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Molina Hidalgo C, Collins AM, Crisafio ME, Grove G, Kamarck TW, Kang C, Leckie RL, MacDonald M, Manuck SB, Marsland AL, Muldoon MF, Rasero J, Scudder MR, Velazquez-Diaz D, Verstynen T, Wan L, Gianaros PJ, Erickson KI. Effects of a laboratory-based aerobic exercise intervention on brain volume and cardiovascular health markers: protocol for a randomised clinical trial. BMJ Open 2023; 13:e077905. [PMID: 37968003 PMCID: PMC10660203 DOI: 10.1136/bmjopen-2023-077905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Physical activity (PA) has beneficial effects on brain health and cardiovascular disease (CVD) risk. Yet, we know little about whether PA-induced changes to physiological mediators of CVD risk influence brain health and whether benefits to brain health may also explain PA-induced improvements to CVD risk. This study combines neurobiological and peripheral physiological methods in the context of a randomised clinical trial to better understand the links between exercise, brain health and CVD risk. METHODS AND ANALYSIS In this 12-month trial, 130 healthy individuals between the ages of 26 and 58 will be randomly assigned to either: (1) moderate-intensity aerobic PA for 150 min/week or (2) a health information control group. Cardiovascular, neuroimaging and PA measurements will occur for both groups before and after the intervention. Primary outcomes include changes in (1) brain structural areas (ie, hippocampal volume); (2) systolic blood pressure (SBP) responses to functional MRI cognitive stressor tasks and (3) heart rate variability. The main secondary outcomes include changes in (1) brain activity, resting state connectivity, cortical thickness and cortical volume; (2) daily life SBP stress reactivity; (3) negative and positive affect; (4) baroreflex sensitivity; (5) pulse wave velocity; (6) endothelial function and (7) daily life positive and negative affect. Our results are expected to have both mechanistic and public health implications regarding brain-body interactions in the context of cardiovascular health. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Pittsburgh Institutional Review Board (IRB ID: 19020218). This study will comply with the NIH Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. TRIAL REGISTRATION NUMBER NCT03841669.
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Affiliation(s)
- Cristina Molina Hidalgo
- AdventHealth Research Institute, Neuroscience Institute, Orlando, Florida, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Audrey M Collins
- AdventHealth Research Institute, Neuroscience Institute, Orlando, Florida, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary E Crisafio
- College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - George Grove
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas W Kamarck
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Regina L Leckie
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Madison MacDonald
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen B Manuck
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew F Muldoon
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Javier Rasero
- ExPhy Research group and Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | - Mark R Scudder
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Velazquez-Diaz
- AdventHealth Research Institute, Neuroscience Institute, Orlando, Florida, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- ExPhy Research group and Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | - Timothy Verstynen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Lu Wan
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kirk I Erickson
- AdventHealth Research Institute, Neuroscience Institute, Orlando, Florida, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
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Kang C, Zhang D, Schuster J, Kogan J, Nikolajski C, Reynolds CF. Bias-corrected and doubly robust inference for the three-level longitudinal cluster-randomized trials with missing continuous outcomes and small number of clusters: Simulation study and application to a study for adults with serious mental illnesses. Contemp Clin Trials Commun 2023; 35:101194. [PMID: 37588771 PMCID: PMC10425901 DOI: 10.1016/j.conctc.2023.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/21/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Abstract
Longitudinal cluster-randomized designs have been popular tools for comparative effective research in clinical trials. The methodologies for the three-level hierarchical design with longitudinal outcomes need to be better understood under more pragmatic settings; that is, with a small number of clusters, heterogeneous cluster sizes, and missing outcomes. Generalized estimating equations (GEEs) have been frequently used when the distribution of data and the correlation model are unknown. Standard GEEs lead to bias and an inflated type I error rate due to the small number of available clinics and non-completely random missing data in longitudinal outcomes. We evaluate the performance of inverse probability weighted (IPW) estimating equations, with and without augmentation, for two types of missing data in continuous outcomes and individual-level treatment allocation mechanisms combined with two bias-corrected variance estimators. Our intensive simulation results suggest that the proposed augmented IPW method with bias-corrected variance estimation successfully prevents the inflation of false positive findings and improves efficiency when the number of clinics is small, with moderate to severe missing outcomes. Our findings are expected to aid researchers in choosing appropriate analysis methods for three-level longitudinal cluster-randomized designs. The proposed approaches were applied to analyze data from a longitudinal cluster-randomized clinical trial involving adults with serious mental illnesses.
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Affiliation(s)
- Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Di Zhang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | | | - Jane Kogan
- UPMC Center for High-Value Health Care, Pittsburgh, PA 15219, USA
| | - Cara Nikolajski
- UPMC Center for High-Value Health Care, Pittsburgh, PA 15219, USA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Kang C, Huang Y. IDENTIFICATION OF IMMUNE RESPONSE COMBINATIONS ASSOCIATED WITH HETEROGENEOUS INFECTION RISK IN THE IMMUNE CORRELATES ANALYSIS OF HIV VACCINE STUDIES. Ann Appl Stat 2023; 17:1199-1219. [PMID: 37396147 PMCID: PMC10312353 DOI: 10.1214/22-aoas1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
In HIV vaccine/prevention research, probing into the vaccine-induced immune responses that can help predict the risk of HIV infection provides valuable information for the development of vaccine regimens. Previous correlate analysis of the Thai vaccine trial aided the discovery of interesting immune correlates related to the risk of developing an HIV infection. The present study aimed to identify the combinations of immune responses associated with the heterogeneous infection risk. We explored a "change-plane" via combination of a subset of immune responses that could help separate vaccine recipients into two heterogeneous subgroups in terms of the association between immune responses and the risk of developing infection. Additionally, we developed a new variable selection algorithm through a penalized likelihood approach to investigate a parsimonious marker combination for the change-plane. The resulting marker combinations can serve as candidate correlates of protection and can be used for predicting the protective effect of the vaccine against HIV infection. The application of the proposed statistical approach to the Thai trial has been presented, wherein the marker combinations were explored among several immune responses and antigens.
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Affiliation(s)
- Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh
| | - Ying Huang
- Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center
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Zhao MJ, Zhu PC, Li Z, Liu Z, Kang C. Stress analysis of self-tightness metal sealing against ultrahigh pressure medium. Inflamm Res 2023; 72:195-202. [PMID: 36385667 DOI: 10.1007/s00011-022-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Stress is one of the most important factors in metal-to-metal sealing. In this paper, two methods (theoretical and empirical) were adopted to calculate the normal stress of the brass sealing surfaces against different ultrahigh pressure liquid. The theoretical formula was derived in terms of force balance, and the empirical formula was obtained by polynomial curve fitting, which the fitted data were from simulated results; besides, the results calculated using the empirical formula agree well with the results by theoretical formula. Meanwhile, the equivalent stresses of the brass seal, normal stress and contact stress on the brass seal surfaces were simulated by finite element method, and the simulated results indicated these stresses are increased with the increase of liquid pressure, and the maximum stresses always appear on the tip of the brass seal.
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Affiliation(s)
- M J Zhao
- The School of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang, 212003, China.
| | - P C Zhu
- The School of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang, 212003, China
| | - Z Li
- The School of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang, 212003, China
| | - Z Liu
- The School of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang, 212003, China
| | - C Kang
- The School of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang, 212003, China
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Raine LB, Erickson KI, Grove G, Watrous JNH, McDonald K, Kang C, Jakicic JM, Forman DE, Kramer AF, Burns JM, Vidoni ED, McAuley E, Hillman CH. Cardiorespiratory fitness levels and body mass index of pre-adolescent children and older adults during the COVID-19 pandemic. Front Public Health 2023; 10:1052389. [PMID: 36733279 PMCID: PMC9888666 DOI: 10.3389/fpubh.2022.1052389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction The social and behavioral effects of the COVID-19 pandemic have impacted the health and physiology of most people, including those never diagnosed with COVID-19. While the impact of the pandemic has been felt across the lifespan, its effects on cardiorespiratory fitness (commonly considered a reflection of total body health) of older adults and children may be particularly profound due to social distancing and stay-at-home advisories, as well as the closure of sport facilities and non-essential businesses. The objective of this investigation was to leverage baseline data from two ongoing clinical trials to determine if cardiorespiratory fitness and body mass index were different during COVID-19 relative to before COVID-19 in older adults and children. Methods Healthy older individuals (N = 593; 65-80 years) and 200 typically developing children (8-10 years) completed a graded maximal exercise test and had their height and weight measured. Results Results revealed that older adults and children tested during COVID-19 had significantly lower cardiorespiratory fitness levels than those tested before COVID-19 shutdowns (older adults: 30% lower; children: 53% lower; p's ≤ 0.001). In addition, older adults and children tested during COVID-19 had significantly higher BMI (older adults: 31.34 ± 0.57 kg/m2, p = 0.004; children: 19.27 ± 0.44 kg/m2, p = 0.05) than those tested before COVID-19 shutdowns (older adults: 29.51 ± 0.26 kg/m2, children: 18.13 ± 0.35 kg/m2). However, these differences in BMI did not remain significant when controlling for cardiorespiratory fitness. Discussion Results from this investigation indicate that the COVID-19 pandemic, and behavior changes taken to reduce potential exposure, may have led to lower cardiorespiratory fitness levels in older adults and children, as well as higher body mass index. These findings provide relevant public health information as lower cardiorespiratory fitness levels and higher body mass indexes recorded during the pandemic could have far-reaching and protracted health consequences. Public health guidance is needed to encourage physical activity to maintain cardiorespiratory fitness and healthy body composition. Clinical trial registration Older adults: https://clinicaltrials.gov/ct2/show/NCT02875301, identifier: NCT02875301; Children: https://clinicaltrials.gov/ct2/show/NCT03592238, identifier: NCT03592238.
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Affiliation(s)
- Lauren B. Raine
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical and Sports Education, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Research Institute, AdventHealth, Orlando, FL, United States
| | - George Grove
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Katherine McDonald
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - John M. Jakicic
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Daniel E. Forman
- Department of Medicine and Veterans Affairs Pittsburgh Healthcare System, Geriatrics, Research, Education and Clinical Care (GRECC), University of Pittsburgh, Pittsburgh, PA, United States
| | - Arthur F. Kramer
- Department of Psychology, Northeastern University, Boston, MA, United States
- Beckman Institute, University of Illinois, Urbana, IL, United States
| | - Jeffrey M. Burns
- Alzheimer's Disease Research Center, University of Kansas Medical Center Fairway, Fairway, KS, United States
| | - Eric D. Vidoni
- Alzheimer's Disease Research Center, University of Kansas Medical Center Fairway, Fairway, KS, United States
| | - Edward McAuley
- Beckman Institute, University of Illinois, Urbana, IL, United States
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, United States
| | - Charles H. Hillman
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
- Department of Psychology, Northeastern University, Boston, MA, United States
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Kang C, Asemota I, Reyes Pinzon V, Khamooshi P, Atluri R, Soon-Shiong R. Hyponatremia and in-hospital outcomes of patients admitted for heart failure: analysis of the national inpatient sample. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyponatremia serves as a well established predictor of mortality for advanced heart failure (1). The aim of this study is to reassess the association between hyponatremia and in-hospital outcomes in patients with acute decompensated heart failure (ADHF) by using a nationally representative sample.
Methods
We queried the National Inpatient Sample (NIS) database collected between 2016 and 2018 to identify patients with a primary diagnosis of HF and stratified the cohort on the basis of presence or absence of hyponatremia. The outcomes of interest included in-hospital mortality, common associated complications and usage of circulatory support.
Results
Among 727,629 hospital admissions for HF, 72,824 (10%) of them had an additional diagnosis of hyponatremia. The hyponatremia cohort appeared similar in age and had similar rates of Charlson comorbidity index greater than 4 (71 years vs 72 years and 33% vs 35%, respectively) compared to the non-hyponatremia cohort. The comorbidities more prevalent in patients with hyponatremia included: hypothyroidism (17% vs 21%, p<0.001), liver disease (4% vs 11%, p<0.001) and anemia (31% vs 42, p<0.001). By contrast, dyslipidemia, chronic obstructive pulmonary disease, chronic kidney disease, hypertension, diabetes mellitus, obesity, smoking status and supplemental oxygen use were comparable in both groups. ADHF patients with hyponatremia did not have higher odds of in-hospital mortality (aOR: 1.08, 95% CI: 0.98–1.19, p=0.138) when adjusted for comorbidities. Nevertheless, patients with hyponatremia had an adjusted increase in mean hospital charges of 14,731 US$ (95% CI: 11065–18397, p<0.001), length of stay by 2.6 days (95% CI: 2.5–2.8, p<0.001), usage of intra-aortic balloon pump (aOR: 1.97, 95% CI: 1.50–2.59, p<0.001) and left ventricular assist device (aOR: 2.21, 95% CI: 1.639–2.98, p<0.001), and higher incidence of acute renal failure (aOR: 1.13, 95% CI: 1.08–1.189, p<0.001) and cardiogenic shock (aOR: 1.58, 95% CI: 1.42–1.76, p<0.001) in comparison to patients without hyponatremia.
Conclusion
Multiple clinical variables excluded in the NIS dataset could have impacted the primary outcome. Clinicians who observe hyponatremia in ADHF patients should stay wary of potential side effects and maintain a low threshold to escalate care.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Kang
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
| | - I Asemota
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
| | - V Reyes Pinzon
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
| | - P Khamooshi
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
| | - R Atluri
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
| | - R Soon-Shiong
- J.H. Stroger Hospital of Cook County , Chicago , United States of America
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Park J, Cho S, Lee K, Choi E, Jung W, Kim S, Park G, Song S, Kang C, Ma M, Yoo D, Paeng K, Ock CY. 94P Performance validation of an artificial intelligence-powered programmed death-ligand 1 (PD-L1) combined positive score analyzer in urothelial cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.126] [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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Stillman CM, Jakicic JM, Rogers RJ, Roecklein KA, Barrett G, Kang C, Erickson KI. The relationship between fat mass and obesity associated gene polymorphism rs9939609 and resting cerebral blood flow in a midlife sample with overweight and obesity. Front Hum Neurosci 2022; 16:904545. [PMID: 36072887 PMCID: PMC9443082 DOI: 10.3389/fnhum.2022.904545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe single nucleotide polymorphism (SNP) rs9939609 in the fat mass and obesity associated fat mass and obesity associated gene (FTO) gene has been linked with increased BMI in adults. Higher BMI has been associated with poor brain health and may exert deleterious effects on neurocognitive health through cerebral hypoperfusion. However, it is unclear if there is a relationship between the FTO genotype and cerebral perfusion, or whether FTO genotype moderates the effects of weight loss on cerebral perfusion. Using data from a randomized controlled behavioral weight loss trial in adults with overweight and obesity, we tested (1) whether carriers of the A allele for FTO rs9939609 demonstrate different patterns of resting cerebral blood flow (rCBF) compared to T carriers, and (2) whether the FTO genotype moderates the effects of weight loss on rCBF. We hypothesized that carriers of the A allele would exhibit lower resting CBF in frontal brain areas compared to T/T homozygotes at baseline, and that intervention-induced weight loss may partially remediate these differences.Methods and resultsOne hundred and five adults (75.2% female, mean age 44.9 years) with overweight or obesity were included in the analyses. These participants represent a subsample of participants in a larger randomized controlled trial (NCT01500356). A resting pseudo-continuous arterial spin labeling (pCASL) scan was acquired to examine rCBF. Age, sex, and BMI were included as covariates. At baseline, A carriers had greater rCBF in a diffuse cluster extending into the brainstem, motor cortex, and occipital lobe, but lower perfusion in the temporal lobe. We found no evidence that FTO moderated the effect of the intervention group assignment on rCBF changes.ConclusionOverall, these results indicate that (a) individual variation in rCBF within a sample with overweight and obesity may be attributed to a common FTO variant, but (b) a weight loss intervention is effective at increasing rCBF, regardless of FTO genotype.
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Affiliation(s)
- Chelsea M. Stillman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Chelsea M. Stillman,
| | - John M. Jakicic
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | | | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Grant Barrett
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- AdventHealth Research Institute, Neuroscience Institute, Orlando, FL, United States
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Aghjayan SL, Bournias T, Kang C, Zhou X, Stillman CM, Donofry SD, Kamarck TW, Marsland AL, Voss MW, Fraundorf SH, Erickson KI. Aerobic exercise improves episodic memory in late adulthood: a systematic review and meta-analysis. Commun Med (Lond) 2022; 2:15. [PMID: 35603310 PMCID: PMC9053291 DOI: 10.1038/s43856-022-00079-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/23/2021] [Accepted: 01/18/2022] [Indexed: 12/30/2022] Open
Abstract
Background Aerobic exercise remains one of the most promising approaches for enhancing cognitive function in late adulthood, yet its potential positive effects on episodic memory remain poorly understood and a matter of intense debate. Prior meta-analyses have reported minimal improvements in episodic memory following aerobic exercise but have been limited by restrictive inclusion criteria and infrequent examination of exercise parameters. Methods We conducted a meta-analysis of randomized controlled trials to determine if aerobic exercise influences episodic memory in late adulthood (M = 70.82 years) and examine possible moderators. Thirty-six studies met inclusion criteria, representing data from 2750 participants. Results Here we show that aerobic exercise interventions are effective at improving episodic memory (Hedges'g = 0.28; p = 0.002). Subgroup analyses revealed a moderating effect of age (p = 0.027), with a significant effect for studies with a mean age between 55-68 but not 69-85. Mixed-effects analyses demonstrated a positive effect on episodic memory among studies with a high percentage of females (65-100%), participants with normal cognition, studies reporting intensity, studies with a no-contact or nonaerobic physical activity control group, and studies prescribing >3900 total minutes of activity (range 540-8190 min). Conclusions Aerobic exercise positively influences episodic memory among adults ≥55 years without dementia, with larger effects observed among various sample and intervention characteristics-the clearest moderator being age. These results could have far-reaching clinical and public health relevance, highlighting aerobic exercise as an accessible, non-pharmaceutical intervention to improve episodic memory in late adulthood.
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Affiliation(s)
- Sarah L. Aghjayan
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA USA
| | - Xueping Zhou
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA USA
| | | | | | - Thomas W. Kamarck
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Anna L. Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Michelle W. Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA USA
| | | | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA USA
- Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA Australia
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
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Orr B, Mahdi H, Fang Y, Strange M, Uygun I, Rana M, Zhang L, Suarez Mora A, Pusateri A, Elishaev E, Kang C, Tseng G, Gooding W, Edwards RP, Kalinski P, Vlad AM. Phase I trial combining chemokine-targeting with loco-regional chemo-immunotherapy for recurrent, platinum-sensitive ovarian cancer shows induction of CXCR3 ligands and markers of type 1 immunity. Clin Cancer Res 2022; 28:2038-2049. [PMID: 35046055 DOI: 10.1158/1078-0432.ccr-21-3659] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased prevalence of cytotoxic T lymphocytes (CTL) in the tumor microenvironment (TME) predicts positive outcomes in patients with epithelial ovarian cancer (EOC), while the regulatory Treg cells predict poor outcomes. Guided by the synergistic activity of TLR3 ligands, interferon-a (IFNa) and cyclooxygenase-2 (COX-2) blockers in selectively enhancing CTL-attractants but suppressing Treg-attractants, we tested a novel intraperitoneal (IP) chemo-immunotherapy combination, to assess its tolerability and TME-modulatory impact in patients with recurrent EOC. METHODS Twelve patients were enrolled in phase I portion of the trial NCT02432378, and treated with IP cisplatin, IP rintatolimod (dsRNA, TLR3 ligand) and oral celecoxib (COX-2 blocker). Patients in cohorts 2, 3 and 4 also received IP IFNa at 2, 6 and 18 million units (MU), respectively. Primary objectives were to evaluate safety, identify phase 2 recommended dose (P2RD) and characterize changes in the immune TME. Peritoneal resident cells and IP wash fluid were profiled via NanoString and Meso Scale Discovery (MSD) multiplex assay, respectively. RESULTS The P2RD of IFNa was 6 MU. Median progression-free and overall survival were 8.4 and 30 months, respectively. Longitudinal sampling of the peritoneal cavity via IP washes demonstrated local upregulation of interferon-stimulated genes (ISG), including CTL-attracting chemokines (CXCL-9, -10, -11), MHC I/II, perforin and granzymes. These changes were present two days post chemokine modulation and subsided within one week. CONCLUSION The chemokine-modulating IP-CITC is safe, tolerable, and associated with ISG changes that favor CTL chemoattraction and function. This combination (plus DC vaccine) will be tested in a phase II trial.
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Affiliation(s)
- Brian Orr
- Gynecologic Oncology, Medical University of South Carolina
| | - Haider Mahdi
- Gynecologic Oncology, University of Pittsburgh Medical Center
| | - Yusi Fang
- Biostatistics, University of Pittsburgh, Graduate School of Public Health
| | | | - Ibrahim Uygun
- Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute
| | - Mainpal Rana
- Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine
| | - Lixin Zhang
- Immunology, University of Pittsburgh School of Medicine
| | | | | | - Esther Elishaev
- Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh
| | - Chaeryon Kang
- Biostatistics, University of Pittsburgh Graduate School of Public Health
| | | | | | - Robert P Edwards
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh
| | | | - Anda M Vlad
- Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine
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Donahue PT, Grove G, Stillman C, Kang C, Burns J, Hillman CH, Kramer AF, McAuley E, Vidoni E, Erickson KI. Estimating the financial costs associated with a phase III, multi-site exercise intervention trial: Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE). Contemp Clin Trials 2021; 105:106401. [PMID: 33857678 DOI: 10.1016/j.cct.2021.106401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Supervised exercise interventions are expensive and time intensive. However, there are financial costs to consider in addition to the intervention itself, namely: advertising and recruitment, outcome assessments, and other trial-related costs. OBJECTIVES In this analysis, we examine the financial costs associated with the administration of Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) to quantify the costs associated with large exercise intervention trials and to provide future investigators with financial estimates if they wish to pursue studies of a similar design. METHODS Cost per randomized participant were calculated in four areas: (1) advertising and recruitment, (2) outcome assessments, (3) delivery of the intervention, and (4) other trial-related expenses. Overall trial costs associated with data analysis, faculty salaries, and indirect costs were estimated as well. RESULTS The total cost per randomized participant was estimated to be $16,494. Outcome assessments accounted for the highest proportion of per-participant (75%) and total trial (38%) costs. Neuroimaging assessments (MRI & PET) cost $8247 per randomized participant, accounting for two-thirds (67%) of outcome assessment costs and half (50%) of per-participant costs. CONCLUSION Large clinical trials of exercise are expensive (~$21 million), particularly when administering several visits to assess study aims. Outcome assessments, specifically those involving neuroimaging, accounted for a significant proportion of total costs in this analysis. Future investigators must budget accordingly if they wish to conduct a comprehensive, multi-site exercise intervention trial that examines numerous physiological and psychological outcomes.
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Affiliation(s)
- Patrick T Donahue
- University of Pittsburgh, Pittsburgh, PA, USA; Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | - Jeffrey Burns
- University of Kansas Medical Center, Kansas City, MO, USA
| | | | - Arthur F Kramer
- Northeastern University, Boston, MA, USA; University of Illinois, Champaign, IL, USA
| | | | - Eric Vidoni
- University of Kansas Medical Center, Kansas City, MO, USA
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12
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MacDonald-Wilson KL, Williams K, Nikolajski CE, McHugo G, Kang C, Deegan P, Carpenter-Song E, Kogan JN. Promoting collaborative psychiatric care decision-making in community mental health centers: Insights from a patient-centered comparative effectiveness trial. Psychiatr Rehabil J 2021; 44:11-21. [PMID: 33119363 DOI: 10.1037/prj0000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mental health service-users face important medication decisions; yet not all are active participants in the decision-making process. Little is known about which technology-supported interventions might effectively promote collaborative decision-making in psychiatric care. We compared the effectiveness of two technology-supported collaborative care decision-making approaches. METHOD We used a cluster-randomized design with a mixed-methods approach. Participants were Medicaid-enrolled adults receiving psychiatric care in participating community mental health centers. Measurement-based care used computerized systematic symptom and medication screenings to inform provider decision-making. Person-centered care supported participants in completing computerized Health Reports and preparing to work with providers on collaborative decision-making about psychiatric care. Primary study outcomes included the patient experience of medication management and shared decision-making during psychiatric care. Analyses examined the impact of both approaches and explored moderating variables. We used qualitative methods to understand participation and implementation experiences. RESULTS Across 14 sites 2,363 participants enrolled (1,162 in measurement-based care, 1,201 in person-centered care). We observed statistically significant improvements in patient experience of medication management scores for both study arms; however, the clinical significance of this change was minor. We found no significant changes for shared decision-making. Qualitative interviews revealed a range of factors associated usefulness of intervention assessment, provider-service-user communication, and site-level logistics. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We observed modest positive findings related to our patient-centered outcomes. We identified important implementation facilitators and barriers that can inform the implementation of future comparative effectiveness patient-centered research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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13
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Kearney SM, Williams K, Nikolajski C, Park MJ, Kraemer KL, Landsittel D, Kang C, Malito A, Schuster J. Stakeholder impact on the implementation of integrated care: Opportunities to consider for patient-centered outcomes research. Contemp Clin Trials 2020; 101:106256. [PMID: 33383229 DOI: 10.1016/j.cct.2020.106256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/02/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022]
Abstract
Nearly half of Americans live with chronic disease. Many have multiple chronic conditions that often present as a combination of physical and mental health conditions. Aligning stakeholder-driven, patient-centered outcomes research with population health strategies such as innovative ways to deliver care management can reduce the burden of multiple chronic conditions. In addition, successfully creating meaningful, inclusive research requires actively engaging stakeholders throughout the lifecycle of a study. This study integrates stakeholder engagement, using a large health plan in western Pennsylvania, to conduct a randomized controlled trial. Three care management strategies, High-Touch, High-Tech, and Usual Care, are compared for effectiveness among members with multiple chronic conditions. Care strategies are delivered via the Community Team, a multidisciplinary community-based team, offering in-person (High-Touch) and digital (High-Tech) care management in 14 counties across Pennsylvania. Participants are followed for 12months, with repeated measurements of self-reported health status and activation in care, while tracking administrative measurements of primary and specialty health service utilization. Quality of life, care satisfaction, engagement in care, and service utilization will be compared using generalized mixed models. Additionally, semi-structured interviews are conducted for both participants and care managers over the course of the study to evaluate feasibility. This manuscript presents implementation strategies, while noting that the implementation of patient-centered outcomes research in a real-world setting requires rapid evaluation, redesign of workflow, and tailored approaches for success.
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Affiliation(s)
- Shannon M Kearney
- UPMC Insurance Services Division, UPMC Center for High-Value Health Care, Pittsburgh, PA, USA
| | - Kelly Williams
- UPMC Insurance Services Division, UPMC Center for High-Value Health Care, Pittsburgh, PA, USA.
| | - Cara Nikolajski
- UPMC Insurance Services Division, UPMC Center for High-Value Health Care, Pittsburgh, PA, USA
| | | | - Kevin L Kraemer
- Medicine and Clinical & Translational Science, Section of Treatment, Research, and Education in Addiction Medicine, GIM Clinician-Researcher Fellowship Program, General Internal Medicine Center for Opioid Recovery, Clinical and Translational Science Fellowship, NRSA for Primary Medical Care, Department of Medicine, University of Pittsburgh, USA
| | - Doug Landsittel
- Biomedical Informatics, Biostatistics, and Clinical and Translational Science, Biostatistics, Starzl Transplant Institute, Expanding National Capacity in PCOR through Training, Comparative Effectiveness Research Center; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chaeryon Kang
- Biostatistics, Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adelina Malito
- UPMC Insurance Services Division, UPMC Center for High-Value Health Care, Pittsburgh, PA, USA
| | - James Schuster
- Medical and Behavioral Services, UPMC Insurance Services Division, Psychiatry, University of Pittsburgh, Pittsburgh, PA, UPMC, USA
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14
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Wilckens KA, Stillman CM, Waiwood AM, Kang C, Leckie RL, Peven JC, Foust JE, Fraundorf SH, Erickson KI. Exercise interventions preserve hippocampal volume: A meta-analysis. Hippocampus 2020; 31:335-347. [PMID: 33315276 DOI: 10.1002/hipo.23292] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022]
Abstract
Hippocampal volume is a marker of brain health and is reduced with aging and neurological disease. Exercise may be effective at increasing and preserving hippocampal volume, potentially serving as a treatment for conditions associated with hippocampal atrophy (e.g., dementia). This meta-analysis aimed to identify whether exercise training has a positive effect on hippocampal volume and how population characteristics and exercise parameters moderate this effect. Studies met the following criteria: (a) controlled trials; (b) interventions of physical exercise; (c) included at least one time-point of hippocampal volume data before the intervention and one after; (d) assessed hippocampal volume using either manual or automated segmentation algorithms. Animal studies, voxel-based morphometry analyses, and multi-modal interventions (e.g., cognitive training or meditation) were excluded. The primary analysis in n = 23 interventions from 22 published studies revealed a significant positive effect of exercise on total hippocampal volume. The overall effect was significant in older samples (65 years of age or older) and in interventions that lasted over 24 weeks and had less than 150 min per week of exercise. These findings suggest that moderate amounts of exercise for interventions greater than 6 months have a positive effect on hippocampal volume including in older populations vulnerable to hippocampal atrophy.
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Affiliation(s)
- Kristine A Wilckens
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chelsea M Stillman
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aashna M Waiwood
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Regina L Leckie
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jamie C Peven
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jill E Foust
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Scott H Fraundorf
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia
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15
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Vidoni ED, Szabo-Reed A, Kang C, Shaw AR, Perales-Puchalt J, Grove G, Hamill M, Henry D, Burns JM, Hillman C, Kramer AF, McAuley E, Erickson KI. The IGNITE trial: Participant recruitment lessons prior to SARS-CoV-2. Contemp Clin Trials Commun 2020; 20:100666. [PMID: 33052319 PMCID: PMC7544598 DOI: 10.1016/j.conctc.2020.100666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/20/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022] Open
Abstract
Full and diverse participant enrollment is critical to the success and generalizability of all large-scale Phase III trials. Recruitment of sufficient participants is among the most significant challenges for many studies. The novel SARS-CoV-2 coronavirus pandemic has further changed and challenged the landscape for clinical trial execution, including screening and randomization. The Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) study has been designed as the most comprehensive test of aerobic exercise effects on cognition and brain health. Here we assess recruitment into IGNITE prior to the increased infection rates in the United States, and examine new challenges and opportunities for recruitment with a goal of informing the remaining required recruitment as infection containment procedures are lifted. The results may assist the design and implementation of recruitment for future exercise studies, and outline opportunities for study design that are flexible in the face of emerging threats.
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Affiliation(s)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | - Ashley R. Shaw
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | | | | | - Jeffrey M. Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | - Arthur F. Kramer
- Northeastern University, Boston, MA, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Edward McAuley
- University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
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16
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Stillman CM, Jakicic J, Rogers R, Alfini AJ, Smith JC, Watt J, Kang C, Erickson KI. Changes in cerebral perfusion following a 12-month exercise and diet intervention. Psychophysiology 2020; 58:e13589. [PMID: 32343445 DOI: 10.1111/psyp.13589] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/17/2019] [Accepted: 04/03/2020] [Indexed: 01/18/2023]
Abstract
Overweight and obesity may damage the cerebrovascular architecture, resulting in a significant reduction in cerebral blood flow. To date, there have been few randomized clinical trials (RCT) examining whether obesity-related reductions in cerebral blood flow could be modified by weight loss. Further, it is unknown whether the behavioral intervention strategy for weight loss (i.e., diet alone or diet combined with exercise) differentially influences cerebral blood flow in adults with overweight or obesity. The primary aim of this study was to determine whether a 12-month RCT of exercise and diet increases cerebral blood flow in 125 midlife (Mean age ± SD = 44.63 ± 8.36 years) adults with overweight and obesity. Further, we evaluated whether weight loss via diet combined with aerobic exercise has an added effect on changes in cerebral blood flow compared to weight loss via diet alone and whether there were regionally specific effects of the type of behavioral intervention on cerebral blood flow patterns. Consistent with our predictions, a 12-month diet and exercise program resulting in 10% weight loss increased cerebral blood flow. These effects were widespread and extended throughout frontal, parietal, and subcortical regions. Further, there was some regional specificity of effects for both diet-only and diet combined with exercise. Our results demonstrate that weight-related reductions in cerebral blood flow can be modified by 10% weight loss over the course of 12 months and that interventions involving exercise exposure may provide unique effects on cerebral blood flow compared to interventions involving only diet.
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Affiliation(s)
| | - John Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Renee Rogers
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alfonso J Alfini
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Carson Smith
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Jennifer Watt
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Jonassaint CR, Kang C, Prussien KV, Yarboi J, Sanger MS, Wilson JD, De Castro L, Shah N, Sarkar U. Feasibility of implementing mobile technology-delivered mental health treatment in routine adult sickle cell disease care. Transl Behav Med 2020; 10:58-67. [PMID: 30508141 PMCID: PMC7295699 DOI: 10.1093/tbm/iby107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 01/05/2023] Open
Abstract
Sickle cell disease (SCD) is a severe hemoglobinopathy characterized by acute and chronic pain. Sufferers of the disease, most of whom are underrepresented minorities, are at increased risk for mental health disorders. The purpose of this study is to test the acceptability and implementation of a computerized cognitive behavioral therapy (cCBT) intervention, Beating the Blues, to improve depression, anxiety, and pain in patients with SCD. Adults with SCD and significant symptoms of depression (Patient Health Questionnaire [PHQ-9] score ≥ 10) or anxiety (Generalized Anxiety Disorder Scale [GAD-7] score ≥ 10) were eligible to participate and be randomized to either receive eight sessions of cCBT with care coach support or treatment as usual. Participants reported daily pain and mood symptoms using a mobile diary app. Depression, anxiety, and pain symptoms were assessed at 1, 3, and 6 months. Thirty patients were enrolled: 18 to cCBT, and 12 to control. The cCBT intervention was feasible to implement in clinical settings and acceptable to participants. Patients in the cCBT arm reported a marginally greater decrease in depression at 6 months (-3.82, SE = 1.30) than those in the control group (-0.50, SE = 1.60; p = .06). There were no significant effects of treatment on anxiety; however, cCBT was associated with improved daily pain reported via a mobile diary app (p = .014). cCBT, delivered via mobile device, is a feasible strategy to provide mental health care to adults living with SCD. cCBT was acceptable to the target population; was able to be implemented in real-world, nonideal conditions; and has the potential to improve patient-reported outcomes.
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Affiliation(s)
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Janet Yarboi
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Maureen S Sanger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Deanna Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura De Castro
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - Urmimala Sarkar
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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18
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Schmitz G, McNeilly C, Hoebee S, Phillips C, Ortega H, Kang C, Blutinger E, Fernandez J, Schneider S. 308 Cardiopulmonary Resuscitation and Skill Retention in Emergency Physicians. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.267] [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: 10/25/2022]
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19
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Erickson KI, Grove GA, Burns JM, Hillman CH, Kramer AF, McAuley E, Vidoni ED, Becker JT, Butters MA, Gray K, Huang H, Jakicic JM, Kamboh MI, Kang C, Klunk WE, Lee P, Marsland AL, Mettenburg J, Rogers RJ, Stillman CM, Sutton BP, Szabo-Reed A, Verstynen TD, Watt JC, Weinstein AM, Wollam ME. Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE): Protocol. Contemp Clin Trials 2019; 85:105832. [PMID: 31465859 PMCID: PMC6815730 DOI: 10.1016/j.cct.2019.105832] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022]
Abstract
Despite the ubiquity of normal age-related cognitive decline there is an absence of effective approaches for improving neurocognitive health. Fortunately, moderate intensity exercise is a promising method for improving brain and cognitive health in late life, but its effectiveness remains a matter of skepticism and debate because of the absence of large, comprehensive, Phase III clinical trials. Here we describe the protocol for such a randomized clinical trial called IGNITE (Investigating Gains in Neurocognition in an Intervention Trial of Exercise), a study capable of more definitively addressing whether exercise influences cognitive and brain health in cognitively normal older adults. We are conducting a 12-month, multi-site, randomized dose-response exercise trial in 639 cognitively normal adults between 65 and 80 years of age. Participants are randomized to (1) a moderate intensity aerobic exercise condition of 150 min/week (N = 213), (2) a moderate intensity aerobic exercise condition at 225 min/week (N = 213), or (3) a light intensity stretching-and-toning control condition for 150 min/week (N = 213). Participants are engaging in 3 days/week of supervised exercise and two more days per week of unsupervised exercise for 12 months. A comprehensive cognitive battery, blood biomarkers and battery of psychosocial questionnaires is assessed at baseline, 6 and 12-months. In addition, brain magnetic resonance imaging, physiological biomarkers, cardiorespiratory fitness, physical function, and positron emission tomography of amyloid deposition are assessed at baseline and at the 12-month follow-up. The results from this trial could transform scientific-based policy and health care recommendations for approaches to improve cognitive function in cognitively normal older adults.
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Affiliation(s)
- Kirk I Erickson
- Department of Psychology, University of Pittsburgh, USA.; Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, Australia.
| | | | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, USA
| | - Charles H Hillman
- Department of Psychology, Northeastern University, USA; Department of Physical Therapy, Movement, & Rehabilitation Sciences, Northeastern University, USA
| | - Arthur F Kramer
- Department of Psychology, Northeastern University, USA; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, USA
| | - Eric D Vidoni
- Department of Neurology, University of Kansas Medical Center, USA
| | - James T Becker
- Department of Psychology, University of Pittsburgh, USA.; Department of Psychiatry, University of Pittsburgh, USA; Department of Neurology, University of Pittsburgh, USA
| | | | - Katerina Gray
- Department of Psychology, University of Pittsburgh, USA
| | - Haiqing Huang
- Department of Psychology, University of Pittsburgh, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, USA
| | - M Ilyas Kamboh
- Department of Human Genetics, University of Pittsburgh, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, USA
| | | | - Phil Lee
- Department of Radiology, University of Kansas Medical Center, USA
| | | | | | - Renee J Rogers
- Department of Health and Physical Activity, University of Pittsburgh, USA
| | | | - Bradley P Sutton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign, USA
| | - Amanda Szabo-Reed
- Department of Internal Medicine, University of Kansas Medical Center, USA
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Nelson RL, Go C, Darwish R, Gao J, Parikh R, Kang C, Mahajan A, Habeeb L, Zalavadiya P, Patnam M. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:809-820. [PMID: 31273486 DOI: 10.1007/s10151-019-02029-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review. METHODS Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI. RESULTS Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes. CONCLUSIONS There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, Chicago, IL, USA.
| | - C Go
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Darwish
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - J Gao
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Parikh
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Kang
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Mahajan
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - L Habeeb
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - P Zalavadiya
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - M Patnam
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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21
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Stillman CM, Donahue PT, Williams MF, Callas M, Lwanga C, Brown C, Wollam ME, Jedrziewski MK, Kang C, Erickson KI. Weight-Loss Outcomes from a Pilot Study of African Dance in Older African Americans. Obesity (Silver Spring) 2018; 26:1893-1897. [PMID: 30358132 PMCID: PMC6249065 DOI: 10.1002/oby.22331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Obesity is a risk factor for both cognitive and physical impairment in late adulthood. Though the rates of obesity are high in many groups, older African Americans are disproportionately affected. A randomized pilot intervention of African Dance was conducted with 28 African American older adults with obesity (mean age = 68.4 ± 5.1 years; mean BMI = 33.4 ± 6.2). The goal of the study was to evaluate the physiological outcomes of a culturally sensitive exercise intervention and specifically changes in weight. METHODS Participants were randomly assigned to an African Dance (experimental) or Culture Education (control) group. They attended their assigned class for 1 hour per session, 3 days per week, for 6 months. RESULTS There was a significant group × time interaction on weight (P = 0.005) such that the African Dance group lost weight (mean = 4.0 ± 6.0 lb) while the Culture Education group gained weight (mean = 2.6 ± 3.9 lb). CONCLUSIONS These results suggest that a culturally sensitive form of physical activity, African Dance, may be effective for promoting weight loss in a population at increased risk for obesity and cognitive decline.
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Affiliation(s)
- Chelsea M. Stillman
- Department of Psychiatry, University of Pittsburgh
- Corresponding author , Address: 4805 Sennott Square, 210 S Bouquet Street, Pittsburgh, PA 15260
| | | | | | | | | | | | | | | | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh
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Booms Z, Stein J, Kang C. 246 IV Lidocaine Versus Ketorolac for Emergency Department Treatment of Known or Suspected Renal Colic: Interim Safety Analysis. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.251] [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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Sanei-Moghaddam A, Kang C, Edwards RP, Lounder PJ, Ismail N, Goughnour SL, Mansuria SM, Comerci JT, Linkov F. Racial and Socioeconomic Disparities in Hysterectomy Route for Benign Conditions. J Racial Ethn Health Disparities 2018; 5:758-765. [PMID: 28840507 DOI: 10.1007/s40615-017-0420-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/10/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this paper was to explore disparities associated with the route of hysterectomy in the University of Pittsburgh Medical Center (UPMC) health system and to evaluate whether the hysterectomy clinical pathway implementation impacted disparities in the utilization of minimally invasive hysterectomy (MIH). METHODS We performed a retrospective medical record review of all the patients who have undergone hysterectomy for benign indications at UPMC-affiliated hospitals between fiscal years (FY) 2012 and 2014. RESULTS A total number of 6373 hysterectomy patient cases were included in this study: 88.7% (5653) were European American (EA), 11.02% (702) were African American (AA), and the remaining 0.28% (18) were of other ethnicities. We found that non-EA, women aged 45-60, traditional Medicaid, and traditional Medicare enrollees were more likely to have a total abdominal hysterectomy (TAH). Residence in higher median income zip code (> $61,000) was associated with 60% lower odds of undergoing TAH. Both FY 2013 and 2014 were associated with significantly lower odds of TAH. Logistic regression results from the model for non-EA patients for FY 2012 and FY 2014 demonstrated that FY and zip code income group were not significant predictors of surgery type in this subgroup. Pathway implementation did not reduce racial disparity in MIH utilization. CONCLUSION This study demonstrated that there is a significant disparity in MIH utilization, where non-EA and Medicaid/Medicare recipients had higher odds of undergoing TAH. Further research is needed to investigate how care standardization may alleviate healthcare disparities.
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Affiliation(s)
- Amin Sanei-Moghaddam
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Chaeryon Kang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15216, USA
| | - Robert P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Paula J Lounder
- Payer Provider Programs, University of Pittsburgh Medical Center, 600 Grant Street, 58th Floor, Pittsburgh, PA, 15219, USA
| | - Naveed Ismail
- Payer Provider Programs, University of Pittsburgh Medical Center, 600 Grant Street, 58th Floor, Pittsburgh, PA, 15219, USA
| | - Sharon L Goughnour
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, 3380 Blvd of the Allies Suite 341, Pittsburgh, PA, 15213, USA
| | - Suketu M Mansuria
- Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - John T Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Faina Linkov
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, 3380 Blvd of the Allies Suite 307, Pittsburgh, PA, 15213, USA.
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Lee SB, Kim DH, Kim T, Lee SH, Jeong JH, Kim SC, Park YJ, Lim D, Kang C. Anion gap and base deficit are predictors of mortality in acute pesticide poisoning. Hum Exp Toxicol 2018; 38:185-192. [PMID: 30001645 DOI: 10.1177/0960327118788146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors. METHODS: A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated. RESULTS: Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively. CONCLUSIONS: Initial high AG and BD values could predict mortality and require precise intensive care.
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Affiliation(s)
- S B Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Y J Park
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Lim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - C Kang
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Kang C, Janes H, Tajik P, Groen H, Mol BWJ, Koopmans CM, Broekhuijsen K, Zwertbroek E, van Pampus MG, Franssen MTM. Evaluation of biomarkers for treatment selection using individual participant data from multiple clinical trials. Stat Med 2018; 37:1439-1453. [PMID: 29444553 PMCID: PMC5889758 DOI: 10.1002/sim.7608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 09/27/2017] [Accepted: 12/22/2017] [Indexed: 11/08/2022]
Abstract
Biomarkers that predict treatment effects may be used to guide treatment decisions, thus improving patient outcomes. A meta-analysis of individual participant data (IPD) is potentially more powerful than a single-study data analysis in evaluating markers for treatment selection. Our study was motivated by the IPD that were collected from 2 randomized controlled trials of hypertension and preeclampsia among pregnant women to evaluate the effect of labor induction over expectant management of the pregnancy in preventing progression to severe maternal disease. The existing literature on statistical methods for biomarker evaluation in IPD meta-analysis have evaluated a marker's performance in terms of its ability to predict risk of disease outcome, which do not directly apply to the treatment selection problem. In this study, we propose a statistical framework for evaluating a marker for treatment selection given IPD from a small number of individual clinical trials. We derive marker-based treatment rules by minimizing the average expected outcome across studies. The application of the proposed methods to the IPD from 2 studies in women with hypertension in pregnancy is presented.
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Affiliation(s)
- Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15261, U.S.A
| | - Holly Janes
- Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, U.S.A
| | - Parvin Tajik
- Department of Clinical Epidemiology & Biostatistics, University of Amsterdam, The Netherlands
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ben W. J. Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Corine M. Koopmans
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kim Broekhuijsen
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Zwertbroek
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria G. van Pampus
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Farkas N, Kang C, Pritchard D, Tang S, Banerjee D. Acellular dermal matrix assisted immediate breast reconstruction: Audit of 5 years single centre experience. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30420-9] [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: 10/17/2022]
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27
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Zhang C, Xu D, Wang J, Kang C. Efficient Synthesis and Biological Activity of Novel Indole Derivatives as VEGFR-2 Tyrosine Kinase Inhibitors. RUSS J GEN CHEM+ 2018. [DOI: 10.1134/s1070363217120465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Schuster J, Nikolajski C, Kogan J, Kang C, Schake P, Carney T, Morton SC, Reynolds CF. A Payer-Guided Approach To Widespread Diffusion Of Behavioral Health Homes In Real-World Settings. Health Aff (Millwood) 2018; 37:248-256. [DOI: 10.1377/hlthaff.2017.1115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Schuster
- James Schuster is chief medical officer for Medicaid, Special Needs, and Behavioral Services and vice president of behavioral integration, both at UPMC Insurance Services Division, and a senior faculty member at the UPMC Center for High-Value Health Care, all in Pittsburgh, Pennsylvania
| | - Cara Nikolajski
- Cara Nikolajski is a senior program administrator at the UPMC Center for High-Value Health Care
| | - Jane Kogan
- Jane Kogan is senior director of the UPMC Center for High-Value Health Care
| | - Chaeryon Kang
- Chaeryon Kang is an assistant professor of biostatistics at the University of Pittsburgh, in Pennsylvania
| | - Patricia Schake
- Patricia Schake is senior director of program innovation, Community Care Behavioral Health Organization, in Pittsburgh
| | - Tracy Carney
- Tracy Carney is a senior recovery and resiliency specialist, Community Care Behavioral Health Organization
| | - Sally C. Morton
- Sally C. Morton is dean of the College of Science, Virginia Tech, in Blacksburg
| | - Charles F. Reynolds
- Charles F. Reynolds III is a distinguished professor of psychiatry emeritus at the University of Pittsburgh School of Medicine
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29
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Kang C, Kim K, Lee J, Jo Y, Park J, Lee S, Kim Y, Rhee J, Kim D. Predictors of Revisit and Admission after Discharge from an Emergency Department in Acute Pyelonephritis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The aim of this study is to construct clinical prediction models to predict emergency department (ED) return visit following initial discharge for acute pyelonephritis (APN) and the need for hospital re-admission upon ED return visits. Method A retrospective analysis included 1250 discharged women with APN. Independent risk factors for revisit and subsequent admission after revisit were determined by multivariate analysis, and a prediction model for revisit and subsequent admission after revisit was constructed. Results Independent risk factors for revisit were nausea (2 points), age ≥ 65 years (2 points), C-reactive protein >20 mg/dL (2 points), serum albumin <3.3 g/dL (3 points) and urine white blood cell count ≥ 30/high power field (2 points). Re-visit risk scores were categorised to five groups and the re-visit rate was 5.4%, 8.6%, 12.2%, 19.1% and 43.8%, respectively, showing an area under curve (AUC) of 0.62. Risk factors for subsequent admission after revisit were vomiting (1 point), hypertension (2 points), serum creatinine <1.5 mg/dL (2 points), C-reactive protein >20 mg/dL (2 points) and serum albumin <3.3 g/dL (4 points). The subsequent admission after revisit risk scores were classified to three groups and subsequent admission after revisit rate was 3.5%, 15.0%, and 38.2%, respectively. Conclusion The developed model can identify a group of patients at high risk for a return visit and for requiring subsequent hospital admission, and might be used to improve initial disposition decision and discharge instructions. (Hong Kong j.emerg. med. 2015;22:154-162)
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Affiliation(s)
- C Kang
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
- Gyeongsang National University Hospital, Department of Emergency Medicine, Jinju, Korea
| | - K Kim
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
| | - Jh Lee
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
| | - Yh Jo
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
| | - Jw Park
- James Cook University, Sixth Year Medicine (Undergraduate), Queensland, Australia
| | - Sh Lee
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
- Gyeongsang National University Hospital, Department of Emergency Medicine, Jinju, Korea
| | - Yj Kim
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
| | - Je Rhee
- Seoul National University Bundang Hospital, Department of Emergency Medicine, Seongnam, Korea
| | - Dh Kim
- Gyeongsang National University Hospital, Department of Emergency Medicine, Jinju, Korea
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30
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Jonassaint CR, Kang C, Abrams DM, Li JJ, Mao J, Jia Y, Long Q, Sanger M, Jonassaint JC, De Castro L, Shah N. Understanding patterns and correlates of daily pain using the Sickle cell disease Mobile Application to Record Symptoms via Technology (SMART). Br J Haematol 2017; 183:306-308. [PMID: 29076140 DOI: 10.1111/bjh.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Charles R Jonassaint
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chaeryon Kang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel M Abrams
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Chicago, IL, USA
| | - Jingyi J Li
- Department of Statistics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jason Mao
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yimeng Jia
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Qi Long
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen Sanger
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jude C Jonassaint
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura De Castro
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nirmish Shah
- Division of Hematology, Duke University, Durham, NC, USA
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31
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Couperus K, Kmiecik K, Kang C. 130 A Better Way to Monitor Intravenous Infusions Away From an Outlet? Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.156] [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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32
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Clifton SM, Kang C, Li JJ, Long Q, Shah N, Abrams DM. Hybrid Statistical and Mechanistic Mathematical Model Guides Mobile Health Intervention for Chronic Pain. J Comput Biol 2017; 24:675-688. [PMID: 28581814 DOI: 10.1089/cmb.2017.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nearly a quarter of visits to the emergency department are for conditions that could have been managed via outpatient treatment; improvements that allow patients to quickly recognize and receive appropriate treatment are crucial. The growing popularity of mobile technology creates new opportunities for real-time adaptive medical intervention, and the simultaneous growth of "big data" sources allows for preparation of personalized recommendations. Here we focus on the reduction of chronic suffering in the sickle cell disease (SCD) community. SCD is a chronic blood disorder in which pain is the most frequent complication. There currently is no standard algorithm or analytical method for real-time adaptive treatment recommendations for pain. Furthermore, current state-of-the-art methods have difficulty in handling continuous-time decision optimization using big data. Facing these challenges, in this study, we aim to develop new mathematical tools for incorporating mobile technology into personalized treatment plans for pain. We present a new hybrid model for the dynamics of subjective pain that consists of a dynamical systems approach using differential equations to predict future pain levels, as well as a statistical approach tying system parameters to patient data (both personal characteristics and medication response history). Pilot testing of our approach suggests that it has significant potential to well predict pain dynamics, given patients reported pain levels and medication usages. With more abundant data, our hybrid approach should allow physicians to make personalized, data-driven recommendations for treating chronic pain.
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Affiliation(s)
- Sara M Clifton
- 1 Department of Engineering Sciences and Applied Mathematics, McCormick School of Engineering and Applied Science, Northwestern University , Evanston, Illinois
| | - Chaeryon Kang
- 2 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jingyi Jessica Li
- 3 Department of Statistics, University of California , Los Angeles, Los Angeles, California
| | - Qi Long
- 4 Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Nirmish Shah
- 5 Department of Medicine, Duke University , Durham, North Carolina
| | - Daniel M Abrams
- 1 Department of Engineering Sciences and Applied Mathematics, McCormick School of Engineering and Applied Science, Northwestern University , Evanston, Illinois
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Linkov F, Sanei-Moghaddam A, Edwards RP, Lounder PJ, Ismail N, Goughnour SL, Kang C, Mansuria SM, Comerci JT. Implementation of Hysterectomy Pathway: Impact on Complications. Womens Health Issues 2017; 27:493-498. [PMID: 28347618 DOI: 10.1016/j.whi.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hysterectomy is one of the most common surgical procedures in the United States. For women who need hysterectomy, it is important to ensure that minimally invasive hysterectomy procedures are used appropriately to reduce surgical complications and improve value of care. Although we previously demonstrated a reduction in total abdominal hysterectomy rates after the implementation of hysterectomy pathway treatment algorithm in 2012, this study focuses on exploring the effect of pathways implementation on surgical outcomes. METHODS All retrospective medical records for hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals between the fiscal years (FY) 2012 and 2014 were identified. We analyzed the health care outcomes by route of surgery and year using Χ2 test for categorical data, and non-parametric approaches for non-normal continuous variables. RESULTS A total of 6,569 hysterectomies for benign indications were performed between FY 2012 and 2014. In FY 2012, 1,154 patients (59.15%) had a length of stay of 1 day or less, whereas in FY 2014 this number increased to 1,791 (74.53%; p < .0001). Within 3 years of implementing the pathway, surgical site infections had a reduction of 47%, with a considerable trend toward significance (p = .067). CONCLUSIONS Implementation of hysterectomy pathway has been associated with reduction of surgical complications in benign hysterectomy settings. Implementation of clinical pathways offers an opportunity for improving patient outcomes that should be investigated in various health care settings and across procedures.
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Affiliation(s)
- Faina Linkov
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Amin Sanei-Moghaddam
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Paula J Lounder
- Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Naveed Ismail
- Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sharon L Goughnour
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Chaeryon Kang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suketu M Mansuria
- Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - John T Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Yang W, Li Y, Kang C, Zhao H, Xiang L, Li C, Wang Q. Sodiation-based in-source collision for profiling of pyranocoumarins in Radix Peucedani (Qianhu): utility of sodium adducts' stability with in-source collision. J Mass Spectrom 2017; 52:152-164. [PMID: 28102926 DOI: 10.1002/jms.3913] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
Full scan mode of liquid chromatography-mass spectrometry equipped with an electrospray ionization source offers a chance on global detection of complicated components; however, the scan mode carries significant challenges in rapidly capturing information of analysts. Sodiation-based in-source collision was proposed here, as a technique for rapid detecting untargeted analytes in full scan analysis, which was based on the stability of sodium adducts and the nonselectivity of in-source collision. Then the technique was applied to profile of angular-type pyranocoumarins (APs) in Radix Peucedani, with full scan analysis performed at two specific in-source collision energy: a high energy 50 V that is tolerated by the sodium adducts of APs, and a low energy 10 V, at which abundant adducts were offered. The spectra list of two average mass spectra was exported, and stable ions were selected based on the intensity ratio of standards at the two collision energy. Then 27 plausible [M + Na]+ m/z values of APs were acquired after filtering the fragment ion and isotope ions and validating with [M + NH4 ]+ . Eighty-two APs finally were tentatively identified based on their accurate spectral data of MSn , fragmentation rules, and elution order regardless of their absolute configuration, which included 25 reported APs from Peucedanum praeruptorum Dunn. The technique provided a novel application of sodium adduct in qualitative analysis. And it was valuable for rapidly capturing information of analytes in full scan analysis, not only for APs but also for other compounds that could form sodium adducts. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- W Yang
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
| | - Y Li
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
| | - C Kang
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
| | - H Zhao
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
| | - L Xiang
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
| | - C Li
- Center for DMPK Research of Herbal Medicines, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, No. 16 Nanxiaojie, Dongzhimennei Ave, Beijing, 100700, China
- Laboratory for DMPK Research of Herbal Medicines, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China
| | - Q Wang
- School of Pharmacy, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, China
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Lee SB, Kang C, Kim DH, Kim T, Lee SH, Jeong JH, Kim SC, Rhee DY, Lim D. Base deficit is a predictor of mortality in organophosphate insecticide poisoning. Hum Exp Toxicol 2017; 37:118-124. [PMID: 29233034 DOI: 10.1177/0960327117694073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Organophosphate insecticide (OPI) self-poisoning is a major medical problem in many countries. Several studies have demonstrated that the base deficit (BD) is a prognostic tool that is correlated with the severity of injury and predicted mortality, particularly in trauma patients. Here, we aimed to investigate the prognostic significance of BD in OPI poisoning. METHODS This retrospective observational study was conducted between January 1, 2006, and January 31, 2015, at a single emergency department (ED). The BD values were divided into quartiles according to the number of patients: 3 mEq/L or less, 3-5.9 mEq/L, 6-9.9 mEq/L, and 10 mEq/L or greater. Survival at 30 days from ED admission was estimated using the Kaplan-Meier survival analysis. RESULTS Among 154 patients, 31 died, yielding a mortality of 20.1%. The highest BD quartile (≥ 10 mEq/L) and the 6-9.9 mEq/L group were associated with an increased risk of 30-day mortality. Patients with a BD of 10 mEq/L or greater had a 5.85-fold higher risk of 30-day mortality and patients with a BD of 6-9.9 mEq/L had a 5.40-fold higher risk of 30-day mortality compared to patients with a BD of 3 mEq/L or less. The area under the curves of the BD and the Acute Physiology and Chronic Health Evaluation II score for mortality were 0.748 (95% confidence interval (CI), 0.660-0.835) and 0.852 (95% CI, 0.789-0.915), respectively. CONCLUSIONS This study showed that the BD is a predictor of 30-day mortality in patients with OPI poisoning.
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Affiliation(s)
- S B Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - C Kang
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T Kim
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- 1 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- 2 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.,3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Y Rhee
- 3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D Lim
- 3 Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Kang C, Yeo D, Ji LL. Muscle immobilization activates mitophagy and disrupts mitochondrial dynamics in mice. Acta Physiol (Oxf) 2016; 218:188-197. [PMID: 27083499 DOI: 10.1111/apha.12690] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [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: 02/22/2016] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 12/23/2022]
Abstract
AIM Skeletal muscle atrophy following prolonged immobilization (IM) is a catabolic state characterized by increased proteolysis and functional deterioration. Previous research indicates that discord of mitochondrial homoeostasis plays a critical role in muscle atrophy. We hypothesized that muscle IM would activate the ubiquitin-proteolysis, autophagy-lysosome (mitophagy) pathway, mitochondrial dynamics remodelling and apoptosis partially controlled by the FoxO signalling pathway. METHODS Female FVB/N mice were randomly divided into five groups (n = 8 each): control (CON), IM with banding of one of the hindlimbs for 1, 2 and 3 weeks (1w-, 2w- and 3w-IM) and 2w-IM followed by 1 week of remobilization (RM). RESULTS Mitochondrial density and DNA copies in tibialis anterior (TA) muscle were reduced by approx. 80% (P < 0.05 for 2w-IM; P < 0.01 for 3w-IM), along with activation of FoxO3a, atrogin-1 and MuRF1 following 2w- and 3w-IM (P < 0.01). Protein markers of autophagy/mitophagy, such as beclin 1 (approx. 2.7-fold; P < 0.01), LC3, ubiquitin-binding adaptor (approx. 1.47-fold; P < 0.01), Rheb (approx. 1.9-fold; P < 0.05) and parkin (approx. 70%; P < 0.05), were all increased by IM and remained activated after RM, whereas BNIP3 and PINK1 levels were decreased by IM (P < 0.05), but elevated upon RM (P < 0.01). IM decreased Mfn2 expression (approx. 50%; P < 0.01) and increased Fis-1 expression (approx. 2.4-fold; P < 0.05). Muscle apoptosis indicator Bax/Bcl2 ratio was elevated at 2w- to 3w-IM (approx. 3.7-fold; P < 0.01), whereas caspase-3 activity was five- to sixfold higher (P < 0.01) and remained threefold higher above CON (P < 0.05). CONCLUSION Our data indicate that IM-induced mitochondrial deterioration is associated with altered protein expressions in the autophagic/mitophagic pathway, more fragmented mitochondrial network and activation of apoptosis partly under the influence of FoxO3 activation.
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Affiliation(s)
- C. Kang
- Laboratory of Physiological Hygiene and Exercise Science; School of Kinesiology; University of Minnesota at Twin Cities; Minneapolis MN USA
| | - D. Yeo
- Laboratory of Physiological Hygiene and Exercise Science; School of Kinesiology; University of Minnesota at Twin Cities; Minneapolis MN USA
| | - L. L. Ji
- Laboratory of Physiological Hygiene and Exercise Science; School of Kinesiology; University of Minnesota at Twin Cities; Minneapolis MN USA
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Kogan JN, Schuster J, Nikolajski C, Schake P, Carney T, Morton SC, Kang C, Reynolds CF. Challenges encountered in the conduct of Optimal Health: A patient-centered comparative effectiveness study of interventions for adults with serious mental illness. Clin Trials 2016; 14:5-16. [PMID: 27681658 DOI: 10.1177/1740774516670895] [Citation(s) in RCA: 7] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of patient-centered comparative effectiveness research is to conduct stakeholder-driven investigations that identify which interventions are most effective for which patients under specific circumstances. Conducting this research in real-world settings comes with unique experiences and challenges. We provide the study design, challenges confronted, and the solutions we devised for Optimal Health, a stakeholder-informed patient-centered comparative effectiveness study focused on the needs of seriously mentally ill individuals receiving case management services in community mental health centers across Pennsylvania. METHODS Optimal Health, supported by the Patient-Centered Outcomes Research Institute, is a cluster-randomized trial of two evidence-based interventions for improving health and wellness across 11 provider sites. Participants were followed for 18-24 months, with repeated measurements of self-reported health status and activation in care and administrative measurements of primary and specialty health service utilization. Health-related quality of life, engagement in care, and service utilization are to be compared via random effects mixed models. Stakeholders were, and continue to be, engaged via focus groups, interviews, and stakeholder advisory board meetings. A learning collaborative model was used to support shared learning and implementation fidelity across provider sites. RESULTS From 1 November 2013 through 15 July 2014, we recruited 1229 adults with serious mental illness, representing 85.1% of those eligible for study participation. Of these, 713 are in the Provider-Supported arm of the study and 516 in Patient Self-Directed Care. Across five data collection time points, we retained 86% and 83% of the participants in the Provider-Supported and Self-Directed arms, respectively. LESSONS LEARNED Lessons learned relate to estimation of the size of our study population, the value of multiple data sources, and intervention training and implementation. The use of historical claims data can lead to an overestimation of eligible participants and, subsequently, a reduced study sample and an imbalance between intervention arms. Disruptions in continuity of care in real-world settings can pose challenges to on-site self-report data collection, although the inclusion of multiple data sources in study design can improve data completeness. Geographic dispersion of rural provider sites and staff turnover can lead to training and intervention fidelity challenges that can be overcome with the use of a "train-the-trainer" model, "wellness champions," and the use of a Learning Collaborative approach. Stakeholder engagement in mitigating these challenges proved to be critical to study progress. CONCLUSION Conducting real-world patient-centered comparative effectiveness research in healthcare systems that care for seriously mentally ill persons is an important yet challenging undertaking, one which requires flexibility in identifying potential adaptations within all major study phases. Advice from a wide range of stakeholders is critical in development of successful strategies.
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Affiliation(s)
- Jane N Kogan
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA.,2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - James Schuster
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA.,2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Cara Nikolajski
- 1 UPMC Center for High-Value Health Care, Pittsburgh, PA, USA
| | - Patricia Schake
- 2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA
| | - Tracy Carney
- 2 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, PA, USA.,3 Columbia Montour Snyder Union Counties of Central Pennsylvania Service System, Danville, PA, USA
| | - Sally C Morton
- 4 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chaeryon Kang
- 4 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles F Reynolds
- 5 School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Quan Y, Ji X, Liu K, Kang C. Synthesis, characterization, and photocatalytic properties of La3+-doped BiPO4 photocatalysts. Kinet Catal 2016. [DOI: 10.1134/s0023158416020105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Choi B, Lim H, Kim K, Shin Y, Yoon C, Kang C. The synergistic effect of PKA activator and HDAC inhibitor to reactivate HIV-1 provirus from latently infected cells. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31371-6] [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: 11/27/2022] Open
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Park H, Chung YS, Yoon CH, Lee SH, Kim SS, Kang C, Choi BS. Presentation of available CTL epitopes that induction of cell-mediated immune response against HIV-1 Koran clade B strain using computational technology. HIV Med 2015; 17:460-6. [PMID: 26471354 DOI: 10.1111/hiv.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Theoretical predicting cytotoxic T lymphocyte (CTL) epitopes are an important tool in vaccine design and CTL therapy for enhancing our understanding of the cellular immune system. We would like to identify available CTL epitopes against HIV-1 Korean clade B. CTL activity was assessed in freshly isolated peripheral blood mononuclear cells from Korean HIV patients in order to assess whether these CTL epitopes induce a cell-mediated immune response (CMI). METHODS NetCTLpan1.1 software, which is the most popular prediction computer software package, and full atom-based simulation (FABS), which is a 3D modelling system for binding activity between epitopes and human leucocyte antigen (HLA) molecules, were used to predict the peptide-spanning Env region binding to HLA-A*24:02, HLA-A*02:01 and HLA-B*15:01, which are frequently found in the Korean population. Granzyme B and interferon-γ ELISPOT assays were used to determine whether identified CTL epitopes induce CMI. RESULTS Three HIV-1 Korean clade B-specific Env CTL epitopes were identified: Gp41-RYL and Gp41-RQG are localized within gp41, and Gp120-LLQ within gp120. In in vitro assays using granzyme B ELISPOT, Gp120-LLQ and Gp41-RQG induced epitope-specific CTL responses in HLA-restricted cells. In ex vivo assay using IFN-γ ELISPOT, cell-mediated immune responses to Gp41-RYL were present in 50% of HLA-matched patients, and responses to Gp120-LLQ and Gp41-RQG were found in 33% of HLA-matched patients. CONCLUSION In this study, we found that a prediction pipeline for CTL epitopes might be based on the most popular computer prediction software and FABS methods. Our results suggest that these CTL epitopes may provide useful tools and information for the development of a therapeutic vaccine against HIV-1 Korean clade B.
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Affiliation(s)
- H Park
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
| | - Y-S Chung
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
| | - C-H Yoon
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
| | - S H Lee
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - S S Kim
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
| | - C Kang
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
| | - B-S Choi
- Division of AIDS, Korea National Institute of Health, Cheongju, Chungbuk, Korea
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Moffett P, Cartwright L, Grossart E, O'Keefe D, Kang C. 60 Intravenous Ondansetron and the QT Interval in Adult Emergency Department Patients: An Observational Study. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.092] [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: 11/29/2022]
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Kim DS, Kang C, Kim DH, Kim SC, Lee SH, Jeong JH, Kang TS, Jung SM, Lee SB, Lee KW, Kim RB. External validation of the prognostic index in acute paraquat poisoning. Hum Exp Toxicol 2015; 35:366-70. [PMID: 25977258 DOI: 10.1177/0960327115586821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Some studies have evaluated the prognostic indicators associated with acute paraquat (PQ) poisoning. In this study, we externally validated the Yamaguchi index, which showed a good prognostic relevance in predicting the outcome of PQ poisoning. METHODS A retrospective analysis of 297 patients was performed. The Yamaguchi index was calculated using the following equation: Eq1 = (K(+) × HCO3(-))/(Creatinine × 0.088)(mEq/L) against time from PQ ingestion (T). The patients were divided into three groups: group A: Eq1 > 1500 - 399 × log T, group B: 930 - 399 × log T < Eq1 ≤ 1500 - 399 × log T, and group C: Eq1 ≤ 930 - 399 × log T). RESULTS The overall mortality rate was 65.3% (194 of 297). The mortality rates of the three groups stratified by the Yamaguchi index were 7.1% (2 of 28), 22.4% (15 of 67), and 87.6% (177 of 202). The area under the receiver-operating characteristic curve for predicting mortality from the external validation of the Yamaguchi index was 0.842 (95% confidence interval: 0.795-0.882). CONCLUSION The Yamaguchi index is a reliable prognostic factor and could be helpful in predicting mortality due to PQ poisoning.
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Affiliation(s)
- D S Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - C Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - D H Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S C Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S H Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - J H Jeong
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - T S Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S M Jung
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S B Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - K W Lee
- Department of Emergency Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - R B Kim
- Department of Preventive Medicine, Dong-A University, Busan, Republic of Korea
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Atallah S, Drake J, Martin-Perez B, Kang C, Larach S. Robotic transanal total mesorectal excision with intersphincteric dissection for extreme distal rectal cancer: a video demonstration. Tech Coloproctol 2015; 19:435. [PMID: 25962631 DOI: 10.1007/s10151-015-1304-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- S Atallah
- Florida Hospital, Winter Park, FL, USA,
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Abstract
Novel aromatic poly(benzoxazole–imide)s containing naphthalene were prepared from synthesized 1,4-di(5-aminobenzoxazol-2-yl)naphthalene and commercial dianhydrides by conventional two-step polymerization. The polymers showed high levels of tensile strength of up to 294 MPa and modulus of up to 6.5 GPa. The glass transition temperatures of the polymers were observed between 267°C and 345°C. The 5% weight loss temperatures of the polymers were tested in the range of 517–562°C in nitrogen atmosphere. The excellent properties of polymers were attributed to their rigid-rod-like molecular structure. The polymers emitted different fluorescence with maximum emission wavelengths in the range of 470–560 nm. Increasing the dianhydride electron affinity, the emission spectra peak value of polyimides (PIs) except PI6 increased gradually, but the fluorescent intensity of the PIs decreased. The 1,4-bis(3,4-dicarboxyphenoxy)benzene dianhydride-derived PI film exhibit highly fluorescent characteristics; however, the PI film from pyromellitic dianhydride was nonfluorescent.
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Affiliation(s)
- X. Ma
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - X. Ma
- CAST-Xi’an Institute of Space Radio Technology, China Academy of Space Technology, Xi’an, China
| | - X. Qiu
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - R. Jin
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - C. Kang
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - L. Gao
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
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Zhao Z, Jiang X, Kang C, Xiao Y, Hou C, Yu J, Wang R, Xiao H, Zhou T, Wen Z, Feng J, Chen G, Ma Y, Shen B, Li Y, Han G. Blockade of the T cell immunoglobulin and mucin domain protein 3 pathway exacerbates sepsis-induced immune deviation and immunosuppression. Clin Exp Immunol 2014; 178:279-91. [PMID: 24945079 DOI: 10.1111/cei.12401] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 01/07/2023] Open
Abstract
Sepsis is a life-threatening condition, but the pathophysiological basis and biomarkers for the monitoring of sepsis and as targets for therapy remain to be determined. We have shown previously that T cell immunoglobulin and mucin domain protein 3 (Tim-3), a negative immune regulator, is involved in the physiopathology of sepsis, but the underlying mechanisms remain unclear. In the present study, we showed that Tim-3 signalling modulated the response patterns of both macrophages and T helper cells in sepsis. Blockade of the Tim-3 pathway exacerbated sepsis-induced proinflammatory macrophage responses and lymphocyte apoptosis during the early phase of sepsis, and enhanced the shift to anti-inflammatory responses for both macrophages and T helper cells during the late phase of sepsis. Tim-3 signalling was found to regulate CD80 and CD86 expression on macrophages both in vivo and in vitro. Co-culture of T cells with Tim-3 knock-down macrophages led to a biased T helper type 2 (Th2) response, partially explaining how Tim-3 signalling shapes inflammation patterns in vivo. Further studies on this pathway might shed new light on the pathogenesis of sepsis and suggest new approaches for intervention.
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Affiliation(s)
- Z Zhao
- Department of Molecular Immunology, Beijing Institute of Basic Medical Sciences, Beijing, China; Institute of Immunology, Medical School of Henan University, Kaifeng, China; Department of Pathology, Zhengzhou People's Hospital, YIHE Hospital, Zhengzhou, China
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Fang J, Kang C, Li Z, Xue J, Lv H. Correlation research of carotid arterial sclerosis and left ventricular diastolic function in hyperthyroidism. Minerva Cardioangiol 2014; 62:379-387. [PMID: 24699548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM This study aims to investigate the correlation of carotid arterial sclerosis and left ventricular diastolic function in hyperthyroidism. METHODS A total of 70 patients with newly-diagnosed hyperthyroidism, including 32 patients clinically cured or improved after I131 therapy, were compared with 74 healthy cases in the control group. Bilateral carotid ultrasound and echocardiography were performed in all subjects. The carotid sclerosis index B, compliance coefficient CC, pulse wave velocity (PWV) and left ventricular diastolic function parameters (mitral valve diastolic peak velocity ratio E/A, mitral annulus tissue Doppler diastolic peak velocity ratio e/a and E/e) were obtained. RESULTS The B, CC, PWV and E/e exhibited correlation. Pre-treatment CC was negatively correlated with E/e (r=-0.325, P<0.01), whereas B and PWV were positively correlated with E/e (r=0.270 and 0.297, P < 0.05). Post-treatment CC was negatively correlated with E/e (r=-0.462, P<0.01), whereas B and PWV were positively correlated with E/e (r=0.513 and 0.479, P<0.01). CONCLUSION Carotid artery function and left ventricular diastolic function of hyperthyroid patients were damaged before the treatment and recovered after the treatment. Thus, a correlation existed between them. The early detection of carotid artery function could help the early detection of cardiovascular disease in the hyperthyroid patients.
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Affiliation(s)
- J Fang
- Department of Ultrasound Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Taiyuan Shanxi Province, P. R. China -
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Kang C, Huang Y, Miller CJ. A discrete-time survival model with random effects for designing and analyzing repeated low-dose challenge experiments. Biostatistics 2014; 16:295-310. [PMID: 25190513 DOI: 10.1093/biostatistics/kxu040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Repeated low-dose (RLD) challenge designs are important in HIV vaccine research. Current methods for RLD designs rely heavily on an assumption of homogeneous risk of infection among animals, which, upon violation, can lead to invalid inferences and underpowered study designs. We propose to fit a discrete-time survival model with random effects that allows for heterogeneity in the risk of infection among animals and allows for predetermined challenge dose changes over time. Based on this model, we derive likelihood ratio tests and estimators for vaccine efficacy. A two-stage approach is proposed for optimizing the RLD design under cost constraints. Simulation studies demonstrate good finite sample properties of the proposed method and its superior performance compared to existing methods. We illustrate the application of the heterogeneous infection risk model on data from a real simian immunodeficiency virus vaccine study using Rhesus Macaques. The results of our study provide useful guidance for future RLD experimental design.
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Affiliation(s)
- Chaeryon Kang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Ying Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Christopher J Miller
- Center for Comparative Medicine and California National Primate Research Center, University of California, Davis, CA 95616, USA
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Kim B, Kim H, Wu H, Kang C, Kim Y, Lee S. Role of Postoperative Radiation Therapy After Curative Resection and Adjuvant Chemotherapy for Patients With Pathological Stage N2 Non-Small Cell Lung Cancer: A Propensity Score Matching Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1831] [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: 10/24/2022]
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Kang C, Janes H, Huang Y. Rejoinder: Combining biomarkers to optimize patient treatment recommendations. Biometrics 2014; 70:719-20. [PMID: 24889787 DOI: 10.1111/biom.12192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Chaeryon Kang
- Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A
| | - Holly Janes
- Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A
| | - Ying Huang
- Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A
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Kang E, Kim S, Kang C, Kang YM, Kang S, Baek H, Lee E, Lee Y, Lee E, Song Y. AB0004 Erap1 Polymorphisms in Korean Patients with Behcet's Disease. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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