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Nemer M, Osman F, Said A. Dietary macro and micronutrients associated with MASLD: Analysis of a national US cohort database. Ann Hepatol 2024; 29:101491. [PMID: 38412922 DOI: 10.1016/j.aohep.2024.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION AND OBJECTIVES Our objective was to measure and compare the intake of macro and micronutrients in a cohort of individuals with Metabolic Syndrome Associated Steatotic Liver Disease (MASLD) compared with matched controls to identify areas of further research in this area; we identified nutrition-associated associations with MASLD in the United States general population. MATERIALS AND METHODS We used the 2017 - 2018 NHANES dataset. Elastography Controlled Attenuation Parameter (CAP score>280) in the absence of other liver disease was defined as MASLD in adults (>18). Advanced fibrosis was defined by transient elastography >10 kPa. Controls were adults without liver disease. RESULTS 1648 MASLD cases (11.4 % advanced fibrosis) and 2527 controls were identified. MASLD cases were older (P<0.001), more likely males (P = 0.01), less likely to have a college education (P = 0.04) and more likely married (P = 0.002). MASLD cases were more likely to be of Mexican American or Hispanic ethnicity (P = 0.002), have higher BMI, and have higher prevalence of diabetes, hyperlipidemia and hypertension (P<0.001 for all). MASLD cases had higher hs-CRP (P = 0.02) and ferritin (P = 0.02). MASLD cases had lower total (P = 0.004) and added vitamin E in their diet (P = 0.002), lower vitamin K intake (P = 0.005), and higher selenium intake (P = 0.03). Caloric intake (P = 0.04), carbohydrate intake (P = 0.02), cholesterol intake (P = 0.03) and saturated fatty acid intake (P = 0.05) were higher in MASLD. Individuals with MASLD were more likely to be on a diet (P<0.001), sedentary (P = 0.008) and less likely to participate in moderate or vigorous recreational activities (P<0.001). CONCLUSIONS The deficiencies of micronutrients and excess of macronutrients point to oxidative stress, pro-inflammatory state, and lipotoxicity as pathways linking the US diet to MASLD. MASLD patients are more often on special diets, which may reflect prior provider counseling on diet changes to improve health.
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Affiliation(s)
- Mary Nemer
- Department of Medicine, Gastroenterology and Hepatology. Medical College of Wisconsin, Milwaukee, WI, United States
| | - Fauzia Osman
- Department of Medicine, Biostatistics. University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Adnan Said
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Wm. S Middleton VA Medical Center, Madison, WI, United States.
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Wong RJ, Ge J, Boike J, German M, Morelli G, Spengler E, Said A, Desai A, Couri T, Paul S, Frenette C, Verna EC, Goel A, Fallon M, Thornburg B, VanWagner L, Lai JC, Kolli KP. Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study. J Vasc Interv Radiol 2023; 34:1364-1371. [PMID: 37100199 PMCID: PMC10998695 DOI: 10.1016/j.jvir.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/02/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To evaluate recovery of platelet count after transjugular intrahepatic portosystemic shunt (TIPS) creation and patient factors predicting platelet recovery after TIPS creation. MATERIALS AND METHODS Adults with cirrhosis who underwent TIPS creation at 9 U.S. hospitals from 2010 to 2015 were included in this retrospective analysis. Change in platelets from before TIPS to 4 months after TIPS creation was characterized. Logistic regression was used to assess factors associated with top quartile percentage platelet increase after TIPS. Subgroup analyses were performed among patients with a pre-TIPS platelet count of ≤50 ×109/L. RESULTS A total of 601 patients were included. The median absolute change in platelets was 1 × 109/L (-26 × 109/L to 25 × 109/L). Patients with top quartile percent platelet increase experienced ≥32% platelet increase. In multivariable analysis, pre-TIPS platelet counts (odds ratio [OR], 0.97 per 109/L; 95% CI, 0.97-0.98), age (OR, 1.24 per 5 years; 95% CI, 1.10-1.39), and pre-TIPS model for end-stage liver disease (MELD) scores (OR, 1.06 per point; 95% CI, 1.02-1.09) were associated with top quartile (≥32%) platelet increase. Ninety-four (16%) patients had a platelet count of ≤50 × 109/L before TIPS. The median absolute platelet change was 14 × 109/L (2 × 109/L to 34 × 109/L). Fifty-four percent of patients in this subgroup were in the top quartile for platelet increase. In multivariable logistic regression, age (OR, 1.50 per 5 years; 95% CI, 1.11-2.02) was the only factor associated with top quartile platelet increase in this subgroup. CONCLUSIONS TIPS creation did not result in significant platelet increase, except among patients with a platelet count of ≤50 × 109/L before TIPS. Lower pre-TIPS platelet counts, older age, and higher pre-TIPS MELD scores were associated with top quartile (≥32%) platelet increase in the entire cohort, whereas only older age was associated with this outcome in the patient subset with a pre-TIPS platelet count of ≤50 × 109/L.
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Affiliation(s)
- Randi J Wong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Francisco, San Francisco, California
| | - Jin Ge
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Francisco, San Francisco, California
| | - Justin Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Margarita German
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Giuseppe Morelli
- Division of Gastroenterology, Hepatology, Department of Medicine, and Nutrition, University of Florida Health, Gainesville, Florida
| | - Erin Spengler
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adnan Said
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Archita Desai
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Thomas Couri
- Section of Gastroenterology, Hepatology & Nutrition, Department of Medicine, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Sonali Paul
- Section of Gastroenterology, Hepatology & Nutrition, Department of Medicine, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Catherine Frenette
- Department for Organ and Cell Transplantation, The Scripps Clinic, La Jolla, California
| | - Elizabeth C Verna
- Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York
| | - Aparna Goel
- Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Michael Fallon
- Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Bartley Thornburg
- Division of Vascular Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California San Francisco, San Francisco, California
| | - K Pallav Kolli
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
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3
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Robertson DJ, Dominitz JA, Beed A, Boardman KD, Del Curto BJ, Guarino PD, Imperiale TF, LaCasse A, Larson MF, Gupta S, Lieberman D, Planeta B, Shaukat A, Sultan S, Menees SB, Saini SD, Schoenfeld P, Goebel S, von Rosenvinge EC, Baffy G, Halasz I, Pedrosa MC, Kahng LS, Cassim R, Greer KB, Kinnard MF, Bhatt DB, Dunbar KB, Harford WV, Mengshol JA, Olson JE, Patel SG, Antaki F, Fisher DA, Sullivan BA, Lenza C, Prajapati DN, Wong H, Beyth R, Lieb JG, Manlolo J, Ona FV, Cole RA, Khalaf N, Kahi CJ, Kohli DR, Rai T, Sharma P, Anastasiou J, Hagedorn C, Fernando RS, Jackson CS, Jamal MM, Lee RH, Merchant F, May FP, Pisegna JR, Omer E, Parajuli D, Said A, Nguyen TD, Tombazzi CR, Feldman PA, Jacob L, Koppelman RN, Lehenbauer KP, Desai DS, Madhoun MF, Tierney WM, Ho MQ, Hockman HJ, Lopez C, Carter Paulson E, Tobi M, Pinillos HL, Young M, Ho NC, Mascarenhas R, Promrat K, Mutha PR, Pandak WM, Shah T, Schubert M, Pancotto FS, Gawron AJ, Underwood AE, Ho SB, Magno-Pagatzaurtundua P, Toro DH, Beymer CH, Kaz AM, Elwing J, Gill JA, Goldsmith SF, Yao MD, Protiva P, Pohl H, Kyriakides T. Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial. JAMA Netw Open 2023; 6:e2321730. [PMID: 37432690 PMCID: PMC10336619 DOI: 10.1001/jamanetworkopen.2023.21730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023] Open
Abstract
Importance The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. Objective To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference's association with geographic and temporal factors. Design, Setting, and Participants This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. Exposure Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. Main Outcomes and Measures Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. Results A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P < .001) or other screening tests (46 [1.0%] P < .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). Conclusions and Relevance In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.
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Affiliation(s)
- Douglas J Robertson
- VA Medical Center, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jason A Dominitz
- VA Puget Sound Health Care System, Seattle, Washington
- University of Washington School of Medicine, Seattle
| | - Alexander Beed
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kathy D Boardman
- Department of Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Barbara J Del Curto
- Department of Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Peter D Guarino
- Statistical Center of HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Thomas F Imperiale
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center and Department of Medicine, Indiana University School of Medicine, Indianapolis
| | | | | | - Samir Gupta
- Section of Gastroenterology, VA San Diego, and Department of Medicine, University of California, San Diego
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Portland VA Medical Center, and Oregon Health and Science University, Portland
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Aasma Shaukat
- New York Harbor VA Healthcare System and New York University Grossman School of Medicine, New York
| | - Shanaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis
| | - Stacy B Menees
- Division of Gastroenterology, Department of Internal Medicine, Ann Arbor VA Medical Center, Ann Arbor, Michigan
- Division of Gastroenterology, Michigan Medicine, Ann Arbor
| | - Sameer D Saini
- US Department of Veteran Affairs Health Services Research and Development Center for Clinical Management Research, Ann Arbor, Michigan
- Division of Gastroenterology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Stephan Goebel
- Atlanta VA Medical Center, Decatur, Georgia
- Emory University, Atlanta, Georgia
| | - Erik C von Rosenvinge
- VA Maryland Health Care System, Baltimore
- University of Maryland School of Medicine, Baltimore
| | - Gyorgy Baffy
- Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
- Primary Care, West Roxbury, Massachusetts
| | - Marcos C Pedrosa
- Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
- Boston University, Boston, Massachusetts
| | - Lyn Sue Kahng
- Gastroenterology Section, Jesse Brown VA Medical Center, and University of Illinois at Chicago
| | - Riaz Cassim
- Louis A. Johnson VA Medical Center, Clarksburg, West Virginia
- Department of Surgery, West Virginia University, Morgantown
| | - Katarina B Greer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Margaret F Kinnard
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- VA Northeast Ohio Healthcare System, Cleveland
| | - Divya B Bhatt
- VA North Texas Health Care Center, University of Texas Southwestern Medical School, Dallas
| | - Kerry B Dunbar
- VA North Texas Healthcare System, University of Texas Southwestern, Dallas
| | - William V Harford
- VA North Texas Health Care Center, University of Texas Southwestern Medical School, Dallas
| | - John A Mengshol
- Division of Gastroenterology and Hepatology University of Colorado School of Medicine, Denver
| | - Jed E Olson
- Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz Medical Center, Aurora
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz Medical Center, Aurora
| | - Fadi Antaki
- John D. Dingell VA Medical Center and Wayne State University School of Medicine, Detroit, Michigan
| | | | - Brian A Sullivan
- Division of Gastroenterology, Durham VA Medical Center, Durham, North Carolina
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
| | | | - Devang N Prajapati
- VA Central California Health Care System, University of California, San Francisco, Fresn
| | - Helen Wong
- VA Central California Health Care System, University of California, San Francisco, Fresn
| | - Rebecca Beyth
- Department of Medicine, University of Florida, Gainesville
| | - John G Lieb
- Division of Gastroenterology, University of Florida, Gainesville
- Malcolm Randall VA Medical Center, Gainesville, Florida
| | | | | | - Rhonda A Cole
- Department of Gastroenterology, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Natalia Khalaf
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Charles J Kahi
- Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis
| | - Divyanshoo Rai Kohli
- Kansas City VA Medical Center, Kansas City, Missouri
- Providence Sacred Heart Medical Center, Spokane, Washington
| | - Tarun Rai
- Borland Groover Clinic, Jacksonville, Florida
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri
| | - Jiannis Anastasiou
- Central Arkansas Veterans Healthcare System, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, Little Rock
| | - Curt Hagedorn
- Gastroenterology Division, New Mexico Veterans Healthcare System, and Department of Medicine, University of New Mexico School of Medicine, Albuquerque
| | - Ronald S Fernando
- VA Loma Linda Healthcare System, Loma Linda, California
- Department of Medicine, University of California, Riverside
| | - Christian S Jackson
- VA Loma Linda Healthcare System, Loma Linda, California
- Department of Medicine, University of California, Riverside
| | - M Mazen Jamal
- Department of Medicine, University of California, Riverside
- Oceana Gastroenterology Associates, Corona, California
| | - Robert H Lee
- VA Long Beach Health Care System, Long Beach, California
- University of California, Irvine
| | | | - Folasade P May
- Greater Los Angeles VA Healthcare System, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joseph R Pisegna
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Departments of Medicine and Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Endashaw Omer
- University of Louisville, Louisville, Kentucky
- Robley Rex VA Medical Center, Louisville, Kentucky
| | - Dipendra Parajuli
- Robley Rex VA Medical Center, Louisville, Kentucky
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
| | - Adnan Said
- William S. Middleton VA Medical Center, Madison, Wisconsin
- Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Toan D Nguyen
- Memphis VA Medical Center, Memphis, Tennessee
- University of Tennessee Health Science Center, Memphis
| | | | | | - Leslie Jacob
- Bruce W. Carter VA Medical Center, Miami, Florida
| | | | | | - Deepak S Desai
- Northport VA Medical Center, State University of New York Stony Brook, Northport
| | - Mohammad F Madhoun
- Oklahoma City VA Medical Center, Oklahoma City
- Section of Digestive Diseases and Nutrition, Department of Medicine, University of Oklahoma, Oklahoma City
| | | | - Minh Q Ho
- Department of Infectious Disease, Orlando VA Healthcare System, University of Central Florida, Orlando
| | | | | | - Emily Carter Paulson
- VA Medical Center, Philadelphia, Pennsylvania
- University of Philadelphia, Philadelphia, Pennsylvania
| | - Martin Tobi
- Department of Research and Development, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Hugo L Pinillos
- Phoenix VA Healthcare System, Phoenix, Arizona
- University of Arizona College of Medicine, Phoenix
| | | | - Nancy C Ho
- Division of Gastroenterology and Hepatology, Portland VA Medical Center, and Oregon Health and Science University, Portland
| | - Ranjan Mascarenhas
- Central Texas Veterans Health Care System, Austin Outpatient Clinic, Austin, Texas
- Department of Medicine, Dell Medical School, The University of Texas at Austin
| | - Kirrichai Promrat
- Providence VA Medical Center, Providence, Rhode Island
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Pritesh R Mutha
- McGuire VA Medical Center, Richmond, Virginia; Now with The University of Texas Health Science Center, Houston
| | - William M Pandak
- Richmond VA Medical Center, Richmond, Virginia
- Virginia Commonwealth University, Richmond, Virginia
| | - Tilak Shah
- Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston
| | - Mitchell Schubert
- Virginia Commonwealth University, Richmond, Virginia
- Central Virginia VA Healthcare System, Richmond
| | - Frank S Pancotto
- Salisbury VA Medical Center, Salisbury, North Carolina
- Wake Forrest University School of Medicine, Winston-Salem, North Carolina
| | - Andrew J Gawron
- Salt Lake City VA Medical Center, Salt Lake City, Utah
- University of Utah, Salt Lake City
| | | | - Samuel B Ho
- VA Medical Center San Diego, San Diego, California
| | | | - Doris H Toro
- Section of Gastroenterology, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Charles H Beymer
- VA Puget Sound Healthcare System, Seattle, Washington
- University of Washington School of Medicine, Seattle
| | - Andrew M Kaz
- University of Washington School of Medicine, Seattle
- Gastroenterology Section, VA Puget Sound Healthcare System, Seattle, Washington
| | - Jill Elwing
- St Louis VA Medical Center, St Louis, Missouri
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey A Gill
- James A. Haley VA Hospital, Tampa, Florida
- University of South Florida College of Medicine, Tampa
| | | | - Michael D Yao
- Gastroenterology and Hepatology Section, VA Medical Center, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Petr Protiva
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Medicine (Digestive Diseases), Yale University School of Medicine, New Haven, Connecticut
| | - Heiko Pohl
- VA Medical Center, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Tassos Kyriakides
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
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Dunckley M, Ahmed K, Said A, Raza M, Dighe S, Al-Temimi A. Variability in the presentation of complicated jejunal diverticulosis. JRSM Open 2023; 14:20542704231183247. [PMID: 37425033 PMCID: PMC10328167 DOI: 10.1177/20542704231183247] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Jejunal diverticulosis is a rare disease which normally presents for the first time with acute complications, often requiring surgical intervention. The diverticulae are acquired, occurring more commonly after middle age, but their aetiology is unclear. We discuss this condition in the context of four cases which presented to our hospital as emergencies over a five year period: small bowel obstruction, gastrointestinal haemorrhage, small bowel volvulus, and visceral perforation. Our aim is to encourage clinicians to include jejunal diverticular disease as a differential diagnosis in patients with abdominal symptoms.
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Affiliation(s)
- M.G. Dunckley
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - K. Ahmed
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - A. Said
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - M. Raza
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - S. Dighe
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
| | - A. Al-Temimi
- Department of General Surgery, Dartford & Gravesham NHS Trust, Dartford, Kent, DA2 8DA, UK
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5
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Bommena S, Mahmud N, Boike JR, Thornburg BG, Kolli KP, Lai JC, German M, Morelli G, Spengler E, Said A, Desai AP, Junna S, Paul S, Frenette C, Verna EC, Goel A, Gregory D, Padilla C, VanWagner LB, Fallon MB. The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study. Hepatology 2023; 77:2041-2051. [PMID: 36651170 PMCID: PMC10192025 DOI: 10.1097/hep.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database. APPROACH AND RESULTS Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included. Primary outcome was mortality. Secondary outcomes were 48-hour post-TIPS complications, post-TIPS portal hypertension complications, and post-TIPS inpatient admission for heart failure. Adjusted Cox Proportional hazards and competing risk model with liver transplant as a competing risk were used to assess RAP association with mortality. Restricted cubic splines were used to model nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes.Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 95% CI, 1.01, 1.08, p =0.009) and composite 48-hour complications. RAP was a predictor of TIPS dysfunction with increased odds of post-90-day paracentesis in outpatient TIPS, hospital admissions for renal dysfunction, and heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. CONCLUSIONS Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.
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Affiliation(s)
- Shoma Bommena
- Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Phoenix, Arizona, USA
| | - Nadim Mahmud
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justin R. Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bartley G. Thornburg
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Kanti P. Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Margarita German
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Giuseppe Morelli
- Division of Gastroenterology, Hepatology, Department of Medicine, and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Erin Spengler
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adnan Said
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Archita P. Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shilpa Junna
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sonali Paul
- Department of Internal Medicine, Section of Gastroenterology and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Catherine Frenette
- Department for Organ and Cell Transplantation, The Scripps Clinic, La Jolla, California, USA
| | - Elizabeth C. Verna
- Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Aparna Goel
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Dyanna Gregory
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia Padilla
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa B. VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael B. Fallon
- Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Phoenix, Arizona, USA
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6
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Ley D, Musto J, Said A. A Case of Progressive Cholestatic Drug-Induced Liver Injury Due to Terbinafine. WMJ 2023; 122:138-142. [PMID: 37141482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Terbinafine is commonly prescribed for onychomycosis. It rarely leads to severe, prolonged cholestatic drug-induced liver injury. Clinicians should remain vigilant for this complication. CASE PRESENTATION A 62-year-old woman was started on terbinafine and developed mixed hepatocellular and cholestatic drug-induced liver injury, confirmed on liver biopsy. The injury became predominantly cholestatic. Unfortunately, she developed coagulopathy with elevated international normalized ratio and progressive drug-induced liver injury with severely elevated alkaline phosphatase and total bilirubin, requiring repeat liver biopsy. Fortunately, she did not develop acute liver failure. DISCUSSION Prior case reports and series have documented severe cholestatic drug-induced liver injury (although with lesser degree of bilirubin elevation) due to terbinafine, which has very rarely been associated with acute liver failure, need for liver transplantation, and/or death. CONCLUSIONS Non-acetaminophen drug-induced liver injury is idiosyncratic. Complications including acute liver failure and vanishing bile duct syndrome can be slow to develop, so monitoring for them is important over longitudinal follow-up.
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Affiliation(s)
- Dana Ley
- University of Wisconsin Hospitals and Clinics, Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
| | - Jessica Musto
- University of Wisconsin Hospitals and Clinics, Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adnan Said
- University of Wisconsin Hospitals and Clinics, Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Enners S, Gradl G, Kieble M, Iliescu O, Freudewald L, Said A, Schulz M. Increased Demand for Pharmaceutical Drugs Containing Potassium Iodide In Connection with the Russia-Ukraine Conflict. Pharmazie 2023; 78:17-19. [PMID: 37138408 DOI: 10.1691/ph.2023.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The current conflict between Russia and Ukraine increased concerns in the German population of a release of radioactive substances, e.g.radioactive iodine. A high dose of potassium iodide (PI) may prevent accumulation of radioactive iodine in the thyroid gland. Therefore, the German government keeps a sufficient quantity of PI in stock for public supply in case of an emergency. We investigated ambulatory drug dispensing rates of PI and found that the total dispensing of PI (statutory health insurance (SHI), private health insurance (PHI), and overthe-counter (OTC)) increased by 106% from February to March 2022. Changes in PI dispensing were mainly due to an increase in OTC sales, where PI as an antidote showed a sevenfold increase from around 930 packages (February 2022) to 6,500 packages (March 2022), while SHI and PHI dispensing remained relatively low. Furthermore, we investigated whether these changes in dispensing raised the number of suspected adverse drug reactions (ADR). We found no increase of ADR reports related to the use of PI-containing medicinal products between February and September 2022, neither in our national pharmacovigilance nor in the European EudraVigilance database. The data suggest that the mere possibility of a nuclear disaster in Ukraine raised the demand of PI in Germany. Thus, timely and proactive information and reassurance of the public of supply reliability by the Government in a case of a nuclear emergency could be helpful in preventing potential drug shortages and unfounded concern.
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Affiliation(s)
- S Enners
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany; German Institute for Drug Use Evaluation (DAPI), Heidestr. 7, 10557 Berlin, Germany;,
| | - G Gradl
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany
| | - M Kieble
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany
| | - O Iliescu
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - L Freudewald
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - A Said
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - M Schulz
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany; Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany; Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany; German Institute for Drug Use Evaluation (DAPI), Heidestr. 7, 10557 Berlin, Germany;,
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8
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Yu Q, Ahmed O, Gutti S, Iyer D, Angle J, Navuluri R, Lorenz J, Sellers E, Ahmed S, Said A, Wahoud W, Patel M. Abstract No. 579 Meta-Analysis of Transjugular Intrahepatic Portosystemic Shunt Creation with Intravascular Ultrasound Guidance. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.437] [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: 02/27/2023] Open
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9
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Pirasteh A, Periyasamy S, Meudt JJ, Liu Y, Lee LM, Schachtschneider KM, Schook LB, Gaba RC, Mao L, Said A, McMillan AB, Laeseke PF, Shanmuganayagam D. Staging Liver Fibrosis by Fibroblast Activation Protein Inhibitor PET in a Human-Sized Swine Model. J Nucl Med 2022; 63:1956-1961. [PMID: 35450958 PMCID: PMC9730920 DOI: 10.2967/jnumed.121.263736] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/07/2022] [Indexed: 01/11/2023] Open
Abstract
Current methods of staging liver fibrosis have notable limitations. We investigated the utility of PET in staging liver fibrosis by correlating liver uptake of 68Ga-labeled fibroblast activation protein inhibitor (FAPI) with histology in a human-sized swine model. Methods: Five pigs underwent baseline 68Ga-FAPI-46 (68Ga-FAPI) PET/MRI and liver biopsy, followed by liver parenchymal embolization, 8 wk of oral alcohol intake, endpoint 68Ga-FAPI PET/MRI, and necropsy. Regions of interest were drawn on baseline and endpoint PET images, and SUVmean was recorded. At the endpoint, liver sections corresponding to regions of interest were identified and cut out. Fibrosis was histologically evaluated using a modified METAVIR score for swine liver and quantitatively using collagen proportionate area (CPA). Box-and-whisker plots and linear regression were used to correlate SUVmean with METAVIR score and CPA, respectively. Results: Liver 68Ga-FAPI uptake strongly correlated with CPA (r = 0.89, P < 0.001). 68Ga-FAPI uptake was significantly and progressively higher across F2 and F3/F4 fibrosis stages, with a respective median SUVmean of 2.9 (interquartile range [IQR], 2.7-3.8) and 7.6 (IQR, 6.7-10.2) (P < 0.001). There was no significant difference between 68Ga-FAPI uptake of baseline liver and endpoint liver sections staged as F0/F1, with a respective median SUVmean of 1.7 (IQR, 1.3-2.0) and 1.7 (IQR, 1.5-1.8) (P = 0.338). Conclusion: The strong correlation between liver 68Ga-FAPI uptake and the histologic stage of liver fibrosis suggests that 68Ga-FAPI PET can play an impactful role in noninvasive staging of liver fibrosis, pending validation in patients.
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Affiliation(s)
- Ali Pirasteh
- Radiology and Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Sarvesh Periyasamy
- Radiology and Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin
| | - Jennifer Jean Meudt
- Animal and Dairy Sciences, University of Wisconsin–Madison, Madison, Wisconsin
| | - Yongjun Liu
- Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin
| | - Laura M. Lee
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, Wisconsin
| | - Kyle M. Schachtschneider
- Radiology and Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, Illinois;,National Center for Supercomputing Applications, University of Illinois at Urbana–Champaign, Champaign, Illinois
| | - Lawrence B. Schook
- Animal Sciences, University of Illinois at Chicago, Chicago, Illinois;,Radiology/Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Ron C. Gaba
- Radiology/Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Lu Mao
- Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Adnan Said
- Medicine, Gastroenterology, and Hepatology, University of Wisconsin–Madison, Madison, Wisconsin;,William S. Middleton VA Medical Center, Madison, Wisconsin
| | - Alan Blair McMillan
- Radiology and Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Paul F. Laeseke
- Radiology and Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin
| | - Dhanansayan Shanmuganayagam
- Animal and Dairy Sciences, University of Wisconsin–Madison, Madison, Wisconsin;,Surgery, University of Wisconsin–Madison, Madison, Wisconsin; and,Center for Biomedical Swine Research and Innovation, University of Wisconsin–Madison, Madison, Wisconsin
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10
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Chow H, Ling H, Chan E, Chung B, Then L, Pang I, Chan S, Khor H, Tan C, Oon Y, Koh K, Cham Y, Said A, Fong A, Ong T. Coronary artery calcification – distribution, extent and 1-year outcomes in patients with low to intermediate pre-test probability of coronary artery disease. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.075] [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: 12/24/2022]
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11
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Umesh S, Chow H, Ling H, Chung B, Then L, Pang I, Chen L, Bhavnani C, Tan C, Oon Y, Koh K, Cham Y, Fong A, Said A, Ong T. Association of Dutch lipid clinic network criteria with reduction in low-density lipoprotein cholesterol in patients with ST-elevation myocardial infarction. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.058] [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: 12/24/2022]
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12
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Khan RU, Khan M, Sohail A, Ullah R, Iqbal A, Ahmad B, Khan IU, Tariq A, Ahmad M, Said A, Ullah S, Ali A, Rahman MU, Zaman A, Bilal H. Efficacy of pentamidine-loaded chitosan nanoparticles as a novel drug delivery system for Leishmania tropica. Trop Biomed 2022; 39:511-517. [PMID: 36602209 DOI: 10.47665/tb.39.4.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The present study compares the in vitro effects of nanoparticles loaded pentamidine drug and conventional pentamidine on Leishmania tropica. Herein, pentamidine-loaded chitosan nanoparticles (PTN-CNPs) have been synthesized through an ionic gelation method with sodium tripolyphosphate (TPP). Next, the physical characteristics of PTN-CNPs were determined through the surface texture, zeta potential, in vitro drug release, drug loading content (DLC), and encapsulation efficacy (EE) and compared its efficacy with free pentamidine (PTN) drug against promastigotes and axenic amastigotes forms of L. tropica in vitro. The PTN-CNPs displayed a spherical shape having a size of 88 nm, an almost negative surface charge (-3.09 mV), EE for PTN entrapment of 86%, and in vitro drug release of 92% after 36 h. In vitro antileishmanial activity of PTN-CNPs and free PTN was performed against Leishmania tropica KWH23 promastigote and axenic amastigote using 3-(4, 5- dimethylthiazol-2-yl)-2, 5-diphenyletetrazolium bromide (MTT) assay. It was observed that the effect of PTN-CNPs and free PTN on both forms of the parasite was dose and time dependent. Free PTN presented low efficacy even at higher dose (40 µg/ml) with 25.6 ± 1.3 and 26.5 ±1.4 mean viability rate of the promastigotes and axenic amastigotes, respectively after 72 hrs incubation. While PTN-CNPs showed strong antileishmanial effects on both forms of parasite with 16 ± 0.4 and 19 ± 0.7 mean viability rate at the same higher concentration (40 µg/ml) after 72 hrs incubation. Half maximal inhibitory concentration (IC50) values of PTN-CNPs toward promastigotes and amastigotes were obtained as 0.1375 µg/ml and 0.1910 µg/ml, respectively. In conclusion, PTN-CNPs effectively inhibited both forms of the L. tropica; however, its effect was more salient on promastigotes. This data indicates that the PTN-CNPs act as a target drug delivery system. However, further research is needed to support its efficacy in animal and human CL.
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Affiliation(s)
- R U Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - M Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - A Sohail
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - R Ullah
- Department of Dairy Technology, Faculty of Veterinary and Animal Sciences, University of Agriculture Dera Ismail Khan, Pakistan
| | - A Iqbal
- Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - B Ahmad
- Department of Animal Sciences, Faculty of Veterinary and Animal Sciences, MNS University of Agriculture Multan, Punjab, 25000, Pakistan
| | - I U Khan
- Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - A Tariq
- Directorate of Livestock and Dairy Development Department, Khyber Pakhtunkhwa, Pakistan
| | - M Ahmad
- Department of Animal Sciences, Quaid-E Azam University Islamabad, Pakistan
| | - A Said
- Department of Parasitology, University of Agriculture Faisalabad, Pakistan
| | - S Ullah
- Department of Biochemistry, Hazara University Mansehra, Pakistan
| | - A Ali
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - M U Rahman
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - A Zaman
- Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - H Bilal
- Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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13
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Thien L, Cham Y, Chan D, Khor H, Chan E, Chung B, Pang I, Ling H, Chow H, Shu F, Ho K, Tan C, Koh K, Oon Y, Said A, Fong A, Ong T. Association between the novel biomarker oxidised LDL/beta 2 glycoprotein I complexes and coronary artery calcification with cardiovascular outcomes – a long term prospective study. Prospective study. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.032] [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: 12/24/2022]
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14
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Foo V, Pang I, Shu F, Fong A, Chen L, Ho K, Ling H, Bhavnani C, Thien L, Chung B, Oon Y, Koh K, Tan C, Cham Y, Said A, Ong T. Safety and efficacy of renal denervation (RDN) in treatment of resistant hypertension: A single centre, 1 year observational study. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.040] [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: 12/24/2022]
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15
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Chow H, Ling H, Chan E, Chung B, Then L, Pang I, Khor H, Chan S, Tan C, Koh K, Cham Y, Said A, Fong A, Ong T, Oon Y. Prevalence of acid alpha-glucosidase (GAA) pseudodefiency allele and it's clinical significance among patients with cardiomyopathy. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.038] [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: 12/24/2022]
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16
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Chung B, Leong T, Chew L, Law W, Thien L, Pang I, Ling H, Chow H, Tan C, Koh K, Cham Y, Said A, Fong A, Ong T, Oon Y. Clinical characteristics of patients with cardiac amyloidosis in Sarawak: Comparison between transthyretin and light-chain amyloid cardiomyopathy. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.10.067] [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: 12/24/2022]
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17
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Rimbert A, Yeung M, Dalila N, Yu H, Loaiza N, Oldoni F, Van Der Graaf A, Wang S, Said A, Blauw L, Girardeau A, Bray L, Caillaud A, Bloks V, Marrec M, Moulin P, Rensen P, Van De Sluis B, Snieder H, Di Filippo M, Van Der Harst P, Tybjærg-Hansen A, Zimmerman P, Cariou B, Kuivenhoven J. GPR146 gene variants are associated with reduced plasma lipids and cardiovascular health: A novel role for GPR146 in hypolipidemia. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.216] [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: 11/02/2022]
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18
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Couillard AB, Knott EA, Zlevor AM, Mezrich JD, Cristescu MM, Agarwal P, Ziemlewicz TJ, Longhurst C, Lubner MG, Hinshaw JL, Said A, Laeseke PF, Lucey MR, Rice JP, Foley D, Al-Adra D, Lee FT. Microwave ablation as bridging to liver transplant for patients with hepatocellular carcinoma: a single-center retrospective analysis. J Vasc Interv Radiol 2022; 33:1045-1053. [PMID: 35667580 DOI: 10.1016/j.jvir.2022.05.019] [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] [Received: 10/30/2021] [Revised: 05/03/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of microwave (MW) ablation as first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant. MATERIALS AND METHODS This retrospective study evaluated 88 patients who received percutaneous MW ablation for 141 tumors as first-line LRT for HCC and listed for liver transplantation at a single medical center between 2011 and 2019. Overall survival rate status-post liver transplant, waitlist retention and disease progression were evaluated using Kaplan-Meier techniques. RESULTS Of 88 patients (72M, 16F, mean age 60 years, MELD=11.2) listed for transplant, median waitlist time was 9.4 months (IQR: 5.5 - 18.9). Seventy-one patients (80.7%) received transplant after median wait time of 8.5 months. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) due to tumors outside of the Milan criteria (HCC-specific dropout). No difference in tumor size or AFP was seen in transplanted vs. non-transplanted patients at time of ablation (2.1 vs. 2.1 cm and 34.4 vs. 34.7 ng/mL for transplanted vs. non-transplanted, respectively, p>0.05). Five of 88 patients (5.1%) experienced adverse events after ablation; however, all recovered. There were no cases of tract seeding. The local tumor progression (LTP) rate was 7.2%. The overall survival status-post liver transplant at 5-years was 76.7% and the disease-specific survival after LT was 89.6% with a median follow-up of 61 months for all patients. CONCLUSION MW ablation appears to be safe and effective for bridging patients with HCC to liver transplant without waitlist removal from seeding, adverse events, or local tumor progression.
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Affiliation(s)
| | - Emily A Knott
- University of Wisconsin-Madison: Department of Radiology
| | - Annie M Zlevor
- University of Wisconsin-Madison: Department of Radiology
| | | | | | | | | | - Colin Longhurst
- Department of Carbone Cancer Center; Department of Biostatistics and Medical Informatics
| | | | - J Louis Hinshaw
- University of Wisconsin-Madison: Department of Radiology; Department of Urology
| | | | - Paul F Laeseke
- University of Wisconsin-Madison: Department of Radiology
| | | | | | | | | | - Fred T Lee
- University of Wisconsin-Madison: Department of Radiology; Department of Urology; Department of Biomedical Engineering.
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Roldán-Alzate A, Campo CA, Mao L, Said A, Wieben O, Reeder SB. Characterization of mesenteric and portal hemodynamics using 4D flow MRI: the effects of meals and diurnal variation. Abdom Radiol (NY) 2022; 47:2106-2114. [PMID: 35419747 PMCID: PMC10599799 DOI: 10.1007/s00261-022-03513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variability of blood flow measurements using 4D flow MRI in the portal and mesenteric circulations and to characterize the effects of meal ingestion, time of day, and between-day (diurnal) variations on portal and mesenteric hemodynamics. METHODS In this IRB-approved and HIPAA-compliant study, 7 healthy and 7 portal hypertension patients imaged. MRI exams were conducted at 3 T using a 32-channel body coil with large volumetric coverage and 1.25-mm isotropic true spatial resolution. Blood flow was quantified (L/min) in the hepatic and splanchnic vasculature. The first MR scan was performed after at least 8 h of fasting. Subsequently, subjects ingested 574 mL EnSure Plus® orally. A second acquisition was started 20 min after the meal ingestion. A third scan was performed before lunch and a fourth acquisition took place 20 min after lunch. A fifth scan was performed around 4 pm. Finally, subjects returned one week later for a repeat morning visit, with identical conditions as the first visit. RESULTS In healthy controls significant increase in blood flow was seen in the PV, SMV, SMA, HA, and SCAo in response to breakfast but only the SCAo, SMA, SMV, and PV had a significant response to lunch. In general, patients with cirrhosis showed reduced response to meals compared to that in healthy controls. Additionally, PV flow in patients had the highest value in the afternoon. CONCLUSION Effects of meal ingestion, time of day, and between-day variations were characterized using Radial 4D flow MRI in patients with cirrhosis and healthy controls.
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Affiliation(s)
- Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA.
- Department of Mechanical Engineering, University of Wisconsin, Madison, USA.
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA.
| | - Camilo A Campo
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, USA
| | - Adnan Said
- Department of Medicine, University of Wisconsin, Madison, USA
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
- Department of Medical Physics, University of Wisconsin, Madison, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, USA
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Said I, Ahad H, Said A. Gut microbiome in non-alcoholic fatty liver disease associated hepatocellular carcinoma: Current knowledge and potential for therapeutics. World J Gastrointest Oncol 2022; 14:947-958. [PMID: 35646285 PMCID: PMC9124992 DOI: 10.4251/wjgo.v14.i5.947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/14/2021] [Accepted: 04/16/2022] [Indexed: 02/06/2023] Open
Abstract
Metabolic diseases such as nonalcoholic fatty liver disease (NAFLD) are rising in incidence and are an increasingly common cause of cirrhosis and hepatocellular carcinoma (HCC). The gut microbiome is closely connected to the liver via the portal vein, and has recently been identified as a predictor of liver disease state. Studies in NAFLD, cirrhosis and HCC have identified certain microbial signatures associated with these diseases, with the disease-associated microbiome changes collectively referred to as dysbiosis. The pathophysiologic underpinnings of these observations are an area of ongoing investigation, with current evidence demonstrating that the gut microbiome can influence liver disease and carcinogenesis via effects on intestinal permeability (leaky gut) and activation of the innate immune system. In the innate immune system, pathogen recognition receptors (Toll like receptors) on resident liver cells and macrophages cause liver inflammation, fibrosis, hepatocyte proliferation and reduced antitumor immunity, leading to chronic liver disease and carcinogenesis. Dysbiosis-associated changes include increase in secondary bile acids and reduced expression of FXR (nuclear receptor), which have also been associated with deleterious effects on lipid and carbohydrate metabolism associated with progressive liver disease. Longitudinal experimental and clinical studies are needed in different populations to examine these questions further. The role of therapeutics that modulate the microbiome is an emerging field with experimental studies showing the potential of diet, probiotics, fecal microbiota transplantation and prebiotics in improving liver disease in experimental models. Clinical studies are ongoing with preliminary evidence showing improvement in liver enzymes and steatosis. The microbial profile is different in responders to cancer immunotherapy including liver cancer, but whether or not manipulation of the microbiome can be utilized to affect response is being investigated.
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Affiliation(s)
- Imaad Said
- Brown University, Providence, RI 02912, United States
| | - Hassan Ahad
- Kansas University, Lawrence, KS 66045, United States
| | - Adnan Said
- Division of Gastroenterology and Hepatology, Department of Medicine, William S. Middleton VAMC, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
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Agarwal PD, Haftoglou BA, Ziemlewicz TJ, Lucey MR, Said A. Psychosocial Barriers and Their Impact on Hepatocellular Carcinoma Care in US Veterans: Tumor Board Model of Care. Fed Pract 2022; 39:S32-S36. [PMID: 35929010 PMCID: PMC9346579 DOI: 10.12788/fp.0272] [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: 06/15/2023]
Abstract
BACKGROUND Psychosocial barriers, including low socioeconomic status, homelessness, alcohol and substance use disorders, and psychiatric disorders are prevalent in US veterans. Our study aims to identify the prevalence of psychosocial barriers in veterans diagnosed with hepatocellular carcinoma (HCC), and their impact on receipt of cancer care. METHODS A retrospective cohort study was performed of all veterans diagnosed with HCC at the William S. Middleton Memorial Veterans' Hospital in Madison, Wisconsin, whose tumor care was coordinated through a multidisciplinary tumor board. Outcomes included receipt of any HCC-specific therapy and overall survival. RESULTS From January 1, 2007, through December 31, 2016, 149 veterans were diagnosed with HCC. Substance use disorders were reported in 124 (83%) patients, psychiatric illness was documented in 55 (37%) patients, 23 (15%) patients had incomes below the poverty threshold, and 7 (5%) were experiencing homelessness. The mean (SD) distance traveled for care was 207.1 (277.9) km; travel and lodging assistance were accessed by 50 (34%) and 33 (22%) veterans, respectively. Seventy-one patients (48%) had HCC exceeding T2 stage at diagnosis. Curative treatment was offered to 78 (52%) patients, with 127 (85%) receiving any HCC-specific care. Median survival from diagnosis was 727 days (95% CI, 488-966). CONCLUSIONS Psychosocial barriers were common in our veteran cohort. Individualizing care, and coordination of travel and lodging, assisted in enabling high rates of receipt of HCC-specific therapy and improving patient survival.
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Affiliation(s)
- Parul D Agarwal
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
- University of Wisconsin, School of Medicine and Public Health, Madison
| | - Beth A Haftoglou
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
| | | | - Michael R Lucey
- University of Wisconsin, School of Medicine and Public Health, Madison
| | - Adnan Said
- William S. Middleton Memorial Veterans' Hospital, Madison, Wisconsin
- University of Wisconsin, School of Medicine and Public Health, Madison
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Rolak S, Said A, German R, Hayney MS, Caldera F. Optimizing Immunization Strategies in Adult Patients With Chronic Liver Disease and Liver Transplant Recipients. Gastroenterol Hepatol (N Y) 2022; 18:196-206. [PMID: 35505940 PMCID: PMC9053492] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk for infections from vaccine-preventable diseases. Gastroenterologists and hepatologists should assess patient immunization history, and necessary vaccinations should be given as soon as possible. Vaccines demonstrate superior immunogenicity when given earlier in the course of liver disease and prior to transplant. This article summarizes recommendations from the Advisory Committee on Immunization Practices for vaccinations in patients with CLD and liver transplant recipients, and includes a discussion of the influenza, herpes zoster, hepatitis A, hepatitis B, pneumococcal, human papillomavirus, and COVID-19 vaccines.
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Affiliation(s)
- Stacey Rolak
- Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Adnan Said
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine & Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Rita German
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine & Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Mary S. Hayney
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine & Public Health, University of Wisconsin–Madison, Madison, Wisconsin
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Mashar M, Said A, Hussain M, Eze V. Reporting acute trauma in a non-trauma centre: improving scan turnover time. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Bhavnani CD, Koh KT, Oon YY, Pang IX, Tan CT, Chen LS, Shu FEP, Ho KH, Cham YL, Ling HS, Said A, Thien LK, Chung BK, Fong AYY, Ong TK. Three year clinical outcomes of fractional flow reserve guided coronary revascularization using a monorail pressure sensor microcatheter. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.123] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Fractional flow reserve (FFR) has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease. Deferral of revascularization for coronary stenosis of FFR >0.80 has shown favorable long-term outcomes, yet the adoption in real-world practice is limited. To date, there is no study on FFR guided PCI in the Malaysian population.
Objective
(1) To explore the 3-year clinical outcome of FFR guided coronary revascularization.
(2) To compare the clinical outcome of FFR guided deferral of coronary revascularization versus FFR guided revascularization. The primary outcome was a composite of all cause mortality, non fatal myocardial infarction (MI) and ischemia driven target vessel revascularization (TVR)
Results
Thirty-five patients were lost to follow up leaving 78 patients (95 vessels) for final analysis. The mean age was 59.3 ± 9.4 years old. 69 (88.5%) patients were male, 24 (30.7%) had diabetes mellitus, 58 (74.3%) had dyslipidemia, 61 (78.2%) had hypertension and 45 (57.7%) were smokers. The mean LVEF was 56.7 ± 14.7%. FFR to the LAD artery was performed in 64 (82%) patients. Based on the FFR value of 0.80, 47 (60.2%) patients had FFR guided deferral of coronary revascularization and 31 (39.7%) patients had FFR guided revascularization.
At 3 years, 11 (14.1%) patients met the primary outcome, mainly driven by all-cause mortality (11.5%). The primary outcome was met in 14.9% of FFR guided deferral versus 12.9% of FFR guided revascularization (p = 0.828). All-cause mortality was 12.7% in patients with FFR guided deferral compared to 9.7% in patients with FFR guided revascularization at 3 years (p = 0.712).
Cox proportional hazards model did not demonstrate any independent predictors associated with the primary outcome or all cause mortality.
Conclusion
FFR guided deferral of revascularization was safe and had comparable long-term clinical outcomes to FFR guided PCI. To our knowledge, this is the first study on long-term clinical outcome on FFR guided revascularization in Malaysia. Abstract Figure. Kaplan-Meier curve primary end point Abstract Figure. Kaplan-Meier curve all cause mortality
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Affiliation(s)
| | - K T Koh
- Sarawak Heart Center, Kuching, Malaysia
| | - Y Y Oon
- Sarawak Heart Center, Kuching, Malaysia
| | - I X Pang
- Sarawak Heart Center, Kuching, Malaysia
| | - C T Tan
- Sarawak Heart Center, Kuching, Malaysia
| | - L S Chen
- Sarawak Heart Center, Kuching, Malaysia
| | - F E P Shu
- Sarawak Heart Center, Kuching, Malaysia
| | - K H Ho
- Sarawak Heart Center, Kuching, Malaysia
| | - Y L Cham
- Sarawak Heart Center, Kuching, Malaysia
| | - H S Ling
- University Malaysia Sarawak (UNIMAS), Kuching, Malaysia
| | - A Said
- University Malaysia Sarawak (UNIMAS), Kuching, Malaysia
| | - L K Thien
- Sarawak Heart Center, Kuching, Malaysia
| | - B K Chung
- Sarawak Heart Center, Kuching, Malaysia
| | | | - T K Ong
- Sarawak Heart Center, Kuching, Malaysia
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25
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Chow H, Ling H, Chung B, Then L, Pang I, Chen L, Bhavnani C, Tan C, Oon Y, Koh K, Cham Y, Fong A, Said A, Ong T. Utility of dutch lipid clinic network score to estimate prevalence of familial hypercholestrolemia in patients with ST-elevation myocardial infarction. Int J Cardiol 2021. [DOI: 10.1016/j.ijcard.2021.10.067] [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: 11/29/2022]
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26
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Bhavnani C, Koh K, Thien L, Chung B, Pang I, Chen L, Ling H, Chow H, Tan C, Oon Y, Cham Y, Said A, Fong A, Ong T. Three-year clinical outcome of fractional flow reserve guided coronary revascularization with monorail pressure microcatheter. Int J Cardiol 2021. [DOI: 10.1016/j.ijcard.2021.10.034] [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: 11/25/2022]
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27
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Chen L, Oon Y, Chung B, Thien L, Chow H, Pang I, Ling H, Chandan D, Tan C, Koh K, Said A, Cham Y, Alan A, Ong T. Clinical characteristics of patients with hereditary transthyretin amyloid cardiomyopathy (ATTR-CM) in Sarawak. Int J Cardiol 2021. [DOI: 10.1016/j.ijcard.2021.10.038] [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: 10/19/2022]
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28
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Chung B, Oon Y, Thien L, Pang I, Chen L, Ling H, Chow H, Chandan D, Tan C, Koh K, Cham Y, Said A, Fong A, Ong T. Comparison of teicholz versus biplane simpson method in the assessment of left ventricular volumes and ejection fraction among healthy subjects. Int J Cardiol 2021. [DOI: 10.1016/j.ijcard.2021.10.122] [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: 11/29/2022]
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29
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Chen L, Oon Y, Rawlings C, Sabeng K, Adam S, Lasep H, Pang I, Ling H, Chandan D, Tan C, Koh K, Cham Y, Said A, Fong A, Ong T. Semi-automated left ventricular endocardial detection versus hand-tracing in the measurement of left ventricular volumes and ejection fraction in daily clinical practice. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.097] [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
The common method of assessing left ventricle (LV) volumes and ejection fraction (EF) is hand-tracing Biplane Simpson method. Alternatively, ultrasound vendors offer different semi-automated LV endocardial border detection software with anatomical intelligence to assess LV volumes and EF. By using speckle-tracking technique, this software tracks the LV endocardium throughout the cardiac cycle and computes the LV volumes in every image frame using the disk summation method from which a volume-curve is generated, and the EF is calculated using the maximum and minimum volumes obtained. Data on the performance of this method in comparison with the hand-tracing Biplane Simpson method in daily clinical practice is scarce.
Purpose
To determine the accuracy of LV volumes and EF using semi-automated LV endocardial detection tracing, and to compare the reproducibility of this method with the hand-tracing Biplane Simpson method, among operators with varying level of experience in echocardiography.
Methods
This was a single center retrospective observational study, conducted in year 2020. 127 patients, aged >18 years, who underwent clinically indicated transthoracic echocardiography were recruited. The echocardiographic images were analyzed independently in a blinded fashion by 3 operators – a sonographer, a fellow-in-training and a cardiologist specialized in echocardiography. The LV volumes and EF were first measured using hand-tracing Biplane Simpson method, then repeated using semi-automated tracing at a different time and the operator were blinded to the initial hand-tracing measurements.
Results
The mean age of patients was 50±16 years, 35.4% were male, mean body surface area was 1.62±0.18m2, 92.1% were in sinus rhythm, and 61.4% had good acoustic window. Table 1 shows the LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF, measured using different method, by the 3 operators. There were excellent correlation and agreement between semi-automated tracing measurements and hand-tracing measurements of LV EDV (r=0.985, LOA [mean ± 1.96 SD] 16.9 ml, ICC 0.991), ESV (r=0.990, LOA 12.7 ml, ICC 0.994) and EF (r=0.962, LOA 7.43%, ICC 0.967) by experienced cardiologist. The limit of agreement (LOA) between cardiologist and sonographer for semi-automated tracing measurement of LV EDV, ESV and EF were 29.13 ml, 19.74 ml and 9.25% respectively, which was comparable with that of hand-tracing measurement. The agreement between cardiologist and fellow-in-training for semi-automated tracing measurement of LV volumes and EF was slightly better than hand-tracing method, with a LOA of 25.60 ml, 17.48 ml and 7.08%, for EDV, ESV and EF respectively (Table 2).
Conclusion
In daily clinical practice, measurement of LV volumes and EF using semi-automated LV endocardial tracing method is accurate and demonstrates comparable reproducibility with hand-tracing Biplane Simpson method among operators with different level of experience in echocardiography.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L.S Chen
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - Y.Y Oon
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - C Rawlings
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - K Sabeng
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - S Adam
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - H Lasep
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - I.X Pang
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - H.S Ling
- University Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Malaysia
| | - D.B Chandan
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - C.T Tan
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - K.T Koh
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - Y.L Cham
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - A Said
- University Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Malaysia
| | - A.Y.Y Fong
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
| | - T.K Ong
- Sarawak Heart Center, Department of Cardiology, Kota Samarahan, Malaysia
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Said A, Lesurf R, Delfosse K, Oliveros W, Mattiolo K, Meng G, Mele M, Maass P, Ellis J, Scherer S, Mital S. FUNCTIONAL VALIDATION OF NON-CODING REGULATORY VARIANTS ASSOCIATED WITH CHILDHOOD CARDIOMYOPATHY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.140] [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: 10/20/2022] Open
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31
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Li H, Zhang TT, Said A, Fabbris G, Mazzone DG, Yan JQ, Mandrus D, Halász GB, Okamoto S, Murakami S, Dean MPM, Lee HN, Miao H. Giant phonon anomalies in the proximate Kitaev quantum spin liquid α-RuCl 3. Nat Commun 2021; 12:3513. [PMID: 34112804 PMCID: PMC8192767 DOI: 10.1038/s41467-021-23826-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022] Open
Abstract
The Kitaev quantum spin liquid epitomizes an entangled topological state, for which two flavors of fractionalized low-energy excitations are predicted: the itinerant Majorana fermion and the Z2 gauge flux. It was proposed recently that fingerprints of fractional excitations are encoded in the phonon spectra of Kitaev quantum spin liquids through a novel fractional-excitation-phonon coupling. Here, we detect anomalous phonon effects in α-RuCl3 using inelastic X-ray scattering with meV resolution. At high temperature, we discover interlaced optical phonons intercepting a transverse acoustic phonon between 3 and 7 meV. Upon decreasing temperature, the optical phonons display a large intensity enhancement near the Kitaev energy, JK~8 meV, that coincides with a giant acoustic phonon softening near the Z2 gauge flux energy scale. These phonon anomalies signify the coupling of phonon and Kitaev magnetic excitations in α-RuCl3 and demonstrates a proof-of-principle method to detect anomalous excitations in topological quantum materials.
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Affiliation(s)
- Haoxiang Li
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - T T Zhang
- Department of Physics, Tokyo Institute of Technology, Okayama, Meguro-ku, Tokyo, Japan
- Tokodai Institute for Element Strategy, Tokyo Institute of Technology, Nagatsuta, Midori-ku, Yokohama, Kanagawa, Japan
| | - A Said
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL, USA
| | - G Fabbris
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL, USA
| | - D G Mazzone
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, NY, USA
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institut, Villigen, Switzerland
| | - J Q Yan
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - D Mandrus
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
- Department of Materials Science and Engineering, the University of Tennessee at Knoxville, Knoxville, TN, USA
| | - Gábor B Halász
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - S Okamoto
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - S Murakami
- Department of Physics, Tokyo Institute of Technology, Okayama, Meguro-ku, Tokyo, Japan
- Tokodai Institute for Element Strategy, Tokyo Institute of Technology, Nagatsuta, Midori-ku, Yokohama, Kanagawa, Japan
| | - M P M Dean
- Condensed Matter Physics and Materials Science Department, Brookhaven National Laboratory, Upton, NY, USA
| | - H N Lee
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - H Miao
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA.
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Ullah N, Said A, Israr M, Rasool A, Akbar F, Ahmad S, Mehmood SA, Jabeen H, Islam M, Muhammad S, Noureenh S, Habiba U, Ahmed D, Shah M, Khan MAA, Siraj M. Effect of different protein based feed on the growth of mahseer. BRAZ J BIOL 2021; 82:e243670. [PMID: 34161428 DOI: 10.1590/1519-6984.243670] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.
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Affiliation(s)
- N Ullah
- University of Swat, Centre for Animal Sciences and Fisheries, Charbagh, Pakistan
| | - A Said
- University of Swat, Centre for Animal Sciences and Fisheries, Charbagh, Pakistan
| | - M Israr
- University of Swat, Department of Forensics Sciences, Charbagh, Pakistan
| | - A Rasool
- University of Swat, Centre for Biotechnology and Microbiology, Charbagh, Pakistan
| | - F Akbar
- University of Swat, Centre for Biotechnology and Microbiology, Charbagh, Pakistan
| | - S Ahmad
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - S A Mehmood
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - H Jabeen
- Women University Mardan, Department of Microbiology, Mardan, Pakistan
| | - M Islam
- Hazara University Mansehra, Department of Genetics, Mansehra, Pakistan
| | - S Muhammad
- University of Swat, Institute of Agricultural Sciences & Forestry, Charbagh, Pakistan
| | - S Noureenh
- University of Haripur, Department of Forestry and Wildlife Management, Haripur, Pakistan
| | - Ume Habiba
- University of Haripur, Department of Forestry and Wildlife Management, Haripur, Pakistan
| | - D Ahmed
- University of Haripur, Department of Medical Lab Technology, Haripur, Pakistan
| | - M Shah
- University of Swat, Centre for Animal Sciences and Fisheries, Charbagh, Pakistan
| | - M A A Khan
- University of Peshawar: Peshawar, Centre of Biotechnology and Microbiology, Pakistan
| | - M Siraj
- Department of Zoology, Abbottabad University of Science & Technology, Pakistan
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Amin YA, Said A. The Addition of Chitosan to GnRH Analog Induces Ovarian Resumption and Improves Conception Rates in Buffaloes. Trop Anim Sci J 2021. [DOI: 10.5398/tasj.2021.44.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ge J, Lai JC, Boike JR, German M, Jest N, Morelli G, Spengler E, Said A, Lee A, Hristov A, Desai AP, Junna S, Pokhrel B, Couri T, Paul S, Frenette C, Christian-Miller N, Laurito M, Verna EC, Rahim U, Goel A, Das A, Pine S, Gregory D, VanWagner LB, Kolli KP. Nonalcoholic Fatty Liver Disease and Diabetes Mellitus Are Associated With Post-Transjugular Intrahepatic Portosystemic Shunt Renal Dysfunction: An Advancing Liver Therapeutic Approaches Group Study. Liver Transpl 2021; 27:329-340. [PMID: 33217178 PMCID: PMC8053375 DOI: 10.1002/lt.25949] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications, but its effect on renal function is not well characterized. Here we describe renal function and characteristics associated with renal dysfunction at 30 days post-TIPS. Adults with cirrhosis who underwent TIPS at 9 hospitals in the United States from 2010 to 2015 were included. We defined "post-TIPS renal dysfunction" as a change in estimated glomerular filtration rate (ΔeGFR) ≤-15 and eGFR ≤ 60 mL/min/1.73 m2 or new renal replacement therapy (RRT) at day 30. We identified the characteristics associated with post-TIPS renal dysfunction by logistic regression and evaluated survival using adjusted competing risk regressions. Of the 673 patients, the median age was 57 years, 38% of the patients were female, 26% had diabetes mellitus, and the median MELD-Na was 17. After 30 days post-TIPS, 66 (10%) had renal dysfunction, of which 23 (35%) required new RRT. Patients with post-TIPS renal dysfunction, compared with those with stable renal function, were more likely to have nonalcoholic fatty liver disease (NAFLD; 33% versus 17%; P = 0.01) and comorbid diabetes mellitus (42% versus 24%; P = 0.001). Multivariate logistic regressions showed NAFLD (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.00-4.17; P = 0.05), serum sodium (Na; OR, 1.06 per mEq/L; 95% CI, 1.01-1.12; P = 0.03), and diabetes mellitus (OR, 2.04; 95% CI, 1.16-3.61; P = 0.01) were associated with post-TIPS renal dysfunction. Competing risk regressions showed that those with post-TIPS renal dysfunction were at a higher subhazard of death (subhazard ratio, 1.74; 95% CI, 1.18-2.56; P = 0.01). In this large, multicenter cohort, we found NAFLD, diabetes mellitus, and baseline Na associated with post-TIPS renal dysfunction. This study suggests that patients with NAFLD and diabetes mellitus undergoing TIPS evaluation may require additional attention to cardiac and renal comorbidities before proceeding with the procedure.
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Affiliation(s)
- Jin Ge
- University of California-San Francisco, San Francisco, CA
| | - Jennifer C Lai
- University of California-San Francisco, San Francisco, CA
| | | | - Margarita German
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Erin Spengler
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adnan Said
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Alexander Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Alexander Hristov
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Shilpa Junna
- College of Medicine University of Arizona, Tucson, AZ
| | | | | | - Sonali Paul
- The University of Chicago Medicine, Chicago, IL
| | | | | | - Marcela Laurito
- Columbia University College of Physicians & Surgeons, New York, NY
| | | | | | | | - Arighno Das
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stewart Pine
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dyanna Gregory
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lisa B. VanWagner
- Northwestern University Feinberg School of Medicine, Chicago, IL,Corresponding Author Lisa B. VanWagner, MD, MSc, Assistant Professor of Medicine-Gastroenterology & Hepatology and Preventive Medicine, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 676 N. St Clair - Suite 1400, Chicago, Illinois 60611, , Fax: 312-695-3999
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Said A, Van De Vegte Y, Verweij N, Van Der Harst P. Associations of observational and genetically determined caffeine intake with coronary artery disease and diabetes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1493] [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
Caffeine is the most widely consumed psychostimulant and is associated with lower risk of coronary artery disease (CAD) and type 2 diabetes (T2D). However, whether these associations are causal remains unknown.
Objectives
This study aimed to identify genetic variants associated with caffeine intake, and to investigate possible causal links between genetically determined caffeine intake and CAD or T2D. Additionally, we aimed to replicate previous observational findings between caffeine intake and CAD or T2D.
Methods
Genome wide associated studies (GWAS) were performed on caffeine intake from coffee, tea or both in 407,072 UK Biobank participants. Identified variants were used in a two-sample Mendelian randomization (MR) approach to investigate evidence for causal links between caffeine intake and CAD in CARDIoGRAMplusC4D (60,801 cases; 123,504 controls) or T2D in DIAGRAM (26,676 cases; 132,532 controls). Observational associations were tested within UK Biobank using Cox regression analyses.
Results
Moderate observational caffeine intakes from coffee or tea were associated with lower risks of CAD or T2D compared to no or high intake, with the lowest risks at intakes of 120–180 mg/day from coffee for CAD (HR=0.77 [95% CI: 0.73–0.82; P<1e-16]), and 300–360 mg/day for T2D (HR=0.76 [95% CI: 0.67–0.86]; P=1.57e-5). GWAS identified 51 novel genetic loci associated with caffeine intake, enriched for central nervous system genes. In contrast to observational analyses, MR analyses in CARDIoGRAMplusC4D and DIAGRAM yielded no evidence for causal links between caffeine intake and the development of CAD or T2D.
Conclusions
MR analyses indicate caffeine intake might not protect against CAD or T2D, despite protective associations in observational analyses.
Manhattan_plot_CaffeineIntake
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Said
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - Y.J Van De Vegte
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - N Verweij
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - P Van Der Harst
- University Medical Center Groningen, Groningen, Netherlands (The)
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Sherman CB, Said A, Kriss M, Potluri VS, Levitsky J, Reese PP, Shea JA, Serper M. In-Person Outreach and Telemedicine in Liver and Intestinal Transplant: A Survey of National Practices, Impact of Coronavirus Disease 2019, and Areas of Opportunity. Liver Transpl 2020; 26:1354-1358. [PMID: 32772459 PMCID: PMC7436220 DOI: 10.1002/lt.25868] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/06/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Courtney B. Sherman
- Division of GastroenterologyDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCA
| | - Adnan Said
- Division of Gastroenterology and HepatologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
- William S. Middleton Memorial Veteran’s HospitalMadisonWI
| | - Michael Kriss
- Division of Gastroenterology and HepatologyUniversity of Colorado School of MedicineAuroraCO
| | - Vishnu S. Potluri
- Divisions of Renal Electrolytes and HypertensionUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Josh Levitsky
- Division of Gastroenterology and HepatologyNorthwestern UniversityChicagoIL
| | - Peter P. Reese
- Divisions of Renal Electrolytes and HypertensionUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Judy A. Shea
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Marina Serper
- Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Leonard Davis Institute of Health EconomicsPhiladelphiaPA
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Said A, Weiss M, Varhelyi A, Farago R, Ballweg C, Rice J, Agarwal P, Fernandez L, Foley D. Utilization of hepatitis C viremic donors for liver transplant recipients without hepatitis C. A veterans transplant center report. Transpl Infect Dis 2020; 23:e13466. [PMID: 32931616 DOI: 10.1111/tid.13466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND We report our experience utilizing liver donors with HCV Viremia (RNA+) for HCV-negative recipients (HCV D+R-) at a Veterans Affairs (VA) transplant center. METHODS In 2018, we introduced an informed consent process for HCV D+R- liver transplants. RESULTS Eight HCV D+R- liver transplants (LT) were performed. Median time from listing to LT was 189 days (range 41-511). Median MELD at LT was 23.5 (median MELD at LT of 31 for center). All recipients developed HCV viremia after transplant. Median time to DAA initiation was 10 days after viremia (range 3-25). After transplant, the DAAs used were Mavyret in five recipients and Epclusa in three, all for 12 weeks. All eight patients completed DAA therapy and achieved negative HCV RNA by end of therapy (ETR) and seven reached sustained virologic response (SVR) by 12 weeks after end of therapy. One patient died from chronic ischemic encephalopathy after ETR, before SVR. CONCLUSIONS HCV D+R- is a practical strategy to expand the pool of donor organs. It shortened waiting time, allowing patients to receive transplants at lower MELD scores. VA liver transplant programs have provided universal and timely access to post-transplant HCV DAA therapy after donor-derived infection.
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Affiliation(s)
- Adnan Said
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Matthew Weiss
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Anna Varhelyi
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Rebecca Farago
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Cristy Ballweg
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - John Rice
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Parul Agarwal
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - Luis Fernandez
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
| | - David Foley
- University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA
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Upton MH, Zhang J, Zheng H, Said A, Mitchell JF. Electronic coupling in square planar La 4Ni 3O 8. J Phys Condens Matter 2020; 32:425503. [PMID: 32629441 DOI: 10.1088/1361-648x/aba314] [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] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
A study of addexcitation in La4Ni3O8(La-438) using x-ray absorption scattering and resonant inelastic x-ray scattering (RIXS) at the Ni K-edge is presented. The incident energy dependence of thisddexcitation shows a maximum at the 1s→ 4pπtransition. Its intensity at the main edge is proportional to the amount of incident x-ray polarization parallel to thec-axis. These observations suggest that the RIXS process underlying this excitation includes a strong Ni 3d-Ni 4pCoulomb interaction and excludes the '4p-as-spectator' approximation. The dominant Ni 3dCoulomb interaction is with Ni 4pπwith limited or no interaction with the Ni 4pσ. An insulating gap closing is observed as a function of temperature.
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Affiliation(s)
- M H Upton
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, United States of America
| | - Junjie Zhang
- Materials Science Division, Argonne National Laboratory, Argonne, IL 60439, United States of America
- Institute of Crystal Materials, Shandong University, Jinan, Shandong 250100, People's Republic of China
| | - Hong Zheng
- Materials Science Division, Argonne National Laboratory, Argonne, IL 60439, United States of America
| | - A Said
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, United States of America
| | - J F Mitchell
- Materials Science Division, Argonne National Laboratory, Argonne, IL 60439, United States of America
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Rich NE, Yang JD, Perumalswami PV, Alkhouri N, Jackson W, Parikh ND, Mehta N, Salgia R, Duarte-Rojo A, Kulik L, Rakoski M, Said A, Oloruntoba O, Ioannou GN, Hoteit MA, Moon AM, Rangnekar AS, Eswaran SL, Zheng E, Jou JH, Hanje J, Pillai A, Hernaez R, Wong R, Scaglione S, Samant H, Kapuria D, Chandna S, Rosenblatt R, Ajmera V, Frenette CT, Satapathy SK, Mantry P, Jalal P, John BV, Fix OK, Leise M, Lindenmeyer CC, Flores A, Patel N, Jiang ZG, Latt N, Dhanasekaran R, Odewole M, Kagan S, Marrero JA, Singal AG. Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol 2020; 18:974-983. [PMID: 31357028 PMCID: PMC8174017 DOI: 10.1016/j.cgh.2019.07.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/13/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. METHODS We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). RESULTS Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3-12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3-12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. CONCLUSIONS Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.
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Affiliation(s)
- Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas.
| | - Ju Dong Yang
- Division of Digestive and Liver Diseases, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Ponni V Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naim Alkhouri
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
| | - Whitney Jackson
- Division of Gastroenterology and Hepatology, University of Colorado Denver School of Medicine, Denver, Colorado
| | - Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Neil Mehta
- Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Andres Duarte-Rojo
- T.E. Starzl Transplantation Institute and Center for Liver Disease, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura Kulik
- Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Mina Rakoski
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Adnan Said
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Omobonike Oloruntoba
- Division of Gastroenterology and Hepatology, Duke University Health Center, Durham, North Carolina
| | - George N Ioannou
- Division of Gastroenterology and Research and Development, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, Washington
| | - Maarouf A Hoteit
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Amol S Rangnekar
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC
| | - Sheila L Eswaran
- Division of Gastroenterology, Rush Medical College, Chicago, Illinois
| | - Elizabeth Zheng
- Division of Digestive and Liver Diseases, Columbia University, New York, New York
| | - Janice H Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California
| | - Steven Scaglione
- Division of Hepatology, Loyola University Medical Center and Edward Hines Veterans Affairs, Chicago, Illinois
| | - Hrishikesh Samant
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Devika Kapuria
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico
| | - Shaun Chandna
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine - New York-Presbyterian Hospital, New York, New York
| | - Veeral Ajmera
- Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California
| | - Catherine T Frenette
- Division of Organ Transplantation, Scripps Green Hospital, San Diego, California
| | - Sanjaya K Satapathy
- Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Prasun Jalal
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas
| | - Binu V John
- Division of Gastroenterology and Hepatology, McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Oren K Fix
- Organ Transplant Department, Swedish Medical Center, Seattle, Washington
| | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Nayan Patel
- Banner Transplant Institute, Banner - University Medical Center Phoenix, Phoenix, Arizona
| | - Z Gordon Jiang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nyan Latt
- Oschner Multi-Organ Transplant Institute, Oschner Health System, New Orleans, Louisiana
| | | | - Mobolaji Odewole
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Sofia Kagan
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Jorge A Marrero
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
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Kuan PX, Chan WK, Chua PF, Yeo J, Sapri FE, Bujang MA, Said A. Lifestyle factors associated with cardiovascular risk among healthcare workers from the tertiary hospitals in Sarawak. Malays Fam Physician 2020; 15:15-22. [PMID: 32284800 PMCID: PMC7136671] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION A cross-sectional study is used to evaluate the lifestyle factors associated with cardiovascular disease (CVD) risk among healthcare workers in tertiary hospitals in Sarawak, Malaysia. METHODS A questionnaire-based survey using the Simple Lifestyle Indicator Questionnaire (SLIQ) was administered to, and anthropometric measurements were collected from, 494 healthcare workers. RESULTS The mean age of the subjects was 32.4±8.4, with a range of 19 to 59 years. The subjects were from the allied health (45.5%), management and professional (25.1%) and executive (29.4%) fields. Overall, 47.4% of the subjects were of normal weight, 30.2% were overweight, 17.2% were obese and 5.2% were underweight. The mean number of working hours per week for the subjects was 47.6±14.0 with the highest working hours found among the management and professional group, followed by the executive and allied health groups. Overall, 39.7% of the healthcare workers worked office hours, 36.6% worked within the shift system, 20.9% worked office hours and were on-call and the remaining 2.8% worked a mixture of office hours and shifts. Based on the SLIQ score, 58.1% were classified as at intermediate risk for CVD, 38.5% were in the healthy category and 3.4% were in the unhealthy category. Factors associated with a healthier lifestyle were being female (Odds Ratio [OR]= 12.1; CI=3.2-46.4), professional (mean score= 6.70), in the allied health group (mean score=7.33) and in the normal BMI group (OR= 9.3, CI= 1.8-47.0). CONCLUSION In our study, healthcare workers had an intermediate risk of developing CVD in the future. Thus, there is a need to intervene in the lifestyle factors contributing to CVD.
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Affiliation(s)
- P X Kuan
- Clinical Research Centre (CRC) Sungai Buloh Hospital, Jalan Hospital 47000 Selangor, Malaysia
| | - W K Chan
- Department of Anaesthesiology and Intensive Care, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - P F Chua
- Department of Paraclinical Science Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia
| | - Jjp Yeo
- Department of Cardiology, Sarawak General Hospital Heart Centre, Jalan Lingkaran Luar Kuching, 94300 Kota Samarahan, Sarawak, Malaysia
| | - F E Sapri
- Clinical Research Centre, Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia
| | - M A Bujang
- Clinical Research Centre, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - A Said
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan Sarawak, Malaysia
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Tan CT, Koh KT, Onn YY, Ho KH, Said A, Mohd Amin NH, Shu FEP, Khiew NZ, Cham YL, Fong AYY, Ong TK, Eng SY, Lee ZY, Madzlan N. P13 Safety and efficacy of sacubitril-valsartan initiation during and after acute decompensated heart failure with reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.018] [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 PIONEER-HF trial has demonstrated the safety of Sacubitril-Valsartan initiation during acute decompensated heart failure (ADHF) compared to Enalapril. The efficacy outcome was also addressed by the surrogate end point of reduction in NT-proBNP. However, the safety and efficacy of Sacubitril-Valsartan initiation during ADHF compared to initiation after ADHF was unknown.
Objectives
(1) To compare the safety and efficacy of Sacubitril-Valsartan initiation during ADHF(inpatient) to initiation after ADHF(outpatient). (2) To explore the echocardiogram parameters associated with Sacubitril-Valsartan initiation during ADHF(inpatient) versus after ADHF(outpatient).
Methods
We enrolled patients diagnosed with heart failure with reduced ejection fraction (HFrEF) initiated on Sacubitril-Valsartan from February 2017 to December 2018. The baseline characteristics, echocardiogram parameters (changes in LVEF and positive remodeling), composite safety outcomes (hypotension, interruption of Sacubitril-Valsartan and worsening of renal function), and efficacy outcomes (cardiac death, readmission for heart failure) were compared.
Results
Thirty-seven patients were identified out of which 21 patients started Entresto after ADHF (outpatient group) and 16 patients during ADHF (inpatient group). The median follow-up duration was 196 days (IQR: 105 to 328days). The baseline characteristics were similar between the 2 groups. Outpatient groups achieved a significantly higher maximally tolerable dose of Sacubitril-Valsartan compared to inpatient group (median 400mg/day versus 200mg/day, p = 0.008) despite a similar starting dose (median 100mg/day versus 100mg/day, p = 0.127). The composite efficacy outcomes were similar between the 2 groups (4.8% versus 18.8%, p = 0.296). The composite safety outcome was similar between the groups (18.8% versus 4.8%, HR5.70 p = 0.054, 95%CI 0.967 to 33.60). Both groups achieved a significant improvement in LVEF after initiation of Sacubitril-Valsartan therapy: mean LVEF 23.44 ± 7.88% to 34.30 ± 13.88% (p = 0.001) in outpatient group; mean LVEF 22.99 ± 11.31% to 38.81 ± 13.91% (p = 0.002) in inpatient group. Reverse remodeling (reduction of LVESV≥15%) was similar between the 2 groups (61.9% versus 50.0%, p = 0.506).
Conclusions
Among patients with HFrEF in ADHF, initiation of Sacubitril-Valsartan therapy during or after ADHF led to similar safety and efficacy. Overall, there was a significant improvement in LVEF and positive remodeling of the LV regardless of the timing of initiation of therapy.
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Affiliation(s)
- C T Tan
- Sarawak General Hospital, Kuching, Malaysia
| | - K T Koh
- Sarawak General Hospital, Kuching, Malaysia
| | - Y Y Onn
- Sarawak General Hospital, Kuching, Malaysia
| | - K H Ho
- Sarawak General Hospital, Kuching, Malaysia
| | - A Said
- Sarawak General Hospital, Kuching, Malaysia
| | | | - F E P Shu
- Sarawak General Hospital, Kuching, Malaysia
| | - N Z Khiew
- Sarawak General Hospital, Kuching, Malaysia
| | - Y L Cham
- Sarawak General Hospital, Kuching, Malaysia
| | - A Y Y Fong
- Sarawak General Hospital, Kuching, Malaysia
| | - T K Ong
- Sarawak General Hospital, Kuching, Malaysia
| | - S Y Eng
- Sarawak General Hospital, Kuching, Malaysia
| | - Z Y Lee
- Sarawak General Hospital, Kuching, Malaysia
| | - N Madzlan
- Sarawak General Hospital, Kuching, Malaysia
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Tan C, Koh K, Said A, Onn Y, Ho K, Shu F, Khiew N, Cham Y, Fong A, Ong T, Mohd Amin N, Eng S, Lee Z, Madzlan N. Safety and Efficacy of Sacubitril-Valsartan Initiation During and After Acute Decompensated Heart Failure with Reduced Ejection Fraction. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.013] [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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Shu F, Ho K, Tan C, Koh K, Oon Y, Bhavani C, Cham Y, Said A, Khiew N, Fong A, Ong T. Infective Endocarditis at A Tertiary Referral Centre in A Developing Country: Aetiology, Microbology and Risk Factors for Embolic Complications and Mortality. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.027] [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: 11/30/2022]
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Oon Y, Koh K, Ho K, Tan C, Shu F, Said A, Cham Y, Khiew N, Mohd Amin N, Fong A, Ong T. Global Longitudinal Strain Predicts Adverse Left Ventricular Remodeling After ST-segment Elevation Myocardial Infarction. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.006] [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: 11/24/2022]
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45
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Tan C, Koh K, Said A, Onn Y, Ho K, Shu F, Khiew N, Cham Y, Fong A, Ong T, Mohd Amin N, Chew S. Impact of Visual Assessment of Stress Cardiac Magnetic Resonance Imaging in Patients with Known or Suspected Coronary Artery Disease in Real World Practice: A Single Centre Experience. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.023] [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: 11/16/2022]
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Singal AG, Rich NE, Mehta N, Branch AD, Pillai A, Hoteit M, Volk M, Odewole M, Scaglione S, Guy J, Said A, Feld JJ, John BV, Frenette C, Mantry P, Rangnekar AS, Oloruntoba O, Leise M, Jou JH, Bhamidimarri KR, Kulik L, Ioannou GN, Huang A, Tran T, Samant H, Dhanasekaran R, Duarte-Rojo A, Salgia R, Eswaran S, Jalal P, Flores A, Satapathy SK, Kagan S, Gopal P, Wong R, Parikh ND, Murphy CC. Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma. Gastroenterology 2019; 157:1253-1263.e2. [PMID: 31374215 PMCID: PMC6815711 DOI: 10.1053/j.gastro.2019.07.040] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/24/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy. METHODS We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting. RESULTS Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18-0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55-2.33). CONCLUSIONS In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.
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Affiliation(s)
- Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Nicole E. Rich
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Neil Mehta
- Division of Gastroenterology, University of California San Francisco
| | | | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago
| | - Maarouf Hoteit
- Division of Gastroenterology and Hepatology, University of Pennsylvania
| | - Michael Volk
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health
| | - Mobolaji Odewole
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Steven Scaglione
- Division of Hepatology, Loyola University Medical Center and Edward Hines Veterans Affairs
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center
| | - Adnan Said
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine
| | - Jordan J. Feld
- Toronto Center for Liver Disease, Toronto General Hospital
| | - Binu V. John
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center
| | | | | | | | | | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University
| | | | - Laura Kulik
- Division of Hepatology, Northwestern University
| | - George N. Ioannou
- Division of Gastroenterology and Research and Development, Veterans Affairs Puget Sound Healthcare System and University of Washington
| | - Annsa Huang
- Division of Gastroenterology, University of California San Francisco
| | - Tram Tran
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center
| | - Hrishikesh Samant
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center
| | | | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Hospital
| | | | - Prasun Jalal
- Division of Abdominal Transplantation, Baylor College of Medicine
| | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine
| | - Sanjaya K. Satapathy
- Division of Hepatology, Donald and Barbara Zucker School of Medicine, Northshore University Hospital, Northwell Health, Manhasset, New York
| | - Sofia Kagan
- Division of Digestive and Liver Disease, UT Southwestern Medical Center
| | - Purva Gopal
- Department of Pathology, UT Southwestern Medical Center
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Alameda Health System
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Phillips PK, Saha S, Foley DP, Iruretagoyena JI, Said A. Deficiencies in reproductive health counseling in liver transplant recipients. Clin Transplant 2019; 33:e13631. [PMID: 31173406 DOI: 10.1111/ctr.13631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND In liver transplant (LT) recipients of childbearing age, there is often rapid return of fertility post-transplant. Our aim was to determine whether healthcare providers are documenting reproductive health counseling in LT recipients. METHODS We performed a review of 365 LT recipients (164 female, 201 male) of childbearing age transplanted between 1994 and 2015 at a single center. We evaluated documentation of reproductive health counseling, content of the counseling and its provider. RESULTS Reproductive health counseling was documented in 7% of LT recipients (14% of females, 0.5% of males). The transplant team provided the counseling in 56%, obstetrics/gynecology in 35%, and primary care in 9%. Twenty-four post-LT pregnancies occurred; these were unplanned in 13%. Miscarriage/stillbirth occurred in 7/24 pregnancies (29%). Mycophenolic acid was used by 20% of female recipients at conception. Only age at transplant (P = 0.001) and post-LT pregnancy was associated with documentation of reproductive health counseling in female recipients (P = 0.0001). CONCLUSION Despite rapid return of fertility in reproductive-aged LT recipients, documentation of reproductive health counseling in this population is rare in men and women. This increases the potential for adverse maternal and fetal outcomes in this high-risk population.
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Affiliation(s)
- Paulina K Phillips
- Division of Gastroenterology and Hepatology, Wm S Middleton VAMC Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, Wm S Middleton VAMC Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David P Foley
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jesus I Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adnan Said
- Division of Gastroenterology and Hepatology, Wm S Middleton VAMC Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Singal AG, Rich NE, Mehta N, Branch A, Pillai A, Hoteit M, Volk M, Odewole M, Scaglione S, Guy J, Said A, Feld JJ, John BV, Frenette C, Mantry P, Rangnekar AS, Oloruntoba O, Leise M, Jou JH, Bhamidimarri KR, Kulik L, Tran T, Samant H, Dhanasekaran R, Duarte-Rojo A, Salgia R, Eswaran S, Jalal P, Flores A, Satapathy SK, Wong R, Huang A, Misra S, Schwartz M, Mitrani R, Nakka S, Noureddine W, Ho C, Konjeti VR, Dao A, Nelson K, Delarosa K, Rahim U, Mavuram M, Xie JJ, Murphy CC, Parikh ND. Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study. Gastroenterology 2019; 156:1683-1692.e1. [PMID: 30660729 PMCID: PMC6598433 DOI: 10.1053/j.gastro.2019.01.027] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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: 10/04/2018] [Revised: 12/15/2018] [Accepted: 01/09/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS There is controversy over the effects of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection on hepatocellular carcinoma (HCC) recurrence and tumor aggressiveness. We compared HCC recurrence patterns between DAA-treated and untreated HCV-infected patients who had achieved a complete response to HCC treatment in a North American cohort. METHODS We conducted a retrospective cohort study of patients with HCV-related HCC with a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy from January 2013 through December 2017 at 31 health systems throughout the United States and Canada. Cox regression was used to examine the association between DAA therapy and time to recurrence after a complete response, with DAA therapy analyzed as a time-varying exposure. We also estimated the association between DAA therapy and risk of early HCC recurrence (defined as 365 days after complete response). RESULTS Of 793 patients with HCV-associated HCC, 304 (38.3%) received DAA therapy and 489 (61.7%) were untreated. HCC recurred in 128 DAA-treated patients (42.1%; early recurrence in 52 patients) and 288 untreated patients (58.9%; early recurrence in 227 patients). DAA therapy was not associated with HCC recurrence (hazard ratio 0.90, 95% confidence interval 0.70-1.16) or early HCC recurrence (hazard ratio 0.96, 95% confidence interval 0.70-1.34) after we adjusted for study site, age, sex, Child-Pugh score, α-fetoprotein level, tumor burden, and HCC treatment modality. In DAA-treated and untreated patients, most recurrences were within the Milan criteria (74.2% vs 78.8%; P = .23). A larger proportion of DAA-treated than untreated patients received potentially curative HCC therapy for recurrent HCC (32.0% vs 24.6%) and achieved a complete or partial response (45.3% vs 41.0%) but this did not achieve statistical significance. CONCLUSION In a large cohort of North American patients with complete response to HCC treatment, DAA therapy was not associated with increased overall or early HCC recurrence. HCC recurrence patterns, including treatment response, were similar in DAA-treated and untreated patients.
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Affiliation(s)
- Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Nicole E. Rich
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Neil Mehta
- Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Andrea Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Maarouf Hoteit
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Volk
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Mobolaji Odewole
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Steven Scaglione
- Division of Hepatology, Loyola University Medical Center, Chicago, Illinois,Edward Hines Veterans Affairs, Chicago, Illinois
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Adnan Said
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Jordan J. Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Binu V. John
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
| | - Catherine Frenette
- Division of Organ Transplantation, Scripps Green Hospital, San Diego, California
| | | | - Amol S. Rangnekar
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC
| | - Omobonike Oloruntoba
- Division of Gastroenterology and Hepatology, Duke University Health Center, Durham, North Carolina
| | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | | | - Laura Kulik
- Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Tram Tran
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hrishikesh Samant
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
| | | | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Sheila Eswaran
- Division of Gastroenterology, Rush Medical College, Chicago, Illinois
| | - Prasun Jalal
- Division of Abdominal Transplantation, Baylor College of Medicine, Dallas, Texas
| | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine, Louis, Missouri
| | - Sanjaya K. Satapathy
- Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California
| | - Annsa Huang
- Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Suresh Misra
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Myron Schwartz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Mitrani
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasank Nakka
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Wassim Noureddine
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Chanda Ho
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Venkata R. Konjeti
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
| | - Alexander Dao
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC
| | - Kevin Nelson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kelly Delarosa
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Usman Rahim
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Meher Mavuram
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
| | - Jesse J. Xie
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Caitlin C. Murphy
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
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Motosugi U, Roldán-Alzate A, Bannas P, Said A, Kelly S, Zea R, Wieben O, Reeder SB. Four-dimensional Flow MRI as a Marker for Risk Stratification of Gastroesophageal Varices in Patients with Liver Cirrhosis. Radiology 2018; 290:101-107. [PMID: 30325278 DOI: 10.1148/radiol.2018180230] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To assess the feasibility of four-dimensional (4D) flow MRI as a noninvasive imaging marker for stratifying the risk of variceal bleeding in patients with liver cirrhosis. Materials and Methods This study recruited participants scheduled for both liver MRI and gastroesophageal endoscopy. Risk of variceal bleeding was assessed at endoscopy by using a three-point scale: no varices, low risk, and high risk requiring treatment. Four-dimensional flow MRI was used to create angiograms for evaluating visibility of varices and to measure flow volumes in main portal vein (PV), superior mesenteric vein, splenic vein (SV), and azygos vein. Fractional flow changes in PV and SV were calculated to quantify shunting (outflow) from PV and SV into varices. Logistic analysis was used to identify the independent indicator of high-risk varices. Results There were 23 participants (mean age, 52.3 years; age range, 25-75 years), including 14 men (mean age, 51.7 years; age range, 25-75 years) and nine women (mean age, 53.2 years; age range, 31-72 years) with no varices (n = 8), low-risk varices (n = 8), and high-risk varices (n = 7) determined at endoscopy. Four-dimensional flow MRI-based angiography helped radiologists to view varices in four of 15 participants with varices. Independent indicators of high-risk varices were flow volume in the azygos vein greater than 0.1 L/min (P = .034; 100% sensitivity [seven of seven] and 62% specificity [10 of 16]) and fractional flow change in PV of less than 0 (P < .001; 100% sensitivity [seven of seven] and 94% specificity [15 of 16]). Conclusion Azygos flow greater than 0.1 L/min and portal venous flow less than the sum of splenic and superior mesenteric vein flow are useful markers to stratify the risk of gastroesophageal varices bleeding in patients with liver cirrhosis. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Utaroh Motosugi
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Alejandro Roldán-Alzate
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Peter Bannas
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Adnan Said
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Sean Kelly
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Ryan Zea
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Oliver Wieben
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Scott B Reeder
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
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50
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Lubner MG, Jones D, Kloke J, Said A, Pickhardt PJ. CT texture analysis of the liver for assessing hepatic fibrosis in patients with hepatitis C virus. Br J Radiol 2018; 92:20180153. [PMID: 30182750 DOI: 10.1259/bjr.20180153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate CT texture analysis (CTTA) for non-invasively staging of hepatic fibrosis (stages F0-F4) in a cohort of patients with hepatitis C virus (HCV). METHODS Quantitative texture analysis of the liver was performed on abdominal multidimensional CT scans. Single slice region of interest measurements of the total liver, Couinaud segments IV-VIII and segments I-III were made. CT texture parameters were tested against stage of hepatic fibrosis in segments IV-VIII on the portal venous phase. Texture parameters were correlated with biopsy performed within 1 year for all cases with intermediate fibrosis (F0-F3). RESULTS CT scans of 556 adults (360 males, 196 females; mean age, 49.8 years), including a healthy control group (F0, n = 77) and patients with hepatitis C virus and Stage 0 disease (n = 49), and patients with increasing stages of fibrosis (F1, n = 80; F2 n = 99; F3 n = 87; F4 n = 164) were evaluated. Mean gray level intensity increased with increasing fibrosis. For significant fibrosis (≥F2), mean showed receiver operatingcharacteristic area under the curve (AUC) of 0.80 with sensitivity and specificity of 74 and 75% using a threshold of 0.44, with similar receiver operatingcharacteristic AUC and sensitivity/specificity for advanced fibrosis (≥F3). Skewness and kurtosis were inversely associated with hepatic fibrosis, most prominently in cirrhotic patients. A multivariate model combining these four texture features (mean, mpp, skewness and kurtosis) showed slightly improved performance with AUC of 0.82, 0.82 and 0.86 for any fibrosis (F0 vs F1-F4), significant fibrosis (F0-1 vs F2-4) and advanced fibrosis (F0-2 vs F3-4) respectively. CONCLUSION CT texture features may be associated with hepatic fibrosis and have utility in staging fibrosis, particularly at advanced levels. ADVANCES IN KNOWLEDGE CTTA may be helpful in detecting and staging hepatic fibrosis, particularly at advanced levels. CT measures like CTTA can be retrospectively evaluated without special equipment.
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Affiliation(s)
- Meghan G Lubner
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Jones
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John Kloke
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Perry J Pickhardt
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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