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Younossi ZM, Stepanova M, Felix S, Jeffers T, Younossi E, Goodman Z, Racila A, Lam BP, Henry L. The combination of the enhanced liver fibrosis and FIB-4 scores to determine significant fibrosis in patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2023; 57:1417-1422. [PMID: 36967586 DOI: 10.1111/apt.17472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/26/2022] [Accepted: 03/07/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The presence of fibrosis in NAFLD is the most significant risk factor for adverse outcomes. We determined the cutoff scores of two non-invasive te sts (NITs) to rule in and rule out significant fibrosis among NAFLD patients. METHODS Clinical data and liver biopsies were used for NAFLD patients included in this analysis (2001-2020). The enhanced liver fibrosis (ELF) and FIB-4 NITs were calculated. Liver biopsies were read by a single hematopathologist and scored by the NASH CRN criteria. Significant fibrosis was defined as stage F2-F4. RESULTS There were 463 NAFLD patients included: 48 ± 13 years old, 31% male, 35% type 2 diabetes; 39% had significant fibrosis; mean ELF score was 9.0 ± 1.2, mean FIB-4 score was 1.22 ± 1.05. Patients with significant fibrosis were older, more commonly male, had lower BMI but more components of metabolic syndrome, higher ELF and FIB-4 (p < 0.0001). The performance of the two NITs in identifying significant fibrosis was: AUC (95% CI) = 0.78 (0.74-0.82) for ELF, 0.79 (0.75-0.83) for FIB-4. The combination of ELF score ≥9.8 and FIB-4 ≥ 1.96 returned a positive predictive value of 95% which can reliably rule in significant fibrosis (sensitivity 22%, specificity >99%), while an ELF score ≤7.7 or FIB-4 ≤ 0.30 had a negative predictive value of 95% ruling out significant fibrosis (sensitivity 98%, specificity 22%). CONCLUSIONS The combination of ELF and FIB-4 may provide practitioners with easily obtained information to risk stratify patients with NAFLD who could be referred to specialists or for enrollment in clinical trials.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Thomas Jeffers
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Elena Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Zachary Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Brian P Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
| | - Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Inova Medicine Service Line, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA
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Krause E, Wittfeld K, Vollmer M, Dörr M, Felix S, Stubbe B, Ewert R, Völzke H, Grabe H. P-101 Exploring the dynamics between brain and heart in the Study of Health in Pomerania. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.118] [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: 03/08/2023]
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Klingenberg R, Gross S, Lehnert K, Wegner D, Hamm CW, Felix S, Keller T, Doerr M. Impact of inflammatory phenotype on prognostic discrimination for the novel biomarker cellular communication network factor 1 (CCN1) in patients with dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.862] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
Circulating cellular communication network factor 1 (CCN1) improves risk stratification in ACS patients and, as we have recently shown, predicts all-cause mortality in patients with dilated cardiomyopathy (DCM). It was the aim of this study to evaluate whether the prognostic role of CCN1 is influenced by an inflammatory phenotype.
Methods
Patients with a primary diagnosis of DCM, defined as LVEF <45% and an increased LVEDD (according to HENRY >117%), were included in this single-center study. Exclusion criteria comprised primary valvular diseases (≥second degree), acute myocarditis, active infectious diseases, pulmonary diseases, cancer, chronic alcoholism, and heart failure of other origins. CCN1 levels were determined in serum at study inclusion using an enzyme-linked immunosorbent assay. The primary endpoint was all-cause mortality during follow-up. An adjusted multivariable cox regression model was used to assess the association between CCN1 and all-cause mortality. We further analysed potential effect modifications by adding either an interaction term between CCN1 and DCMi diagnosis (DCMi vs. DCM). The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score to predict all-cause mortality in HF patients was used as a reference model. The performance of CCN1 in combination with the MAGGIC score and NT-proBNP to predict all-cause mortality was assessed using Cox's proportional-hazards models
Results
A total of 283 predominantly male DCM patients (78.5% males) with a median age of 55.7 (interquartile range [IQR 48.2, 65.7]) years and predominantly recent onset of disease (3.8 [IQR 1.1, 20.5] months) with a severely reduced LVEF (31 [IQR 25, 37] %), increased LVEDD (67.0 [IQR 62.8, 72.0] mm), and normal eGFR (CKD-EPI) (90.9 [IQR73.9, 102.4] ml/min) were analyzed. During a median follow-up of 12.4 [IQR 10.5, 14.0] years, a total of 107 (37.8%) patients died. Patients in the highest CCN1 tertile had a significantly higher mortality risk than those in the lower tertile (HR 1.82; 95% CI 1.06, 3.14; P=0.030) in adjusted multivariable Cox regression models. Adding CCN1 to the MAGGIC risk score improved c-statistics for prognostic accuracy of all-cause mortality at 6 years (0.624 to 0.645, p=0.012), unlike NT-proBNP (0.624 to 0.630, p=0.123). Patients classified as DCMi (n=128) had significantly lower CCN1 levels compared with classical DCM (n=155) (154.9 (115.4–191.7) vs. 174.7 (130.0–241.0) pg/ml, P=0.022). Inflammation status (DCMi vs DCM) had no significant impact (P interaction = 0.28) on the association of CCN1 and all-cause mortality (Fig. 1).
Conclusion
CCN1 independently predicts all-cause mortality in DCM patients and improves risk stratification beyond the MAGGIC score. In this pilot cohort, the inflammatory phenotype had no impact on prognostic discrimination. Data are currently analyzed in a validation cohort.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Kerckhoff Research Foundation
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Affiliation(s)
- R Klingenberg
- Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - S Gross
- University Hospital of Greifswald , Greifswald , Germany
| | - K Lehnert
- University Hospital of Greifswald , Greifswald , Germany
| | - D Wegner
- University Hospital of Greifswald , Greifswald , Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center , Bad Nauheim , Germany
| | - S Felix
- University Hospital of Greifswald , Greifswald , Germany
| | - T Keller
- Justus-Liebig University of Giessen , Giessen , Germany
| | - M Doerr
- University Hospital of Greifswald , Greifswald , Germany
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Stepanova M, Lam B, Younossi E, Felix S, Ziayee M, Price J, Pham H, de Avila L, Terra K, Austin P, Jeffers T, Escheik C, Golabi P, Cable R, Srishord M, Venkatesan C, Henry L, Gerber L, Younossi ZM. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect Dis 2022; 22:702. [PMID: 35996076 PMCID: PMC9394045 DOI: 10.1186/s12879-022-07657-z] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 outcomes among hospitalized patients may have changed due to new variants, therapies and vaccine availability. We assessed outcomes of adults hospitalized with COVID-19 from March 2020–February 2022. Methods Data were retrieved from electronic health medical records of adult COVID-19 patients hospitalized in a large community health system. Duration was split into March 2020–June 2021 (pre-Delta period), July–November 2021 (Delta period), and December 2021–February 2022 (Omicron period). Results Of included patients (n = 9582), 75% were admitted during pre-Delta, 9% during Delta, 16% during Omicron period. The COVID-positive inpatients were oldest during Omicron period but had lowest rates of COVID pneumonia and resource utilization (p < 0.0001); 46% were vaccinated during Delta and 61% during Omicron period (p < 0.0001). After adjustment for demographics and comorbidities, vaccination was associated with lower inpatient mortality (OR = 0.47 (0.34–0.65), p < 0.0001). The Omicron period was independently associated with lower risk of inpatient mortality (OR = 0.61 (0.45–0.82), p = 0.0010). Vaccination and Omicron period admission were also independently associated with lower healthcare resource utilization (p < 0.05). Magnitudes of associations varied between age groups with strongest protective effects seen in younger patients. Conclusion Outcomes of COVID-19 inpatients were evolving throughout the pandemic and were affected by changing demographics, virus variants, and vaccination. Key point In this observational study of almost 10,000 patients hospitalized from March 2020–February 2022 with COVID-19, age and having multiple comorbidities remained consistent risk factors for mortality regardless of the variant. Vaccination was high in our hospitalized patients. Vaccination conveyed less severe illness and was associated with lower inpatient mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07657-z.
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Affiliation(s)
- Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. .,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA. .,Medicine Service Line, Inova Health System, Falls Church, VA, USA. .,Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research bldg., 3300 Gallows rd, Falls Church, VA, 22042, USA.
| | - Brian Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Elena Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Mariam Ziayee
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Jillian Price
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Kathy Terra
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Patrick Austin
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Thomas Jeffers
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Carey Escheik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Rebecca Cable
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Manirath Srishord
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Chapy Venkatesan
- Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Lynn Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. .,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA. .,Medicine Service Line, Inova Health System, Falls Church, VA, USA. .,Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research bldg., 3300 Gallows rd, Falls Church, VA, 22042, USA.
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Younossi ZM, Yilmaz Y, El-Kassas M, Duseja A, Hamid S, Esmat G, Méndez-Sánchez N, Chan WK, Singal AK, Lam B, Felix S, Younossi E, Verma M, Price JK, Nader F, Younossi I, Racila A, Stepanova M. The impact of the COVID-19 pandemic on patients with chronic liver disease: Results from the Global Liver Registry. Hepatol Commun 2022; 6:2860-2866. [PMID: 35880475 PMCID: PMC9350183 DOI: 10.1002/hep4.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022] Open
Abstract
Patients with preexisting chronic liver disease (CLD) may experience a substantial burden from both coronavirus 2019 (COVID-19) infection and pandemic-related life disruption. We assessed the impact of the COVID-19 pandemic on patients with CLD. Patients enrolled in our Global Liver Registry were invited to complete a COVID-19 survey. As of June 2021, 2500 patients (mean age ± SD, 49 ± 13 years; 53% men) from seven countries completed the survey. Of all survey completers, 9.3% had COVID-19. Of these patients, 19% were hospitalized, 13% needed oxygen support, but none required mechanical ventilation. Of all patients including those not infected with COVID-19, 11.3% reported that the pandemic had an impact on their liver disease, with 73% of those reporting delays in follow-up care. The Life Disruption Event Perception questionnaire confirmed worsening in at least one area (food/nutrition, exercise, social life, vocation/education, financial situation, housing, or health care) in 81% and 69% of patients with and without a history of COVID-19, respectively (p = 0.0001). On a self-assessed Likert health score scale (range, 1-10; 10 indicates perfect health), patients with a COVID-19 history scored lower (mean ± SD, 6.7 ± 2.2 vs. 7.4 ± 2.2, respectively; p < 0.0001) despite reporting similar health scores if there was no pandemic (mean ± SD, 8.5 ± 1.4 vs. 8.4 ± 1.6, respectively; p = 0.59). After adjustment for country of enrollment, liver disease etiology and severity, age, sex, body mass index, diabetes, and history of psychiatric comorbidities, COVID-19 was found to be independently associated with lower self-assessed health scores (beta = -0.71 ± 0.14; p < 0.0001). The COVID-19 pandemic resulted in a substantial burden on the daily life of patients with CLD.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.,Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Gamal Esmat
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ashwani K Singal
- Division of Gastroenterology and Hepatology, University of South Dakota, Sioux Falls, South Dakota, USA.,Avera University Health Center and Transplant Institute, Sioux Falls, South Dakota, USA
| | - Brian Lam
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Sean Felix
- Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Elena Younossi
- Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Manisha Verma
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Jillian K Price
- Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
| | - Issah Younossi
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
| | - Andrei Racila
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Inova Medicine, Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.,Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
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Younossi ZM, Felix S, Jeffers T, Younossi E, Lam B, Nader F, Tran HA, Schneider I, Stepanova M. Serum Biomarkers are Associated With Atherosclerotic Cardiovascular Disease Among Patients With Nonalcoholic Fatty Liver Disease Undergoing Elective Angiography. Clin Gastroenterol Hepatol 2022; 20:e1149-e1156. [PMID: 34464720 DOI: 10.1016/j.cgh.2021.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cardiovascular disease is the most common cause of death among patients with nonalcoholic fatty liver disease (NAFLD). We assessed select cardiac biomarker associations for existing or future coronary artery disease (CAD) risk in patients with NAFLD. METHODS Patients with/without NAFLD undergoing elective cardiac angiography were prospectively enrolled. Severe CAD was defined as presence of at least 1 proximal artery >70% stenosis; risk of severe CAD as either existing severe CAD or atherosclerotic cardiovascular disease score ≥20; NAFLD was defined as hepatic fat in the absence of other liver diseases. Cardiac biomarkers (high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin I [hs-cTnI]) were measured using Atellica Solution assays (Siemens Healthineers). RESULTS A total of 619 patients were enrolled (mean age, 63 ± 10 years; 80% male; 31% type 2 diabetes; 65% NAFLD); 42% had severe CAD, and 57% had risk of severe CAD. NAFLD prevalence was similar between patients with and without severe CAD (68% vs 62%; P > .05). Patients with NAFLD with severe CAD (44%) or with risk of severe CAD (58%) had higher levels of hs-cTnI than NAFLD controls (both P < .001). Presence of severe CAD or risk of severe CAD in all patients was associated with older age, male, aspects of metabolic syndrome, and elevated hs-cTnI: odds ratio 2.0 (95% confidence interval [CI],1.4-2.9) and 1.8 (95% CI, 1.1-3.0), respectively; 2.3 (95% CI, 1.4-3.8) and 2.2 (95% CI, 1.2-4.2), respectively, in patients with NAFLD (all P < .02). CONCLUSION CAD is common in patients with NAFLD. High hs-cTnI was associated with an increased risk of CAD. Pending validation, hs-cTnI may be a useful marker for CAD risk prediction in patients with NAFLD.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia.
| | - Sean Felix
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Thomas Jeffers
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Elena Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Brian Lam
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington, DC
| | - Henry A Tran
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Ingrid Schneider
- Department of Radiology, Inova Fairfax Hospital, Falls Church, Virginia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, DC
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7
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Younossi ZM, Felix S, Jeffers T, Younossi E, Nader F, Pham H, Afendy A, Cable R, Racila A, Younoszai Z, Lam BP, Golabi P, Henry L, Stepanova M. Performance of the Enhanced Liver Fibrosis Test to Estimate Advanced Fibrosis Among Patients With Nonalcoholic Fatty Liver Disease. JAMA Netw Open 2021; 4:e2123923. [PMID: 34529067 PMCID: PMC8446814 DOI: 10.1001/jamanetworkopen.2021.23923] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Importance The most important surrogate for increased risk of adverse clinical outcomes among patients with nonalcoholic fatty liver disease (NAFLD) is the patient's stage of liver fibrosis. There is a significant barrier to risk-stratifying patients in clinical practice owing to the need for liver biopsy. Objective To determine the performance of the enhanced liver fibrosis (ELF) test as a noninvasive test for assessment of liver fibrosis among patients with NAFLD. Design, Setting, and Participants This retrospective cross-sectional study was conducted among patients recruited from a large, community-based hospital system's outpatient liver clinic from 2001 to 2020. Patients with NAFLD defined as steatosis greater than 5% without evidence of other liver disease or excessive alcohol use were included. Data were analyzed from August 2020 through February 2021. Intervention Enhanced liver fibrosis score was calculated. Main Outcomes and Measures Advanced fibrosis was identified by liver biopsy or transient elastography. Results Among 829 patients with NAFLD, the mean (SD) age was 53.1 (14.0) years, there were 363 (43.8%) men, 294 patients (35.5%) had type 2 diabetes, and the mean (SD) fibrosis-4 (fib-4) score was 1.34 (0.97). There were 463 patients with liver biopsy, among whom 113 individuals (24.4%) had bridging fibrosis or cirrhosis; among 462 patients with transient elastography data, 79 individuals (17.1%) had liver stiffness results of 9.6 kPa or more (ie, advanced fibrosis). Patients with advanced fibrosis had statistically significantly increased mean (SD) ELF scores compared with patients without advanced fibrosis as determined by biopsy (10.1 [1.3] vs 8.6 [1.0]; P < .001) or transient elastography (10.0 [1.1] vs 9.0 [0.8]; P < .001). Among all patients with NAFLD, the area under the receiver operating characteristic curve (AUROC) for ELF in identifying patients with advanced fibrosis was 0.81 (95% CI, 0.77-0.85) for patients diagnosed by biopsy and 0.79 (95% CI, 0.75-0.82) for those diagnosed by transient elastography. Performance of the ELF score was similar among patients with NAFLD who were aged 65 years or older (AUROC, 0.74; 95% CI, 0.58-0.87) or had type 2 diabetes (AUROC, 0.78; 95% CI, 0.71-0.84). The combination of an ELF score of 7.2 or greater with a fib-4 score of 0.74 or greater was associated with a negative predictive value of 95.1% (95% CI, 91.8%-98.4%) and a sensitivity of 92.5% (95% CI, 87.4%-97.5%), which can reliably rule out advanced fibrosis. An ELF score of 9.8 or greater with a fib-4 score of 2.9 or greater was associated with a positive predictive value of 95.0% (95% CI, 85.5%-100%) and a specificity of 99.7% (95% CI, 99.1%-100%), which can be used to rule in advanced fibrosis. Conclusions and Relevance These findings suggest that the ELF test performs well in identifying patients with NAFLD who are at increased risk of advanced fibrosis and that this test combined with fib-4 score may be reliably used in clinical practice to assess the presence or absence of advanced fibrosis among patients with NAFLD.
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Affiliation(s)
- Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
- Department of Medicine, Inova Health System, Falls Church, Virginia
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Thomas Jeffers
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Elena Younossi
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
| | - Fatema Nader
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Arian Afendy
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
| | - Rebecca Cable
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
- Department of Medicine, Inova Health System, Falls Church, Virginia
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Zahra Younoszai
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Brian P. Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
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8
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Younossi ZM, Stepanova M, Lam B, Cable R, Felix S, Jeffers T, Younossi E, Pham H, Srishord M, Austin P, Estep M, Terra K, Escheik C, de Avila L, Golabi P, Kolacevski A, Racila A, Henry L, Gerber L. Independent Predictors of Mortality Among Patients With NAFLD Hospitalized With COVID-19 Infection. Hepatol Commun 2021; 6:3062-3072. [PMID: 34558853 PMCID: PMC8426701 DOI: 10.1002/hep4.1802] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic among patients with chronic liver disease is unknown. Given the high prevalence of nonalcoholic fatty liver disease (NAFLD), we determined the predictors of mortality and hospital resource use among patients with NAFLD admitted with COVID-19 by using electronic medical records data for adult patients with COVID-19 hospitalized in a multihospital health system who were discharged between March and December 2020. NAFLD was diagnosed by imaging or liver biopsy without other liver diseases. Charlson's comorbidity index (CCI) and Elixhauser comorbidity index (ECI) scores were calculated. In the study sample, among the 4,835 patients hospitalized for COVID-19, 553 had NAFLD (age: 55 ± 16 years, 51% male, 17% White, 11% Black, 58% Hispanic, 8% Asian, 5% from congregated living, 58% obese, 15% morbid obesity [body mass index ≥ 40], 51% type 2 diabetes, 63% hypertension, mean [SD] baseline CCI of 3.9 [3.2], and baseline ECI of 13.4 [11.3]). On admission, patients with NAFLD had more respiratory symptoms, higher body temperature and heart rate, higher alanine aminotransferase and aspartate aminotransferase than non-NAFLD controls (n = 2,736; P < 0.05). Of the patients with NAFLD infected with COVID-19, 3.9% experienced acute liver injury. The NAFLD group had significantly longer length of stay, intensive care unit use, and mechanical ventilation, with a crude inpatient mortality rate of 11%. In multivariate analysis, independent predictors of inpatient mortality among patients with NAFLD infected with COVID-19 were older age, morbid obesity, ECI score ≥ 11, higher Fibrosis-4 Index (FIB-4) score, and oxygen saturation <90% (all P < 0.05), but not sex, race/ethnicity, or any individual comorbidity (all P > 0.05). Conclusion: Patients with NAFLD infected with COVID-19 tend to be sicker on admission and require more hospital resource use. Independent predictors of mortality included higher FIB-4 and multimorbidity scores, morbid obesity, older age, and hypoxemia on admission.
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Affiliation(s)
- Zobair M. Younossi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Maria Stepanova
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Brian Lam
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Rebecca Cable
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Sean Felix
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Thomas Jeffers
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Elena Younossi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Huong Pham
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Manirath Srishord
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Patrick Austin
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Michael Estep
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Kathy Terra
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Carey Escheik
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Leyla de Avila
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Pegah Golabi
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Andrej Kolacevski
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Andrei Racila
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Linda Henry
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
| | - Lynn Gerber
- Inova MedicineInova Health SystemFalls ChurchVAUSA,Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUSA
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9
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Haid M, Bahls M, Doerr M, Felix S, Zylla S, Markus M, Friedrich N, Ewert R, Glaeser S. Galectin-3 is inversely associated with cardiorespiratory fitness in the general population. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Low cardiorespiratory fitness (CRF) is associated with high mortality and morbidity. Galectin-3 (Gal-3) is a prognostic biomarker for fibrosis, different cancers, renal impairment and, in particular, for heart failure. Further, higher Gal-3 levels are associated with increased cardiovascular mortality. Whether Gal-3 is related with the protective effects of a high CRF is unclear.
Purpose
The present study examined the relation between Gal-3 and CRF as determined by body weight adjusted peak oxygen uptake (VO2peak/kg), oxygen uptake at the anaerobic threshold (VO2@AT) and maximal workload (Wmax).
Methods
We used data of the population-based Study of Health in Pomerania (SHIP-TREND) from Northeast Germany. A total of n = 1,483 participants with a median age of 49 (IQR: 39 – 59 years, male 48%) were included in the analysis. CRF parameters were measured using standardized cardiopulmonary exercise testing on a bicycle ergometer. Plasma galectin-3 concentrations were determined using a quantitative sandwich enzyme immunoassay. Individuals with left ventricular ejection fraction < 40%, previous myocardial infarction, atrial fibrillation, chronic lung disease, severe renal disease (eGFR < 30 ml/min/mm2), a history of cancer, and extreme values for Gal-3 were excluded. Linear regression models adjusted for age, sex and lean mass were used to analyze the association between Gal-3 and CRF.
Results
A one ml/min/kg greater VO2peak was related to a 0.32 ng/ml (95% confidence interval [CI] -0.45 to -0.18, p <.001) lower Gal-3. Further, a one Watt larger power output was also associated with a 1.32 ng/ml (95% CI -2.10 to – 0.54, p <.001) lesser Gal-3. VO2@AT was not related to Gal-3 (β: -3.31 95% CI -8.68 to 2.05, p = .23).
Conclusions
In the general population Gal-3 is inversely associated with CRF. Further studies should investigate whether lower Gal-3, beyond its importance as a biomarker for heart disease, may even play a role in the protective effect of the CRF.
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Affiliation(s)
- M Haid
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - M Bahls
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - M Doerr
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - S Felix
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - S Zylla
- University of Greifswald, Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M Markus
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - N Friedrich
- University of Greifswald, Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - R Ewert
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - S Glaeser
- University of Greifswald, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
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10
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Rotheudt L, Moritz E, Markus M, Voelzke H, Friedrich N, Rauch B, Schwedhelm E, Buelow R, Schminke U, Felix S, Doerr M, Bahls M. The association between S1P and vascular disease markers in the general population. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Sphingosine-1-phosphate (S1P) is a lipid mediator of the immune system and vascular bed. However, cross-sectional analyses of S1P and parameters of vascular health in the population are sparse.
Purpose
We explored the relation between S1P concentrations and several parameters of vascular health, i.e. ankle-brachial index (ABI), carotid intima-media thickness (cIMT), presence of carotid atherosclerotic plaques/stenosis, brachial artery flow-mediated dilation (FMD) as well as aortic wall thickness (AWT).
Methods
S1P was measured by liquid chromatography-tandem mass spectrometry in the population-based Study of Health in Pomerania (SHIP-TREND-0). ABI was calculated as the ratio of systolic blood pressure in arms and ankles. For cIMT, the distance between the lumen-intima and media-adventitia interfaces in longitudinal scans were measured. Carotid plaques were defined as a focal protrusion of the carotid vessel wall. Carotid stenosis was assessed with Doppler ultrasonography. FMD was evaluated by measuring the increase in brachial artery diameter after transient forearm ischemia. AWT was assessed by Magnetic Resonance Imaging. Subjects with cancer, severe renal insufficiency, previous myocardial infarction and extreme values for S1P (< 1st and > 99th percentile) were excluded. Sex stratified linear regression models adjusted for age, smoking, waist-to-hip ratio and platelets were used to assess the relation between S1P and vascular disease parameters.
Results
A total of n = 3,643 participants (48% male, median age 51, 25th and 75th percentile 39 and 63 years) could be included in the analyses. The median S1P concentration was 0.788 µM (25th and 75th percentile 0.679 and 0.906, respectively). In men a 1 standard deviation higher S1P was associated with a significantly greater cIMT (β: 0.0057 95% confidence interval [CI]: 0.00027 to 0.0112 mm; p = 0.0396) and a lower ABI (β: -0.0090 (95% confidence interval [CI]: -0.0153 to -0.0029; p = 0.0038. In women S1P was significantly associated with cIMT (β: 0.0044 95% confidence interval [CI]: 0.0001 to 0.0086 mm; p = 0.0445) while no significant association was found for the relation of S1P with ABI. For both men and women S1P was not associated with FMD, the presence of carotid plaques/stenosis and AWT.
Conclusions
We found that S1P concentrations were positively related to a thicker cIMT in both sexes and lower ABI values in men. There was no association of S1P with any of the other vascular markers of interest. Future studies need to validate our results in other populations.
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Affiliation(s)
- L Rotheudt
- University of Greifswald, Department of Internal Medicine B , Greifswald, Germany
| | - E Moritz
- University of Greifswald, Institute of Pharmacology, Department of General Pharmacology, Greifswald, Germany
| | - M Markus
- University of Greifswald, Department of Internal Medicine B , Greifswald, Germany
| | - H Voelzke
- University of Greifswald, Institute of Community Medicine, Greifswald, Germany
| | - N Friedrich
- University of Greifswald, Institute of Clinical Chemistry and Laboratory Medicine, Greifswald, Germany
| | - B Rauch
- University of Greifswald, Institute of Pharmacology, Department of General Pharmacology, Greifswald, Germany
| | - E Schwedhelm
- University Medical Center Hamburg Eppendorf, Institute of Clinical Pharmacology and Toxicology, Hamburg, Germany
| | - R Buelow
- University of Greifswald, Department of Radiology , Greifswald, Germany
| | - U Schminke
- University of Greifswald, Department of Neurology , Greifswald, Germany
| | - S Felix
- University of Greifswald, Department of Internal Medicine B , Greifswald, Germany
| | - M Doerr
- University of Greifswald, Department of Internal Medicine B , Greifswald, Germany
| | - M Bahls
- University of Greifswald, Department of Internal Medicine B , Greifswald, Germany
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11
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Younossi ZM, Pham H, Felix S, Stepanova M, Jeffers T, Younossi E, Allawi H, Lam B, Cable R, Afendy M, Younoszai Z, Afendy A, Rafiq N, Alzubaidi N, Ousman Y, Bailey M, Chris Z, Castillo-Catoni M, Fozdar P, Ramirez M, Husain M, Hudson E, Schneider I, Golabi P, Nader F. Identification of High-Risk Patients With Nonalcoholic Fatty Liver Disease Using Noninvasive Tests From Primary Care and Endocrinology Real-World Practices. Clin Transl Gastroenterol 2021; 12:e00340. [PMID: 33825721 PMCID: PMC8032357 DOI: 10.14309/ctg.0000000000000340] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/05/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We aimed to identify high-risk nonalcoholic fatty liver disease (NAFLD) patients seen at the primary care and endocrinology practices and link them to gastrohepatology care. METHODS Using the electronic health record, patients who either had the diagnosis of type 2 diabetes or had 2 of 3 other metabolic risk factors met criteria for inclusion in the study. Using noninvasive fibrosis tests (NITs) to identify high risk of fibrosis, patients who met the NIT prespecified criteria were referred to gastrohepatology for clinical assessment and transient elastography. RESULTS From 7,555 patients initially screened, 1707 (22.6%) met the inclusion criteria, 716 (42%) agreed to enroll, and 184 (25.7%) met the prespecified NIT criteria and eligibility for linkage to GE-HEP where 103 patients (68 ± 9 years of age, 50% men, 56% white) agreed to undergo linkage assessments. Their NIT scores were APRI of 0.38 ± 0.24, FIB-4 of 1.98 ± 0.87, and NAFLD Fibrosis Score of 0.36 ± 1.03; 68 (66%) linked patients had controlled attenuation parameter >248 dB/m, 62 (60%) had liver stiffness <6 kPa, and 8 (8%) had liver stiffness >12 kPa. Liver stiffness for the overall group was 6.7 ± 4.2 kPa, controlled attenuation parameter 282 ± 64 dB/m, and FAST score 0.22 ± 0.22. Linked patients with presumed advanced fibrosis had significantly higher body mass index (36.4 ± 6.6 vs 31.2 ± 6.4 kg/m2, P = 0.025) and higher NIT scores (APRI 0.89 ± 0.52 vs 0.33 ± 0.14, FIB-4 3.21 ± 2.06 vs 1.88 ± 0.60, and NAFLD Fibrosis Score 1.58 ± 1.33 vs 0.25 ± 0.94). DISCUSSION By applying a simple prespecified multistep algorithm using electronic health record with clinical risk factors and NITs followed by transient elastography, patients with nonalcoholic fatty liver disease seen in PCP and ENDO practices can be easily identified.
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Affiliation(s)
- Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, DC, USA
| | - Thomas Jeffers
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Elena Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Hussain Allawi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Brian Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Rebecca Cable
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mariam Afendy
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Zahra Younoszai
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Arian Afendy
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Nila Rafiq
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Nahrain Alzubaidi
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
- Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Yasser Ousman
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Marc Bailey
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Zik Chris
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | | | - Pratima Fozdar
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Maria Ramirez
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Mehreen Husain
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Evis Hudson
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Ingrid Schneider
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Inova Medicine, Inova Health System, Falls Church Virginia, USA
| | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington, DC, USA
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12
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Lanmueller P, Eulert-Grehn JJ, Felix S, Pieske B, Mulzer J, Mueller M, Falk V, Potapov E. Long-Term Mechanical Circulatory Support in Patients with Heart Failure with Preserved Ejection Fraction. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725791] [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: 10/21/2022]
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13
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Karrar A, Rajput B, Hariharan S, Abdelatif D, Houry M, Moosvi A, Ali I, Tan D, Noor S, Esmaeili D, Felix S, Alaparthi L, Otgonsuren M, Lam B, Goodman ZD, Younossi ZM. Major Histocompatibility Complex Class I-Related Chain A Alleles and Histology of Nonalcoholic Fatty Liver Disease. Hepatol Commun 2021; 5:63-73. [PMID: 33437901 PMCID: PMC7789833 DOI: 10.1002/hep4.1610] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/11/2020] [Accepted: 08/30/2020] [Indexed: 01/05/2023] Open
Abstract
Major histocompatibility complex class I-related chain A (MICA) is a highly polymorphic gene that modulates immune surveillance by binding to its receptor on natural killer cells, and its genetic polymorphisms have been associated with chronic immune-mediated diseases. The progressive form of nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), is characterized by accumulation of fat and inflammatory cells in the hepatic parenchyma, potentially leading to liver cell injury and fibrosis. To date, there are no data describing the potential role of MICA in the pathogenesis of NAFLD. Therefore, our aim was to assess the association between MICA polymorphism and NASH and its histologic features. A total of 134 subjects were included. DNA from patients with biopsy-proven NAFLD were genotyped using polymerase chain reaction-sequence-specific oligonucleotide for MICA alleles. Liver biopsies were assessed for histologic diagnosis of NASH and specific pathologic features, including stage of fibrosis and grade of inflammation. Multivariate analysis was performed to draw associations between MICA alleles and the different variables; P ≤ 0.05 was considered significant. Univariate analysis showed that MICA*011 (odds ratio [OR], 7.14; 95% confidence interval [CI], 1.24-41.0; P = 0.04) was associated with a higher risk for histologic NASH. Multivariate analysis showed that MICA*002 was independently associated with a lower risk for focal hepatocyte necrosis (OR, 0.24; 95% CI, 0.08-0.74; P = 0.013) and advanced fibrosis (OR, 0.11; 95% CI, 0.02-0.70; P = 0.019). MICA*017 was independently associated with a higher risk for lymphocyte-mediated inflammation (OR, 5.12; 95% CI, 1.12-23.5; P = 0.035). Conclusion: MICA alleles may be associated with NASH and its histologic features of inflammation and fibrosis. Additional research is required to investigate the potential role of MICA in increased risk or protection against NAFLD.
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Affiliation(s)
- Azza Karrar
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Bijal Rajput
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Siddharth Hariharan
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Dinan Abdelatif
- Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Mohamad Houry
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Ali Moosvi
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Irfan Ali
- Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Daisong Tan
- Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Sohailla Noor
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Donna Esmaeili
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Lakshmi Alaparthi
- Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Munkhzul Otgonsuren
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA
| | - Brian Lam
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA.,Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Zachary D Goodman
- Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated ResearchInova Fairfax Medical CampusFalls ChurchVAUSA.,Center for Liver DiseasesDepartment of MedicineInova Fairfax HospitalFalls ChurchVAUSA
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14
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Nersesian G, Nelki VA, Tschöpe C, Stein J, Starck C, Falk V, Felix S, Krackhardt F, Potapov E, Spillmann F. Dual-Center Retrospective Analysis of 30-Day Survival in Cardiogenic Shock Patients Supported with Catheter-Based Microaxial Left Ventricular Assist Devices. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725797] [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: 10/21/2022]
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15
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Felix S, Oerlemans M, Asselbergs F, Van Laake L, De Jonge N. Predictors of late right heart failure after mechanical circulatory support. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited.
Purpose
We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation.
Methods
Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF.
Results
262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211).
Conclusion
Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Felix
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - M.I.F Oerlemans
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - F.W Asselbergs
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - L.W Van Laake
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - N De Jonge
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
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16
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Poller C, Kuss A, Weiss S, Haghikia A, Gast M, Mochmann L, Zeller T, Blankenberg S, Felix S, Voelker U, Doerr M, Voelzke H, Hoffmann W, Landmesser U, Rauch B. Experimental and population-genetic evidence for inflammation control functions of long noncoding RNAs and a novel tRNA-like transcript arising from the human NEAT1-MALAT1 genomic region. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Uncontrolled inflammation is a key driver of atherosclerosis, myocardial infarction (MI), and multiple other diseases. Beyond proteins and microRNAs, long noncoding RNAs (lncRNAs) are implicated in inflammation control. We previously reported suppression of lncRNA NEAT1 in circulating immune cells of post-MI patients. In mice lacking lncRNAs NEAT1 or MALAT1 we observed major immune disturbances affecting monocyte-macrophage and T cell differentiation and rendering the immune system unstable and highly vulnerable to immune stress. Here, we report functions of a novel tRNA-type transcript arising from the NEAT1-MALAT1 gene cluster, and on genetic heterogeneity of this region in the human population.
Methods and results
While previously investigated mice were deficient in the entire NEAT1 or MALAT1 locus, we here aimed to selectively disrupted only the novel 59-nt tRNA-like transcript “menRNA” with hitherto unknown functions. Through CRISPR/Cas9 editing we developed 4 human THP-1 monocyte-macrophage cell line clones with deletions of different extension all of which prevented, however, normal transcript folding and formation of “menRNA”. Transcriptome mapping of all clones by RNA-sequencing identified dysregulation of innate immunity-related genes (IFI16, IFITM3, IRAK3, IRF2BP2, IRF3), chemokine and interleukin receptors (CCR10, IL11RA, IL12RB2, IL23A), cell surface receptors (CD37, CD40LG, CD72, FOCAD, ITGA6, MAEA, THY1), macrophage function-associated genes (ELANE, GRN, MIF, MMP25, MST1P2, PRTN3), tRNA-processing transcripts (GARS, QRSL1P3, QTRT1P1, THG1L, VARS), and small nucleolar RNAs (SNORA26.62.64, SNORD65.112). These data and functional assays indicate functions of NEAT1-derived “menRNA” distinct from those previously described for MALAT1-derived mascRNA.
As multiple data suggest inflammation control functions of the NEAT1-MALAT1 region, we investigated the extent of genetic variability of this region in humans. In cohorts from the SHIP study coordinated by the Institute for Community Medicine Greifswald, screening of this region for sequence variants and possible phenotype associations was conducted the results of which are given in Figure 1. Consistent with prior findings, a MALAT1 SNP with very low minor allele frequency (MAF=0.01) was associated (p=0.0062) with systemic low level inflammation (CRP >3.0 mg/L). Unexpected was the association (p<0.01) of eight SNPs (low MAF=0.09 for all) with BMI >35 kg/m2 and LDL >164 mg/dl.
Conclusions
First, selective disruption of menRNA formation in human monocyte-macrophages provides evidence that this novel type of noncoding RNA has immunoregulatory functions. Second, the phenotype associations of SNPs within the NEAT1-MALAT1 gene cluster warrant further in-depth investigation of the molecular basis of these associations, and of their allele frequencies in cardiovascular disease patient cohorts.
The first three and the last authors contributed equally to this work.
Figure 1
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): “Transcriptome analysis of circulating immune cells to improve the assessment of prognosis and the response to novel anti-inflammatory treatments after myocardial infarction”; DZHK Shared Expertise project B19-006_SE FKZ 81X2100257
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Affiliation(s)
- C Poller
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - A.W Kuss
- University of Greifswald, Greifswald, Germany
| | - S Weiss
- University of Greifswald, Greifswald, Germany
| | - A Haghikia
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - M Gast
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - L Mochmann
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - T Zeller
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - S Felix
- University Hospital of Greifswald, Cardiology, Greifswald, Germany
| | - U Voelker
- University of Greifswald, Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Greifswald, Germany
| | - M Doerr
- Universitaetsmedizin Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - H Voelzke
- Universitaetsmedizin Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - W Hoffmann
- Universitaetsmedizin Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - B Rauch
- Universitätsmedizin Greifswald, Institute for Pharmacology, Greifswald, Germany
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17
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Schrage B, Christina M, Westermann D, Meyns B, Felix S, Gummert J, Theo DB, Reichenspurner H, Bernhardt A. Development of a European Risk Score for Left Ventricular Assist Device Implantation—The EUROMACS-LVAD Score. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705349] [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: 10/24/2022]
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18
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Nemchyna O, Dandel M, Solowjowa N, Hrytsyna Y, Stein J, Soltani S, Knierim J, Felix S, Falk V, Knosalla C. Strain Study in Patients after Surgical Ventricular Repair: Prognostic Role of Strain Parameters and Evaluation of Left-Ventricle Remodeling. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705327] [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: 10/24/2022]
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19
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Hennig F, Kemper D, Felix S, Yeter R, Potapov E, Starck C, Falk V, Knosalla C. Evolving Results in Post-VAD Heart Transplantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705374] [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: 10/24/2022]
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20
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Menaga M, Felix S, Charulatha M, Gopalakannan A, Panigrahi A. Effect of in-situ and ex-situ biofloc on immune response of Genetically Improved Farmed Tilapia. Fish Shellfish Immunol 2019; 92:698-705. [PMID: 31202966 DOI: 10.1016/j.fsi.2019.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 05/20/2023]
Abstract
The present study is aimed to investigate the effect of biofloc intake on Genetically Improved Farmed Tilapia (GIFT), developed within the system and its influence as feed supplementation on water quality, growth performance, immunological parameters, antioxidant status, immune gene expression, and its resistance to Aeromonas hydrophila infection. GIFT Tilapia juveniles of 5.1 g (±0.05) were stocked at a density of 15/m3 in lined ponds of 300 m2 in triplicates for 180 days. The experimental groups consisted of T1-biofloc developed within the culture systems (insitu), T2-biofloc supplementation in fish feed (exsitu) and C- Control without biofloc. Distillery Spent wash was used as a carbon source to maintain the C/N ratio of 10:1 for floc development in T1. Free CO2, pH, BOD, dissolved oxygen, alkalinity, Calcium and Magnesium ions, Nitrate, Nitrite and ammonia were found to be significantly different between the treatments and control throughout the experiment. The immunological (Serum protein, Respiratory burst test (RBT) and Myeloperoxidase) and antioxidant indicators (Glucose, Superoxide dismutase (SOD) and catalase) were found to be significantly higher in T1 at the end of the trial. Increased weight gain, specific growth rate, survival and decreased feed conversion ratio was found in T1 when compared with the other experimental groups. Real time quantitative PCR analysis revealed that there was no folded expression of the immunological genes such as Metallothionein gene, cathepsin L, Toll like receptor 7, Interleukin 1 β and Tumour necrosis factor α in liver and intestine for both control and treatment. However, the upregulated expression of targeted genes except tumour necrosis factor α was found in head kidney of T1. At the end of the study, GIFT Tilapia when infected with Aeromonas hydrophila showed an improved immune response in T1 and T2 with lesser signs of infection than Control. The findings of the present study affirmed the importance of biofloc technology in triggering the immunomodulatory response of GIFT Tilapia with its upregulated immune gene expression and its role as an antimicrobial agent against Aeromonas hydrophila. This study suggests the adoption of in-situ (T1) based biofloc method to obtain better performance of GIFT Tilapia culture.
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Affiliation(s)
- M Menaga
- Department of Aquaculture, Dr.MGR.Fisheries College and Research Institute, Ponneri, India
| | - S Felix
- Tamil Nadu Dr.J.Jayalalithaa Fisheries University, Nagapattinam, India.
| | - M Charulatha
- Department of Aquaculture, Dr.MGR.Fisheries College and Research Institute, Ponneri, India
| | - A Gopalakannan
- Department of Aquaculture, Dr.MGR.Fisheries College and Research Institute, Ponneri, India
| | - A Panigrahi
- Principal Scientist, Crustacean Culture Division, ICAR-Central Institute of Brackishwater Aquaculture, Chennai, India
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21
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Greve F, Beirer M, Zyskowski M, Crönlein M, Müller M, Pesch S, Felix S, Biberthaler P, Buchholz A, Kirchhoff C. Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures. Injury 2019; 50:681-685. [PMID: 30770122 DOI: 10.1016/j.injury.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking plate fixation and biceps tenodesis for treating proximal humerus fractures. METHODS 56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40% Neer III, 43% Neer IV) served as control group receiving only interlocking plate fixation. The patients were asked to complete the Munich Shoulder Questionnaire (MSQ) for evaluation of postoperative shoulder function. Results of the Disabilities of the Arm, Shoulder and Hand (DASH) Score and Shoulder Pain and Disability Index (SPADI) were calculated from the MSQ. Patients were clinically evaluated for a positive O'Brien test and Popeye sign. RESULTS The tenodesis group demonstrated significant superior outcome regarding the MSQ (mean 90.47 points vs. 79.41 points, p = 0.006), DASH Score (mean 4.2 points vs. 16.81 points, p = 0.017) and SPADI (mean 94.59 points vs. 83.56, p = 0.045). Flexion, external rotation and the capability of throwing a soft ball were significantly improved in the tenodesis group compared to the control group. The O'Brien test as indicator for lesions of the LHB was positive in fewer patients of the tenodesis group (2/26, vs. 21/30, p = 0.001). There was no significant difference of a positive Popeye Sign. CONCLUSION Our results show evidence of an improved shoulder function when a simultaneous tenodesis of the LHB tendon is performed during treatment of proximal humerus fractures using interlocking plate fixation.
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Affiliation(s)
- F Greve
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - M Beirer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - M Zyskowski
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - M Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - M Müller
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - S Pesch
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - S Felix
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - A Buchholz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Germany.
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22
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Shahab O, Sayiner M, Paik J, Felix S, Golabi P, Younossi ZM. Burden of Primary Biliary Cholangitis Among Inpatient Population in the United States. Hepatol Commun 2019; 3:356-364. [PMID: 30859148 PMCID: PMC6396368 DOI: 10.1002/hep4.1314] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022] Open
Abstract
Primary biliary cholangitis (PBC) is an autoimmune liver disease that can lead to cirrhosis and liver failure. Our aim was to assess the recent trends in the mortality rates and health care utilization of patients with PBC seen in the inpatient setting in the United States. We used the National (Nationwide) Inpatient Sample data (2005‐2014). The study population included adults with PBC, using International Classification of Diseases, Ninth Revision codes. Trends in PBC‐related discharges, total charges, length of stay (LoS), and in‐hospital mortality were evaluated. Hierarchical generalized linear models were performed for determining predictors of mortality and total hospital charges. Between the study years of 2005 and 2014, a total of 22,665 hospitalized cases with PBC were identified (mean age 63 years; 84% female, 76% white). The number of PBC‐related discharges increased from 3.24 per 100,000 in 2005 to 3.68 per 100,000 in 2014, with an average annual increase of 1.4% (95% confidence interval [CI]: 0.4%‐2.4%). Fifty‐seven percent had Medicare as their primary payer, 37% had cirrhosis, and 1.3% had hepatocellular carcinoma. Between 2005 and 2014, the average total charges for PBC increased from $53,901 to $57,613 (annual percent change [APC], 1.7%; 95% CI: −0.2%‐3.5%), LoS decreased from 6.9 days to 5.4 days (APC, −2.2%; 95% CI: −3.2% to −1.1%), and mortality rate decreased from 3.8% to 2.8% (APC, −5.4%; 95% CI: −8.4% to −2.4%). Multivariable analysis revealed that ascites were independently associated with increased risk of in‐hospital mortality (odds ratio: 1.77; 95% CI: 1.50‐2.08), increased charge (percent change: 22.5%; 95% CI: 18.6%‐26.7%), and increased LoS (percent change: 29.7%; 95% CI: 25.7%‐33.9%). Conclusion: The number of PBC cases has increased in recent years. Mortality and LoS have decreased, and the total charges have remained the same.
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Affiliation(s)
- Omer Shahab
- Center for Liver Disease, Department of Medicine Inova Fairfax Hospital Falls Church VA
| | - Mehmet Sayiner
- Center for Liver Disease, Department of Medicine Inova Fairfax Hospital Falls Church VA
| | - James Paik
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
| | - Zobair M Younossi
- Center for Liver Disease, Department of Medicine Inova Fairfax Hospital Falls Church VA.,Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA
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23
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Younossi ZM, Karrar A, Pierobon M, Birerdinc A, Stepanova M, Abdelatif D, Younoszai Z, Jeffers T, Felix S, Jeiran K, Hodge A, Zhou W, Monge F, Alaparthi L, Chandhoke V, Goodman ZD, Petricoin EF. An exploratory study examining how nano-liquid chromatography-mass spectrometry and phosphoproteomics can differentiate patients with advanced fibrosis and higher percentage collagen in non-alcoholic fatty liver disease. BMC Med 2018; 16:170. [PMID: 30205811 PMCID: PMC6134795 DOI: 10.1186/s12916-018-1136-1] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-alcoholic steatohepatitis (NASH) is among the leading causes of liver disease worldwide. It is increasingly recognized that the phenotype of NASH may involve a number of different pathways, of which each could become important therapeutic targets. The aim of this study is to use high resolution mass spectrometry (MS) and phosphoproteomics techniques to assess the serum proteome and hepatic phosphoproteome in subjects with NASH-related fibrosis. METHODS Sixty-seven biopsy-proven NAFLD subjects with frozen sera and liver tissue were included. Reverse phase protein microarray was used to quantify the phosphorylation of key signaling proteins in liver and nano-liquid chromatography (LC)-MS was used to sequence target biomarkers in the serum. An image analysis algorithm was used to quantify the percentage of collagen (% collagen) using computer-assisted morphometry. Using multiple regression models, serum proteomes and phosphorylated hepatic proteins that were independently (p ≤ 0.05) associated with advanced fibrosis (stage ≥ 2) and higher % collagen were assessed. RESULTS Phosphorylated signaling pathways in the liver revealed that apoptosis signal-regulating kinase 1, mitogen-activated protein kinase (ASK1-MAPK pathway involving ASK1 S38 (p < 0.02) and p38 MAPK (p = 0.0002)) activated by the inflammatory cytokine interleukin (IL-10) (p < 0.001), were independently associated with higher % collagen. LC-MS data revealed that serum alpha-2 macroglobulin (α2M) (p = 0.0004) and coagulation factor V (p = 0.0127) were independently associated with higher % hepatic collagen. CONCLUSIONS Simultaneous profiling of serum proteome and hepatic phosphoproteome reveals that the activation of ASK1 S38, p38 MAPK in the liver, and serum α2M and coagulation factor V are independently associated with hepatic collagen deposition in patients with NASH. These data suggest the role of these pathways in the pathogenesis of NASH-related fibrosis as a potential therapeutic target.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA. .,Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. .,Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
| | - Azza Karrar
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Aybike Birerdinc
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Dinan Abdelatif
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Zahra Younoszai
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Thomas Jeffers
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Sean Felix
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Kianoush Jeiran
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Alex Hodge
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Weidong Zhou
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Fanny Monge
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Lakshmi Alaparthi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Vikas Chandhoke
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Zachary D Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Rd., Falls Church, VA, USA.,Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Emanuel F Petricoin
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
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24
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Mehta R, Shaw G, Masschelin P, Felix S, Otgonsuren M, Baranova A, Goodman Z, Younossi Z. Polymorphisms in the receptor for advanced glycation end-products (RAGE) gene and circulating RAGE levels as a susceptibility factor for non-alcoholic steatohepatitis (NASH). PLoS One 2018; 13:e0199294. [PMID: 29928018 PMCID: PMC6013208 DOI: 10.1371/journal.pone.0199294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/05/2018] [Indexed: 01/14/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome and major cause of chronic liver disease in developed countries. Its prevalence is increasing in parallel with the prevalence of obesity and other components of the metabolic syndrome. As the liver is central to the clearance and catabolism of circulating advanced glycosylation end-products (AGEs), AGEs and their cognate receptors—RAGE (receptor for AGEs) system might be involved in NAFLD in obese patients. To examine this, we investigated four common polymorphisms of RAGE gene: 1704G/T (rs184003), G82S (rs2070600), -374T/A (rs1800624) and −429T/C (rs1800625) in 340 obese patients with metabolic syndrome. and protein levels of AGE and RAGE. This is the first study to describe association of 4 common polymorphisms with non-alcoholic steatohepatitis (NASH) as well as to examine protein levels of RAGE and AGE. Univariate analysis showed patients carrying the rs1800624 heterozygote genotype (AT) exhibited 2.36-fold increased risk of NASH (odds ratio (OR) = 2.36; 95% confidence interval (95% CI): 1.35–4.19) after adjusting for confounders. The minor allele -374 A has been shown to suppress the expression of RAGE protein. The protein levels of esRAGE, total sRAGE and AGE protein levels did not correlate with each other in obese patients with no liver disease, indicative of RAGE signaling playing an independent role in liver injury. In obese patients with non-NASH NAFLD and NASH respectively, esRAGE protein showed strong positive correlation with total sRAGE protein. Further, haplotype analysis of the 4 SNPs, indicated that haplotype G-A-T-G was significantly associated with 2-fold increased risk for NASH (OR = 2.08; 95% CI: 1.21–3.5; P = 0.006) after adjusting for confounders. In conclusion, the presented data indicate that the G-A-T-G haplotype containing minor allele at position −374 A and major allele at position −429T, 1704G, and G82S G could be regarded as a marker for NASH.
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Affiliation(s)
- Rohini Mehta
- Betty and Guy Beatty Center for Integrated Research, Inova Fairfax Medical Campus, Falls Church, Virginia, United States of America
| | - Gladys Shaw
- Center for the Study of Chronic Metabolic Diseases, George Mason University, Fairfax, Virginia, United States of America
| | - Peter Masschelin
- Center for the Study of Chronic Metabolic Diseases, George Mason University, Fairfax, Virginia, United States of America
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Fairfax Medical Campus, Falls Church, Virginia, United States of America
| | - Munkzhul Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Fairfax Medical Campus, Falls Church, Virginia, United States of America
| | - Ancha Baranova
- Center for the Study of Chronic Metabolic Diseases, George Mason University, Fairfax, Virginia, United States of America
| | - Zachary Goodman
- Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
| | - Zobair Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Fairfax Medical Campus, Falls Church, Virginia, United States of America
- Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, United States of America
- * E-mail:
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25
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Parthiban F, Balasundari S, Gopalakannan A, Rathnakumar K, Felix S. Comparison of the Quality of Chitin and Chitosan from Shrimp, Crab and Squilla Waste. ACTA ACUST UNITED AC 2017. [DOI: 10.12944/cwe.12.3.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chitin and Chitosan obtained from the crustaceans are having more biological value such as physiological compatibility, non-toxicity, bio digestibility, adsorption and chelating capacity. These biological values of chitosan depend on the quality parameters which are directly related to the source of the raw material. In this study, three commercially available crustacean shell waste such as shrimp, crab and squilla were used for the extraction of chitin and chitosan. The chemical treatment of demineralization, deproteinization and deacetylation were used for the production of chitosan. The viscosity quality parameter of the shrimp chitosan (5300cPs) was better than the crab and squilla chitosan. It is due the high solubility (97.65%) of the shrimp chitosan in 1% acetic acid. The degree of deacetylation of the shrimp chitosan (81.24%) directly relates the solubility of the chitosan. The chitosan with these quality parameters considered to be the excellent biological value. The yield of shrimp chitosan (15.4%) was also more when compare to crab and squilla chitosan. These result showed that utilisation of shrimp shell waste for the production of chitin and chitosan will give more economical and biological value along with reduction of environmental pollution.
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Affiliation(s)
- F. Parthiban
- Fisheries College and Research Institute,Tamil Nadu Fisheries University, Ponneri, India
| | - S. Balasundari
- Fisheries College and Research Institute,Tamil Nadu Fisheries University, Ponneri, India
| | - A. Gopalakannan
- Fisheries College and Research Institute,Tamil Nadu Fisheries University, Ponneri, India
| | - K. Rathnakumar
- Fisheries College and Research Institute,Tamil Nadu Fisheries University, Ponneri, India
| | - S. Felix
- Fisheries College and Research Institute,Tamil Nadu Fisheries University, Ponneri, India
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Masyuk M, Abel P, Hug M, Haneya A, Sack S, Sideris K, Langwieser N, Graf T, Fuernau G, Franz M, Westenfeld R, Kelm M, Felix S, Jung C. P3020Real-world clinical experience with percutaneous extracorporeal life support system (ECLS): analysis of the German Lifebridge registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3020] [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: 11/12/2022] Open
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27
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Gutierrez MM, Pillai G, Felix S, Romero F, Onyango KO, Owusu-Agyei S, Asante KP, Barnes KI, Sinxadi P, Allen E, Abdulla S, Masimirembwa C, Munyoro M, Yimer G, Gebre-Mariam T, Spector J, Ogutu B. Building Capability for Clinical Pharmacology Research in Sub-Saharan Africa. Clin Pharmacol Ther 2017; 102:786-795. [PMID: 28378903 DOI: 10.1002/cpt.695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 01/13/2023]
Abstract
A strong scientific rationale exists for conducting clinical pharmacology studies in target populations because local factors such as genetics, environment, comorbidities, and diet can affect variability in drug responses. However, clinical pharmacology studies are not widely conducted in sub-Saharan Africa, in part due to limitations in technical expertise and infrastructure. Since 2012, a novel public-private partnership model involving research institutions and a pharmaceutical company has been applied to developing increased capability for clinical pharmacology research in multiple African countries.
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Affiliation(s)
- M M Gutierrez
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - G Pillai
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - S Felix
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - F Romero
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - K O Onyango
- Kenya Medical Research Institute (KEMRI)/Strathmore University (SU), Nairobi, Kenya
| | | | - K P Asante
- Kintampo Health Research Center, Kintampo, Ghana
| | - K I Barnes
- University of Cape Town, Cape Town, South Africa
| | - P Sinxadi
- University of Cape Town, Cape Town, South Africa
| | - E Allen
- University of Cape Town, Cape Town, South Africa
| | - S Abdulla
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - C Masimirembwa
- African Institute of Biomedical Science & Technology, Harare, Zimbabwe
| | - M Munyoro
- African Institute of Biomedical Science & Technology, Harare, Zimbabwe
| | - G Yimer
- Addis Ababa University/Regional Bioequivalence Center, Addis Ababa, Ethiopia
| | - T Gebre-Mariam
- Addis Ababa University/Regional Bioequivalence Center, Addis Ababa, Ethiopia
| | - J Spector
- Novartis Pharma and Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, Massachusetts, USA
| | - B Ogutu
- Kenya Medical Research Institute (KEMRI)/Strathmore University (SU), Nairobi, Kenya
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Ewert R, Ittermann T, Bollmann T, Spielhagen T, Dörr M, Schäper C, Warnke C, Obst A, Friedrich N, Felix S, Markus M, Piontek M, Penzel T, Fietze I, Glos M, Stubbe B, Desole S, Kaczmarek S, Schmidt C, Völzke H, Gläser S. Pneumologisch relevante Daten aus der „Study of Health in Pomerania“ (SHIP) – eine Übersicht zu den Kohorten, Methoden und ersten Ergebnissen. Pneumologie 2017; 71:17-35. [DOI: 10.1055/s-0042-117461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Ewert
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - T. Ittermann
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - T. Bollmann
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | | | - M. Dörr
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Schäper
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Warnke
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - A. Obst
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - N. Friedrich
- Universitätsmedizin Greifswald, Institut für Klinische Chemie und Laboratoriumsmedizin
| | - S. Felix
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - M. Markus
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - M. Piontek
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - T. Penzel
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - I. Fietze
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - M. Glos
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - B. Stubbe
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S. Desole
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S. Kaczmarek
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Schmidt
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - H. Völzke
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - S. Gläser
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
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Koenig A, Stepanova M, Felix S, Kalwaney S, Clement S, Younossi ZM. Vaccination against hepatitis A and B in patients with chronic liver disease and type 2 diabetes: has anything changed? Liver Int 2016; 36:1096-100. [PMID: 27187614 DOI: 10.1111/liv.13164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Given the severity of acute hepatitis in patients with chronic liver diseases (CLD) and patients with type 2 diabetes (DM), most of these patients are recommended to be vaccinated. The aim is to assess the recent changes in HAV and HBV vaccination rates in patients with CLD and DM in the U.S. using the most recent population data. METHODS We used the National Health and Nutrition Examination Surveys (NHANES) cycles 2009-2012 and 2013-2014, and compared those to previous cycles (1999-2004 and 2005-2008). RESULTS In general U.S. population, the rates of quality measure (QM, serologic immunity or history of vaccination) for HBV increased from 31.9% in 1999-2004 to 49.5% in 2013-2014 (P < 0.0001), synchronously with an increase in self-reported HBV vaccination: from 24.4% to 41.3% (P < 0.0001). A similar increase was noted for HAV: 12.0% in 1999-2004 to 33.4% in 2013-2014 in vaccination, 44.0% to 52.4% in HAV QM (all P < 0.0001). Greater recent increases in HBV QM were noted in non-HBV CLD patients: 34.7% to 56.8% in HBV QM and 22.7% to 51.1% in HBV vaccination (all P < 0.0001), while the changes in patients with diabetes were similar to those in general U.S. population despite the recent CDC recommendation (for the age 19-59): 31.0% to 45.1% (P = 0.007) in HBV QM, and 22.3% to 39.0% (P = 0.0004) in HBV vaccination. CONCLUSIONS Despite recommendations, HAV and HBV vaccination rates in patients with CLD and DM remain relatively low. Better vaccination strategies for these high risk patients should be undertaken.
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Affiliation(s)
- Aaron Koenig
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Maria Stepanova
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Sean Felix
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Shirley Kalwaney
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Stephen Clement
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Aust S, Felix S, Auer K, Dekan S, Kenner L, Polterauer S, Reinthaller A, Pils D. Vergleichende Analyse der PD-L1 Expression in Primär- und Rezidivgewebeproben von Frauen mit epithelialem Ovarialkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1579585] [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: 10/22/2022] Open
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31
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Golabi P, Otgonsuren M, Cable R, Felix S, Koenig A, Sayiner M, Younossi ZM. Non-alcoholic Fatty Liver Disease (NAFLD) is associated with impairment of Health Related Quality of Life (HRQOL). Health Qual Life Outcomes 2016; 14:18. [PMID: 26860700 PMCID: PMC4746896 DOI: 10.1186/s12955-016-0420-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/27/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND NAFLD impacts patient reported outcomes (PROs). Our aim was to assess the impact of NAFLD on patients' HRQOL. METHODS National Health and Nutrition Examination Survey (NHANES) 2001-2011 data were used to identify adult patients with NAFLD [Fatty Liver Index (FLI) > 60 in absence of other liver disease and excessive alcohol >20 g/day for men, >10 g/day for women]. Patients with other chronic diseases (ex. HIV, cancer, end-stage kidney disease) were excluded. Subjects without any of these conditions were healthy controls. HCV RNA (+) patients were HCV-controls. All patients completed NHANES HRQOL-4 questionnaire. Linear regression determined the association between NAFLD and HRQOL components adjusting for age, gender, race, and BMI. RESULTS Participants with complete data were included (n = 9661); 3333 NAFLD (age 51 years and BMI 34 kg/m(2)); 346 HCV+ (age 49 years; BMI 27 kg/m(2)) and 5982 healthy controls (age 48 years and BMI 26 kg/m(2)). The proportion of subjects rating their health as "fair" or "poor" in descending order were HCV controls (30 %) NAFLD (20 %) and healthy controls (10 %) (p < 0.001). HRQOL-4 components scores 2-4 were lowest for HCV, followed by NAFLD and then healthy controls (p-values p = 0.011 to < .0001). After adjustment for age, gender, race, and BMI, NAFLD patients were 18-20 % more likely to report days when their physical health wasn't good or were unable to perform daily activities as a result (p < .0001). CONCLUSIONS NAFLD causes impairment of HRQOL. As NAFLD is becoming the most important cause of CLD, its clinical and PRO impact must be assessed.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Munkhzul Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Rebecca Cable
- Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Aaron Koenig
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. .,Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
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Sibon I, Tourdias T, Felix S, Asselineau J, Bracoud L, Vivot A, Rouanet F, Renou P, Orgogozo J, Dousset V. Magnetisation transfer parameters and stroke outcome. J Clin Neurosci 2015; 22:1012-7. [DOI: 10.1016/j.jocn.2014.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/23/2022]
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Maria Eugenia M, Jimena Maria R, Teresa M, Maria carmen G, Amelia S, Felix S. CP-103 Optimisation of antibiotic treatment in general surgery. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.99] [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: 11/04/2022] Open
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34
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Felix S, Chakkravarthy RBP, Grace AN. Microwave assisted synthesis of copper oxide and its application in electrochemical sensing. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1757-899x/73/1/012115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Warnke C, Bollmann T, Ittermann T, Gläser S, Koch B, Schäper C, Lau K, Felix S, Ewert R. Referenzwerte für den arteriellen Sauerstoffgehalt. Pneumologie 2014; 68:788-92. [DOI: 10.1055/s-0034-1378089] [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: 10/24/2022]
Affiliation(s)
- Ch. Warnke
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - T. Bollmann
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - T. Ittermann
- Institut für Community Medicine, Abteilung SHIP, Klinisch Epidemiologische Forschung, Universitätsmedizin Greifswald
| | - S. Gläser
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - B. Koch
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - Ch. Schäper
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - K. Lau
- Institut für Community Medicine, Abteilung SHIP, Klinisch Epidemiologische Forschung, Universitätsmedizin Greifswald
| | - S. Felix
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - R. Ewert
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald
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Busch M, Busch R, Felix S. Update: implantierbare Diagnostika. Aktuel Kardiol 2013. [DOI: 10.1055/s-0033-1346887] [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: 10/25/2022]
Affiliation(s)
- M. Busch
- Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
| | - R. Busch
- Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
| | - S. Felix
- Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
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Santhosh C, James A, T M, Saranya M, Ramachandran R, Felix S, T M, Velmurugan V, Grace A. Solvothermal Preparation of Graphene Supported Mn Ferrites and its Photocatalytic Activity. ACTA ACUST UNITED AC 2013. [DOI: 10.2174/22106812112029990007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Kuon E, Empen K, Weitmann K, Staudt A, Hummel A, Dörr M, Reffelmann T, Hoffmann W, Felix S. Long-Term Efficacy of a Mini-Course in Radiation-Reducing Techniques in Invasive Cardiology. ROFO-FORTSCHR RONTG 2013; 185:720-5. [DOI: 10.1055/s-0033-1335323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E. Kuon
- Abteilung für Kardiologie, Klinik Fränkische Schweiz, Ebermannstadt
| | - K. Empen
- Abteilung für Innere Medizin B, Ernst-Moritz-Arndt Universität, Greifswald
| | - K. Weitmann
- Institut für Versorgungsmedizin, Ernst-Moritz-Arndt Universität, Greifswald
| | - A. Staudt
- Abteilung für Kardiologie und Angiologie, Helios Kliniken, Schwerin
| | - A. Hummel
- Abteilung für Innere Medizin B, Ernst-Moritz-Arndt Universität, Greifswald
| | - M. Dörr
- Abteilung für Innere Medizin B, Ernst-Moritz-Arndt Universität, Greifswald
| | - T. Reffelmann
- Abteilung für Innere Medizin B, Ernst-Moritz-Arndt Universität, Greifswald
| | - W. Hoffmann
- Institut für Versorgungsmedizin, Ernst-Moritz-Arndt Universität, Greifswald
| | - S. Felix
- Abteilung für Innere Medizin B, Ernst-Moritz-Arndt Universität, Greifswald
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Bonnet C, Aupy J, Felix S, Marchal C. Intérêt du bilan dysimmunitaire dans une épilepsie isolée tardive. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.142] [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: 11/16/2022]
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Affiliation(s)
- A. Riad
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald
| | - S. Felix
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald
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Vidal J, Carvalho N, Felix S, Bessa C, Vieira L, Patury P, Franco V, Silva A, Almeida L, Moreira M. 1159 Diversity of HPV Genotypes in Cervical Tumors From Rio De Janeiro, Brazil. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71755-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Bollmann T, Schäper C, Walther D, Puls R, Vogelgesang S, Ewert R, Felix S. Progrediente klinische Verschlechterung bei ausgeprägter intra- und retroperitonealer Lipomatose - ein Fallbericht. Pneumologie 2012. [DOI: 10.1055/s-0032-1309182] [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: 10/28/2022]
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Gläser S, Henkel B, Obst A, Halank M, Bruch L, Felix S, Ewert R. Nicht-invasive Prädiktoren einer pulmonalen Hypertonie bei Patienten mit idiopathischer Lungenfibrose. Pneumologie 2012. [DOI: 10.1055/s-0032-1309167] [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: 10/28/2022]
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Bollmann T, Schäper C, Walther D, Puls R, Vogelgesang S, Ewert R, Felix S. Progrediente klinische Verschlechterung bei ausgeprägter intra- und retroperitonealer Lipomatose – ein Fallbericht. Pneumologie 2012. [DOI: 10.1055/s-0032-1302688] [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: 10/28/2022]
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Koch B, Lau K, Ittermann T, Völzke H, Felix S, Ewert R, Schäper C, Gläser S. Spiroergometrische Referenzwerte für Parameter der Atemmechanik - Ergebnisse der Study of Health in Pomerania. Pneumologie 2011. [DOI: 10.1055/s-0031-1272228] [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: 10/18/2022]
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Dörr M, Ittermann T, Baumeister S, Reffelmann T, Kors J, Felix S, Völzke H. Are changes of serum TSH levels associated with alteration of cardiac electrical activity? Results from a large population-based cohort study. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266643] [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: 10/19/2022]
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Völzke H, Lorbeer R, Dörr M, Kock H, Assel H, Ott K, Völker U, Hecker M, Hoffmann W, Nauck M, Zygmunt M, Felix S, Kroemer H. Greifswald Approach to Individualized Medicine (GANI_MED) – Rationale and Design. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266381] [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: 10/19/2022]
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Schipf S, Alte D, Völzke H, Friedrich N, Haring R, Lohmann T, Rathmann W, Nauck M, Felix S, Hoffmann W, John U, Wallaschofski H. Prävalenz des Metabolischen Syndroms in Deutschland: Ergebnisse der Study of Health in Pomerania (SHIP). DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1247406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Koch B, Gläser S, Friedrich N, Völzke H, Felix S, Ewert R, Schäper C. Referenzwerte für die Bodyplethysmografie bei Erwachsenen – Ergebnisse der Study of Health in Pomerania (SHIP). Pneumologie 2010. [DOI: 10.1055/s-0030-1251306] [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: 10/19/2022]
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50
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Gläser S, Schäper C, Warnke C, Obst A, Felix S, Opitz C, Ewert R, Koch B. Endothelfunktion: ein peripher messbares Surrogat für Gasaustauscheffizienz und kardiopulmonale Belastbarkeit? Pneumologie 2010. [DOI: 10.1055/s-0030-1251114] [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: 10/19/2022]
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