Chan
- Nova Southeastern University, Fort Lauderdale
| | | | - Atulya Khosla
- Miami Cancer Institute, Baptist Health South Florida
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Universidad Espíritu Santo, Ecuador
| | - Anshul Saxena
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida
| | | | - Mayur Doke
- University of Miami, Miami, Florida, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
| | | | - Sandra Chaparro
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Javier Jimenez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
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Ramamoorthy V, Appunni S, Roy M, Saxena A, Rubens M. In reply to the Letter to the Editor regarding: Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107429. [PMID: 37866986 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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Ramamoorthy V, Chan K, Roy M, Saxena A, Ahmed MA, Zhang Z, Appunni S, Thomas R, McGranaghan P, McDermott M, La Rosa FDLR, Rubens M. Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107333. [PMID: 37659191 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND In the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. CONCLUSION Our study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Michael McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Felipe De Los Rios La Rosa
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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Appunni S, Rubens M, Ramamoorthy V, Saxena A, Doke M, Roy M, Ruiz-Pelaez JG, Zhang Y, Ahmed A, Zhang Z, McGranaghan P, Chaparro S, Jimenez J. Adverse Outcomes in Hospitalizations for Amyloid-Related Heart Failure. Am J Cardiol 2023; 203:169-174. [PMID: 37499596 DOI: 10.1016/j.amjcard.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
Transthyretin amyloid cardiomyopathy is being increasingly recognized as an important cause of heart failure (HF). In this study, we looked at adverse outcomes in hospitalizations with amyloid-related HF. This study was a retrospective analysis of the National Inpatient Sample data, collected from 2016 to 2019. Patients ≥41 years of age and admitted for HF were included in the study. In these hospitalizations, amyloid-related HF was identified through the International Classification of Diseases, Tenth Revision, Clinical Modification codes for amyloidosis. The primary outcome of the study was in-hospital mortality, whereas secondary outcomes were prolonged length of stay, mechanical ventilation, mechanical circulatory support, vasopressors use, and dispositions other than home. From 2016 to 2019, there were 4,705,274 HF hospitalizations, of which 16,955 (0.4%) had amyloid cardiomyopathy. In all HF hospitalizations, amyloid-related increased from 0.26% in 2016 to 0.46% in 2019 (relative increase, 76.9%, P for trend <0.001). Amyloid-related HF hospitalizations were more common in older, male, and Black patients. The odds of in-hospital mortality (odds ratio [OR], 1.29; 95% confidence interval [CI]: 1.11 to 1.38), prolonged hospital length (OR, 1.61; 95% CI: 1.49 to 1.73) and vasopressors use (OR, 1.59; 95% CI: 1.23 to 2.05) were significantly higher for amyloid-related hospitalizations. Amyloid-related HF hospitalizations are increasing substantially and are associated with adverse hospital outcomes. These hospitalizations were disproportionately higher for older, male, and Black patients. Amyloid-related HF is rare and underdiagnosed yet has several adverse outcomes. Hence, healthcare providers should be watchful of this condition for early identification and prompt management.
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Affiliation(s)
| | - Muni Rubens
- Office of Clinical Research, Baptist Health South Florida, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Health Science, Universidad Espíritu Santo, Ecuador
| | | | - Anshul Saxena
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Mayur Doke
- Diabetic Research Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mukesh Roy
- Office of Clinical Research, Baptist Health South Florida, Miami, Florida
| | - Juan Gabriel Ruiz-Pelaez
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Yanjia Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Peter McGranaghan
- Office of Clinical Research, Baptist Health South Florida, Miami, Florida; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Sandra Chaparro
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Javier Jimenez
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida.
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Conroy A, Zhang V, Kaito M, Ramamoorthy V, Roy M, Ahmed MA, Zhang Z, McGranaghan P, Appunni S, Saxena A, Rubens M, Cristian A. Effect of Frailty on Hospital Outcomes Among Pediatric Cancer Patients in the United States: Results From the National Inpatient Sample. Am J Clin Oncol 2023; 46:381-386. [PMID: 37259194 DOI: 10.1097/coc.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies on frailty among pediatric patients with cancer are scarce. In this study, we sought to understand the effects of frailty on hospital outcomes in pediatric patients with cancer. METHODS This retrospective study used data collected and stored in the Nationwide Inpatient Sample (NIS) between 2005 and 2014. These were hospitalized patients and hence represented the sickest group of patients. Frailty was measured using the frailty definition diagnostic indicator by Johns Hopkins Adjusted Clinical Groups. RESULTS Of 187,835 pediatric cancer hospitalizations included in this analysis, 11,497 (6.1%) were frail. The average hospitalization costs were $86,910 among frail and $40,358 for nonfrail patients. In propensity score matching analysis, the odds of in-hospital mortality (odds ratio, 2.08; 95% CI, 1.71-2.52) and length of stay (odds ratio, 3.76; 95% CI, 3.46-4.09) were significantly greater for frail patients. The findings of our study suggest that frailty is a crucial clinical factor to be considered when treating pediatric cancer patients in a hospital setting. CONCLUSIONS These findings highlight the need for further research on frailty-based risk stratification and individualized interventions that could improve outcomes in frail pediatric cancer patients. The adaptation and validation of a frailty-defining diagnostic tool in the pediatric population is a high priority in the field.
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Affiliation(s)
- Abigail Conroy
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Vicky Zhang
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Max Kaito
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | - Anshul Saxena
- Center for Advanced Analytics
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
- Universidad Espíritu Santo, Guayaquil, Ecuador
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Ramamoorthy V, Chan K, Appunni S, Zhang Z, Ahmed MA, McGranaghan P, Saxena A, Rubens M. Prevalence and trends of perioperative major adverse cardiovascular and cerebrovascular events during cancer surgeries. Sci Rep 2023; 13:2410. [PMID: 36765154 PMCID: PMC9918731 DOI: 10.1038/s41598-023-29632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Major adverse cardiovascular and cerebrovascular events (MACCE) is an important cause of morbidity and mortality during perioperative period. In this study, we looked for national trends in perioperative MACCE and its components as well as cancer types associated with high rates of perioperative MACCE during major cancer surgeries. This study was a retrospective analysis of the National Inpatient Sample, 2005-2014. Hospitalizations for surgeries of prostate, bladder, esophagus, pancreas, lung, liver, colorectal, and breast among patients 40 years and greater were included in the analysis. MACCE was defined as a composite measure that included in-hospital all-cause mortality, acute myocardial infarction (AMI), and ischemic stroke. A total of 2,854,810 hospitalizations for major surgeries were included in this study. Of these, 67,316 (2.4%) had perioperative MACCE. Trends of perioperative MACCE showed that it decreased significantly for AMI, death and any MACCE, while stroke did not significantly change during the study period. Logistic regression analysis for perioperative MACCE by cancer types showed that surgeries for esophagus, pancreas, lung, liver, and colorectal cancers had significantly greater odds for perioperative MACCE. The surgeries identified to have greater risks for MACCE in this study could be risk stratified for better informed decision-making and management.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, USA
| | | | - Zhenwei Zhang
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Dr, Miami, FL, 33176, USA
| | - Md Ashfaq Ahmed
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Dr, Miami, FL, 33176, USA
| | - Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, 10117, Berlin, Germany.
| | - Anshul Saxena
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Dr, Miami, FL, 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, 8900 N Kendall Dr, Miami, FL, 33176, USA.
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Rubens M, Ramamoorthy V, Saxena A, Appunni S, Sundil S, Veledar E, McGranaghan P, Tonse R, Fitz SJT, Chuong MD, Odia Y, Kotecha R, Mehta MP, Kotecha R. Relationship between insurance status and interhospital transfers among cancer patients in the United States. BMC Cancer 2022; 22:121. [PMID: 35093015 PMCID: PMC8801067 DOI: 10.1186/s12885-022-09242-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background The relationship between insurance status and interhospital transfers has not been adequately researched among cancer patients. Hence this study aimed for understanding this relationship using a nationally representative database. Methods A retrospective analysis was conducted using National Inpatient Sample (NIS) data collected during 2010–2016 and included all cancer hospitalization between 18 and 64 years of age. Interhospital transfers were compared based on insurance status (Medicare, Medicaid, private, and uninsured). Weighted multivariable logistic regressions were used to calculate the odds of interhospital transfers based on insurance status, after adjusting for many covariates. Results There were 3,580,908 weighted cancer hospitalizations, of which 72,353 (2.02%) had interhospital transfers. Uninsured patients had significantly higher rates of interhospital transfers, compared to those with Medicare (P = 0.005) and private insurance (P < 0.001). Privately insured patients had significantly lower rates of interhospital transfers, compared to those with Medicare (P < 0.001) and Medicaid (P < 0.001). Logistic regression analyses showed that the odds of having interhospital transfers were significantly higher among uninsured (adjusted odds ratio [aOR], 1.57, 95% CI: 1.45–1.69), Medicare (aOR, 1.38, 95% CI: 1.32–1.45) and Medicaid (aOR, 1.23, 95% CI: 1.16–1.30) patients when compared to those with private insurance coverages. Conclusion Among cancer patients, uninsured and Medicare and Medicaid beneficiaries were more likely to experience interhospital transfers. In addition to medical reasons, factors such as affordability and socioeconomic status are influencing interhospital transfer decisions, indicating existing healthcare disparities. Further studies should focus on identifying the causal associations between factors explored in this study as well as additional unexplored factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09242-8.
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Appunni S, Rubens M, Ramamoorthy V, Saxena A, Tonse R, Veledar E, McGranaghan P. Association between vitamin D deficiency and hypothyroidism: results from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. BMC Endocr Disord 2021; 21:224. [PMID: 34772378 PMCID: PMC8590325 DOI: 10.1186/s12902-021-00897-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/05/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Many smaller studies have previously shown a significant association between thyroid autoantibody induced hypothyroidism and lower serum vitamin D levels. However, these finding have not been confirmed by large-scale studies. In this study, we evaluated the relationship between hypothyroidism and vitamin D levels using a large population-based data. METHODS For this study, we used National Health and Nutrition Examination Survey (NHANES) during the years 2007-2012. We categorized participants into three clinically relevant categories based on vitamin D levels: optimal, intermediate and deficient. Participants were also split into hypothyroid and hyperthyroid. Weighted multivariable logistic regression analyses were used to calculate the odds of being hypothyroid based on vitamin D status. RESULTS A total of 7943 participants were included in this study, of which 614 (7.7%) were having hypothyroidism. Nearly 25.6% of hypothyroid patients had vitamin D deficiency, compared to 20.6% among normal controls. Adjusted logistic regression analyses showed that the odds of developing hypothyroidism were significantly higher among patients with intermediate (adjusted odds ratio [aOR], 1.7, 95% CI: 1.5-1.8) and deficient levels of vitamin D (aOR, 1.6, 95% CI: 1.4-1.9). CONCLUSION Low vitamin D levels are associated with autoimmune hypothyroidism. Healthcare initiatives such as mass vitamin D deficiency screening among at-risk population could significantly decrease the risk for hypothyroidism in the long-term.
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Affiliation(s)
- Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala, India
| | | | | | | | | | - Emir Veledar
- Baptist Health South Florida, Miami, Florida, USA
- Department of Biostatistics, Florida International University, Miami, FL, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter McGranaghan
- Miami Cancer Institute, Miami, Florida, USA.
- Baptist Health South Florida, Miami, Florida, USA.
- Department of Internal Medicine and Cardiology, Charité - Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Appunni S, Rubens M, Ramamoorthy V, Tonse R, Saxena A, McGranaghan P, Kaiser A, Kotecha R. Emerging Evidence on the Effects of Dietary Factors on the Gut Microbiome in Colorectal Cancer. Front Nutr 2021; 8:718389. [PMID: 34708063 PMCID: PMC8542705 DOI: 10.3389/fnut.2021.718389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Dietary factors have important role in modulating the gut microbiome, which in-turn regulates the molecular events in colonic mucosa. The composition and resulting metabolism of the gut microbiome are decisive factors in colorectal cancer (CRC) tumorigenesis. Altered gut microbiome is associated with impaired immune response, and the release of carcinogenic or genotoxic substances which are the major microbiome-induced mechanisms implicated in CRC pathogenesis. Diets low in dietary fibers and phytomolecules as well as high in red meat are important dietary changes which predispose to CRC. Dietary fibers which reach the colon in an undigested form are further metabolized by the gut microbiome into enterocyte friendly metabolites such as short chain fatty acid (SCFA) which provide anti-inflammatory and anti-proliferative effects. Healthy microbiome supported by dietary fibers and phytomolecules could decrease cell proliferation by regulating the epigenetic events which activate proto-oncogenes and oncogenic pathways. Emerging evidence show that predominance of microbes such as Fusobacterium nucleatum can predispose the colonic mucosa to malignant transformation. Dietary and lifestyle modifications have been demonstrated to restrict the growth of potentially harmful opportunistic organisms. Synbiotics can protect the intestinal mucosa by improving immune response and decreasing the production of toxic metabolites, oxidative stress and cell proliferation. In this narrative review, we aim to update the emerging evidence on how diet could modulate the gut microbial composition and revive colonic epithelium. This review highlights the importance of healthy plant-based diet and related supplements in CRC prevention by improving the gut microbiome.
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Affiliation(s)
- Sandeep Appunni
- Government Medical College, Kozhikode, India
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | | | - Raees Tonse
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Anshul Saxena
- Baptist Health South Florida, Miami, FL, United States
- Department of Radiation Oncology, Florida International University, Miami, FL, United States
| | - Peter McGranaghan
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
- Department of Radiation Oncology, Florida International University, Miami, FL, United States
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
- Department of Radiation Oncology, Florida International University, Miami, FL, United States
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13
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Appunni S, Gupta D, Rubens M, Ramamoorthy V, Singh HN, Swarup V. Deregulated Protein Kinases: Friend and Foe in Ischemic Stroke. Mol Neurobiol 2021; 58:6471-6489. [PMID: 34549335 DOI: 10.1007/s12035-021-02563-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022]
Abstract
Ischemic stroke is the third leading cause of mortality worldwide, but its medical management is still limited to the use of thrombolytics as a lifesaving option. Multiple molecular deregulations of the protein kinase family occur during the period of ischemia/reperfusion. However, experimental studies have shown that alterations in the expression of essential protein kinases and their pharmacological modulation can modify the neuropathological milieu and hasten neurophysiological recovery. This review highlights the role of key protein kinase members and their implications in the evolution of stroke pathophysiology. Activation of ROCK-, MAPK-, and GSK-3β-mediated pathways following neuronal ischemia/reperfusion injury in experimental conditions aggravate the neuropathology and delays recovery. Targeting ROCK, MAPK, and GSK-3β will potentially enhance myelin regeneration, improve blood-brain barrier (BBB) function, and suppress inflammation, which ameliorates neuronal survival. Conversely, protein kinases such as PKA, Akt, PKCα, PKCε, Trk, and PERK salvage neurons post-ischemia by mechanisms including enhanced toxin metabolism, restoring BBB integrity, neurotrophic effects, and apoptosis suppression. Certain protein kinases such as ERK1/2, JNK, and AMPK have favourable and unfavourable effects in salvaging ischemia-injured neurons. Targeting multiple protein kinase-mediated pathways simultaneously may improve neuronal recovery post-ischemia.
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Affiliation(s)
- Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala, India
| | - Deepika Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Himanshu Narayan Singh
- Department of Systems Biology, Columbia University Irving Medical Centre, New York City, NY, USA.
| | - Vishnu Swarup
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
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McGranaghan P, Kirwan JA, Garcia-Rivera MA, Pieske B, Edelmann F, Blaschke F, Appunni S, Saxena A, Rubens M, Veledar E, Trippel TD. Lipid Metabolite Biomarkers in Cardiovascular Disease: Discovery and Biomechanism Translation from Human Studies. Metabolites 2021; 11:metabo11090621. [PMID: 34564437 PMCID: PMC8470800 DOI: 10.3390/metabo11090621] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Lipids represent a valuable target for metabolomic studies since altered lipid metabolism is known to drive the pathological changes in cardiovascular disease (CVD). Metabolomic technologies give us the ability to measure thousands of metabolites providing us with a metabolic fingerprint of individual patients. Metabolomic studies in humans have supported previous findings into the pathomechanisms of CVD, namely atherosclerosis, apoptosis, inflammation, oxidative stress, and insulin resistance. The most widely studied classes of lipid metabolite biomarkers in CVD are phospholipids, sphingolipids/ceramides, glycolipids, cholesterol esters, fatty acids, and acylcarnitines. Technological advancements have enabled novel strategies to discover individual biomarkers or panels that may aid in the diagnosis and prognosis of CVD, with sphingolipids/ceramides as the most promising class of biomarkers thus far. In this review, application of metabolomic profiling for biomarker discovery to aid in the diagnosis and prognosis of CVD as well as metabolic abnormalities in CVD will be discussed with particular emphasis on lipid metabolites.
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Affiliation(s)
- Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Jennifer A. Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.A.K.); (M.A.G.-R.)
- Max Delbrück Center for Molecular Research, 13125 Berlin, Germany
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire LE12 5RD, UK
| | - Mariel A. Garcia-Rivera
- Metabolomics Platform, Berlin Institute of Health at Charité Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.A.K.); (M.A.G.-R.)
- Max Delbrück Center for Molecular Research, 13125 Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
- Berlin Institute of Health, 13353 Berlin, Germany
- German Heart Center Berlin, Department of Cardiology, 13353 Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
- German Heart Center Berlin, Department of Cardiology, 13353 Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala 673008, India;
| | - Anshul Saxena
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Muni Rubens
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Emir Veledar
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
- Department of Biostatistics, Florida International University, Miami, FL 33199, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-553765
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Saxena A, Rubens M, Ramamoorthy V, Suarez M, Appunni S, McGranaghan P, Veledar E, Garelnabi MO. Abstract P181: Machine Learning Methods For Predicting 30-day All Cause Readmission Following Carotid Endarterectomy Among Acute Ischemic Stoke Cases: A Nsqip Study (2014 - 2017). Arterioscler Thromb Vasc Biol 2021. [DOI: 10.1161/atvb.41.suppl_1.p181] [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: 11/16/2022]
Abstract
Background:
Carotid endarterectomy (CEA) is associated with improved overall clinical outcomes in patients with acute ischemic stroke (AIS). However, studies on rates and factors associated with readmission following CEA for AIS are scarce. In this study, we used machine learning (ML) methods to identify the factors associated with readmission using a large-scale national database.
Methods:
We used National Surgical Quality Improvement Program (NSQIP) registry (2014-2017) and included patients 18 years or older, who underwent CEA for AIS. AIS and CEA were identified using ICD-9 and ICD-10 diagnosis and CPT procedure codes, respectively. We used Naïve Bayes, Boosted Decision Trees, and Bootstrapped Random Forest classification techniques to explore the predictors of 30-day readmission using demographics, past medical history, and preoperative variables.
Results:
There were a total of 22,373 AIS patients who underwent CEA. Mean (SD) age of the patients was 70.7 (9.4) years, and 61% were men. Majority were non-Hispanic White (80%), followed by non-Hispanic Black (4.6%). During the study period, 1 in 15 AIS patients who underwent CEA experienced 30-day readmission. Bootstrapped Random Forest classification performed best and Naïve Bayes worst with an AUROC of 92% and 59% respectively. The top 5 predictors of 30-day readmission after CEA were Hematocrit, BUN, Creatinine, WBC count, and Platelet count, all collected pre-operatively.
Conclusion:
Our study showed that ML techniques could accurately predict 30-day readmission using pre-operative risk factors. This ML model could be incorporated in EMR as a potential clinical decision support system. Implementing this system could help in early identification of patients who are at high risk for readmission following CEA. This could help physicians to plan and intervene effectively and prevent short-term readmissions; thereby improving quality of care and saving healthcare costs.
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Affiliation(s)
| | - Muni Rubens
- Baptist Health South Florida, Coral Gables, FL
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Appunni S, Rubens M, Ramamoorthy V, Anand V, Khandelwal M, Sharma A. Biglycan: an emerging small leucine-rich proteoglycan (SLRP) marker and its clinicopathological significance. Mol Cell Biochem 2021; 476:3935-3950. [PMID: 34181183 DOI: 10.1007/s11010-021-04216-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
Extracellular matrix (ECM) plays an important role in the structural organization of tissue and delivery of external cues to the cell. Biglycan, a class I small leucine-rich proteoglycans (SLRP), is a key component of the ECM that participates in scaffolding the collagen fibrils and mediates cell signaling. Dysregulation of biglycan expression can result in wide range of clinical conditions such as metabolic disorder, inflammatory disorder, musculoskeletal defects and malignancies. In this review, we aim to update our current understanding regarding the link between altered expression of biglycan and different clinicopathological states. Biglycan interacts with toll like receptors (TLR)-2 and TLR-4 on the immune cells which initiates inflammation and aggravates inflammatory disorders. ECM unbound soluble biglycan acts as a DAMP (danger associated molecular pattern) resulting in sterile inflammation. Dysregulation of biglycan expression is also observed in inflammatory metabolic conditions such as atherosclerosis and obesity. In cancer, high-biglycan expression facilitates tumor growth, invasion and metastasis which is associated with poor clinical outcome. As a pivotal structural component of the ECM, biglycan strengthens the musculoskeletal system and its absence is associated with musculoskeletal defects. Thus, SLRP biglycan is a potential marker which is significantly altered in different clinicopathological states.
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Affiliation(s)
- Sandeep Appunni
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, 110 029, India
- Government Medical College, Kozhikode, Kerala, India
| | | | | | | | - Madhuram Khandelwal
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, 110 029, India.
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McGranaghan P, Saxena A, Düngen HD, Rubens M, Appunni S, Salami J, Veledar E, Lacour P, Blaschke F, Obradovic D, Loncar G, Tahirovic E, Edelmann F, Pieske B, Trippel TD. Performance of a cardiac lipid panel compared to four prognostic scores in chronic heart failure. Sci Rep 2021; 11:8164. [PMID: 33854188 PMCID: PMC8046832 DOI: 10.1038/s41598-021-87776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/05/2021] [Indexed: 02/02/2023] Open
Abstract
The cardiac lipid panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to four commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham risk score (FRS), Barcelona bio-HF (BCN Bio-HF) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, BCN Bio-HF 0.72, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients.
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Affiliation(s)
- Peter McGranaghan
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Anshul Saxena
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Hans-Dirk Düngen
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Muni Rubens
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Sandeep Appunni
- grid.253527.40000 0001 0705 6304Department of Biochemistry, Government Medical College, Kozhikode, Kerala 673008 India
| | - Joseph Salami
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Emir Veledar
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA ,grid.65456.340000 0001 2110 1845Department of Biostatistics, Florida International University, Miami, FL USA ,grid.189967.80000 0001 0941 6502Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Philipp Lacour
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian Blaschke
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Danilo Obradovic
- grid.9647.c0000 0004 7669 9786Department of Cardiology and Internal Medicine, Heart Center Leipzig at the University of Leipzig, Russenstrasse 69A, 04289 Leipzig, Germany
| | - Goran Loncar
- grid.7149.b0000 0001 2166 9385Institute for Cardiovascular Diseases Dedinje, Department of Cardioloy, Faculty of Medicine, University of Belgrade, Heroja Milana Tepića br. 1, 11040 Belgrade, Serbia
| | - Elvis Tahirovic
- grid.11374.300000 0001 0942 1176Apostolovic Clinic for Cardiovascular Diseases, Clinical Centre Nis, University of Niš, Niš, Serbia
| | - Frank Edelmann
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany ,grid.484013.aBerlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany ,grid.484013.aBerlin Institute of Health (BIH), Berlin, Germany ,Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Tobias Daniel Trippel
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Appunni S, Rubens M, Ramamoorthy V, Sharma H, Singh AK, Swarup V, Singh HN. Differentially Expressed Genes and Their Clinical Significance in Ischaemic Stroke: An In-Silico Study. Malays J Med Sci 2021; 27:53-67. [PMID: 33447134 PMCID: PMC7785266 DOI: 10.21315/mjms2020.27.6.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Ischaemic stroke (IS), a multifactorial neurological disorder, is mediated by interplay between genes and the environment and, thus, blood-based IS biomarkers are of significant clinical value. Therefore, this study aimed to find global differentially expressed genes (DEGs) in-silico, to identify key enriched genes via gene set enrichment analysis (GSEA) and to determine the clinical significance of these genes in IS. Methods Microarray expression dataset GSE22255 was retrieved from the Gene Expression Omnibus (GEO) database. It includes messenger ribonucleic acid (mRNA) expression data for the peripheral blood mononuclear cells of 20 controls and 20 IS patients. The bioconductor-package ‘affy’ was used to calculate expression and a pairwise t-test was applied to screen DEGs (P < 0.01). Further, GSEA was used to determine the enrichment of DEGs specific to gene ontology (GO) annotations. Results GSEA analysis revealed 21 genes to be significantly plausible gene markers, enriched in multiple pathways among all the DEGs (n = 881). Ten gene sets were found to be core enriched in specific GO annotations. JunD, NCX3 and fibroblast growth factor receptor 4 (FGFR4) were under-represented and glycoprotein M6-B (GPM6B) was persistently over-represented. Conclusion The identified genes are either associated with the pathophysiology of IS or they affect post-IS neuronal regeneration, thereby influencing clinical outcome. These genes should, therefore, be evaluated for their utility as suitable markers for predicting IS in clinical scenarios.
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Affiliation(s)
| | | | | | - Hina Sharma
- National Network of Depression Centers India Foundation, New Delhi, India
| | | | - Vishnu Swarup
- All India Institute of Medical Sciences, New Delhi, India
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Ramamoorthy V, Rubens M, Saxena A, Bhatt C, Das S, Appunni S, Veledar E, McGranaghan P, Shehadeh N, Viamonte-Ros A, Linhares Y, Odia Y, Kotecha R, Mehta MP. Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States. Am J Hosp Palliat Care 2020; 38:47-53. [PMID: 32462883 DOI: 10.1177/1049909120928980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. METHODS The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. RESULTS There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. CONCLUSIONS Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.
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Affiliation(s)
| | - Muni Rubens
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- 7403Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
| | | | - Sankalp Das
- 7403Baptist Health South Florida, Miami, FL, USA
| | | | - Emir Veledar
- 7403Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
| | - Peter McGranaghan
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Ana Viamonte-Ros
- 7403Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
| | - Yuliya Linhares
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Yazmin Odia
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, 455694Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,1782Florida International University, Miami, FL, USA
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20
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Khandelwal M, Anand V, Appunni S, Seth A, Singh P, Mathur S, Sharma A. RASSF1A-Hippo pathway link in patients with urothelial carcinoma of bladder: plausible therapeutic target. Mol Cell Biochem 2019; 464:51-63. [PMID: 31754973 DOI: 10.1007/s11010-019-03648-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/20/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Abstract
RASSF1A is a tumor suppressor gene, and its hypermethylation has been observed in cancers. RASSF1A acts as an upstream regulator of Hippo pathway and modulates its function. The aim of this study was to analyze expression of RASSF1A, Hippo pathway molecules (YAP, MST) and downstream targets (CTGF, Cyr61 and AREG) in bladder cancer patients. Later, the link between RASSF1A and Hippo pathway and a potential therapeutic scope of this link in UBC were also studied. MSPCR was performed to study methylation of RASSF1A promoter. Expression of molecules was studied using qPCR, Western blot and IHC. The link between RASSF1A and Hippo pathway was studied using Spearman's correlation in patients and validated by overexpressing RASSF1A in HT1376 cells and its effect on Hippo pathway was observed using qPCR and Western blot. Further therapeutic potential of this link was studied using MTT and PI assays. The expression of RASSF1A was lower, whereas the expression of YAP, CTGF and CYR61 was higher. The expression of RASSF1A protein gradually decreased, while the expression of YAP, CTGF and CYR61 increased with severity of disease. Based on Spearman's correlation, RASSF1A showed a negative correlation with YAP, CTGF and CYR61. YAP showed a positive correlation with CTGF and CYR61. To validate this link, RASSF1A was overexpressed in HT1376 cells. Overexpressed RASSF1A activated Hippo pathway, followed by a decrease in CTGF and CYR61 at mRNA, and enhanced cytotoxicity to chemotherapeutic drugs. This study finds a previously unrecognized role of RASSF1A in the regulation of CTGF and CYR61 through mediation of Hippo pathway in UBC and supports the significance of this link as a potential therapeutic target for UBC.
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Affiliation(s)
| | - Vivek Anand
- Department of Biochemistry, AIIMS, New Delhi, India
| | | | - Amlesh Seth
- Department of Urology, AIIMS, New Delhi, India
| | | | | | - Alpana Sharma
- Department of Biochemistry, AIIMS, New Delhi, India.
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21
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Ramamoorthy V, Rubens M, Appunni S, Saxena A, McGranaghan P, Veledar E, Viamonte-Ros A, Shehadeh N, Kaiser A, Kotecha R. Lack of Efficacy of the Neutropenic Diet in Decreasing Infections among Cancer Patients: A Systematic Review. Nutr Cancer 2019; 72:1125-1134. [PMID: 31608705 DOI: 10.1080/01635581.2019.1675723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objective of this systematic review is to evaluate the existing evidence supporting the effectiveness of the neutropenic diet in decreasing infection and mortality among cancer patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus for relevant articles published from database inception until March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for this review. Individual studies were evaluated using the Oxford Center for Evidence-Based Medicine guidelines. A total of 473 articles were identified and 11 articles were selected after assessing eligibility. Our review showed that the neutropenic diet does not decrease infection rates or mortality among cancer patients. Currently, there is no uniform definition for the neutropenic diet across different institutions. For example, some institutions follow general food safety practices while others avoid foods that increase exposure to microbes and bacteria, and some follow both. Given these differences in practice regarding what constitutes a neutropenic diet, it is advisable that safe food handling and preparation practices recommended by the Food and Drug Administration be uniformly followed for neutropenic patients.
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Affiliation(s)
| | - Muni Rubens
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Sandeep Appunni
- Department of Biochemistry, Calicut Medical College, Calicut, India
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Peter McGranaghan
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Ana Viamonte-Ros
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
| | - Nancy Shehadeh
- Department of Business, Florida Atlantic University, Boca Raton, Florida, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Florida International University, Miami, Florida, USA
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22
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Rubens M, Appunni S, Ramamoorthy V, Saxena A, Das S, Bhatt C, Boulanger BK, Viamonte-Ros A, Veledar E. Prevalence of Cardiovascular Risk Factors Among Cancer Patients in the United States. Metab Syndr Relat Disord 2019; 17:397-405. [DOI: 10.1089/met.2018.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | | | - Anshul Saxena
- Baptist Health South Florida, Miami, Florida
- Department of Medical Education, Florida International University, Miami, Florida
| | - Sankalp Das
- Baptist Health South Florida, Miami, Florida
| | | | | | - Ana Viamonte-Ros
- Baptist Health South Florida, Miami, Florida
- Department of Medical Education, Florida International University, Miami, Florida
| | - Emir Veledar
- Baptist Health South Florida, Miami, Florida
- Department of Medical Education, Florida International University, Miami, Florida
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23
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Anand V, Khandelwal M, Appunni S, Gupta N, Seth A, Singh P, Mathur S, Sharma A. CD44 splice variant (CD44v3) promotes progression of urothelial carcinoma of bladder through Akt/ERK/STAT3 pathways: novel therapeutic approach. J Cancer Res Clin Oncol 2019; 145:2649-2661. [PMID: 31529191 DOI: 10.1007/s00432-019-03024-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/08/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE The incidence of Urothelial carcinoma of bladder (UBC) is gradually increasing by changing lifestyle and environment. The development of a tumor has been noted to be accompanied by modifications in the extracellular matrix (ECM) consisting of CD44, hyaluronic acid (HA) and its family members. The importance of CD44 splice variants and HA family members has been studied in UBC. METHODS The cohort of study included 50 UBC patients undergoing radical cystectomy and 50 healthy subjects. The molecular expression of CD44 and HA family members was determined. Effect of CD44 variant-specific silencing on downstream signaling in HT1376 cells was investigated. Combinatorial treatment of 4-MU (4-methylumbelliferone) with cisplatin or doxorubicin on chemosensitivity was also explored. RESULTS Higher expression of HA, HAS2, and CD44 was observed in Indian UBC patients which also showed the trend with severity of disease. Splice variant assessment of CD44 demonstrated the distinct role of CD44v3 and CD44v6 in bladder cancer progression. shRNA-mediated downregulation of CD44v3 showed an increase effect on cell cycle, apoptosis and multiple downstream signaling cascade including pAkt, pERK and pSTAT3. Furthermore, 4-MU, an HA synthesis inhibitor, observed to complement the effect of Cisplatin or Doxorubicin by enhancing the chemosensitivity of bladder cancer cells. CONCLUSIONS Our findings exhibit involvement of CD44 splice variants and HA family members in UBC and significance of 4-MU in enhancing chemosensitivity suggesting their novel therapeutic importance in disease therapeutics.
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Affiliation(s)
- Vivek Anand
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Madhuram Khandelwal
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sandeep Appunni
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nidhi Gupta
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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24
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Rubens M, Ramamoorthy V, Saxena A, Das S, Appunni S, Rana S, Puebla B, Suarez DT, Khawand-Azoulai M, Medina S, Viamonte-Ros A. Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014. Am J Hosp Palliat Care 2018; 36:294-301. [DOI: 10.1177/1049909118809975] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). Methods: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ2 and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations. Results: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, Ptrend < .01). Factors associated with higher palliative care consultations were increasing age, ≥80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84). Conclusion: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Sankalp Das
- Employee Health and Wellness Advantage, Baptist Health South Florida, Miami, FL, USA
| | - Sandeep Appunni
- Malabar Medical College Hospital and Research Center, Kerala, India
| | - Sagar Rana
- Department of Biometrics, Chiltern Inc, Reston, VA, USA
| | - Brittany Puebla
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Deborah T. Suarez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Suleyki Medina
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ana Viamonte-Ros
- Bioethics and Palliative Care, Baptist Health South Florida, Miami, FL, USA
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Khandelwal M, Anand V, Appunni S, Seth A, Singh P, Mathur S, Sharma A. Decitabine augments cytotoxicity of cisplatin and doxorubicin to bladder cancer cells by activating hippo pathway through RASSF1A. Mol Cell Biochem 2018; 446:105-114. [PMID: 29368096 DOI: 10.1007/s11010-018-3278-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022]
Abstract
Genetic abnormalities and epigenetic alterations both play vital role in initiation as well as progression of cancer. Whereas genetic mutations cannot be reversed, epigenetic alterations such as DNA methylation can be reversed by the application of DNA methyltransferase inhibitor decitabine. Epigenetic silencing of RASSF1A and involvement of hippo pathway both have been shown to involve in chemo-resistance. Purpose of this study was to observe the effect of combination treatment of decitabine with cisplatin or doxorubicin on bladder cancer cells involving hippo pathway through RASSF1A. Bladder cancer cells (HT1376 & T24) were treated with decitabine and its effect on RASSF1A expression, hippo pathway molecules (MST & YAP), and its downstream targets (CTGF, CYR61 & CTGF) was observed. Effect of decitabine pretreatment on sensitivity of bladder cancer cells towards chemotherapeutic drugs was also studied. Decitabine treatment leads to restoration of RASSF1A, activation of hippo pathway followed by decreased expression of its oncogenic downstream targets (CTGF & CYR61). Further pretreatment of decitabine enhanced cytotoxicity of cisplatin and doxorubicin to bladder cancer cells.
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Affiliation(s)
| | - Vivek Anand
- Department of Biochemistry, AIIMS, New Delhi, India
| | | | - Amlesh Seth
- Department of Urology, AIIMS, New Delhi, India
| | | | | | - Alpana Sharma
- Department of Biochemistry, AIIMS, New Delhi, India.
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Appunni S, Anand V, Khandelwal M, Seth A, Mathur S, Sharma A. Altered expression of small leucine-rich proteoglycans (Decorin, Biglycan and Lumican): Plausible diagnostic marker in urothelial carcinoma of bladder. Tumour Biol 2017; 39:1010428317699112. [DOI: 10.1177/1010428317699112] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Small leucine-rich proteoglycans are components of extracellular matrix that regulates neoplastic transformation. Among small leucine rich proteoglycans, Decorin, Biglycan and Lumican are most commonly implicated markers, and their expression is well studied in various malignancies. In this novel study, we have collectively evaluated expression of these three molecules in urothelial carcinoma of bladder. Thirty patients of confirmed untreated bladder cancer, 30 healthy controls for blood and 30 controls for adjacent non-tumour tissue were enrolled. Blood was collected from all subjects and tumour/adjacent normal tissue was obtained from the patients. Circulatory levels were estimated by enzyme-linked immunosorbent assay, relative messenger RNA expression by quantitative polymerase chain reaction and protein expression by immunohistochemistry and western-blotting. Circulatory levels of Biglycan (p = 0.0038) and Lumican (p < 0.0001) were significantly elevated, and that of Decorin (p < 0.0001) was significantly reduced in patients as compared with controls. Protein expression by immunohistochemistry and western-blotting showed elevated expression of Lumican and Biglycan and lower expression of Decorin in urothelial carcinoma of bladder. Quantitative polymerase chain reaction for messenger RNA expression from tissue specimens revealed significantly higher expression of Biglycan (p = 0.0008) and Lumican (p = 0.01) and lower expression of Decorin (p < 0.0001) in urothelial carcinoma of bladder. Out of all molecules receiver operating characteristic curve showed that the 0.207 ng/ml cut-off of serum Lumican provided optimum sensitivity (90.0%) and specificity (90.0%). Significant alteration of matrix small leucine-rich proteoglycans in urothelial carcinoma of bladder was observed. Higher expression of Lumican in Bladder cancer patients with the cut-off value of highest optimum sensitivity and specificity shows its importance as a potential non-invasive marker for early detection of UBC following further validation in large patient cohort.
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Affiliation(s)
- Sandeep Appunni
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Anand
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Madhuram Khandelwal
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Appunni S, Rajisha P, Rubens M, Chandana S, Singh HN, Swarup V. Targeting PknB, an eukaryotic-like serine/threonine protein kinase of Mycobacterium tuberculosis with phytomolecules. Comput Biol Chem 2017; 67:200-204. [DOI: 10.1016/j.compbiolchem.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/15/2022]
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