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Yun S, Kiffer FC, Bancroft GL, Guzman CS, Soler I, Haas HA, Shi R, Patel R, Lara-Jiménez J, Kumar PL, Tran FH, Ahn KJ, Rong Y, Luitel K, Shay JW, Eisch AJ. The longitudinal behavioral effects of acute exposure to galactic cosmic radiation in female C57BL/6J mice: implications for deep space missions, female crews, and potential antioxidant countermeasures. bioRxiv 2024:2024.04.12.588768. [PMID: 38659963 PMCID: PMC11042186 DOI: 10.1101/2024.04.12.588768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Galactic cosmic radiation (GCR) is an unavoidable risk to astronauts that may affect mission success. Male rodents exposed to 33-beam-GCR (33-GCR) show short-term cognitive deficits but reports on female rodents and long-term assessment is lacking. Here we asked: What are the longitudinal behavioral effects of 33-GCR on female mice? Also, can an antioxidant/anti-inflammatory compound mitigate the impact of 33-GCR? Mature (6-month-old) C57BL/6J female mice received the antioxidant CDDO-EA (400 µg/g of food) or a control diet (vehicle, Veh) for 5 days and either Sham-irradiation (IRR) or whole-body 33-GCR (0.75Gy) on the 4th day. Three-months post-IRR, mice underwent two touchscreen-platform tests: 1) location discrimination reversal (which tests behavior pattern separation and cognitive flexibility, two abilities reliant on the dentate gyrus) and 2) stimulus-response learning/extinction. Mice then underwent arena-based behavior tests (e.g. open field, 3-chamber social interaction). At the experiment end (14.25-month post-IRR), neurogenesis was assessed (doublecortin-immunoreactive [DCX+] dentate gyrus neurons). Female mice exposed to Veh/Sham vs. Veh/33-GCR had similar pattern separation (% correct to 1st reversal). There were two effects of diet: CDDO-EA/Sham and CDDO-EA/33-GCR mice had better pattern separation vs. their respective control groups (Veh/Sham, Veh/33-GCR), and CDDO-EA/33-GCR mice had better cognitive flexibility (reversal number) vs. Veh/33-GCR mice. Notably, one radiation effect/CDDO-EA countereffect also emerged: Veh/33-GCR mice had worse stimulus-response learning (days to completion) vs. all other groups, including CDDO-EA/33-GCR mice. In general, all mice show normal anxiety-like behavior, exploration, and habituation to novel environments. There was also a change in neurogenesis: Veh/33-GCR mice had fewer DCX+ dentate gyrus immature neurons vs. Veh/Sham mice. Our study implies space radiation is a risk to a female crew's longitudinal mission-relevant cognitive processes and CDDO-EA is a potential dietary countermeasure for space-radiation CNS risks.
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Yun S, Casado J, Pérez-Silvestre J, Salamanca P, Llàcer P, Quirós R, Ruiz-Hueso R, Méndez M, Manzano L, Formiga F. Clinical suspicion, diagnosis and management of cardiac amyloidosis: update document and executive summary. Rev Clin Esp 2024:S2254-8874(24)00056-0. [PMID: 38614320 DOI: 10.1016/j.rceng.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.
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Affiliation(s)
- S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Atención a la Insuficiencia Cardíaca Comunitaria, Servicios de Cardiología y Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain
| | - J Pérez-Silvestre
- Servicio de Medicina Interna, UMIPIC, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Salamanca
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - P Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - R Quirós
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain; RICAPPS, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Spain
| | - R Ruiz-Hueso
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Méndez
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Yun J, Yun S, Park JE, Cheong EN, Park SY, Kim N, Kim HS. Deep Learning of Time-Signal Intensity Curves from Dynamic Susceptibility Contrast Imaging Enables Tissue Labeling and Prediction of Survival in Glioblastoma. AJNR Am J Neuroradiol 2023; 44:543-552. [PMID: 37105676 PMCID: PMC10171378 DOI: 10.3174/ajnr.a7853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE An autoencoder can learn representative time-signal intensity patterns to provide tissue heterogeneity measures using dynamic susceptibility contrast MR imaging. The aim of this study was to investigate whether such an autoencoder-based pattern analysis could provide interpretable tissue labeling and prognostic value in isocitrate dehydrogenase (IDH) wild-type glioblastoma. MATERIALS AND METHODS Preoperative dynamic susceptibility contrast MR images were obtained from 272 patients with IDH wild-type glioblastoma (training and validation, 183 and 89 patients, respectively). The autoencoder was applied to the dynamic susceptibility contrast MR imaging time-signal intensity curves of tumor and peritumoral areas. Representative perfusion patterns were defined by voxelwise K-means clustering using autoencoder latent features. Perfusion patterns were labeled by comparing parameters with anatomic reference tissues for baseline, signal drop, and percentage recovery. In the validation set (n = 89), a survival model was created from representative patterns and clinical predictors using Cox proportional hazard regression analysis, and its performance was calculated using the Harrell C-index. RESULTS Eighty-nine patients were enrolled. Five representative perfusion patterns were used to characterize tissues as high angiogenic tumor, low angiogenic/cellular tumor, perinecrotic lesion, infiltrated edema, and vasogenic edema. Of these, the low angiogenic/cellular tumor (hazard ratio, 2.18; P = .047) and infiltrated edema patterns (hazard ratio, 1.88; P = .009) in peritumoral areas showed significant prognostic value. The combined perfusion patterns and clinical predictors (C-index, 0.72) improved prognostication when added to clinical predictors (C-index, 0.55). CONCLUSIONS The autoencoder perfusion pattern analysis enabled tissue characterization of peritumoral areas, providing heterogeneity and dynamic information that may provide useful prognostic information in IDH wild-type glioblastoma.
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Affiliation(s)
- J Yun
- From the Departments of Convergence Medicine (J.Y., N.K.)
- Radiology and Research Institute of Radiology (J.Y., J.E.P., N.K., H.S.K.), Asan Medical Center
| | - S Yun
- Department of Radiology (S.Y.), Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - J E Park
- Radiology and Research Institute of Radiology (J.Y., J.E.P., N.K., H.S.K.), Asan Medical Center
| | - E-N Cheong
- Medical Science and Asan Medical Institute of Convergence Science and Technology (E.-N.C.), University of Ulsan College of Medicine, Seoul, Korea
| | - S Y Park
- Department of Statistics and Data Science (S.Y.P.), Korea National Open University, Seoul, Korea
| | - N Kim
- From the Departments of Convergence Medicine (J.Y., N.K.)
- Radiology and Research Institute of Radiology (J.Y., J.E.P., N.K., H.S.K.), Asan Medical Center
| | - H S Kim
- Radiology and Research Institute of Radiology (J.Y., J.E.P., N.K., H.S.K.), Asan Medical Center
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Farghaly S, Yun S, Mansour A, Stryker K, Joseph J, Forest S, Borgi J, Alsunaid S. Outcomes and Immunosuppression of Combined Liver-Lung Transplantation: A Single Center Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1373] [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: 04/05/2023] Open
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Alcoberro L, Jimenez-Marrero S, Cainzos-Achirica M, Monterde D, Enjuanes C, Jose N, Garay A, Moliner P, Yun S, Ramos R, Ras M, Calero E, Hidalgo E, Corbella X, Comin-Colet J. Factors associated to renin-angiotensin-aldosterone system inhibitors discontinuation or down-titration due to hyperkalaemia in patients with chronic cardiovascular conditions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2694] [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/Introduction
The renin-angiotensin-aldosterone system inhibitors (RAASI) are one of the keystones of the medical treatment in chronic cardiovascular disorders and have shown improvements in clinical outcomes in many clinical trials. Hyperkalaemia is a well-defined non-desirable effect of RAASI that occasionally forces to interrupt these medications. That enforced RAASI discontinuation or down-titration due to hyperkalaemia may have adverse prognostic consequences.
Purpose
Describe the demographical, clinical and pharmacological variables associated to a higher risk of RAASI discontinuation or down-titration due to hyperkalaemia among individuals with chronic cardiovascular conditions.
Methods
We used data from more than 375,000 individuals 55 years of age or older, included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. We included participants with at least one relevant condition: chronic heart failure, chronic kidney disease, diabetes mellitus, ischemic heart disease or hypertension. They had to be under RAASI treatment as of January 1st, 2016, and with evidence of at least one episode of hyperkalaemia (serum potassium >5.0 mmol/L) during 2016. Then, were classified in one of the two following profiles: RAASI treatment discontinuation or down-titration versus RAASI treatment unchanged or up-titrated. For the statistical analysis, we used logistic regression to calculate the multivariable-adjusted odds ratios of each study variable, comparing RAASI discontinuation or down-titration group to RAASI treatment unchanged or up-titrated controls (reference group).
Results
In the multivariable-adjusted model, the risk of RAASI treatment discontinuation or down-titration due to hyperkalaemia was significantly associated with the use of RAASI, very high comorbidity index, potassium derangements (both hypokalaemia and hyperkalaemia), prior hospitalizations and prior emergency visits. Among RAASI treatments, the use of Angiotensin receptor blockers (OR 2.518, 95% CI 2.317–2.735) and Angiotensin-converting enzyme inhibitors (OR 2.341, 95% CI 2.149–2.549) were associated with a higher risk of RAASI discontinuation or down-titration due to hyperkalaemia than Aldosterone inhibitors (1.428, 95% CI 1.285–1.584).
Conclusion
These results suggest that vulnerable populations such as those with very high comorbidity index, potassium derangements or prior emergency visits or hospitalizations have a higher risk of RAASI treatment discontinuation or down-titration due to hyperkalaemia.
A more careful and exhaustive management of RAASI should be advised in those patients.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet has received speaker fees from Vifor Pharma.
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Affiliation(s)
- L Alcoberro
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Jimenez-Marrero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | | | - D Monterde
- Department of Health , Barcelona , Spain
| | - C Enjuanes
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - N Jose
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - A Garay
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - P Moliner
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - S Yun
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - R Ramos
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - M Ras
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - E Calero
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - E Hidalgo
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
| | - X Corbella
- Bellvitge University Hospital, Internal Medicine , Hospitalet De Llobregat , Spain
| | - J Comin-Colet
- Bellvitge University Hospital, Cardiology , Hospitalet De Llobregat , Spain
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Jimenez-Marrero S, Cainzos-Achirica M, Monterde D, Enjuanes C, Garay A, Moliner P, Alcoberro L, Yun S, Ras M, Ramos R, Calero E, Hidalgo E, Jose N, Corbella X, Comin-Colet J. Management of renin-angiotensin-aldosterone system inhibitors in patients with chronic cardiovascular conditions and its association with clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.853] [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
Background
In chronic cardiovascular diseases, the renin-angiotensin-aldosterone system inhibitors (RAASI) are one of the keystones of the medical treatment and have revealed improvements in clinical outcomes in many clinical trials. In contrast, is well defined as non-desirable effect of RAASI the development of hyperkalemia, which could force to interrupt these treatments. Hyperkalemia has been associated with worse outcomes in observational studies. Though, it is controversial if those negative outcomes in hyperkalemic patients could be because the potassium derangement itself or the circumstance that in these individuals could be enforced to discontinue RAASI medications with prognostic consequences at mid- to long-term.
Purpose
Assess associations between management of RAASI and clinical outcomes among individuals with chronic cardiovascular conditions and hyperkalemia.
Methods
Data from more than 375,000 individuals 55 years of age or older were analyzed, in a population-based healthcare database of a public Institute of Health between 2015 and 2017. We conducted a longitudinal analysis, in which participants with at least one relevant condition were included: chronic heart failure, chronic kidney disease, diabetes mellitus, ischemic heart disease or hypertension. They had to be under RAASI treatment as of January 1st, 2016, and with evidence of at least one episode of hyperkalemia (serum potassium >5.0 mmol/L) during 2016. Then, were classified in one of the two following profiles: RAASI treatment discontinuation or down-titration versus RAASI treatment unchanged or up-titrated. Subsequently, all-cause death and hospitalization has been assessed in the follow-up period as clinical outcomes. For the statistical analysis, we calculated unadjusted incidence rate ratios and Cox Proportional Hazards Regression models to calculate the multivariable-adjusted risk ratios for the clinical endpoints comparing both groups.
Results
There was found an association with mortality and hospitalization for the RAASI treatment interruption/down-titration group when compared unadjusted incidence rate ratios of each clinical endpoints to RAASI treatment unchanged patients (reference group). We presented these results in a Kaplan-Meier survivor curves for endpoint mortality (Figure 1). In the multivariable-adjusted model, the risk of mortality and hospitalization was associated mainly with older age, hypokalemia and down-titration of RAASI treatments, achieving statistical significance (Table 1). The risk ratio for mortality associated with down-titration and with hyperkalemia compared with the reference group was 1.676 (95% CI 1.54–1.82) and 1.161 (95% CI 1.07–1.26) respectively.
Conclusion
These results suggest that the worse outcomes in hyperkalemia individuals could be influenced more for the discontinuation of RAASI prognostic drugs then for the hyperkalemia itself. It is necessary clinical randomized trials to confirm this observational hypothesis.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet has received speaker fees from Vifor Pharma
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Affiliation(s)
| | | | - D Monterde
- Department of Health , Barcelona , Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - M Ras
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - R Ramos
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - N Jose
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine , Barcelona , Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology , Barcelona , Spain
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Comin-Colet J, Capdevila C, Vela E, Cleries M, Fernandez C, Alcober L, Calero-Molina E, Hidalgo E, Jose N, Moliner P, Corbella X, Yun S, Jimenez-Marrero S, Garay A, Enjuanes-Grau C. Effect on mortality and hospitalization of real-world implementation of transitional care heart failure programmes in patients with heart failure: a population-based study in 77,554 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1029] [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
Background
The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real-world practice setting is more controversial.
Purpose
This study evaluates the efficacy of a comprehensive, transitional-care nurse-based HF programme integrating hospital and primary care resources in a healthcare area covering a population of 209,255 (implementation area).
Methods
We designed a pragmatic, population-based evaluation of the implementation of the program conducting a natural experiment. Study periods were: pre-implementation period (years 2015 and 2016), transition period (year 2017) and consolidation of implementation period (years 2018 and 2019). For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. Efficacy of the implementation of the program was measured at two levels: first, comparing the outcomes of patients exposed to the HF program between periods of implementation taking 2015–2016 as the reference period and, second, comparing outcomes between patients of the implementation area with patients of the remaining areas of the Catalonia at each predefined period.
Results
We included 77,554 patients in the study: 3,396 exposed to the implementation area and 74,158 exposed to the rest of healthcare areas in Catalonia. During the period of the study, 55,886 (72.1%) patients experienced at least one major adverse event. Death occurred in 37,469 (48.3%), clinically related hospitalisation in 41,709 (53.8%) and HF readmission in 29,755 (38.4%).
As shown in Table 1, multivariate Cox proportional hazards models adjusted for age, gender, previous hospitalisation, co-morbidities, socioeconomic status, and time since HF diagnosis showed there was a significant (all p-values <0.001) relative risk reduction of the risk of all-cause death (5%), clinically related hospitalisation (13%) and HF hospitalisation (14%) in the consolidation period (2018–2019) compared to the pre-programme period (2015–2016). Similarly, as shown in Table 1 and Figure 1, while in the pre-programme period (2015–2016) the risk of adverse outcomes was significantly higher in patients exposed to the implementation area compared to the rest of Catalonia, this association was inverted during the consolidation period (2018–2019) where the risk of mortality, clinically-related readmission and HF re-hospitalisation was significantly reduced (all p-values <0.025) by 19%, 11% and 16%, respectively, among patients exposed to the implementation area compared with patients of the remaining areas of Catalonia.
Conclusions
The implementation of multidisciplinary transitional-care nurse-based heart failure programmes integrating hospital and primary care reduce mortality and hospitalisation in vulnerable patients with heart-failure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Capdevila
- University Hospital Bellvitge , Barcelona , Spain
| | - E Vela
- Department of Health , Barcelona , Spain
| | - M Cleries
- Department of Health , Barcelona , Spain
| | - C Fernandez
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | - L Alcober
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | | | - E Hidalgo
- University Hospital Bellvitge , Barcelona , Spain
| | - N Jose
- University Hospital Bellvitge , Barcelona , Spain
| | - P Moliner
- University Hospital Bellvitge , Barcelona , Spain
| | - X Corbella
- University Hospital Bellvitge , Barcelona , Spain
| | - S Yun
- University Hospital Bellvitge , Barcelona , Spain
| | | | - A Garay
- University Hospital Bellvitge , Barcelona , Spain
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8
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Comin-Colet J, Capdevila C, Vela E, Cleries M, Fernandez C, Alcober L, Calero-Molina E, Hidalgo E, Jose N, Moliner P, Corbella X, Yun S, Jimenez-Marrero S, Garay A, Enjuanes-Grau C. Effect of socioeconomic status in medical resource use and outcomes in patients with heart failure in integrated care settings: real-world evidence from population-based data of 77,554 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1030] [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
Low socioeconomic status (SES) has a negative impact in terms of outcomes and medical resource use despite open access to care in universal health-care systems in patients with heart failure (HF). Whether the breach in outcomes determined by SES inequalities can be mitigated by intensive HF management in integrate care programs is not known.
Purpose
To analyse the effect of SES status on health outcomes before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program integrating hospital and primary care and resources for patients with HF at a high risk of events in a health-care area of 209,255 inhabitants.
Methods
For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. We considered 3 distinct periods of implementation of the HF programme: pre-implementation (2015–2016), transition (2017 start of implementation) and consolidation (2018–2019). To evaluate the efficacy of the programme according to SES strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia across implementation periods and stratified according to levels of SES. SES was defined based on individual annual income.
Results
We included 77,554 patients in the study: 3,396 in the implementation area and 74, 158 in the rest of Catalonia. Distribution of patients according to SES was: 12,018 (15.5%) high or medium SES, 61,967 (79.9%) low SES and 3,535 (4.5%) very low SES. During the period of the study death occurred in 37,469 (48.3%), clinically related hospitalisation in 41,709 (53.8%) and HF readmission in 29,755 (38.4%).
Multivariate Cox proportional hazards models (Table 1) showed that low or very low SES was associated with worse outcomes compared to patients with high or medium SES. Implementation of HF programme significantly improved outcomes in patients with HF (Figure 1, left column). As shown in Figure 1 central and right columns, improvement in clinical outcomes was observed across all SES strata in patients exposed to the HF programme. The size effect for hospitalisation was more prominent among patients with medium of high SES (47% relative change) compared to patients with low or very low SES (32% relative change). Size effect for mortality did not differ between both strata (10% relative improvement in both groups).
Conclusions
The SES is an independent predictor of mortality, clinically related hospitalisation, and HF hospitalisation in vulnerable patients with HF. The implementation of an intensive transitional care nurse-based HF management program improve clinical outcomes across SES strata. However, the size effect in the prevention of hospitalisation is more pronounced among patients with medium or high SES.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - C Capdevila
- University Hospital Bellvitge , Barcelona , Spain
| | - E Vela
- Department of Health , Barcelona , Spain
| | - M Cleries
- Department of Health , Barcelona , Spain
| | - C Fernandez
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | - L Alcober
- Primary Care Research Institute (IDIAP) , Barcelona , Spain
| | | | - E Hidalgo
- University Hospital Bellvitge , Barcelona , Spain
| | - N Jose
- University Hospital Bellvitge , Barcelona , Spain
| | - P Moliner
- University Hospital Bellvitge , Barcelona , Spain
| | - X Corbella
- University Hospital Bellvitge , Barcelona , Spain
| | - S Yun
- University Hospital Bellvitge , Barcelona , Spain
| | | | - A Garay
- University Hospital Bellvitge , Barcelona , Spain
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Yun S, Greco V. 117 Determinants of epithelial morphogenic change during oncogenic transformation. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.052] [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: 10/17/2022]
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Cho YB, Kim JW, Heo K, Kim HJ, Yun S, Lee HS, Shin HG, Shim H, Yu H, Kim YH, Lee S. An internalizing antibody targeting of cell surface GRP94 effectively suppresses tumor angiogenesis of colorectal cancer. Biomed Pharmacother 2022; 150:113051. [PMID: 35658213 DOI: 10.1016/j.biopha.2022.113051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Colorectal cancer (CRC) is one of the life-threatening malignancies worldwide. Thus, novel potential therapeutic targets and therapeutics for the treatment of CRC need to be identified to improve the clinical outcomes of patients with CRC. In this study, we found that glucose-regulated protein 94 (GRP94) is overexpressed in CRC tissues, and its high expression is correlated with increased microvessel density. Next, through phage display technology and consecutive in vitro functional isolations, we generated a novel human monoclonal antibody that specifically targets cell surface GRP94 and shows superior internalizing activity comparable to trastuzumab. We found that this antibody specifically inhibits endothelial cell tube formation and simultaneously promotes the downregulation of GRP94 expression on the endothelial cell surface. Finally, we demonstrated that this antibody effectively suppresses tumor growth and angiogenesis of HCT116 human CRC cells without causing severe toxicity in vivo. Collectively, these findings suggest that cell surface GRP94 is a novel potential anti-angiogenic target in CRC and that antibody targeting of GRP94 on the endothelial cell surface is an effective strategy to suppress CRC tumor angiogenesis.
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Affiliation(s)
- Yea Bin Cho
- Department of Chemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Ji Woong Kim
- Department of Chemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Kyun Heo
- Department of Biopharmaceutical Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Biopharmaceutical Chemistry Major, School of Applied Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Antibody Research Institute, Kookmin University, Seoul 02707, Republic of Korea
| | - Hyun Jung Kim
- Department of Biopharmaceutical Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Biopharmaceutical Chemistry Major, School of Applied Chemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Sumi Yun
- Samkwang Medical Laboratories, Department of Diagnostic Pathology, Seoul 06742, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ha Gyeong Shin
- Department of Biopharmaceutical Chemistry, Kookmin University, Seoul 02707, Republic of Korea
| | - Hyunbo Shim
- Department of Life Science, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Hanjin Yu
- HauulBio, Chuncheon, Gangwon 24398, Republic of Korea
| | - Yun-Hee Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea; Division of Convergence Technology, Research Institute of National Cancer Center, Goyang 10408, Republic of Korea
| | - Sukmook Lee
- Department of Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Department of Biopharmaceutical Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Biopharmaceutical Chemistry Major, School of Applied Chemistry, Kookmin University, Seoul 02707, Republic of Korea; Antibody Research Institute, Kookmin University, Seoul 02707, Republic of Korea.
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11
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Yoo MH, Kim HJ, Choi IH, Park S, Yun S, Park HK, Byun DW, Suh K. Efficacy of Differential Diagnosis of Thyroid Nodules by Shear Wave Elastography-the Stiffness Map. J Endocr Soc 2021; 5:bvab154. [PMID: 34703960 PMCID: PMC8533983 DOI: 10.1210/jendso/bvab154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fine needle aspiration is the gold standard for differential diagnosis of thyroid nodules; however, the malignancy rate for indeterminate cytology is 20% to 50%. OBJECTIVE We evaluated the efficacy of shear wave elastography added to ultrasonography for differential diagnosis of thyroid nodules. METHODS We retrospectively reviewed the medical records of 258 consecutive patients. Thyroid nodules were divided into 4 categories according to maximum elasticity (EMax) and nodule depth/width (D/W) ratio: Category 1 (EMax ≥ 42.6 kPa; D/W < 0.9); Category 2 (EMax < 42.6 kPa; D/W < 0.9); Category 3 (EMax ≥ 42.6 kPa; D/W ≥ 0.9); and Category 4 (EMax < 42.6 kPa; D/W ≥ 0.9). The EMax cutoff value was set using receiver operating characteristic (ROC) curve analysis to predict nodular hyperplasia (NH) vs follicular neoplasm (FN). Cutoff value for nodule D/W ratio was set using ROC curve analysis for malignancy. RESULTS NH was the most prevalent pathology group in Category 1, FN in Category 2, and papillary thyroid carcinoma in Category 3. Category 3 demonstrated the highest rate of malignancy (81.8%) and had 55.4% sensitivity and 90% specificity for predicting malignancy. When assessing the benign pathology of NH in follicular patterned lesion, Category 1 demonstrated the highest NH prevalence of 88.9% (34/37) and had 73.9% sensitivity and 85.0% specificity. CONCLUSION The performance for malignancy was highest in Category 3 and predictive ability for benign pathology of NH in follicular lesion was highest in Category 1. The information of EMax and nodule D/W ratio was useful to predict the pathology of thyroid nodules.
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Affiliation(s)
- Myung Hi Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
- Elim Thyroid Clinic, Seoul 06520, Korea
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, Korea
| | - Suyeon Park
- Department of Biostatics and Data Innovation, Soonchunhyang University, College of Medicine, Seoul 04401, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul 06974, Korea
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul 06742, Korea
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
| | - Kyoil Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea
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12
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Yun S, Lee S, Lee HY, Oh HJ, Kwak Y, Lee HS. Clinicopathologic and Prognostic Association of GRP94 Expression in Colorectal Cancer with Synchronous and Metachronous Metastases. Int J Mol Sci 2021; 22:ijms22137042. [PMID: 34208855 PMCID: PMC8267630 DOI: 10.3390/ijms22137042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
Patients with advanced colorectal cancer (CRC) with distant metastases have a poor prognosis. We evaluated the clinicopathological relevance of GRP94 expression in these cases. The immunohistochemical expression of GRP94 was studied in 189 CRC patients with synchronous (SM; n = 123) and metachronous metastases (MM; n = 66), using tissue microarray; the association between GRP94 expression, outcome, and tumor-infiltrating lymphocytes (TILs) was also evaluated. GRP94 was expressed in 64.6% (122/189) patients with CRC; GRP94 positivity was found in 67.5% and 59.1% patients with SM and MM, respectively. In the SM group, high GRP94 expression was more common in patients with a higher density of CD4+ TILs (p = 0.002), unlike in the MM group. Survival analysis showed that patients with GRP94 positivity had significantly favorable survival (p = 0.030); after multivariate analysis, GRP94 only served as an independent prognostic factor (p = 0.034; hazard ratio, 0.581; 95% confidence interval, 0.351-0.961) in the SM group. GRP94 expression was detected in 49.4% of metastatic sites and showed significant heterogeneity between primary and metastatic lesions (p = 0.012). GRP94 is widely expressed in CRC with distant metastases; its expression was associated with favorable prognosis in the SM group, unlike in the MM group.
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Affiliation(s)
- Sumi Yun
- Samkwang Medical Laboratories, Department of Diagnostic Pathology, Seoul 06742, Korea;
| | - Sukmook Lee
- Biopharmaceutical Chemistry Major, School of Applied Chemistry, Kookmin University, Seoul 02707, Korea;
| | - Ho-Young Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea;
| | - Hyeon Jeong Oh
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea;
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (Y.K.); (H.S.L.)
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (Y.K.); (H.S.L.)
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13
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Tajes M, Díez-López C, Enjuanes C, Moliner P, Ferreiro JL, Garay A, Jiménez-Marrero S, Yun S, Sosa SG, Alcoberro L, González-Costello J, García-Romero E, Yañez-Bisbe L, Benito B, Comín-Colet J. Neurohormonal activation induces intracellular iron deficiency and mitochondrial dysfunction in cardiac cells. Cell Biosci 2021; 11:89. [PMID: 34001233 PMCID: PMC8130332 DOI: 10.1186/s13578-021-00605-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Iron deficiency (ID) is common in patients with heart failure (HF) and is associated with poor outcomes, yet its role in the pathophysiology of HF is not well-defined. We sought to determine the consequences of HF neurohormonal activation in iron homeostasis and mitochondrial function in cardiac cells. Methods HF was induced in C57BL/6 mice by using isoproterenol osmotic pumps and embryonic rat heart-derived H9c2 cells were subsequently challenged with Angiotensin II and/or Norepinephrine. The expression of several genes and proteins related to intracellular iron metabolism were assessed by Real time-PCR and immunoblotting, respectively. The intracellular iron levels were also determined. Mitochondrial function was analyzed by studying the mitochondrial membrane potential, the accumulation of radical oxygen species (ROS) and the adenosine triphosphate (ATP) production. Results Hearts from isoproterenol-stimulated mice showed a decreased in both mRNA and protein levels of iron regulatory proteins, transferrin receptor 1, ferroportin 1 and hepcidin compared to control mice. Furthermore, mitoferrin 2 and mitochondrial ferritin were also downregulated in the hearts from HF mice. Similar data regarding these key iron regulatory molecules were found in the H9c2 cells challenged with neurohormonal stimuli. Accordingly, a depletion of intracellular iron levels was found in the stimulated cells compared to non-stimulated cells, as well as in the hearts from the isoproterenol-induced HF mice. Finally, neurohormonal activation impaired mitochondrial function as indicated by the accumulation of ROS, the impaired mitochondrial membrane potential and the decrease in the ATP levels in the cardiac cells. Conclusions HF characteristic neurohormonal activation induced changes in the regulation of key molecules involved in iron homeostasis, reduced intracellular iron levels and impaired mitochondrial function. The current results suggest that iron could be involved in the pathophysiology of HF.
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Affiliation(s)
- M Tajes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Díez-López
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - C Enjuanes
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Moliner
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J L Ferreiro
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Garay
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Jiménez-Marrero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Yun
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - S G Sosa
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Alcoberro
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J González-Costello
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - E García-Romero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - L Yañez-Bisbe
- Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - B Benito
- Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Cardiology Department, Hospital Vall d'Hebron Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Comín-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. .,Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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14
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Yoo MH, Kim HJ, Choi IH, Park S, Yun S, Park HK, Byun DW, Suh K. Efficacy of Differential Diagnosis of Thyroid Nodules by Shear Wave Elastography, the Stiffness Map. J Endocr Soc 2021. [PMCID: PMC8090315 DOI: 10.1210/jendso/bvab048.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Fine-needle aspiration (FNA) is the first step in the differential diagnosis of thyroid nodules. However, malignancy rate of the indeterminate FNA is reported as 20-50 %. We aimed to evaluate the efficacy of shear wave elastography (SWE), the map of stiffness in the differential diagnosis of the histopathology of thyroid nodules. Methods: We retrospectively reviewed the medical records of 258 consecutive patients who visited the thyroid clinic for thyroid nodules and who underwent SWE before ultrasound-guided FNA and/or core-needle biopsy. We analyzed the EI using the total nodular region of interest method by the Q-Box Trace program. Thyroid nodules were divided in to 4 categoies according to maximum elasticity (EMax) and nodule depth/width (D/W) ratio; Category 1 (EMax ≥42.6 kPa & D/W<0.9), Category 2 (EMax <42.6 kPa & D/W<0.9), Category 3 (EMax ≥42.6 kPa & D/W≥ 0.9) and Category 4 (EMax<46.2 kPa & D/W≥ 0.9). The cutoff value of EMax was set using ROC curve analysis to predict follicular neoplasm (FN) from nodular hyperplasia (NH). Cutoff value for nodule D/W ratio was set using ROC curve analysis to differentiate malignant nodule. Results: FN showed the lowest EMax among all pathologies and lower EMax than NH (p<0.05). FN was distributed mostly in the category 2 (70%) and NH was distributed mainly in the category 1 (73.9%). CLT belonged mostly to the category 1 (57.1%). PTC belonged in majority to the category 3 (58.9%) and the rest.to the category 1 (25%). So NH was the most frequent pathology group in category 1.FN was the most frequent pathology group in the category 2 and PTC was the most frequent pathology group in the category 3. Conclusion: SWE showed characteristic patterns of various pathology groups reflecting the degree of fibrosis and the information of EMax and nodule depth/width (D/W) ratio determining the category was useful to predict the pathology of thyroid nodules along with the advantage of noninvasiveness.
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Affiliation(s)
- Myung Hi Yoo
- SoonChunHyang University, Seoul, Korea, Republic of
| | | | - In Ho Choi
- SoonChunHyang University, Seoul, Korea, Republic of
| | - Suyeon Park
- SoonChunHyang University, Seoul, Korea, Republic of
| | - Sumi Yun
- Samkwang Medical Laboratories, Seoul, Korea, Republic of
| | | | | | - Kyoil Suh
- SoonChunHyang University, Seoul, Korea, Republic of
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15
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Lim S, Kim J, Park JY, Min J, Yun S, Park T, Kim Y, Choi J. Suppressed Degradation and Enhanced Performance of CsPbI 3 Perovskite Quantum Dot Solar Cells via Engineering of Electron Transport Layers. ACS Appl Mater Interfaces 2021; 13:6119-6129. [PMID: 33499586 DOI: 10.1021/acsami.0c15484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
CsPbI3 perovskite quantum dots (CsPbI3-PQDs) have recently come into focus as a light-harvesting material that can act as a platform through which to combine the material advantages of both perovskites and QDs. However, the low cubic-phase stability of CsPbI3-PQDs in ambient conditions has been recognized as a factor that inhibits device stability. TiO2 nanoparticles are the most regularly used materials as an electron transport layer (ETL) in CsPbI3-PQD photovoltaics; however, we found that TiO2 can facilitate the cubic-phase degradation of CsPbI3-PQDs due to its vigorous photocatalytic activity. To address these issues, we have developed chloride-passivated SnO2 QDs (Cl@SnO2 QDs), which have low photocatalytic activity and few surface traps, to suppress the cubic-phase degradation of CsPbI3-PQDs. Given these advantages, the CsPbI3-PQD solar cells based on Cl@SnO2 ETLs show significantly improved device operational stability (under conditions of 50% relative humidity and 1-sun illumination), compared to those based on TiO2 ETLs. In addition, the Cl@SnO2-based devices showed improved open circuit voltage and photocurrent density, resulting in enhanced power conversion efficiency (PCE) up to 14.5% compared to that of TiO2-based control devices (PCE of 13.8%).
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Affiliation(s)
- S Lim
- Department of Chemical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea
| | - J Kim
- Department of Chemical Engineering, Hanyang University, Seoul 04763, Republic of Korea
- Division of Energy Technology, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - J Y Park
- Department of Energy Science and Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - J Min
- Department of Chemical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea
| | - S Yun
- Department of Chemical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea
| | - T Park
- Department of Chemical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea
| | - Y Kim
- Division of Energy Technology, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - J Choi
- Department of Energy Science and Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
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16
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Vela E, Cleries M, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Calero E, Hidalgo E, Corbella X, Comin-Colet J. 36,269 patients with chronic cardiovascular, metabolic and renal conditions: impact on clinical outcomes, medical resource use and health-related costs of deranged serum potassium levels. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0946] [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
Chronic Heart Failure (CHF) and its risk factors at stage A of the disease are conditions that trends to facilitate potassium (K+) derangements, for pathophysiology mechanisms and medication use than could facilitate both hyper- and hypokalamia. Studies on the associations between potassium derangements and clinical outcomes in these patient populations have yielded mixed findings, and the implications for healthcare expenditure are unknown.
Purpose
The objectives of our analysis was to asses the population-based associations between hyperkalemia, hypokalemia (compared to normokalemia) and all-cause death, urgent hospitalization, emergency department visits, daycare visits, and a yearly healthcare expenditure >85th percentile, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension and ischemic heart disease.
Methods
Population-based, longitudinal study including up to 36,269 patients from the Public Healthcare Area with at least one of those conditions. We used three linked administrative, hospital and primary care healthcare databases with exhaustive information on sociodemographics, medical diagnoses, pharmacy dispensing and laboratory data. Participants were identified and followed between 2015 and 2017, had to be ≥55 years old and have at least one serum potassium measurement recorded; and were classified as hyperkalemic, hypokalemic or normokalemic. Four analytic designs were used to evaluate prevalent and incident disease cases as well as prevalent and incident use of renin-angiotensin-aldosterone system inhibitors
Results
The majority of study participants remained normokalemic during the 3 months following study entry (ranging 94%–96%) and hyperkalemia was twice as frequent as hypokalemia. In all analyses, compared to normokalemic patients those with hyperkalemia had a worse crude event-free survival for all endpoints, and the worst survival was observed for hypokalemic patients [see Figure 1: prevalent case analysis; Kaplan-Meier cumulative survivor function curves for all-cause death (upper left), hospitalization (upper right), ED visits (lower left) and daycare visits (lower right)].
In multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (hazard ratios from Cox regression models ranging 1.31–1.68) and with an increased odds of a yearly healthcare expenditure >85th percentile (odds ratios 1.21–1.29). Associations were even stronger in hypokalemic patients (hazard ratios for all-cause death 1.92–2.60; odds ratios for healthcare expenditure >percentile 85th 1.81–1.85).
Conclusions
Experimental studies are needed to confirm whether prevention of potassium derangements reduces mortality and healthcare expenditure in patients with these chronic conditions. Until then, our findings provide further observational evidence on the potential importance of maintaining normal potassium levels in this setting.
Figure 1
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - E Vela
- Department of Health, Barcelona, Spain
| | - M Cleries
- Department of Health, Barcelona, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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17
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Alcoberro L, Vime J, Enjuanes C, Jimenez S, Garay A, Yun S, Moliner P, Guerrero C, Hidalgo E, Calero E, Marin R, Alcober L, Delso C, Comin J. Double check discharge planning to improve the results of a heart failure programme. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1125] [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
Background
Reduction of readmissions in heart failure (HF) patients is a main goal of HF programmes. Establishing a discharge planning for the patient and coordinating it with primary care teams are key aspects for their success.
Purpose
Evaluate whether a double check discharge planning based on adding face-to-face joint weekly sessions with primary care managers to the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.
Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between September 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (single check; September 2017 - April 2018) and those discharged during Period #2 (double check; May 2018 - January 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 6 months after discharge from the index hospitalization.
Results
The study enrolled 317 patients: 182 in Period #1 and 135 in Period #2.
Mean age was 76±9 years. There was a higher proportion of patients with diabetes and COPD in Period #1, with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization at 6 months was significantly reduced in patients in the double check discharge planning group (27% vs. 16%, p 0.021).
Conclusions
In a HF programme, the addition of a double check discharge planning based on having joint weekly sessions with primary care managers on top of the conventional electronic communication of care plan reduces 6-month readmission and 6-month mortality.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
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Affiliation(s)
- L Alcoberro
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - J Vime
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Jimenez
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - A Garay
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Yun
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - P Moliner
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Guerrero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Calero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - R Marin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - L Alcober
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - C Delso
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - J Comin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
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18
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Guerrero G, Alcoberro L, Vime J, Calero E, Hidalgo E, Marin R, Enjuanes C, Garay A, Yun S, Jimenez S, Moliner P, Delso C, Fernandez I, Rosenfeld L, Comin J. Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1121] [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
Background
Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored.
Methods
We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization.
Results
The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011).
Conclusions
Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients.
Event-free survival cumulative curves.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Guerrero
- University Hospital Bellvitge, Barcelona, Spain
| | - L Alcoberro
- University Hospital Bellvitge, Barcelona, Spain
| | - J Vime
- University Hospital Bellvitge, Barcelona, Spain
| | - E Calero
- University Hospital Bellvitge, Barcelona, Spain
| | - E Hidalgo
- University Hospital Bellvitge, Barcelona, Spain
| | - R Marin
- University Hospital Bellvitge, Barcelona, Spain
| | - C Enjuanes
- University Hospital Bellvitge, Barcelona, Spain
| | - A Garay
- University Hospital Bellvitge, Barcelona, Spain
| | - S Yun
- University Hospital Bellvitge, Barcelona, Spain
| | - S Jimenez
- University Hospital Bellvitge, Barcelona, Spain
| | - P Moliner
- University Hospital Bellvitge, Barcelona, Spain
| | - C Delso
- University Hospital Bellvitge, Barcelona, Spain
| | - I Fernandez
- University Hospital Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- University Hospital Bellvitge, Barcelona, Spain
| | - J Comin
- University Hospital Bellvitge, Barcelona, Spain
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19
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Enjuanes C, Garay A, Yun S, Moliner P, Alcoberro L, Calero E, Hidalgo E, Marin R, Corbella X, Comin-Colet J. Epidemiology of potassium derangements among chronic cardiovascular, metabolic and renal conditions: a population-based analysis data from more than 375,000 individuals. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0950] [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
Introduction
In patients with chronic cardiovascular, metabolic and renal disorders, potassium (K)+ homeostasis is often delicate, especially in the presence of renin-angiotensin-aldosterone system inhibition (RAASI) and/or diuretic therapies. In this context, current clinical practical guidelines for the management of these patients recommend close monitoring of renal function and K+ levels, particularly in the presence of drug titration. Nevertheless, very limited epidemiological data on their importance at a population level is available.
Purpose
The objectives of the present analysis are to estimate the prevalence of potassium (K+) derangements in five key chronic cardiovascular, metabolic and renal conditions at the population level, its use of RAASI medication and describe potassium derangements among RAASI users.
Methods
We used data from more than 375,000 individuals 55 years of age or older included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD), and hypertension (HTN). RAASI medications included angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and rennin inhibitors. Hyperkalemia was defined as K+ levels >5.0 mEq/L and hypokalemia as K+ <3.5 mEq /L
Results
The prevalence of chronic cardiovascular, metabolic and renal conditions was high, particularly of HTN (48.2–48.9%). The prevalence of hyperkalemia was ranging between 10% and 25% depending of the condition, more frequent in CKD and less frequent in HTN patients. In figure, we display the prevalence of hyperkalemia among individuals with each of the relevant chronic conditions, January 1st, 2016 and January 1st, 2017. Use of at least one RAASI medication was very prevalent in HTN patients (75.2–77.3%). Among RAASI users, the frequency of K+ derangements and mainly of hyperkalemia was very noticeable (12% overall), especially in patients with CKD, CHF, elderly individuals, and users of MRAs. Hypokalemia was less frequent (1%).
Conclusion
The high prevalence of K+ derangements and predominantly hyperkalemia among RAASI users highlights the real-world relevance of K+ derangements and the importance of close monitoring and management of K+ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk.
Figure 1. Prevalence of hyperkalemia
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet and Miguel Cainzos-Achirica have participated in other research projects funded by unrestricted grants from Vifor Pharma
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - R Marin
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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20
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Calero E, Hidalgo E, Rosenfeld L, Fernandez I, Garay A, Alcoberro L, Jimenez S, Yun S, Guerrero C, Moliner P, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Psychosocial and clinical factors associated with poor self-care in patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1040] [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
Self care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease.
Beyond heart failure related factors, the role of psychosocial determinants and its interaction with clinical aspects has not been fully explored.
Aims
The aim of the study was to analyze both clinical and psychosocial factors associated with poor self care in patients with chronic HF.
Methods
Self care was evaluated at baseline with the 9 item European HFR Self Care Behaviour Scale (9 item ESCBS).
Scores were standardized and reversed from 0 (worst self care) to 100 (better self care). This study we analysed the associations between poor self care (defined as scores in the lower tertile of the 9 item ESCBS) with demographic, HF-related (clinical) and psychosocial factors in all patients at baseline.
Results
We included 1123 patients: mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40%) were in NYHA class III or IV. Mean score of the 9-item ESCBS was 69±28. In the clinical multivariate analyses HF-related factors associated with poor self-care were serum albumins level, ckd level and previous admission due to heart failure. In the psychosocial multivariate analyses poor social support, depressive symptoms and needing a caregiver were independently associated with poor self care. In combined models, only psychosocial factors were independently associated with poor self care whereas no clinical factors remain in the model.
Conclusion
Our study showed that psychosocial conditions are the main factors independently associated with poor self-care in patients with chronic heart failure
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital del Bellvitge
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Affiliation(s)
- E Calero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Hidalgo
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - I Fernandez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Garay
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcoberro
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Jimenez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Yun
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Guerrero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Moliner
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Delso
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcober
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Comin-Colet
- Hospital Universitari de Bellvitge, Barcelona, Spain
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21
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Calero E, Hidalgo E, Marin R, Rosenfeld L, Fernandez I, Garay A, Alcoberro L, Jimenez S, Yun S, Guerrero C, Moliner P, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Association between self-care and prognosis in 1123 patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1041] [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
Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF.
Aims and methods
The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF.
We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline.
Results
We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour.
Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception.
Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028]
Conclusion
Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure.
These results highlight the importance of assessing self-care and provide measures to improve them.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge
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Affiliation(s)
- E Calero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E Hidalgo
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R Marin
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Rosenfeld
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - I Fernandez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Garay
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L Alcoberro
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Jimenez
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - S Yun
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Guerrero
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Moliner
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C Delso
- Institut Catala de la Salut, Barcelona, Spain
| | - L Alcober
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
| | - J Comin-Colet
- Primary Care Centre Just Oliveres, Hospitalet De Llobregat, Spain
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22
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Jimenez S, Cainzos-Achirica M, Monterde D, Garcia-Eroles L, Enjuanes C, Garay A, Yun S, Alcoberro L, Moliner P, Hidalgo E, Calero E, Marin R, Corbella X, Comin-Colet J. A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0960] [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
Background
Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts.
Purpose
To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions.
Methods
In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN).
Results
The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase).
Conclusion
In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.
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Affiliation(s)
- S Jimenez
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - M Cainzos-Achirica
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | | | - C Enjuanes
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - A Garay
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - S Yun
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - L Alcoberro
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - P Moliner
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Hidalgo
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - E Calero
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - R Marin
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
| | - X Corbella
- University Hospital of Bellvitge, Internal Medicine, Barcelona, Spain
| | - J Comin-Colet
- University Hospital of Bellvitge, Cardiology, Barcelona, Spain
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23
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Alcoberro L, Vime J, Enjuanes C, Jimenez S, Garay A, Yun S, Moliner P, Guerrero C, Hidalgo C, Calero E, Marin R, Alcober L, Delso C, Comin J. Long-term effectiveness of a nurse-led 7-step transitional intervention programme in heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1124] [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
Background
Reduction of 30-day readmission in heart failure (HF) patients is a main goal of health-care systems. Programmes to decrease 30-day readmission have successfully reduced it but have failed to neither maintain benefit afterwards nor decrease mortality. Moreover, in many cases the price of reducing 30-day readmission is a mortality increase.
Purpose
Evaluate whether the impact of a fully nurse-led HF programme directed to reduce 30-day readmission and mortality extends to longer periods of time, including 90 days and 180 days after discharge.
Methods
We evaluated all patients discharged from hospital with HF as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1 (pre-programme; Jan 2017 - Aug 2017) and those discharged during Period #2 (HF programme; Sept 2017 - Jan 2019).
Primary endpoint was the combined endpoint of all-cause death or all-cause hospitalization 90 days and 180 days after discharge from the index hospitalization.
Results
The study enrolled 440 patients: 123 in Period #1 and 317 in Period #2.
Mean age was 75±9 years. There was a higher proportion of female patients in Period #2 (38.2% vs 26.8%, p=0.025), with no differences in other baseline characteristics.
The combined endpoint of all cause-death and all-cause hospitalization was significantly reduced in patients in the HF programme group, both at 90 days [OR 0.37 (0.22–0.63), p<0.001] and at 180 days [OR 0.27 (CI 0.17–0.43), p<0.001]. Such a decrease was at expense of a reduction in cardiovascular (CV) hospitalization and HF hospitalization.
There were no differences between groups in mortality [OR 0.96 (0.18–5.00), p=0.293].
Conclusions
A fully nurse-led HF programme reduces the combined endpoint of all-cause death and all-cause hospitalization both at 90 days and 180 days after an index discharge for HF.
Such a decrease is driven by a reduction of CV and HF hospitalization, which are maintained over time. There were no differences between groups in mortality.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospital Universitari de Bellvitge
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Affiliation(s)
- L Alcoberro
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - J Vime
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Enjuanes
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Jimenez
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - A Garay
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - S Yun
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - P Moliner
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Guerrero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - C Hidalgo
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Calero
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - R Marin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - L Alcober
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - C Delso
- Delta Primary Care Service, ICS, Hospitalet de Llobregat, Spain
| | - J Comin
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
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Hu Q, Rix LR, Li X, Welsh E, Fang B, Yun S, Kroeger J, Lawrence H, Marusyk A, Koomen J, Haura E, Rix U. Dissecting the landscape of CAF-mediated drug resistance mechanisms in ALK-rearranged NSCLC. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31205-3] [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: 10/23/2022]
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25
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Yun S, Koh J, Nam SK, Kwak Y, Ahn SH, Do Park J, Kim HH, Kim WH, Lee HS. Immunoscore is a strong predictor of survival in the prognosis of stage II/III gastric cancer patients following 5-FU-based adjuvant chemotherapy. Cancer Immunol Immunother 2020; 70:431-441. [PMID: 32785776 DOI: 10.1007/s00262-020-02694-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/04/2020] [Indexed: 12/25/2022]
Abstract
The prognostic impact of Immunoscore (IS) in gastric cancer (GC) patients treated with adjuvant chemotherapy remains unelucidated. We evaluated the CD3 + , CD8 + , and Foxp3 + T-lymphocyte densities in tumor centers and invasive margin regions of 389 patients with surgically resected stage II/III GC who received 5-FU-based adjuvant chemotherapy and investigated the impact of IS on survival. In univariate analysis, high CD3 + , CD8 + , and Foxp3 + T-lymphocyte densities in the invasive margin were correlated with better prognosis (all P < 0.05). Patients with high IS had significantly longer disease-free survival (DFS; P < 0.001) and overall survival (OS; P < 0.001). In multivariate analysis, IS demonstrated a powerful prognostic impact on patient outcome [DFS, hazard ratio (HR) = 0.465; 95% confidence interval (CI), 0.306-0.707, P < 0.001; OS, HR = 0.478; 95% CI, 0.308-0.743, P = 0.001]. Additionally, although all EBV-positive cases had high IS, IS was similar in both microsatellite instability (MSI)-high and microsatellite stable (MSS)/MSI-low groups (83.3% and 80.5%, respectively). Subgroup analysis according to MSI status revealed that high IS patients had significant DFS and OS benefits in both MSS/MSI-low (DFS, HR = 0.527, 95% CI, 0.341-0.816, P = 0.004; OS, HR = 0.528, 95% CI, 0.334-0.837, P = 0.007) and MSI-high (DFS, HR = 0.166, 95% CI, 0.033-0.826, P = 0.028; OS, HR = 0.177, 95% CI, 0.036-0.883, P = 0.035) groups. Thus, the assessment of immune cell infiltration based on IS may provide a strong indicator of survival in stage II/III GC patients with curative resection following 5-FU-based adjuvant chemotherapy.
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Affiliation(s)
- Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Republic of Korea
| | - Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumiro, Bundang-gu, Gyeonggi-do, Seongnam-si, 463-707, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Do Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumiro, Bundang-gu, Gyeonggi-do, Seongnam-si, 463-707, Republic of Korea. .,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lee KS, Choe G, Yun S, Lee K, Moon S, Lee S, Hong SK, Byun SS, Lee SE. Comparative analysis of programmed cell death ligand 1 assays in renal cell carcinoma. Histopathology 2020; 77:67-78. [PMID: 31872892 DOI: 10.1111/his.14054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/03/2019] [Accepted: 12/21/2019] [Indexed: 01/08/2023]
Abstract
AIMS The importance of programmed cell death ligand 1 (PD-L1) expression has emerged in clinical trials of PD-L1 target therapy in renal cell carcinoma (RCC). This study compares PD-L1 assays in RCC. METHODS AND RESULTS Two US Food and Drug Administration-approved PD-L1 assays (22C3 and SP142) and one research-use only antibody (E1L3N) were used in a retrospective cohort of 591 patients with RCC. PD-L1 positivity on tumour cells (TCs) and immune cells (ICs) and combined positive score (CPS) were evaluated. With the 22C3, SP142 and E1L3N assays, positive PD-L1 expression on TCs ≥1% was observed in 24 (4.1%), 12 (2.0%) and 16 (2.7%) cases and on ICs ≥1% was observed in 132 (22.3%), 120 (20.3%) and 65 (11.0%) cases, respectively. PD-L1 expression scores among the three assays showed moderate-high positive correlation (ρ = 0.599-0.835, P < 0.001). Assays appeared similar, although staining in ICs was comparatively less frequent with E1L3N. 22C3 showed frequent positivity in TCs. PD-L1 expression on TCs was associated with papillary type 2 RCC (P < 0.001). IC infiltration and PD-L1 expression on ICs were predominantly found in clear cell and papillary type 1 RCC (P < 0.05). CONCLUSIONS Programmed death 1 (PD-1)/PD-L1 target therapy may be beneficial for patients with papillary type 2 RCC, even if they are categorised as a heterogeneous group. PD-L1 assays should be carefully selected, and accurate histological subtyping of RCC is needed prior to decisions on PD-L1 testing, because of the different PD-L1 expression observed among varying RCC subtypes.
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Affiliation(s)
- Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, South Korea
| | - Kyoungyul Lee
- Department of Pathology, Kangwon National University Hospital, Chuncheon-Si, South Korea
| | - Seyoung Moon
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Mithani S, Yun S, Pattinson C, Kim H, Guedes V, Fink A, Weljie A, Gehrman P, Gill J. 0021 RNA Sequencing Reveals Transcriptomic Changes in Individuals with Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Insomnia affects 10–20% of the US population and is associated with negative health and psychosocial sequelae. Despite the public health impact of insomnia little is known about its underlying molecular mechanisms. The purpose of this study is to examine differentially expressed genes in 15 patients with chronic insomnia and age- and sex-matched good sleepers (n=15).
Methods
We performed total RNA-seq on 30 whole blood samples collected at 09:00 at 150 bp paired-ends on the Illumina NovaSeq-6000 platform. Alignment was performed using the STAR version 2.7.2a software on the human reference genome (GRCh38). Differential gene expression analysis was performed using DESeq2 version 1.24.0. Pathway analysis was performed using IPA, release 2019-08-30.
Results
An average of 86.7 million paired end reads per sample were sequenced. We found that 289 genes were differentially expressed in insomnia patients with a log fold change (LFC) ±0.50 and had a FDR p-value < 0.05. Top dysregulated genes include CSMD1 (L2FC=-2.78; p=1.35E-06), DUX4L9 (L2FC=3.40; p=2.81E-06) and GRM4 (L2FC=2.45; p=4.50E-05). Among the functionally relevant genes, CSMD encodes a complement control protein that is known to participate in the complement activation and inflammation in the developing central nervous system. UTS2 (L2FC=1.778; p=8.94E-06) is involved in regulation of orexin A and B activity and rapid eye movement during sleep. Ingenuity Pathway Analysis revealed 3 associated networks: Hematological, Hereditary Disorder, Organismal Injury and Abnormalities (score: 46), Developmental, Hereditary Disorder, Metabolic Disease (score: 43), and Cell Cycle, Cell mediated Immune Response, Cellular Development (score: 43).
Conclusion
Overall, our study revealed dysregulated genes in individuals who suffer from insomnia. Notably, dysregulation of these functionally relevant genes could impair functional brain connectivity and synaptic function. Further investigation of these biological pathways will be useful to elucidate the pathogenesis of insomnia and identify novel biomarkers or drug targets for developing improved diagnostics and therapeutics.
Support
National Institutes of Nursing Research, Graduate Partnership Program
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Affiliation(s)
- S Mithani
- National Institutes of Health, Bethesda, MD
| | - S Yun
- Yotta Biomed, LLC., Bethesda, MD
| | | | - H Kim
- National Institutes of Health, Bethesda, MD
| | - V Guedes
- National Institutes of Health, Bethesda, MD
| | - A Fink
- University of Illinois at Chicago, Chicago, IL
| | - A Weljie
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA
| | - P Gehrman
- University of Pennsylvania, Department of Pharmacology, Philadelphia, PA
| | - J Gill
- National Institutes of Health, Bethesda, MD
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Pattinson CL, Edwards K, Guedes VA, Mithani S, Yun S, Taylor P, Dunbar K, Lai C, Roy MJ, Gill JM. 0024 PTSD with Concurrent Excessive Daytime Sleepiness Alters Gene Expression in Military Personnel and Veterans; An RNA-Sequencing Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Up to 91% of military personnel and veterans with posttraumatic stress disorder (PTSD) report co-occurring sleep disturbances, including. insomnia and excessive daytime sleepiness (EDS). Sleep disturbances have been shown not only to increase the risk of developing PTSD, but to exacerbate and maintain PTSD symptomology. The aim of this study was to examine gene expression in active duty military personnel and veterans with PTSD, with and without EDS. Participants were categorized into three groups; 1) PTSD with EDS (PTSDwEDS; n=21), 2) PTSD without EDS (PTSDnoEDS; n=25), or 3) Controls (no PTSD and no EDS; n=57).
Methods
Participants were 79% male, mean age of 37.6years (SD=11.2years). PTSD symptoms were measured using the PTSD checklist for civilians (PCL-C); participants were classified as PTSD-present using DSM-IV-TR criteria of “moderate-to-severe”. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS), high sleepiness was indicated by an ESS score >13. We performed RNA-seq with Illumina’s HiSeq 2500 in paired-end. We conducted quality control using FastQC and aligned to GRCh38 reference genome using STAR (v2.5.3a). Differentially expressed genes identified using DESeq2 (v1.20.0) with False Discovery Rate of 0.10. Finally, Ingenuity Pathway Analysis (IPA) was conducted to identify dysregulated gene networks.
Results
Between the Controls and PTSDnoEDS groups, two genes were significantly dysregulated. In controls and PTSDwEDS groups, 251 genes were dysregulated. The IPA networks showed that genes associated with inflammation were significantly dysregulated. Finally, between PTSDwEDS and PTSDnoEDS there were 1,873 significantly dysregulated genes. The IPA networks identified dysregulation of genes related to sleep, fatigue, circadian, and mitochondrial function.
Conclusion
Taken together this data indicates that EDS that is co-morbidly experienced with PTSD is associated with significant gene dysregulation, above and beyond that observed in participants with PTSD without significant EDS and controls. Treating EDS in military personnel and veterans with PTSD is important.
Support
This work was supported by the Center for Neuroscience and Regenerative Medicine (CNRM)
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Affiliation(s)
- C L Pattinson
- The University of Queensland, Institute for Social Science Research, Brisbane, AUSTRALIA
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - K Edwards
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - V A Guedes
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - S Mithani
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - S Yun
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - P Taylor
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Bethesda, MD
| | - K Dunbar
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Bethesda, MD
| | - C Lai
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
| | - M J Roy
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD., Bethesda, MD
| | - J M Gill
- National Institutes of Health (NIH), National institutes of Nursing Research, Bethesda, MD
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Dugovic C, Yun S, Lovenberg T, Bonaventure P. Endocannabinoids and sleep: impact of monoacylglycerol lipase inhibition in rodent models. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yun S, Park Y, Moon S, Ahn S, Lee K, Park HJ, Lee HS, Choe G, Lee KS. Clinicopathological and prognostic significance of programmed death ligand 1 expression in Korean melanoma patients. J Cancer 2019; 10:3070-3078. [PMID: 31281485 PMCID: PMC6590033 DOI: 10.7150/jca.30573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
Programmed death ligand 1 (PD-L1) expression provides significant value to predict prognosis and response following immunotherapy in several types of cancers. However, its clinicopathological and prognostic significance in melanoma remains unclear. PD-L1 and the number of tumor infiltrating lymphocytes (TILs) were investigated in 63 Korean patients with melanoma based on the melanoma scoring system. We also compared the results using the PD-L1 antibodies—22C3 and E1L3N clones. In addition, BRAF gene mutation was detected using anti-BRAF antibody and real-time polymerase chain reaction. Overall, 29 (46.0%), 16 (25.4%), and 18 (28.6%) patients exhibited the acral lentiginous type, nodular type, and other histological subtypes of melanoma, respectively. PD-L1 expression was detected in 37 (58.7%) cases and was closely associated with a CD8+TILhigh phenotype (P < 0.001). Combined survival analysis depending on PD-L1 and CD8+TILs status showed that the PD-L1-/CD8+TILhigh group demonstrated the best survival outcome, whereas patients with PD-L1+/CD8+ TILlow showed the worst prognosis (P = 0.039). However, PD-L1+/CD8+ TILlow was not an independent prognostic factor. The 22C3 and E1L3N clones showed a high concordance rate (kappa value, 0.799). BRAF mutation status was not correlated with PD-L1 expression. We suggest that evaluation of the combined status of PD-L1 and TIL might be useful to predict the survival of patients with melanoma.
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Affiliation(s)
- Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Republic of Korea
| | - Yujun Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seyoung Moon
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Soomin Ahn
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyoungyul Lee
- Department of Pathology, Kangwon National University Hospital, Chuncheon-Si, Kangwon-Do, Republic of Korea
| | - Hyo Jin Park
- Department of Pathology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Yun S, Baek K, Shin H, Kang H. WT1-specific cytotoxic T lymphocytes induced by activated B cells as apc. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Yun S, Kim SH, Cho HS, Choe G, Lee KS. EWSR1
-PBX3
fused myoepithelioma arising in metatarsal bone: Case report and review of the literature. Pathol Int 2019; 69:42-47. [DOI: 10.1111/pin.12746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sumi Yun
- Department of Diagnostic Pathology; Samkwang Medical Laboratories; 57 Baumoe-ro 41-gil Seocho-gu Seoul 06742 Republic of Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-13620 Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
| | - Kyu Sang Lee
- Department of Pathology; Seoul National University Bundang Hospital; 173-82 Gumi-ro, Bundang-gu Seongnam-si Gyeonggi-do 13620 Republic of Korea
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Yun S, Lee K, Park Y, Moon S, Lee H, Choe G, Lee K. Clinicopathological and prognostic significance of programmed death ligand 1 expression in Korean melanoma patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy439.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yun S, Maxfield M. EXAMINING CORRELATES OF DEMENTIA ATTITUDES AMONG MIDDLE-AGED AND OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Yun
- University of Colorado Colorado Springs
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Lee H, Lee S, Jeon J, Kwon S, Noh H, Han D, Yun S, Song D. Thymoglobulin Versus Basiliximab Induction Therapy in Low-Risk Kidney Transplant Recipients: A Single-Center Experience. Transplant Proc 2018; 50:1285-1288. [DOI: 10.1016/j.transproceed.2018.02.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/17/2018] [Indexed: 10/14/2022]
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36
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Kim SW, Jun JW, Giri SS, Chi C, Yun S, Kim HJ, Kim SG, Kang JW, Park SC. Cover Image. Transbound Emerg Dis 2018. [DOI: 10.1111/tbed.12863] [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: 12/01/2022]
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37
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Koh J, Ock CY, Kim JW, Nam SK, Kwak Y, Yun S, Ahn SH, Park DJ, Kim HH, Kim WH, Lee HS. Clinicopathologic implications of immune classification by PD-L1 expression and CD8-positive tumor-infiltrating lymphocytes in stage II and III gastric cancer patients. Oncotarget 2018; 8:26356-26367. [PMID: 28412752 PMCID: PMC5432263 DOI: 10.18632/oncotarget.15465] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/06/2017] [Indexed: 12/11/2022] Open
Abstract
We co-assessed PD-L1 expression and CD8+ tumor-infiltrating lymphocytes in gastric cancer (GC), and categorized into 4 microenvironment immune types. Immunohistochemistry (PD-L1, CD8, Foxp3, E-cadherin, and p53), PD-L1 mRNA in situ hybridization (ISH), microsatellite instability (MSI), and EBV ISH were performed in 392 stage II/III GCs treated with curative surgery and fluoropyrimidine-based adjuvant chemotherapy, and two public genome databases were analyzed for validation. PD-L1+ was found in 98/392 GCs (25.0%). The proportions of immune types are as follows: PD-L1+/CD8High, 22.7%; PD-L1−/CD8Low, 22.7%; PD-L1+/CD8Low, 2.3%; PD-L1−/CD8High, 52.3%. PD-L1+/CD8High type accounted for majority of EBV+ and MSI-high (MSI-H) GCs (92.0% and 66.7%, respectively), and genome analysis from public datasets demonstrated similar pattern. PD-L1−/CD8High showed the best overall survival (OS) and PD-L1−/CD8Low the worst (P < 0.001). PD-L1 expression alone was not associated with OS, however, PD-L1−/CD8High type compared to PD-L1+/CD8High was independent favorable prognostic factor of OS by multivariate analysis (P = 0.042). Adaptation of recent molecular classification based on EBV, MSI, E-cadherin, and p53 showed no significant survival differences. These findings support the close relationship between PD-L1/CD8 status based immune types and EBV+, MSI-H GCs, and their prognostic significance in stage II/III GCs.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Republic of Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Sumi Yun
- Department of Pathology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul 04401, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
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Yun S, Koh J, Nam SK, Park JO, Lee SM, Lee K, Lee KS, Ahn SH, Park DJ, Kim HH, Choe G, Kim WH, Lee HS. Clinical significance of overexpression of NRG1 and its receptors, HER3 and HER4, in gastric cancer patients. Gastric Cancer 2018; 21:225-236. [PMID: 28573357 DOI: 10.1007/s10120-017-0732-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/07/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuregulin 1 (NRG1), a ligand for human epidermal growth factor (HER) 3 and HER4, can activates cell signaling pathways to promote carcinogenesis and metastasis. METHODS To investigate the clinicopathologic significance of NRG1 and its receptors, immunohistochemistry was performed for NRG1, HER3, and HER4 in 502 consecutive gastric cancers (GCs). Furthermore, HER2, microsatellite instability (MSI), and Epstein-Barr virus (EBV) status were investigated. NRG1 gene copy number (GCN) was determined by dual-color fluorescence in situ hybridization (FISH) in 388 available GCs. RESULTS NRG1 overexpression was observed in 141 (28.1%) GCs and closely correlated with HER3 (P = 0.034) and HER4 (P < 0.001) expression. NRG1 overexpression was significantly associated with aggressive features, including infiltrative tumor growth, lymphovascular, and neural invasion, high pathologic stage, and poor prognosis (all P < 0.05), but not associated with EBV, MSI, or HER2 status. Multivariate analysis identified NRG1 overexpression as an independent prognostic factor for survival (P = 0.040). HER3 and HER4 expressions were observed in 157 (31.3%) and 277 (55.2%), respectively. In contrast to NRG1, expression of these proteins was not associated with survival. NRG1 GCN gain (GCN ≥ 2.5) was detected in 14.7% patients, including two cases of amplification, and was moderately correlated with NRG1 overexpression (κ, 0.459; P < 0.001). CONCLUSIONS Although our results indicate a lack of prognostic significance of HER3 and HER4 overexpression in GC, overexpression of their ligand, NRG1, was associated with aggressive clinical features and represented an independent unfavorable prognostic factor. Therefore, NRG1 is a potential prognostic and therapeutic biomarker in GC patients.
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Affiliation(s)
- Sumi Yun
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, South Korea
| | - Jiwon Koh
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jung Ok Park
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Mi Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kyoungyul Lee
- Department of Pathology, Kangwon National University Hospital, Chuncheon, Kangwon, South Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Yun S, Kwak Y, Nam SK, Seo AN, Oh HK, Kim DW, Kang SB, Lee HS. Ligand-Independent Epidermal Growth Factor Receptor Overexpression Correlates with Poor Prognosis in Colorectal Cancer. Cancer Res Treat 2018; 50:1351-1361. [PMID: 29361822 PMCID: PMC6192927 DOI: 10.4143/crt.2017.487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/15/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose Molecular treatments targeting epidermal growth factor receptors (EGFRs) are important strategies for advanced colorectal cancer (CRC). However, clinicopathologic implications of EGFRs and EGFR ligand signaling have not been fully evaluated. We evaluated the expression of EGFR ligands and correlation with their receptors, clinicopathologic factors, and patients’ survival with CRC. Materials and Methods The expression of EGFR ligands, including heparin binding epidermal growth factor-like growth factor (HBEGF), transforming growth factor (TGF), betacellulin, and epidermal growth factor (EGF), were evaluated in 331 consecutive CRC samples using mRNA in situ hybridization (ISH). We also evaluated the expression status of EGFR, human epidermal growth factor receptor 2 (HER2), HER3, and HER4 using immunohistochemistry and/or silver ISH. Results Unlike low incidences of TGF (38.1%), betacellulin (7.9%), and EGF (2.1%), HBEGF expression was noted in 62.2% of CRC samples. However, the expression of each EGFR ligand did not reveal significant correlations with survival. The combined analyses of EGFR ligands and EGFR expression indicated that the ligands‒/EGFR+ group showed a significant association with the worst disease-free survival (DFS; p=0.018) and overall survival (OS; p=0.005). It was also an independent, unfavorable prognostic factor for DFS (p=0.026) and OS (p=0.007). Additionally, HER4 nuclear expression, regardless of ligand expression, was an independent, favorable prognostic factor for DFS (p=0.034) and OS (p=0.049), by multivariate analysis. Conclusion Ligand-independent EGFR overexpression was suggested to have a significant prognostic impact; thus, the expression status of EGFR ligands, in addition to EGFR, might be necessary for predicting patients' outcome in CRC.
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Affiliation(s)
- Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.,Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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Yun S. Ischaemic Lumbosacral Plexopathy following an Acute Thrombosed Abdominal Aortic Aneurysm Mimicking Stroke: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neuropathy is a disease affecting the nerves that can be caused by infectious, ischaemic, or autoimmune disease. Aortic thrombosis may develop neurologic symptoms; however, when unilateral paraplegia is the first main symptom, it could be misinterpreted as a neuropathy. An 82-year-old man with a history of intracranial haemorrhage complained of motor weakness in the right lower extremity. Magnetic resonance imaging did not show any evidence of cerebral infarction or haemorrhage. A subsequent computed tomography angiogram confirmed the diagnosis of an acutely thrombosed abdominal aortic aneurysm and revealed thrombosed common, internal and external iliac arteries bilaterally including the left femoral artery. Aortobifemoral bypass surgery with open thrombectomy was performed. The patient recovered successfully despite a tendency for bleeding due to the use of anticoagulants. In conclusion, this is a rare case with the initial predominant presentation being painless unilateral paraplegia mimicking stroke. (Hong Kong j.emerg. med. 2016;23:52-56)
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Kim SW, Jun JW, Giri SS, Chi C, Yun S, Kim HJ, Kim SG, Kang JW, Park SC. First report of carp oedema virus infection of koi (Cyprinus carpio haematopterus) in the Republic of Korea. Transbound Emerg Dis 2017; 65:315-320. [PMID: 29226602 DOI: 10.1111/tbed.12782] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 11/29/2022]
Abstract
Twenty-five koi (Cyprinus carpio haematopterus) bought from a wholesale fish market in Korea, showed lethargic behaviour and 100% mortality within 20 days. Carp oedema virus (CEV) was detected by PCR in all 25 koi. Results of detailed histopathological and clinical examinations of 17 koi indicated loss of body balance, severe infiltration of inflammatory cells into the inter-lamellar spaces of the gills and vacuolization and inclusion bodies in gill epithelial cells. Sequence analysis of PCR products of these koi showed up to 99% identity to the previously reported sequences, suggesting that the observed mass mortality resulted from koi sleepy disease (KSD) due to CEV infection. To the best of our knowledge, this study is the first report of KSD in the Republic of Korea. Partial sequences of 4a protein from the virus indicated that the present CEV detected in koi from Korea is more closely related to that from the UK and Poland than from Japan. The present findings indicate that the prevalence and spread of KSD must be closely monitored in both European and Asian countries to avoid potential economic losses to the global koi industry.
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Affiliation(s)
- S W Kim
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - J W Jun
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - S S Giri
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - C Chi
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - S Yun
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - H J Kim
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - S G Kim
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - J W Kang
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - S C Park
- Laboratory of Aquatic Biomedicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
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Abstract
RATIONALE Adrenal myelolipomas are rare benign tumors, composed of a variable mixture of mature adipose tissue and hematopoietic tissue. These tumors are frequently detected incidentally and are usually asymptomatic, and hormonally inactive. PATIENT CONCERNS During a routine health checkup, a 52-year-old man was found to have a tumor on the bilateral adrenal glands. Abdominal computed tomography revealed a well-defined, heterogeneously enhanced bilateral adrenal mass, suggesting a myelolipoma. DIAGNOSES The hormonal evaluation revealed adrenocorticotropic hormone (ACTH) dependent Cushing syndrome. INTERVENTIONS The patient underwent left adrenalectomy, and transsphenoidal resection of a pituitary mass. The final diagnosis was adrenal myelolipoma associated with Cushing disease. OUTCOMES Growth of right adrenal myelolipoma was detected during the 7-year follow-up. There were enhancing pituitary lesions in repeat magnetic resonance imaging of the sellar region, which implies persistent or recurrent pituitary adenoma. This case reinforces relationship between Cushing disease and adrenal myelolipoma. LESSONS To the best of our knowledge, this is the first reported pathologically confirmed bilateral adrenal myelolipoma associated with Cushing disease. This report supports the idea that ACTH is associated with the development of adrenal myelolipoma.
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Affiliation(s)
- Se Yoon Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Kyo-Il Suh
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - Myung Hi Yoo
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
| | - So Young Jin
- Departments of Pathology, Soon Chun Hyang University College of Medicine
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea
| | - Dong Won Byun
- Division of Endocrinology and Metabolism, Departments of Internal Medicine
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Lee S, Choi J, Lee J, Yun S, Jung J. 147 UVB irradiation induces barrier dysfunction in epidermal keratinocytes, which can be repaired by ethanol extract of peanut sprouts, a new antioxidant to be originated from peanuts. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.457] [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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Kwak Y, Yun S, Nam S, Seo A, Lee K, Oh HK, Kim D, Kang S, Kim W, Lee H. Comparative and multimodal analysis of the EGFR, HER2, c-MYC, and MET copy number alteration using in situ hybridization in Korean colorectal cancer patients with integration of array-based copy number data from The Cancer Genome Atlas. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.077] [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: 11/15/2022] Open
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Kwak Y, Yun S, Nam SK, Seo AN, Lee KS, Shin E, Oh HK, Kim DW, Kang SB, Kim WH, Lee HS. Comparative analysis of the EGFR, HER2, c-MYC, and MET variations in colorectal cancer determined by three different measures: gene copy number gain, amplification status and the 2013 ASCO/CAP guideline criterion for HER2 testing of breast cancer. J Transl Med 2017; 15:167. [PMID: 28764718 PMCID: PMC5540452 DOI: 10.1186/s12967-017-1265-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to explore gene copy number (GCN) variation of EGFR, HER2, c-MYC, and MET in patients with primary colorectal cancer (CRC). Methods Dual-colour silver-enhanced in situ hybridization was performed in tissue samples of 334 primary CRC patients. The amplification status (GCN ratio ≥2) and GCN gain (average GCN ≥4) data for the EGFR, HER2, c-MYC and MET genes were obtained. GCN variation was also assessed by the criterion of the 2013 ASCO/CAP guidelines for HER2 testing. Results Amplification of EGFR, HER2, c-MYC and MET was detected in 8 (2.4%), 20 (6.0%), 29 (8.7%), and 14 (4.2%) patients, respectively. Of 66 patients with at least one amplified gene, five exhibited co-amplification of genes studied (HER2-MET co-amplification: two patients; HER2-c-MYC co-amplification: two patients; EGFR-c-MYC co-amplification: one patient). There were 109 patients with GCN gains of one or more genes (EGFR: 11/334, HER2: 29/334, c-MYC; 60/334, MET: 48/334) and 32.1% (35/109) had multiple GCN gains. When each GCN was assessed by the criterion of the ASCO/CAP 2013 guideline for HER2 testing, 116 people showed positive or equivocal results for one or more genes. The cumulative amplification status had no association with patients’ outcome. However, the cumulative results of the GCN gain and GCN status determined according to the ASCO/CAP guideline had a significant prognostic correlation in the univariate analysis (P values of 0.006 and 0.022, respectively). In the multivariate analysis, GCN gain and GCN status were independent prognostic factors (P values of 0.010 and 0.017, respectively). Conclusions In this study, we evaluated GCN variation of four genes in a large sample of Korean CRC patients. The amplification status was not related to patient outcome. However, the GCN gain and GCN status according to the ASCO/CAP 2013 guideline were independent prognostic factors.
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Affiliation(s)
- Yoonjin Kwak
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Sumi Yun
- Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Republic of Korea
| | - Soo Kyung Nam
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea
| | - Eun Shin
- Department of Pathology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Duck Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea.
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Jimenez S, Enjuanes C, Verdu-Rotellar J, Chivite D, Diez C, Ruiz-Bustillo S, Badosa N, Ruiz-Rodriguez P, Linas A, Yun S, Comin-Colet J. P2466Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary care of patients with heart failure and mid-range or preserved LVEF: a randomised controlled trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2466] [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: 11/13/2022] Open
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Choi J, Piao M, Park E, Yun S, Lee J, Lee S. 444 Reactive oxygen species induce Th2 allergic inflammation in the skin by activating PI3K-HIF-α pathway. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.463] [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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Choi J, Yun S, Lee J, Piao M, Park E, Lee S. 445 A set of plant essential oils have antioxidant activity in ultraviolet B-irradiated epidermal keratinocytes by upregulating antioxidant and detoxifying enzymes. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.464] [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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Sallman D, Yun S, Al Ali N, Song J, Vaupel C, Hussaini M, Sweet K, Lancet J, Hall J, List A, Padron E, Kormokji R. Prognostic Significance of Serial Molecular Annotation in Myelodysplastic Syndromes (MDS) and Secondary Acute Myeloid Leukemia (SAML). Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30131-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schootman M, Chien L, Yun S, Pruitt SL. Explaining large mortality differences between adjacent counties: a cross-sectional study. BMC Public Health 2016; 16:681. [PMID: 27484009 PMCID: PMC4970203 DOI: 10.1186/s12889-016-3371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
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