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Mirza A, Watt R, Heilmann A, Stennett M, Singh A. Social Disadvantage and Multimorbidity Including Oral Conditions in the United States. J Dent Res 2024; 103:477-483. [PMID: 38504091 PMCID: PMC11047010 DOI: 10.1177/00220345241228834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Existing studies on multimorbidity have largely excluded oral diseases in multimorbidity prevalence estimates. The reason behind this is somewhat unclear, as chronic oral conditions are highly prevalent, affecting over half the global population. To address this gap, we examined the relationship between social disadvantage and multimorbidity, stratifying by the inclusion and exclusion of oral conditions. For participants aged 30 y and over (n = 3,693), cross-sectional analysis was carried out using the US National Health and Nutrition Survey (2013-2014). Multimorbidity was defined as having 2 or more chronic conditions. Five medical conditions were examined: diabetes, asthma, arthritis, cardiovascular disease, and depression, as well as 4 oral health conditions: caries, periodontal disease, number of teeth, and edentulousness. Education and income poverty ratio were selected as measures of social disadvantage. Multimorbidity prevalence estimates according to social disadvantage were analyzed on an absolute and relative scale using inverse probability treatment weighting (IPTW), adjusting for age, sex, and ethnicity. The inclusion of oral health conditions in the assessment of multimorbidity increased the overall prevalence of multimorbidity from 20.8% to 53.4%. Findings from IPTW analysis demonstrated clear social gradients for multimorbidity estimates stratified by the exclusion of oral conditions. Upon inclusion of oral conditions, the prevalence of multimorbidity was higher across all social groups for both education and income. Stratifying by the inclusion of oral conditions, the mean probability of multimorbidity was 27% (95% confidence interval [CI], 23%-30%) higher in the low-education group compared to the high-education group. Similarly, the mean probability of multimorbidity was 44% (95% CI, 40%-48%) higher in the low-income group. On a relative scale, low education was associated with a 1.52 times (95% CI, 1.44-1.61) higher prevalence of multimorbidity compared to high education. Low income was associated with a 2.18 (95% CI, 1.99-2.39) higher prevalence of multimorbidity. This novel study strongly supports the impact of chronic oral conditions on multimorbidity prevalence estimates.
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Affiliation(s)
- A. Mirza
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A. Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M. Stennett
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A. Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
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2
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Hwang HS, Lo CM, Murphy M, Grudda T, Gallagher N, Luo CH, Robinson ML, Mirza A, Conte M, Conte A, Zhou R, Vergara C, Brooke CB, Pekosz A, Mostafa HH, Manabe YC, Thio CL, Balagopal A. Characterizing SARS-CoV-2 Transcription of Subgenomic and Genomic RNAs During Early Human Infection Using Multiplexed Droplet Digital Polymerase Chain Reaction. J Infect Dis 2023; 227:981-992. [PMID: 36468309 PMCID: PMC10319975 DOI: 10.1093/infdis/jiac472] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/20/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission requires understanding SARS-CoV-2 replication dynamics. METHODS We developed a multiplexed droplet digital polymerase chain reaction (ddPCR) assay to quantify SARS-CoV-2 subgenomic RNAs (sgRNAs), which are only produced during active viral replication, and discriminate them from genomic RNAs (gRNAs). We applied the assay to specimens from 144 people with single nasopharyngeal samples and 27 people with >1 sample. Results were compared to quantitative PCR (qPCR) and viral culture. RESULTS sgRNAs were quantifiable across a range of qPCR cycle threshold (Ct) values and correlated with Ct values. The ratio sgRNA:gRNA was stable across a wide range of Ct values, whereas adjusted amounts of N sgRNA to a human housekeeping gene declined with higher Ct values. Adjusted sgRNA and gRNA amounts were quantifiable in culture-negative samples, although levels were significantly lower than in culture-positive samples. Daily testing of 6 persons revealed that sgRNA is concordant with culture results during the first week of infection but may be discordant with culture later in infection. sgRNA:gRNA is constant during infection despite changes in viral culture. CONCLUSIONS Ct values from qPCR correlate with active viral replication. More work is needed to understand why some cultures are negative despite presence of sgRNA.
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Affiliation(s)
- Hyon S Hwang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Che-Min Lo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Murphy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tanner Grudda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Gallagher
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chun Huai Luo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew L Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Agha Mirza
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madison Conte
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Candelaria Vergara
- Department of Microbiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher B Brooke
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashwin Balagopal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Mikheev A, Adawi M, Mirza A, Bechtel A. Prolonged fever and inflammation in a young child in the midst of the pandemic – it’s not always MIS-C. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00717-6] [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: 01/28/2023]
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4
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Ke R, Martinez PP, Smith RL, Gibson LL, Achenbach CJ, McFall S, Qi C, Jacob J, Dembele E, Bundy C, Simons LM, Ozer EA, Hultquist JF, Lorenzo-Redondo R, Opdycke AK, Hawkins C, Murphy RL, Mirza A, Conte M, Gallagher N, Luo CH, Jarrett J, Conte A, Zhou R, Farjo M, Rendon G, Fields CJ, Wang L, Fredrickson R, Baughman ME, Chiu KK, Choi H, Scardina KR, Owens AN, Broach J, Barton B, Lazar P, Robinson ML, Mostafa HH, Manabe YC, Pekosz A, McManus DD, Brooke CB. Longitudinal Analysis of SARS-CoV-2 Vaccine Breakthrough Infections Reveals Limited Infectious Virus Shedding and Restricted Tissue Distribution. Open Forum Infect Dis 2022; 9:ofac192. [PMID: 35791353 PMCID: PMC9047214 DOI: 10.1093/ofid/ofac192] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2022] [Indexed: 02/07/2023] Open
Abstract
Background The global effort to vaccinate people against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during an ongoing pandemic has raised questions about how vaccine breakthrough infections compare with infections in immunologically naive individuals and the potential for vaccinated individuals to transmit the virus. Methods We examined viral dynamics and infectious virus shedding through daily longitudinal sampling in 23 adults infected with SARS-CoV-2 at varying stages of vaccination, including 6 fully vaccinated individuals. Results The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. Conclusions Vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.
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Affiliation(s)
- Ruian Ke
- T-6, Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Pamela P Martinez
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Rebecca L Smith
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura L Gibson
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chad J Achenbach
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sally McFall
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Chao Qi
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua Jacob
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Etienne Dembele
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camille Bundy
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lacy M Simons
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Egon A Ozer
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Judd F Hultquist
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anita K Opdycke
- Department of Health Service, Northwestern University, Evanston, Illinois, USA
| | - Claudia Hawkins
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert L Murphy
- Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Agha Mirza
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Madison Conte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Gallagher
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chun Huai Luo
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Junko Jarrett
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mireille Farjo
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Gloria Rendon
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Christopher J Fields
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Leyi Wang
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Richard Fredrickson
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Melinda E Baughman
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Karen K Chiu
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Hannah Choi
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Kevin R Scardina
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alyssa N Owens
- Center for Clinical and Translational Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John Broach
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bruce Barton
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Peter Lazar
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew L Robinson
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David D McManus
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christopher B Brooke
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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5
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Ranoa DRE, Holland RL, Alnaji FG, Green KJ, Wang L, Fredrickson RL, Wang T, Wong GN, Uelmen J, Maslov S, Weiner ZJ, Tkachenko AV, Zhang H, Liu Z, Ibrahim A, Patel SJ, Paul JM, Vance NP, Gulick JG, Satheesan SP, Galvan IJ, Miller A, Grohens J, Nelson TJ, Stevens MP, Hennessy PM, Parker RC, Santos E, Brackett C, Steinman JD, Fenner MR, Dohrer K, DeLorenzo M, Wilhelm-Barr L, Brauer BR, Best-Popescu C, Durack G, Wetter N, Kranz DM, Breitbarth J, Simpson C, Pryde JA, Kaler RN, Harris C, Vance AC, Silotto JL, Johnson M, Valera EA, Anton PK, Mwilambwe L, Bryan SP, Stone DS, Young DB, Ward WE, Lantz J, Vozenilek JA, Bashir R, Moore JS, Garg M, Cooper JC, Snyder G, Lore MH, Yocum DL, Cohen NJ, Novakofski JE, Loots MJ, Ballard RL, Band M, Banks KM, Barnes JD, Bentea I, Black J, Busch J, Conte A, Conte M, Curry M, Eardley J, Edwards A, Eggett T, Fleurimont J, Foster D, Fouke BW, Gallagher N, Gastala N, Genung SA, Glueck D, Gray B, Greta A, Healy RM, Hetrick A, Holterman AA, Ismail N, Jasenof I, Kelly P, Kielbasa A, Kiesel T, Kindle LM, Lipking RL, Manabe YC, Mayes J́, McGuffin R, McHenry KG, Mirza A, Moseley J, Mostafa HH, Mumford M, Munoz K, Murray AD, Nolan M, Parikh NA, Pekosz A, Pflugmacher J, Phillips JM, Pitts C, Potter MC, Quisenberry J, Rear J, Robinson ML, Rosillo E, Rye LN, Sherwood M, Simon A, Singson JM, Skadden C, Skelton TH, Smith C, Stech M, Thomas R, Tomaszewski MA, Tyburski EA, Vanwingerden S, Vlach E, Watkins RS, Watson K, White KC, Killeen TL, Jones RJ, Cangellaris AC, Martinis SA, Vaid A, Brooke CB, Walsh JT, Elbanna A, Sullivan WC, Smith RL, Goldenfeld N, Fan TM, Hergenrother PJ, Burke MD. Mitigation of SARS-CoV-2 transmission at a large public university. Nat Commun 2022. [DOI: doi.org/10.1038/s41467-022-30833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AbstractIn Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal “SHIELD: Target, Test, and Tell” program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university.
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6
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Ranoa DRE, Holland RL, Alnaji FG, Green KJ, Wang L, Fredrickson RL, Wang T, Wong GN, Uelmen J, Maslov S, Weiner ZJ, Tkachenko AV, Zhang H, Liu Z, Ibrahim A, Patel SJ, Paul JM, Vance NP, Gulick JG, Satheesan SP, Galvan IJ, Miller A, Grohens J, Nelson TJ, Stevens MP, Hennessy PM, Parker RC, Santos E, Brackett C, Steinman JD, Fenner MR, Dohrer K, DeLorenzo M, Wilhelm-Barr L, Brauer BR, Best-Popescu C, Durack G, Wetter N, Kranz DM, Breitbarth J, Simpson C, Pryde JA, Kaler RN, Harris C, Vance AC, Silotto JL, Johnson M, Valera EA, Anton PK, Mwilambwe L, Bryan SP, Stone DS, Young DB, Ward WE, Lantz J, Vozenilek JA, Bashir R, Moore JS, Garg M, Cooper JC, Snyder G, Lore MH, Yocum DL, Cohen NJ, Novakofski JE, Loots MJ, Ballard RL, Band M, Banks KM, Barnes JD, Bentea I, Black J, Busch J, Conte A, Conte M, Curry M, Eardley J, Edwards A, Eggett T, Fleurimont J, Foster D, Fouke BW, Gallagher N, Gastala N, Genung SA, Glueck D, Gray B, Greta A, Healy RM, Hetrick A, Holterman AA, Ismail N, Jasenof I, Kelly P, Kielbasa A, Kiesel T, Kindle LM, Lipking RL, Manabe YC, Mayes J, McGuffin R, McHenry KG, Mirza A, Moseley J, Mostafa HH, Mumford M, Munoz K, Murray AD, Nolan M, Parikh NA, Pekosz A, Pflugmacher J, Phillips JM, Pitts C, Potter MC, Quisenberry J, Rear J, Robinson ML, Rosillo E, Rye LN, Sherwood M, Simon A, Singson JM, Skadden C, Skelton TH, Smith C, Stech M, Thomas R, Tomaszewski MA, Tyburski EA, Vanwingerden S, Vlach E, Watkins RS, Watson K, White KC, Killeen TL, Jones RJ, Cangellaris AC, Martinis SA, Vaid A, Brooke CB, Walsh JT, Elbanna A, Sullivan WC, Smith RL, Goldenfeld N, Fan TM, Hergenrother PJ, Burke MD. Mitigation of SARS-CoV-2 transmission at a large public university. Nat Commun 2022; 13:3207. [PMID: 35680861 PMCID: PMC9184485 DOI: 10.1038/s41467-022-30833-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal “SHIELD: Target, Test, and Tell” program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university. Safely opening university campuses has been a major challenge during the COVID-19 pandemic. Here, the authors describe a program of public health measures employed at a university in the United States which, combined with other non-pharmaceutical interventions, allowed the university to stay open in fall 2020 with limited evidence of transmission.
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Affiliation(s)
- Diana Rose E Ranoa
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA.,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robin L Holland
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Fadi G Alnaji
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kelsie J Green
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Leyi Wang
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Richard L Fredrickson
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Tong Wang
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - George N Wong
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Johnny Uelmen
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sergei Maslov
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA.,Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Zachary J Weiner
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alexei V Tkachenko
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
| | - Hantao Zhang
- Computer Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Zhiru Liu
- Department of Physics, Stanford University, Palo Alto, CA, USA
| | - Ahmed Ibrahim
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sanjay J Patel
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John M Paul
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Nickolas P Vance
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph G Gulick
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Isaac J Galvan
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Andrew Miller
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph Grohens
- Department of English, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Todd J Nelson
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mary P Stevens
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Robert C Parker
- McKinley Health Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | | | - Julie D Steinman
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Melvin R Fenner
- McKinley Health Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kirstin Dohrer
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Michael DeLorenzo
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura Wilhelm-Barr
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Catherine Best-Popescu
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gary Durack
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.,Tekmill, Champaign, IL, USA
| | | | - David M Kranz
- Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jessica Breitbarth
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charlie Simpson
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Julie A Pryde
- Champaign-Urbana Public Health District, Champaign, IL, USA
| | - Robin N Kaler
- Public Affairs, College of Media, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Chris Harris
- Public Affairs, College of Media, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Allison C Vance
- Public Affairs, College of Media, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jodi L Silotto
- Public Affairs, College of Media, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mark Johnson
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Enrique Andres Valera
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Patricia K Anton
- Housing Division, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Lowa Mwilambwe
- Office of the Vice Chancellor for Student Affairs, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Stephen P Bryan
- Office of the Dean of Students, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deborah S Stone
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Danita B Young
- Office of the Vice Chancellor for Student Affairs, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Wanda E Ward
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John Lantz
- Office of the Dean of Students, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John A Vozenilek
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Rashid Bashir
- Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jeffrey S Moore
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mayank Garg
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Julian C Cooper
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gillian Snyder
- Interdisciplinary Health Sciences Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Michelle H Lore
- Interdisciplinary Health Sciences Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Dustin L Yocum
- Office for the Protection of Human Subjects, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Neal J Cohen
- Office of the Dean of Students, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Psychology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jan E Novakofski
- College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Melanie J Loots
- Office of the Vice Chancellor for Research and Innovation, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Randy L Ballard
- Department of Intercollegiate Athletics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mark Band
- Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kayla M Banks
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph D Barnes
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Iuliana Bentea
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Black
- Illinois Human Resources, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jeremy Busch
- Department of Intercollegiate Athletics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Madison Conte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Curry
- Illinois Human Resources, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jennifer Eardley
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - April Edwards
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Therese Eggett
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Judes Fleurimont
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Delaney Foster
- Division of Campus Recreation, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bruce W Fouke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA.,Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nicholas Gallagher
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Gastala
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott A Genung
- Office of the Chief Info Officer, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Declan Glueck
- Illinois Human Resources, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Brittani Gray
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Andrew Greta
- University of Illinois System Office, Urbana, IL, USA
| | - Robert M Healy
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ashley Hetrick
- University Health Services, University of Wisconsin-Madison, Madison, WI, USA
| | - Arianna A Holterman
- Office of the Dean of Students, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nahed Ismail
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ian Jasenof
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Patrick Kelly
- University Health Services, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron Kielbasa
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Teresa Kiesel
- University Health Services, University of Wisconsin-Madison, Madison, WI, USA
| | - Lorenzo M Kindle
- Technology Services, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rhonda L Lipking
- Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jade Mayes
- Department of Intercollegiate Athletics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Reubin McGuffin
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kenton G McHenry
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Agha Mirza
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jada Moseley
- Illinois Human Resources, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melody Mumford
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Kathleen Munoz
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Arika D Murray
- Illinois Human Resources, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Moira Nolan
- Office of Corporate Relations, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nil A Parikh
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Janna Pflugmacher
- University Administration, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Janise M Phillips
- McKinley Health Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Collin Pitts
- University Health Services, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark C Potter
- Department of Family and Community Medicine, College of Medicine, University of Illinois at Chicago, Chicago, USA
| | - James Quisenberry
- Division of Student Affairs, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Janelle Rear
- Office of the Vice President for Economic Development and Innovation, University of Illinois System, Urbana, IL, USA
| | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Edith Rosillo
- Library Department, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Leslie N Rye
- Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - MaryEllen Sherwood
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Anna Simon
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jamie M Singson
- Division of Student Affairs, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Carly Skadden
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Tina H Skelton
- Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charlie Smith
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mary Stech
- McKinley Health Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ryan Thomas
- Office of the Chief Info Officer, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Erika A Tyburski
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Emory University School of Medicine, Children's Healthcare of Atlanta, and Georgia Institute of Technology, Atlanta, GA, USA.,Georgia Institute of Technology, Institute for Electronics and Nanotechnology, Atlanta, GA, USA
| | - Scott Vanwingerden
- IT Service Delivery, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Evette Vlach
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ronald S Watkins
- University of Illinois System Office, Urbana, IL, USA.,Office of the President, University of Illinois System, Urbana, IL, USA
| | - Karriem Watson
- Mile Square Health Center, University of Illinois Health, Chicago, IL, USA
| | - Karen C White
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Timothy L Killeen
- Gies College of Business, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Robert J Jones
- Office of the Chancellor, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Susan A Martinis
- Office of the Vice Chancellor for Research and Innovation, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Awais Vaid
- Champaign-Urbana Public Health District, Champaign, IL, USA
| | - Christopher B Brooke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA.,Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Joseph T Walsh
- Library Department, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ahmed Elbanna
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - William C Sullivan
- Department of Landscape Architecture, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Rebecca L Smith
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA. .,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Nigel Goldenfeld
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA. .,Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Physics, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Timothy M Fan
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Paul J Hergenrother
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA. .,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Martin D Burke
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Urbana, IL, USA. .,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Mirza A, Win Naing Z, Khonsari P, Khan H, Rezai P, Abbas AK, Nisar M. POS1421 AROMATASE INHIBITORS AND SKELETAL HEALTH – NATURAL HISTORY AND INTERVENTIONAL EPIDEMIOLOGY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBreast cancer remains the most common cancer diagnosed in women worldwide. Aromatase inhibitors (AI) are employed for hormone sensitive disease in mainly postmenopausal women. AI related bone loss (AIBL) is a known complication; although data regarding the natural history in the real-world, long-term outcomes and the role of bone active therapy in fracture prevention is sparse.ObjectivesOur aim was to determine the real-world impact of AIBL and whether bone sparing therapy utilising standard risk stratification model is sufficient for fracture prevention.MethodsWe undertook a longitudinal study of patients prescribed AI for breast cancer over a seven-year period at our university teaching hospital. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management. DEXA scans performed prior to initiation of AI were compared with subsequent imaging over a mean follow up of 3 years. Outcome data for cancer and all fractures was collected. Statistical analysis was done to investigate significant relationships amongst the variables of interest.Results1001 women were identified during the study period. The mean age of the cohort was 64 years (range 29-93). 929 (93%) were Caucasian, 57 (6%) were Asian and 15 (1%) were Afro-Caribbean. 723 women (72%) were diagnosed with invasive ductal carcinoma and 863 women (86%) were postmenopausal. At diagnosis, 428 women (43%) had node positive disease and 35 women (4%) had metastases. 91 women (9%) had sustained fractures prior to their breast cancer diagnosis.All women had a baseline DEXA: 496 (49.6%) had osteopenia, 151 (15%) had osteoporosis and 354 (35.4%) had a normal result. 478 (48%) of women had a repeat scan available. Overall, there was a decline (from a mean of 0.888 g/cm2 to 0.858 g/cm2, p<0.0001) in left neck of femur (LNOF) bone mineral density (BMD) over time (mean of 3 years, with a range of 1-6).334 (33%) were prescribed bone active therapy with 276 women (83%) given oral bisphosphonates. This group had an improvement in BMD by 0.4% (LNOF mean BMD of 0.785 g/cm2 at baseline compared to LNOF mean BMD of 0.788 at repeat DEXA, p=0.82).Women who were not offered any treatment (n=667, 66%), showed a significant decline in bone density with the decline being -5%. (LNOF mean BMD of 0.939 g/cm2 at baseline compared to LNOF mean BMD of 0.888 g/cm2 at repeat DEXA, p< 0.0001).The rate of fractures remained the same between the treatment (19 fractures, 5.67%) and non-treatment group (38 fractures, 5.70%)ConclusionOur study provides long term data for AIBL and confirms a significant decline in BMD over seven years. It confirms that bone sparing therapy is effective in reducing the pace of decline in BMD. However standard risk stratification model such as FRAX based intervention thresholds in mainly those with WHO defined osteoporosis (T ≤-2.5) is ineffective in fracture prevention in keeping with prior literature. Since our study period overlaps with publication of newer guidelines recommending different T score-based risk model, further studies are required to confirm their utility.References[1]https://www.wcrf.org/dietandcancer/worldwide-cancer-data/. Date accessed: 26.01.2022[2]R. Coleman, J.J. Body, M. Aapro, et al., Bone health in cancer patients: ESMO clinical practice guidelines, Ann. Oncol. 25 (Suppl 3) (2014) iii124–iii137.[3]E. Amir, B. Seruga, S. Niraula, et al., Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis, J. Natl. Cancer Inst. 103 (2011) 1299–1309.Disclosure of InterestsNone declared
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Mirza A, Win Naing Z, Khonsari P, Khan H, Rezai P, Abbas AK, Nisar M. OP0244 AROMATASE INHIBITORS AND FRACTURE PREVENTION – DO NEW GUIDELINES WORK IN REAL WORLD? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background2,261,419 women were diagnosed with breast cancer worldwide in 2020. For postmenopausal women with hormone sensitive disease, aromatase inhibitors (AI) are recommended for their mortality benefit. However, AI bone loss (AIBL) is a recognised adverse event with resultant increase in fracture risk. In 2017, a consensus statement of 7 international bone and cancer societies was published proposing an algorithm based on clinical risk factors and different bone mineral density (BMD) threshold for bone active therapeutic intervention.ObjectivesTo determine the real-world impact of the 2017 consensus guidelines on AIBL and whether bone sparing therapy utilising proposed risk stratification model is effective in fracture prevention.MethodsOver a 7-year study period, 1001 women were prescribed AI at our university teaching hospital. The new guidelines were adopted in July 2017. We split the participants in two groups: 361 (36%) women had commenced their AI prior to the adoption of guidelines and 640 (64%) were in the post implementation group.First group were offered bone active treatment based on NOS 2009 guidelines whereas the second group followed the 2017 consensus guidelines. Women with osteoporosis were all offered treatment, however the difference in guideline is pertinent to osteopenia and we compared the results of that group.Results1001 women were included. Mean age was 64 years (range 29-93). 929 (93%) were Caucasian, 57 (6%) were Asian and 15 (1%) were Afro-Caribbean. 723 women (72%) had invasive ductal carcinoma and 863 women (86%) were postmenopausal. At diagnosis, 428 women (43%) had node positive disease and 35 women (4%) had metastases. 91 women (9%) had sustained fractures prior to their cancer diagnosis.276 women (28%) were offered oral bisphosphonates based on DEXA result, with 58 (6%) offered parenteral therapy.First group: 361 women had a baseline DEXA with a mean left neck of femur (LNOF) BMD of 0.888 g/cm2 (range 0.552-1.222). 143 (40%) women had a normal DEXA, 174 (48%) had osteopenia and 44 (12%) had osteoporosis.Of the women with osteopenia, 44 (25%) women were offered treatment and 33 women had a repeat DEXA after a mean of 4 years. In the treatment group, LNOF mean BMD remained relatively unchanged from 0.814 g/cm2 to 0.812 g/cm2 at the repeat DEXA (p= 0.94).Of the 174 women with osteopenia, 22 (13%) women had a fracture.Second group: 640 women had a baseline DEXA with a mean LNOF BMD of 0.888 g/cm2 (range 0.512-1.390). 216 (33%) women were normal, 322(50%) had osteopenia and 107 (17%) had osteoporosis.Of the women with osteopenia, 127 (39%) women were offered treatment and 56 women had a repeat DEXA after a mean of 3 years. In the treatment group, LNOF mean BMD remained relatively unchanged from 0.822 g/cm2 to 0.829 g/cm2 at the repeat DEXA (p= 0.6169).Of the 322 women with osteopenia, 8 (2.5%) women had a fracture.ConclusionOur study provides real world evidence of the success of 2017 consensus statement in lowering fracture risk. Though there has been data for positive impact on BMD decline with this approach, evidence for fracture prevention has been limited. This study showcases the success of lowering bone active therapy threshold employing alternative risk modelling strategy for women with breast cancer commenced on AI. A significant reduction in fractures pre (13%) and post guidelines change (2.5%) was demonstrated (absolute risk reduction of 10.5%) which has implications for healthcare systems worldwide as we have demonstrated this approach can reduce morbidity.References[1]https://www.wcrf.org/dietandcancer/worldwide-cancer-data/. Accessed: 26.01.2022.[2]Reid DM, Doughty J, Eastell R, et al. Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer Treat Rev. 2008;34 Suppl 1:S3-S18.[3]Hadji P, Aapro MS, Body JJ, et al. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1-12.Disclosure of InterestsNone declared
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Ke R, Martinez PP, Smith RL, Gibson LL, Mirza A, Conte M, Gallagher N, Luo CH, Jarrett J, Zhou R, Conte A, Liu T, Farjo M, Walden KKO, Rendon G, Fields CJ, Wang L, Fredrickson R, Edmonson DC, Baughman ME, Chiu KK, Choi H, Scardina KR, Bradley S, Gloss SL, Reinhart C, Yedetore J, Quicksall J, Owens AN, Broach J, Barton B, Lazar P, Heetderks WJ, Robinson ML, Mostafa HH, Manabe YC, Pekosz A, McManus DD, Brooke CB. Daily longitudinal sampling of SARS-CoV-2 infection reveals substantial heterogeneity in infectiousness. Nat Microbiol 2022; 7:640-652. [PMID: 35484231 PMCID: PMC9084242 DOI: 10.1038/s41564-022-01105-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
The dynamics of SARS-CoV-2 replication and shedding in humans remain poorly understood. We captured the dynamics of infectious virus and viral RNA shedding during acute infection through daily longitudinal sampling of 60 individuals for up to 14 days. By fitting mechanistic models, we directly estimated viral expansion and clearance rates and overall infectiousness for each individual. Significant person-to-person variation in infectious virus shedding suggests that individual-level heterogeneity in viral dynamics contributes to 'superspreading'. Viral genome loads often peaked days earlier in saliva than in nasal swabs, indicating strong tissue compartmentalization and suggesting that saliva may serve as a superior sampling site for early detection of infection. Viral loads and clearance kinetics of Alpha (B.1.1.7) and previously circulating non-variant-of-concern viruses were mostly indistinguishable, indicating that the enhanced transmissibility of this variant cannot be explained simply by higher viral loads or delayed clearance. These results provide a high-resolution portrait of SARS-CoV-2 infection dynamics and implicate individual-level heterogeneity in infectiousness in superspreading.
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Affiliation(s)
- Ruian Ke
- T-6, Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Pamela P Martinez
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rebecca L Smith
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Laura L Gibson
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Agha Mirza
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Madison Conte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Gallagher
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chun Huai Luo
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Junko Jarrett
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tongyu Liu
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Mireille Farjo
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kimberly K O Walden
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gloria Rendon
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Christopher J Fields
- High-Performance Biological Computing at the Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Leyi Wang
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Richard Fredrickson
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Darci C Edmonson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Melinda E Baughman
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Karen K Chiu
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Hannah Choi
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kevin R Scardina
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shannon Bradley
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Stacy L Gloss
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Crystal Reinhart
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jagadeesh Yedetore
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jessica Quicksall
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Alyssa N Owens
- Center for Clinical and Translational Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - John Broach
- UMass Memorial Medical Center, Worcester, MA, USA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bruce Barton
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Peter Lazar
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - William J Heetderks
- National Institute for Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David D McManus
- Division of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christopher B Brooke
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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10
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Robinson ML, Mirza A, Gallagher N, Boudreau A, Garcia L, Yu T, Norton J, Luo CH, Conte A, Zhou R, Kafka K, Hardick J, McManus DD, Gibson LL, Pekosz A, Mostafa H, Manabe YC. Limitations of molecular and antigen test performance for SARS-CoV-2 in symptomatic and asymptomatic COVID-19 contacts. medRxiv 2022. [PMID: 35169814 DOI: 10.1101/2022.02.05.22270481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES COVID-19 has brought unprecedented attention to the crucial role of diagnostics in pandemic control. We compared SARS-CoV-2 test performance by sample type and modality in close contacts of SARS-CoV-2 cases. METHODS Close contacts of SARS-CoV-2 positive individuals were enrolled after informed consent. Clinician-collected nasopharyngeal (NP) swabs in viral transport media (VTM) were tested with a nucleic acid test (NAT). NP VTM and self-collected passive drool were tested using the PerkinElmer real-time reverse transcription PCR (RT-PCR) assay. For the first 4 months of study, mid-turbinate swabs were tested using the BD Veritor rapid antigen test. NAT positive NP samples were tested for infectivity using a VeroE6TMPRSS2 cell culture model. RESULTS Between November 17, 2020, and October 1, 2021, 235 close contacts of SARS-CoV-2 cases were recruited, including 95 with symptoms (82% symptomatic for < 5 days) and 140 asymptomatic individuals. NP swab reference tests were positive for 53 (22.6%) participants; 24/50 (48%) were culture positive. PerkinElmer testing of NP and saliva samples identified an additional 28 (11.9%) SARS-CoV-2 cases who tested negative by clinical NAT. Antigen tests performed for 99 close contacts showed 83% positive percent agreement (PPA) with reference NAT among early symptomatic persons, but 18% PPA in others; antigen tests in 8 of 11 (72.7%) culture-positive participants were positive. CONCLUSIONS Contacts of SARS-CoV-2 cases may be falsely negative early after contact, which more sensitive platforms may identify. Repeat or serial SARS-CoV-2 testing with both antigen and molecular assays may be warranted for individuals with high pretest probability for infection.
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11
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Ali RF, Offeddu V, Siddiqi DA, Mirza A, Naz N, Abdullah S, Lim JM, Kembhavi G, Tam CC, Chandir S. Adolescent girls’ recommendations for designing Human Papillomavirus Vaccination Program in Pakistan. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In Pakistan, cervical cancer is the third most frequent cancer among women. Most cases are caused by sexually-acquired infection with human papillomaviruses (HPV). Vaccination of adolescent girls against HPV significantly reduces the incidence of cervical cancer. HPV vaccination is available in Pakistan, but plans to develop a HPV vaccination program are currently at a very early stage. We conducted a formative study to explore adolescent girls' perspectives on HPV and cervical cancer, and collected their recommendations for implementing an HPV vaccination program. We conducted qualitative focus group discussions (FGDs), with unmarried adolescent girls aged 16-19 years, residing in Karachi. We conducted four FGDs with 12 participants each. The topic guide assessed i) girls' knowledge of cervical cancer and HPV vaccination, ii) vaccination decision-making dynamics within families, and iii) factors girls would consider essential for the successful implementation of HPV vaccination program. Overall, participants displayed a positive attitude towards the HPV vaccine. However, many basic concepts related to female reproductive health were unfamiliar to them. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as the definitive decision-making authority on vaccination. Girls gave critical input for the development of a HPV vaccination program. Eligible girls should be recruited through individual household visits and the vaccine should be administered at community-based camps, which would ensure both good accessibility and a large outreach. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. Adolescents demonstrated great capacity and shared recommendations for a future program's acceptability. Integrating their perspectives will be essential to design an effective program in local context.
Key messages
Adolescent girls’ perspectives should be incorporated to develop context-specific recommendations for the implementation of a HPV vaccination program. Community-based camps and household visits by adolescent girls to recruit the target population could potentially increase program penetration among communities.
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Affiliation(s)
- RF Ali
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - V Offeddu
- MCH, IRD-Global, Singapore, Singapore
| | | | - A Mirza
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - N Naz
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - S Abdullah
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - JM Lim
- National University of Singapore, Singapore, Singapore
| | - G Kembhavi
- National University of Singapore, Singapore, Singapore
| | - CC Tam
- National University of Singapore, Singapore, Singapore
| | - S Chandir
- MCH, IRD-Global, Singapore, Singapore
- Harvard Medical School, Boston, MA, USA
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12
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Smith RL, Gibson LL, Martinez PP, Ke R, Mirza A, Conte M, Gallagher N, Conte A, Wang L, Fredrickson R, Edmonson DC, Baughman ME, Chiu KK, Choi H, Jensen TW, Scardina KR, Bradley S, Gloss SL, Reinhart C, Yedetore J, Owens AN, Broach J, Barton B, Lazar P, Henness D, Young T, Dunnett A, Robinson ML, Mostafa HH, Pekosz A, Manabe YC, Heetderks WJ, McManus DD, Brooke CB. Longitudinal Assessment of Diagnostic Test Performance Over the Course of Acute SARS-CoV-2 Infection. J Infect Dis 2021; 224:976-982. [PMID: 34191025 PMCID: PMC8448437 DOI: 10.1093/infdis/jiab337] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [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: 04/21/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Serial screening is critical for restricting spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by facilitating timely identification of infected individuals to interrupt transmission. Variation in sensitivity of different diagnostic tests at different stages of infection has not been well documented. METHODS In a longitudinal study of 43 adults newly infected with SARS-CoV-2, all provided daily saliva and nasal swabs for quantitative reverse transcription polymerase chain reaction (RT-qPCR), Quidel SARS Sofia antigen fluorescent immunoassay (FIA), and live virus culture. RESULTS Both RT-qPCR and Quidel SARS Sofia antigen FIA peaked in sensitivity during the period in which live virus was detected in nasal swabs, but sensitivity of RT-qPCR tests rose more rapidly prior to this period. We also found that serial testing multiple times per week increases the sensitivity of antigen tests. CONCLUSIONS RT-qPCR tests are more effective than antigen tests at identifying infected individuals prior to or early during the infectious period and thus for minimizing forward transmission (given timely results reporting). All tests showed >98% sensitivity for identifying infected individuals if used at least every 3 days. Daily screening using antigen tests can achieve approximately 90% sensitivity for identifying infected individuals while they are viral culture positive.
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Affiliation(s)
- Rebecca L Smith
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura L Gibson
- Division of Infectious Diseases and Immunology, Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Pamela P Martinez
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ruian Ke
- T-6, Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Agha Mirza
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Madison Conte
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Gallagher
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abigail Conte
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Leyi Wang
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Richard Fredrickson
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Darci C Edmonson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Melinda E Baughman
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Karen K Chiu
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Hannah Choi
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Tor W Jensen
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Kevin R Scardina
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Shannon Bradley
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Stacy L Gloss
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Crystal Reinhart
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Jagadeesh Yedetore
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alyssa N Owens
- Center for Clinical and Translational Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John Broach
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bruce Barton
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Peter Lazar
- Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Todd Young
- Carle Foundation Hospital, Urbana, Illinois, USA
| | | | - Matthew L Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - William J Heetderks
- National Institute for Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - David D McManus
- Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christopher B Brooke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Correspondence: Christopher Brooke, PhD, 390 Burrill Hall, Urbana, IL 61801 ()
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13
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Ke R, Martinez PP, Smith RL, Gibson LL, Achenbach CJ, McFall S, Qi C, Jacob J, Dembele E, Bundy C, Simons LM, Ozer EA, Hultquist JF, Lorenzo-Redondo R, Opdycke AK, Hawkins C, Murphy RL, Mirza A, Conte M, Gallagher N, Luo CH, Jarrett J, Conte A, Zhou R, Farjo M, Rendon G, Fields CJ, Wang L, Fredrickson R, Baughman ME, Chiu KK, Choi H, Scardina KR, Owens AN, Broach J, Barton B, Lazar P, Robinson ML, Mostafa HH, Manabe YC, Pekosz A, McManus DD, Brooke CB. Longitudinal analysis of SARS-CoV-2 vaccine breakthrough infections reveal limited infectious virus shedding and restricted tissue distribution. medRxiv 2021:2021.08.30.21262701. [PMID: 34494028 PMCID: PMC8423226 DOI: 10.1101/2021.08.30.21262701] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The global effort to vaccinate people against SARS-CoV-2 in the midst of an ongoing pandemic has raised questions about the nature of vaccine breakthrough infections and the potential for vaccinated individuals to transmit the virus. These questions have become even more urgent as new variants of concern with enhanced transmissibility, such as Delta, continue to emerge. To shed light on how vaccine breakthrough infections compare with infections in immunologically naive individuals, we examined viral dynamics and infectious virus shedding through daily longitudinal sampling in a small cohort of adults infected with SARS-CoV-2 at varying stages of vaccination. The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. These data indicate that vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.
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14
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Ke R, Martinez PP, Smith RL, Gibson LL, Mirza A, Conte M, Gallagher N, Luo CH, Jarrett J, Conte A, Liu T, Farjo M, Walden KKO, Rendon G, Fields CJ, Wang L, Fredrickson R, Edmonson DC, Baughman ME, Chiu KK, Choi H, Scardina KR, Bradley S, Gloss SL, Reinhart C, Yedetore J, Quicksall J, Owens AN, Broach J, Barton B, Lazar P, Heetderks WJ, Robinson ML, Mostafa HH, Manabe YC, Pekosz A, McManus DD, Brooke CB. Daily sampling of early SARS-CoV-2 infection reveals substantial heterogeneity in infectiousness. medRxiv 2021. [PMID: 34282424 DOI: 10.1101/2021.07.12.21260208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The dynamics of SARS-CoV-2 replication and shedding in humans remain poorly understood. We captured the dynamics of infectious virus and viral RNA shedding during acute infection through daily longitudinal sampling of 60 individuals for up to 14 days. By fitting mechanistic models, we directly estimate viral reproduction and clearance rates, and overall infectiousness for each individual. Significant person-to-person variation in infectious virus shedding suggests that individual-level heterogeneity in viral dynamics contributes to superspreading. Viral genome load often peaked days earlier in saliva than in nasal swabs, indicating strong compartmentalization and suggesting that saliva may serve as a superior sampling site for early detection of infection. Viral loads and clearance kinetics of B.1.1.7 and non-B.1.1.7 viruses in nasal swabs were indistinguishable, however B.1.1.7 exhibited a significantly slower pre-peak growth rate in saliva. These results provide a high-resolution portrait of SARS-CoV-2 infection dynamics and implicate individual-level heterogeneity in infectiousness in superspreading.
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Mirza A, Nisar MK. POS0227 SHOULD ALL PATIENTS TRIAL SUBCUTANEOUS METHOTREXATE PRIOR TO COMMENCING BIOLOGIC THERAPY – A REAL WORLD STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Methotrexate (MTX) is the bed rock of inflammatory arthritis management. However intolerance is a major limiting factor for drug optimisation and retention. There is data to suggest that subcutaneous (SC) MTX is tolerated better and is now being recommended in several guidelines including ACR’s. It is less clear though whether this strategy is effective in those where oral preparation is inefficacious and its potential to avoid escalation to biologic therapy.Objectives:Our aim was to analyse the reasons for switching to SC formulation in a real world setting, clinical outcomes achieved and proportion requiring biologic prescription.Methods:We undertook a retrospective survey of all patients prescribed SC MTX in a large university teaching hospital between 1983 and Apr 2019. We had access to full patient records including details on co-morbidities, drugs and disease management. We analysed demographics, reasons for SC MTX initiation, clinical outcomes and impact on biologic prescription.Results:352 patients were identified during the study period. The mean age of the cohort was 54 yrs (3-87). 192 (70%) were women. 260 (74%) were Caucasian, 64 (18%) Asian, 21 (6%) Afro-Caribbean and remaining of other ethnicity. Two most common diagnoses were RA [n=243 (69%)] and pSpA [n=66 (18%)]. Average disease duration was 74 months (11-324) with mean of three comorbidities (0-11).284 (80%) had switched from oral to SC MTX. 137 (49%) stopped oral MTX due to side effects. Mean duration of oral MTX prior to switching was 26 months (0.25-167). Follow up period for SC MTX ranged from two to 132 months (mean 29) until the data cut-off date of Apr 2019. 103 (29%) patients progressed to biologic therapy.Amongst RA patients, DAS28 improved from mean 4.16 (0.63-8.06) to 2.83 (0.14-7.32) following the switch. pSpA cohort’s mean TJC and SJC improved from mean seven (0-42) and two (0-26) to two (0-25) and one (0-6) respectively.Conclusion:Our study confirms that SC MTX is an effective solution irrespective of whether oral MTX is inefficacious or intolerable. This applies to people with both RA and pSpA. In accordance with prior published data, our findings support the utility of SC MTX for those intolerant of enteral option. Additionally, it shows that even in instances where oral MTX was ineffective, a switch to SC formulation achieved low disease activity despite multi-morbidity, long disease course and protracted oral MTX exposure. This intervention also prevented over two-thirds of patients progressing to biologic therapy with significant financial savings. SC MTX therefore remains a durable strategy with excellent disease outcomes and confers substantial economic benefits to healthcare.Disclosure of Interests:None declared
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16
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Smith RL, Gibson LL, Martinez PP, Ke R, Mirza A, Conte M, Gallagher N, Conte A, Wang L, Fredrickson R, Edmonson DC, Baughman ME, Chiu KK, Choi H, Jensen TW, Scardina KR, Bradley S, Gloss SL, Reinhart C, Yedetore J, Owens AN, Broach J, Barton B, Lazar P, Henness D, Young T, Dunnett A, Robinson ML, Mostafa HH, Pekosz A, Manabe YC, Heetderks WJ, McManus DD, Brooke CB. Longitudinal assessment of diagnostic test performance over the course of acute SARS-CoV-2 infection. medRxiv 2021. [PMID: 33791719 DOI: 10.1101/2021.03.19.21253964] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
What is already known about this topic? Diagnostic tests and sample types for SARS-CoV-2 vary in sensitivity across the infection period. What is added by this report? We show that both RTqPCR (from nasal swab and saliva) and the Quidel SARS Sofia FIA rapid antigen tests peak in sensitivity during the period in which live virus can be detected in nasal swabs, but that the sensitivity of RTqPCR tests rises more rapidly in the pre-infectious period. We also use empirical data to estimate the sensitivities of RTqPCR and antigen tests as a function of testing frequency. What are the implications for public health practice? RTqPCR tests will be more effective than rapid antigen tests at identifying infected individuals prior to or early during the infectious period and thus for minimizing forward transmission (provided results reporting is timely). All modalities, including rapid antigen tests, showed >94% sensitivity to detect infection if used at least twice per week. Regular surveillance/screening using rapid antigen tests 2-3 times per week can be an effective strategy to achieve high sensitivity (>95%) for identifying infected individuals.
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17
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Siddiqi DA, Mirza A, Abdullah S, Dharma VK, Shah MT, Akhter MA, Habib A, Khan AJ, Chandir S. Real-time immunization trends in under-2 children in Pakistan: insights from big data analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite the provision of free-of-cost vaccines in Pakistan, fully immunized child (FIC) coverage in Sindh province remains low at 49%. In 2012, we developed and piloted the Zindagi Mehfooz (Safe Life; ZM) Digital Immunization Registry, an Android-based platform that enables vaccinators to enroll and track child level immunization data of children in the catchment population. In 2017, ZM was scaled-up across Sindh province and is currently being used by 2,284 vaccinators across 1,526 facilities serving >48 million (m) population.
Methods
All children under-2 years of age visiting EPI centers are enrolled. At enrollment, caregiver and child bio-data and child immunization history are recorded, and the child is provided with a unique Quick Response (QR) code for identification. For follow-up immunization visits, 3 SMS reminders are sent to caregivers, and upon immunization, child history is retrieved by scanning the QR code and vaccination record updated. ZM allows real-time access to data and generation of monitoring reports. Data from ZM was used to calculate coverage rates, timeliness, and trends for immunization coverage in Sindh.
Results
From Oct'17 to Dec'19, more than 2.4m children and 0.8m women were enrolled in the Registry, while >17m immunizations were administered. The FIC coverage in 12-23 months old children has increased from 49% (at baseline) to 57% for children enrolled in ZM. Additionally, pentavalent-3 coverage increased from 59% to 68%.
Discussion
ZM demonstrates the potential of DIRs to improve immunization outcomes within low-resource settings by enabling better child tracking and a higher retention rate. Additionally, the big dataset provides the opportunity to identify real-time trends and provides actionable data for evidence-based decision making.
Key messages
ZM Immunization Registry has strengthened the current EPI program through increased FIC coverage and timeliness through better tracking of children and increased retention. Big Data from ZM can be used to analyze immunization trends of global relevance, and guide strategic policy decisions for improving immunization coverage and equity, based on actionable data insights.
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Affiliation(s)
| | - A Mirza
- IRD Pakistan, Karachi, Pakistan
| | | | - V K Dharma
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | | | - M A Akhter
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | - A Habib
- Interactive Health Solutions, Karachi, Pakistan
| | - A J Khan
- IRD Global, Singapore, Singapore
- Harvard Medical School, Boston, USA
| | - S Chandir
- IRD Global, Perry Hall, USA
- Harvard Medical School, Boston, USA
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18
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Siddique M, Abdullah S, Siddiqi DA, Mirza A, Dharma VK, Shah MT, Akhter MA, Khan AJ, Chandir S. Using mobile immunization vans to cover under-served populations in hard-to-reach areas. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In Pakistan, only 66% of children receive their basic vaccinations. However, the figure masks significant inequalities in vaccine coverage between urban and rural residences, slums and areas distantly located from EPI centers. Frequent outbreaks of vaccine-preventable diseases such as polio and measles, in urban cities like Karachi, signal the need for expanding vaccine services to underserved areas. In Apr'19, we introduced the Mobile Immunization Van initiative in Karachi in collaboration with EPI Sindh. Currently, two vans are deployed in hard-to-reach areas and slums to immunize under-2 children for routine vaccines.
Methods
Before the van visit, mobilization efforts are conducted in targeted areas to encourage caretakers to bring their child for vaccination. On the day of visit, the van is parked at a central location, and announcements are played on a loudspeaker to attract caregivers. All vaccinations are administered in the van, and entries are recorded in Government's Digital Immunization Registry along with GIS coordinates of immunized children. The data is then automatically transferred on to a web-dashboard for analysis and tracking.
Results
From Apr'19 to Jan'20, the vans have vaccinated 2,867 children, out of which 50% had never been immunized prior to the van visit. Of those who received their follow-up vaccines from the van, 80% were at least 4 weeks beyond from their vaccine due date. GIS analysis of van data confirmed that immunizations were conducted in slums, and areas distantly located from EPI centers. Moreover, compared to government outreach activity, proportion of BCG, Penta3 and Measles1 administrations in slums was higher through the vans by 5%, 6%, and 4% respectively.
Conclusions
The vans provide an opportunity for immunizing never-vaccinated children and children defaulting on their vaccine schedule, from the most vulnerable geographies, while simultaneously enrolling them in the Government's EPI Program for effective tracking.
Key messages
The mobile vans help achieve universal immunization coverage through provision of vaccine services in slum and rural hard-to-reach areas with limited access to government-provided services. The mobile vans help vaccinate and capture never-immunized children into the Government’s EPI records, reducing the number of children missed through routine services.
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Affiliation(s)
| | | | | | - A Mirza
- IRD Pakistan, Karachi, Pakistan
| | - V K Dharma
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | | | - M A Akhter
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | - A J Khan
- IRD Global, Singapore, Singapore
- Harvard Medical School, Boston, USA
| | - S Chandir
- IRD Global, Perry Hall, USA
- Harvard Medical School, Boston, USA
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Tolah A, Masaudi SAL, El-Kafrawy S, Mirza A, Harakeh S, Hassan A, Alzahrani A, Alsaaidi G, Alagaili A, Hashem A, Azhar E. Cross-sectional prevalence study of MERS-CoV in local and imported dromedary camels in Saudi Arabia, 2016-2018. J Infect Public Health 2020. [PMCID: PMC7129807 DOI: 10.1016/j.jiph.2020.01.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Bhargavan RV, Mirza A, Cherian K, Krishna J, Augustine P. Level III dissection in locally advanced breast cancer following neoadjuvant chemotherapy: a retrospective study. Ann R Coll Surg Engl 2019; 102:214-219. [PMID: 31755729 DOI: 10.1308/rcsann.2019.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common female cancer in India, and 30-60% of patients present with locally advanced breast cancer. Level III clearance is routinely performed in India in locally advanced breast cancer following neoadjuvant chemotherapy, even in clinical complete response. We analysed our data of patients with locally advanced breast cancer post-neoadjuvant chemotherapy who have undergone level III clearance to identify any subgroup in which level III dissection can be avoided. MATERIAL AND METHODS This is a retrospective study of female patients with locally advanced breast cancer who received neoadjuvant chemotherapy and underwent breast surgery including level III nodal clearance between June 2016 and May 2018. Data collected included age, menopausal status, TNM stage at presentation, grade, estrogen, progesterone, human epidermal growth factor receptor 2 status, response to treatment, post-chemotherapy stage and final histopathology. Uni- and multivariate analysis was undertaken. RESULTS Data from 200 patients was analysed. The level III positivity rate was 15.5%. The clinical complete response rate was 43%, of which 41% had pathological complete response. A significant association was present between level III node positivity and pathological T stage (p=0.03). No association was seen between level III positivity and any other studied variables. In the subset of patients with cT3N1 and cT2N2, level III positivity was seen in only 3/49 (6.1%) and 1/31 (3%), respectively. CONCLUSION Level III positivity rate is high and so cannot be avoided in locally advanced breast cancer following neoadjuvant chemotherapy. None of the preoperative factors predict for level III positivity. Level III positivity in cT3N1 and cT2N2 is low and these subgroups require further studies.
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Affiliation(s)
- R V Bhargavan
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - A Mirza
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K Cherian
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - J Krishna
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - P Augustine
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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21
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Blacksburg S, Carpenter T, Demircioglu G, Mirza A, Coakley M, Mieles M, Murray A, Witten M, Mendez C, Katz A, Haas J. Comparison of 5-Year Outcomes of Stereotactic Body Radiotherapy for African American and white Men Treated for Low Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Blacksburg S, Demircioglu G, Carpenter T, Mirza A, Witten M, Mendez C, Katz A, Haas J. Demographic and Pharmaceutical Predictors of Unfavorable Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Blacksburg S, Powers A, Carpenter T, Demircioglu G, Mirza A, Witten M, Haas J. An Eighteen-Year Longitudinal Analysis of Accepted Prostate Cancer Presentations at the Annual ASTRO Meeting (2000-2017): Historical Trends In SBRT Technique Composition. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Demircioglu G, Haas J, Mirza A, Witten M, Carpenter T, Mendez C, Coakley M, Mieles M, Murray A, Blacksburg S. Assessing the Impact of Increased Dose Rate Output on Bladder and Rectal Quality of Life in Men Treated with Definitive SBRT for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019. [PMID: 30832732 DOI: 10.1186/s40425-018-0493-9.pmid:30832732;pmcid:pmc6399967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
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Affiliation(s)
- E Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - D S Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Q Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M D To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Binnewies
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - M L Broz
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - H Mori
- Center for Comparative Medicine UC Davis, Davis, CA, USA
| | - D Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - O Li
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - T Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - B Liang
- Xoma Corporation, Berkeley, CA, USA
| | - J Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - F Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B C Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - A Mirza
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - S A Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M D Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M F Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Pathology, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - A Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA, USA
| | - R J Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Department of Anatomy, UCSF, San Francisco, CA, USA.
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26
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Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019; 7:62. [PMID: 30832732 PMCID: PMC6399967 DOI: 10.1186/s40425-018-0493-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
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MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
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Affiliation(s)
- E. Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - D. S. Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Q. Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. D. To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Binnewies
- Department of Pathology, UCSF, San Francisco, CA USA
| | - M. L. Broz
- Department of Pathology, UCSF, San Francisco, CA USA
| | - H. Mori
- Center for Comparative Medicine UC Davis, Davis, CA USA
| | - D. Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - O. Li
- Department of Medicine, UCSF, San Francisco, CA USA
| | - T. Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - B. Liang
- Xoma Corporation, Berkeley, CA USA
| | - J. Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - F. Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B. C. Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - A. Mirza
- Department of Medicine, UCSF, San Francisco, CA USA
| | - S. A. Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M. D. Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. F. Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Pathology, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
| | - A. Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA USA
| | - R. J. Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Anatomy, UCSF, San Francisco, CA USA
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Abdulwahid D, Abutaleb K, Mirza A. Single centre real life experience with first line pembrolizumab in advanced NSCLC in the North West Coast (Lans and South Cumbria). Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30149-7] [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: 11/26/2022]
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Blacksburg S, Carpenter T, Demircioglu G, Mirza A, Witten M, Sheu R, Mendez C, Morgenstern J, Pappas D, Garbus J, Haas J. Robotic-Based SBRT for Prostate Cancer is Well Tolerated in Patients with a History of Inflammatory Bowel Disease. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.375] [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: 11/25/2022]
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Blacksburg S, Sheu R, Demircioglu G, Mirza A, Carpenter T, Morgenstern J, Witten M, Mendez C, Endres P, Katz A, Haas J. PSA Nadir 2 Years after Definitive SBRT for Prostate Cancer: Predictors of Absolute PSA Decline. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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30
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Demircioglu G, Mirza A, Fernandez S, Morgenstern J, Murray A, Haas J, Oliveri M, Aime S, Blacksburg S. Addressing Billing Errors: Results of a Prospective Quality Assurance Initiative to Optimize the Accuracy of Radiation Oncology Patient Charges. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Blacksburg S, Sheu R, Carpenter T, Demircioglu G, Mirza A, Morgenstern J, Witten M, Mendez C, Endres P, Pappas D, Garbus J, Haas J. Characterizing Rectal Dosimetry in Patients Who Have Received Definitive SBRT for Prostate Cancer: The 7-year Freedom from Proctitis in a Large Patient Cohort. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Blacksburg S, Sheu R, Carpenter T, Demircioglu G, Morgenstern J, Mirza A, Witten M, Endres P, Haas J. Dosimetric Predictors For Attaining Rectal V3600cGy <1cc During SBRT for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Whitson R, Mirza A, Yao C, McKeller S, Hollmig S, Aasi S, Sarin K, Tang J, Oro A. 210 MRTF inhibition displays promising therapeutic potential in human BCC patient explants. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim G, Kwon G, Bailey-Healy I, Mirza A, Whitson R, Oro A, Tang J. 456 Pilot study of topical itraconazole for the treatment of basal cell carcinomas in gorlin syndrome patients. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Mirza A, McKeller S, Oro A. 179 Drug resistance in basal cell carcinoma identifies the inner nuclear membrane as a critical GLI1 regulatory checkpoint. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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36
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Ibrahim E, Biswas A, Mirza A, Sivaramalingam M. PO-0698: Severe and late dysphagia after head and neck cancer IMRT without residual disease. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31008-9] [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: 10/14/2022]
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37
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Jao J, Yu W, Patel K, Miller TL, Karalius B, Geffner ME, DiMeglio LA, Mirza A, Chen JS, Silio M, McFarland EJ, Van Dyke RB, Jacobson D. Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study. HIV Med 2017; 19:175-183. [PMID: 29159965 DOI: 10.1111/hiv.12566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Dyslipidaemia is common in perinatally HIV-infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs. METHODS We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TC:HDL-C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)- or darunavir/ritonavir (DRV/r)-based antiretroviral therapy (ART) from an older PI-based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r- or DRV/r-based ART with the rate of change in lipids, adjusted for potential confounders. RESULTS From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL-C. (β = -0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL-C, LDL-C, or TG change. CONCLUSIONS A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL-C ratio in PHIV youth, potentially impacting long-term cardiovascular disease risk.
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Affiliation(s)
- J Jao
- Department of Obstetrics, Gynecology and Reproductive Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Yu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - K Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - T L Miller
- Department of Pediatrics, University of Miami, Miami, FL, USA
| | - B Karalius
- Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M E Geffner
- Keck School of Medicine of USC, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - L A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Mirza
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA
| | - J S Chen
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA
| | - M Silio
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - E J McFarland
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - R B Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - D Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Blacksburg S, Mirza A, Katz A, Carpenter T, Witten M, Haas J. Testicular Dose as a Function of Robotic Non-coplanar Planimetry: Computing the Effect of Limiting Transtesticular Beam Pathway for Prostate Cancer SBRT. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Blacksburg S, Mirza A, Carpenter T, Ebling D, Catell D, Witten M, Haas J. Chart Rounds at a High Volume Hospital Program: Quantifying Discussion Time as a Function of Patient and Treatment Parameters. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Blacksburg S, Mirza A, Murray A, Maher N, Mieles M, Scalia K, Carpenter T, Witten M, Katz A, Haas J. Fiducials as Surrogate for Prostate Motion During Robotic SBRT for Prostate Cancer: Predictors of Migration and Interfraction Discursion. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1117] [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: 11/26/2022]
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King A, Troakes C, Aizpurua M, Mirza A, Hodges A, Al-Sarraj S, Exley C. Unusual neuropathological features and increased brain aluminium in a resident of Camelford, UK. Neuropathol Appl Neurobiol 2017; 43:537-541. [PMID: 28603852 DOI: 10.1111/nan.12417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 12/20/2022]
Affiliation(s)
- A King
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - C Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - M Aizpurua
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - A Mirza
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Keele, Staffordshire, UK
| | - A Hodges
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - S Al-Sarraj
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - C Exley
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Keele, Staffordshire, UK
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Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017; 7:26-31. [PMID: 28775940 DOI: 10.5588/pha.16.0125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. Objective: To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. Design: This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Results: Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Conclusion: Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.
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Affiliation(s)
- Y Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M A Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E Heldal
- Independent TB Consultant, Oslo, Norway
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
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Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017. [DOI: 10.5588/pha.16.0125%0asetting] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- Y. Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. A. Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R. Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E. Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E. Heldal
- Independent TB Consultant, Oslo, Norway
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union South-East Asia Office, New Delhi, India
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Whitson R, Lee A, Urman N, Li J, Mirza A, Brown A, Yao C, Shankar G, Fry M, Atwood S, Epstein E, Tang J, Oro A. 081 Resistant basal cell carcinomas require SRF/MRTF to maintain hedgehog pathway activation and tumor growth. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.107] [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: 10/21/2022]
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Zia S, Mirza A, Ozbek U, Sheu R, Ghafar R, Posner M, Misiukiewicz K, Genden E, Gupta V, Bakst R. Clinical and Treatment Predictors of Weight Loss in Patients With Head and Neck Malignancies Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mirza A, Galloway S. Laparoscopy, computerised tomography and fluorodeoxyglucose positron emission tomography in the management of gastric and gastro-oesophageal junction cancers. Surg Endosc 2015; 30:2690-6. [PMID: 26487234 DOI: 10.1007/s00464-015-4590-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The staging laparoscopy has been used in the management of gastrointestinal cancers. The aim of this study was to evaluate the role of staging laparoscopy, in comparison with computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in staging patients with gastro-oesophageal junction (GOJ) and gastric cancers. METHODS The data were collected for patients between 1996 and 2013 undergoing investigation and treatment for GOJ and gastric cancers at a single institute. The pre-operative data (staging data), intraoperative details, post-operative course and follow-up were analysed for individual cases. RESULTS Staging laparoscopy altered management plan in 64 (17 %) of 387 patients with negative staging CT and FDG-PET scan. Twenty-seven (7 %) patients with GOJ cancer (types I, II and III) were identified with pathological intraperitoneal nodes, 15 (4 %) gastric cancer with metastatic intraperitoneal deposits and liver metastases and 3 % gastric cancers with positive ascitic fluid for cancer cells. Ten (3 %) of patients were downstaged and were offered curative resection. Patients with metastatic disease were referred for palliative chemotherapy. The overall sensitivity of staging laparoscopy in diagnosing intraabdominal pathology was 86 % in comparison with CT (81 %) and FDG-PET (78 %). CONCLUSIONS The diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease not evident on the staging CT scan and FDG-PET. This could potentially alter treatment and prognosis in patients with upper gastrointestinal cancer. The diagnostic laparoscopy should be performed as part of investigation and treatment planning for patients suffering from GOJ and gastric cancers. This can help to avoid surgery in patients with advanced disease.
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Affiliation(s)
- A Mirza
- Department of Oesophago-Gastric Surgery, The University Hospital of South Manchester, Manchester, UK. .,Department of General Surgery, The University Hospital of South Manchester, SouthMoor Road, Manchester, M23 2RW, UK.
| | - S Galloway
- Department of Oesophago-Gastric Surgery, The University Hospital of South Manchester, Manchester, UK
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Raza F, Oliveros E, Mirza A, Forfia P, Schwartz D, Dries D, Tsai E, Punnoose L, Shiose A, Toyoda Y, Alvarez R, Bove A, Hamad E. Simple RVOT Doppler Measurements in Addition to Hemodynamic Variables Can Help Identify Need for RVAD at Time of LVAD Placement. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.636] [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: 11/26/2022] Open
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Mirza A, Foster L, Valentine H, Welch I, West CM, Pritchard S. Investigation of the epithelial to mesenchymal transition markers S100A4, vimentin and Snail1 in gastroesophageal junction tumors. Dis Esophagus 2014; 27:485-92. [PMID: 23082947 DOI: 10.1111/j.1442-2050.2012.01435.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial to mesenchymal transition (EMT) promotes tumor progression and invasion. As no study has focused on gastroesophageal junction (GEJ) tumors, the expression of three EMT-related proteins (S100A4, vimentin, and Snail1) was investigated with the aim of assessing their pathologic and prognostic significance. Resection specimens were obtained from 104 patients who underwent surgery for GEJ adenocarcinoma, without preoperative chemotherapy. Three tissue cores were obtained from each of the tumor body (TB), luminal surface (LS), and invasive edge (IE) to produce tissue microarrays, and immunohistochemical staining was performed. The microarrays were scored independently by two observers. The demographic and histopathologic details of the patients were collected. Overall positive expression was observed in 88 (S100A4, 85%), 16 (vimentin, 14%), and 92 (Snail1, 89%) tumors. Staining for S100 A4 was positive in 79 (76%) of TB, 69 (66%) of IE, and 69 (66%) of LS specimens. Staining for vimentin was positive in 7 (6%) of TB, 11 (11%) of IE, and 5 (5%) of LS specimens. Staining for Snail1 was positive in 83 (80%) of TB, 51 (49%) of IE, and 78 (75%) of LS specimens. Positive staining of TB for S100A4 (P = 0.04) and Snail1 at IE (P = 0.01) was associated with involvement of circumferential resection margins. Positive staining for S100A4 in the TB (P = 0.02) and LS (P = 0.01) was associated with poor 5-year overall survival. Vimentin had no statistically significant relationships with pathologic factors or outcome. The acquisition of mesenchymal protein S100A4 is associated with a poor prognosis in patients with GEJ tumors who undergo potentially curative surgery, and LS samples can be used to obtain prognostic information. Increased EMT-related protein expression (S100A4, Snail1) is associated with the involvement of circumferential resection margin.
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Affiliation(s)
- A Mirza
- Department of Gastrointestinal Surgery, University Hospital of South Manchester, Manchester, UK; Department of Histopathology, University Hospital of South Manchester, Manchester, UK
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Vermes E, Sirinelli A, Marliere J, Mirza A, Aupart M. Impact of Sex Mismatch on Overall and Cardiac Survivals in Male Heart Recipients: A 21-Year French Experience. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.668] [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: 10/27/2022] Open
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