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Dharmani C, Fofah O, Wang E, Salas M, Wooddell M, Tu N, Tse J, Near A, Tinoco G. Real-world drug utilization and treatment patterns in patients with tenosynovial giant cell tumors in the USA. Future Oncol 2024. [PMID: 38380590 DOI: 10.2217/fon-2023-0363] [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: 02/22/2024] Open
Abstract
Aim: Real-world treatment patterns in tenosynovial giant cell tumor (TGCT) patients remain unknown. Pexidartinib is the only US FDA-approved treatment for TGCT associated with severe morbidity or functional limitations and not amenable to improvement with surgery. Objective: To characterize drug utilization and treatment patterns in TGCT patients. Methods: In a retrospective observational study using IQVIA's linked prescription and medical claims databases (2018-2021), TGCT patients were stratified by their earliest systemic therapy claim (pexidartinib [N = 82] or non-FDA-approved systemic therapy [N = 263]). Results: TGCT patients treated with pexidartinib versus non-FDA-approved systemic therapies were predominantly female (61 vs 50.6%) and their median age was 47 and 54 years, respectively. Pexidartinib-treated patients had the highest 12-month probability of remaining on treatment (54%); 34.1% of pexidartinib users had dose reduction after their first claim. Conclusion: This study provides new insights into the unmet need, utilization and treatment patterns of systemic therapies for the treatment of TGCT patients.
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Affiliation(s)
- Charles Dharmani
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Oluwatosin Fofah
- Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Eric Wang
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Maribel Salas
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Margaret Wooddell
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Nora Tu
- Daiichi Sankyo, Inc., 211, Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | | | | | - Gabriel Tinoco
- The Ohio State University Wexner Medical Center, 460 W 10th Ave, Columbus, OH 43210, USA
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Pearson-Stuttard J, Banerji T, Capucci S, de Laguiche E, Faurby MD, Haase CL, Sommer Matthiessen K, Near AM, Tse J, Zhao X, Evans M. Real-world costs of obesity-related complications over eight years: a US retrospective cohort study in 28,500 individuals. Int J Obes (Lond) 2023; 47:1239-1246. [PMID: 37723273 PMCID: PMC10663144 DOI: 10.1038/s41366-023-01376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Obesity-related complications (ORCs) are associated with high costs for healthcare systems. We assessed the relationship between comorbidity burden, represented by both number and type of 14 specific ORCs, and total healthcare costs over time in people with obesity in the USA. METHODS Adults (≥ 18 years old) identified from linked electronic medical records and administrative claims databases, with a body mass index measurement of 30-< 70 kg/m2 between 1 January 2007 and 31 March 2012 (earliest measurement: index date), and with continuous enrolment for ≥ 1 year pre index (baseline year) and ≥ 8 years post index, were included. Individuals were grouped by type and number of ORCs during the pre-index baseline year. The primary outcome was annual total adjusted direct per-person healthcare costs. RESULTS Of 28,583 included individuals, 12,686 had no ORCs, 7242 had one ORC, 4180 had two ORCs and 4475 had three or more ORCs in the baseline year. Annual adjusted direct healthcare costs increased with the number of ORCs and over the 8-year follow-up. Outpatient costs were the greatest contributor to baseline annual direct costs, irrespective of the number of ORCs. For specific ORCs, costs generally increased gradually over the follow-up; the largest percentage increases from year 1 to year 8 were observed for chronic kidney disease (+ 78.8%) and type 2 diabetes (+ 47.8%). CONCLUSIONS In a US real-world setting, the number of ORCs appears to be a cost driver in people with obesity, from the time of initial obesity classification and for at least the following 8 years.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Lane Clark & Peacock LLP, London, UK.
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | | | | | | | | | | | | | | | | | | | - Marc Evans
- University Hospital, Llandough, Penarth, Cardiff, UK
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Tse J, Prajapati G, Zhao X, Near AM, Kumar PN. Weight gain following switch to integrase inhibitors from non-nucleoside reverse transcriptase or protease inhibitors in people living with HIV in the United States: analyses of electronic medical records and prescription claims. Curr Med Res Opin 2023; 39:1237-1246. [PMID: 37480288 DOI: 10.1080/03007995.2023.2239661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES Real-world data evaluating weight changes in people living with HIV (PLWH) following switch to integrase strand transfer inhibitor (INSTI), specifically bictegravir (BIC), are limited. This retrospective cohort study analyzed weight changes upon switching to INSTI from non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) in treatment-experienced PLWH. METHODS Adult PLWH (≥18 years) treated with NNRTI or PI (non-switch cohorts) and those switching to INSTI (switch cohorts) between January 1, 2014 and August 31, 2019 were identified using IQVIA's Ambulatory Electronic Medical Records linked to a prescription drug claims database. The associations of switching to INSTI and individual INSTI agents with having ≥5% weight gain at 12 months of follow-up were evaluated, adjusting for demographics and baseline clinical characteristics. RESULTS At 12 months of follow-up, PLWH in the NNRTI-INSTI switch cohort (n = 508) were more likely to have ≥5% weight gain over 12 months compared to the NNRTI non-switch cohort (n = 614; odds ratio, OR [95% CI], 1.7 [1.2-2.4]). Switching from NNRTI to dolutegravir (DTG: OR [95% CI], 2.1 [1.4-3.0]) or BIC (2.0 [1.0-4.2]) resulted in significantly higher odds of ≥5% weight gain. PI-INSTI switch (n = 295) and non-switch (n = 228) cohorts had similar proportions of PLWH with ≥5% (21.1-23.4%) or ≥10% (7.8-7.9%) weight gain, and no significant association was found between switching from PI to INSTI and weight gain. CONCLUSION Weight gain and related metabolic health of PLWH switching from NNRTI to DTG or BIC should be closely monitored by clinicians. Further research is needed to assess other metabolic outcomes in PLWH remaining on PI and those who switch from PI to INSTI.
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Affiliation(s)
- Jenny Tse
- Real World Solutions, IQVIA, Durham, NC, USA
| | | | | | | | - Princy N Kumar
- Georgetown University Medical Center, Washington, DC, USA
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Zhao X, Prajapati G, Tse J, Near AM, Kumar PN. Weight gain after antiretroviral therapy initiation in people living with HIV in the United States: analyses of electronic medical records and prescription claims. Curr Med Res Opin 2023; 39:997-1006. [PMID: 37334707 DOI: 10.1080/03007995.2023.2224165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Treatment guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) regimens for treatment naïve people living with HIV (PLWH) in the United States (US). This retrospective database study compared weight changes following initiation of INSTI-, non-nucleoside reverse transcriptase inhibitor (NNRTI)-, or protease inhibitor (PI)-based ART in treatment-naïve PLWH. METHODS Adult (≥18 years) PLWH initiated on INSTI, NNRTI, or PI plus ≥2 nucleoside reverse transcriptase inhibitors (NRTI) between 1 January 2014 to 31 August 2019 were identified in IQVIA's Ambulatory Electronic Medical Records (AEMR) linked to prescription drug claims (LRx). Weight changes over up to 36 months (M) of follow-up were compared among PLWH on INSTI- vs. NNRTI- and PI-based ART separately using non-linear mixed effect models, adjusting for demographics and baseline clinical characteristics. RESULTS The INSTI, NNRTI, and PI cohorts included 931, 245, and 124 PLWH, respectively. For all three cohorts, the majority were male (78.2-81.2%) and overweight/obese (53.6-61.6%) at baseline; 40.8-45.2% of the groups were African American. The INSTI vs. NNRTI/PI cohorts were younger (median age: 38 years vs. 44 years/46 years), had lower weight at ART initiation (mean: 80.9 kg vs. 85.7 kg/85.0 kg), and had higher TAF usage during follow-up (55.6% vs. 24.1%/25.8%; all p < .05). Multivariate models showed higher weight gain among PLWH in INSTI vs. NNRTI and PI cohorts during treated follow-up (estimated weight gain after 36 M: 7.1 kg vs. 3.8 kg and 3.8 kg, both p < .05). CONCLUSION Study findings highlight the need to monitor an increase in weight and potential metabolic complications among PLWH starting ART with INSTI.
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Affiliation(s)
| | - Girish Prajapati
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | - Jenny Tse
- Real World Solutions, IQVIA, Durham, NC, USA
| | | | - Princy N Kumar
- Department of Medicine and Microbiology, Georgetown University Medical Center, Washington, DC, USA
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Teschemaker A, Hakre S, Tse J, Shaikh NF, Gu Y, Near A. HSR23-119: Real-World Duration of Venetoclax Treatment for Chronic Lymphocytic Leukemia and Small Lymphocytic Leukemia (CLL/SLL). J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Castaldo T, Selva C, Johnson P, Hunter AG, Tse J, Martinez A, Cortright A, Carroll H, Chen H, Lumry W. Comparison of Selected Health and Well Being Characteristics in Seniors with Hereditary Angioedema (HAE) and a Non-HAE Patient Matched Cohort. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Shenolikar R, Liu S, Shah A, Tse J, Cao Y, Near A. Real-world treatment patterns of metastatic non-small cell lung cancer patients receiving epidermal growth factor receptor tyrosine kinase inhibitors. Cancer Med 2023; 12:159-169. [PMID: 35702932 PMCID: PMC9844647 DOI: 10.1002/cam4.4918] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/16/2021] [Revised: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) have been approved for first-line (1L) treatment of EGFR-mutated metastatic non-small cell lung cancer (mNSCLC) in the United States (US). Real-world analyses of 1L treatment patterns with EGFR TKIs, including the third-generation EGFR TKI osimertinib which was most recently approved in 2018, are still sparse. METHODS This retrospective observational study used data from IQVIA's prescription claims (LRx) and medical claims (Dx) databases. mNSCLC patients newly treated with any EGFR TKI in the 1L setting were identified from January 1, 2015 to April 30, 2020; the first date of EGFR TKI (third-generation osimertinib, first-generation [erlotinib, gefitinib], or second-generation [afatinib, dacomitinib]) was the index date. Treatment patterns were reported in the cohorts stratified by 1L EGFR TKI. RESULTS A total of 2505 patients were included in the study (982 osimertinib, 1060 first-generation, and 463 second-generation EGFR TKI). Beginning in 2018, osimertinib became the most common 1L EGFR TKI (66.7%) and in early 2020, it accounted for 90.6% of 1L EGFR TKIs. Nearly all patients (>97%) were treated with 1L EGFR TKI monotherapy. Patients with 1L osimertinib had longer treatment duration compared to patients with 1L first- or second-generation EGFR TKI (median months: 17.8 vs. 8.7 vs. 10.5, respectively; log-rank test for comparisons with osimertinib p < 0.0001) over median follow-up times of 9.8, 20.5, and 19.3 months. 32.5% and 36.3% of the first- and second-generation EGFR TKI cohorts, respectively, had evidence of 2L treatment. Osimertinib monotherapy accounted for the majority of 2L treatments (58.3%/60.7%) and 11.3%/8.9% had 2L chemotherapy or immuno-oncology therapy following 1L first- or second-generation EGFR TKI. CONCLUSION In this real-world study of a US claims database, 1L treatment duration was longer with osimertinib compared with other EGFR TKIs. Future studies with longer follow-up are recommended to understand treatment patterns after progression on EGFR TKIs.
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Affiliation(s)
| | | | | | | | - Yao Cao
- IQVIADurhamNorth CarolinaUSA
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Makutonin M, Newton S, Tse J, Ma Y, Moghtaderi A, Meltzer A. 8 Comparison of One-year Outcomes by Management Type in Patients Presenting to the Emergency Department With Uncomplicated Acute Appendicitis. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Near AM, Tse J, Young-Xu Y, Hong DK, Reyes CM. Burden of influenza hospitalization among high-risk groups in the United States. BMC Health Serv Res 2022; 22:1209. [PMID: 36171601 PMCID: PMC9520810 DOI: 10.1186/s12913-022-08586-y] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Seasonal influenza poses a substantial clinical and economic burden in the United States and vulnerable populations, including the elderly and those with comorbidities, are at elevated risk for influenza-related medical complications. Methods We conducted a retrospective cohort study using the IQVIA PharMetrics® Plus claims database in two stages. In Stage 1, we identified patients with evidence of medically-attended influenza during influenza seasons from October 1, 2014 to May 31, 2018 (latest available data for Stage 1) and used a multivariable logistic regression model to identify patient characteristics that predicted 30-day influenza-related hospitalization. The findings from Stage 1 informed high-risk subgroups of interest for Stage 2, where we selected cohorts of influenza patients during influenza seasons from October 1, 2014 to March 1, 2019 and used 1:1 propensity score matching to patients without influenza with similar high-risk characteristics to compare influenza-attributable rates of all-cause hospital and emergency department (ED) visits during follow-up (30-day and in the index influenza season). Results In Stage 1, more than 1.6 million influenza cases were identified, of which 18,509 (1.2%) had a hospitalization. Elderly age was associated with 9 times the odds of hospitalization (≥65 years vs. 5–17 years; OR = 9.4, 95% CI 8.8–10.1) and select comorbidities were associated with 2–3 times the odds of hospitalization. In Stage 2, elderly influenza patients with comorbidities had 3 to 7 times higher 30-day hospitalization rates compared to matched patients without influenza, including patients with congestive heart failure (41.0% vs.7.9%), chronic obstructive pulmonary disease (34.6% vs. 6.1%), coronary artery disease (22.8% vs. 3.8%), and late-stage chronic kidney disease (44.1% vs. 13.1%; all p < 0.05). Conclusions The risk of influenza-related complications is elevated in the elderly, especially those with certain underlying comorbidities, leading to excess healthcare resource utilization. Continued efforts, beyond currently available vaccines, are needed to reduce influenza burden in high-risk populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08586-y.
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Affiliation(s)
- Aimee M Near
- IQVIA, 4820 Emperor Blvd, Durham, NC, 27703, USA.
| | - Jenny Tse
- IQVIA, 4820 Emperor Blvd, Durham, NC, 27703, USA
| | - Yinong Young-Xu
- US Department of Veterans Affairs, Clinical Epidemiology Program, 215 N Main St, White River Junction, VT, 05009, USA
| | - David K Hong
- VIR Biotechnology Inc, 499 Illinois St, San Francisco, CA, USA
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Lin F, Tse J, Liu H, Wada K, Near AM, Kwong WJ, Ingham M. HSR22-152: Healthcare Resource Utilization, Dosing and Time on Treatment in Patients on Pexidartinib Tenosynovial Giant Cell Tumors: Real-World Evidence from a Claims-Based Dataset. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Feng Lin
- 1 Daiichi Sankyo, Inc., Basking Ridge, NJ
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Burudpakdee C, Near AM, Tse J, Faccone J, Rodriguez PL, Karichu JK, Cheng MM. Real-world HIV diagnostic testing patterns in the United States. Am J Manag Care 2022; 28:e42-e48. [PMID: 35139295 DOI: 10.37765/ajmc.2022.88826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To understand real-world implementation of the updated CDC HIV diagnostic testing algorithm. STUDY DESIGN Retrospective database analysis. METHODS Using data from Quest Diagnostics, we identified patients with at least 1 HIV-1/HIV-2 antibody differentiation test (BioRad Geenius HIV 1/2 Supplemental Assay [Geenius]) between January 1 and December 31, 2017. Study measures included Health Insurance Portability and Accountability Act-compliant patient demographics, test results, test frequency, and sequence relative to the CDC HIV diagnostic algorithm, including HIV-1 RNA Qualitative Assay (Aptima) or HIV-2 nucleic acid test (NAT). RESULTS A total of 26,319 patients were identified (mean [SD] age, 40.7 [14.3] years; 66.4% male), with 28,954 Geenius tests, 7234 Aptima tests, and 298 HIV-2 NATs. In 26.4% of test sequences, the Geenius results were indeterminate or negative and required subsequent confirmatory NATs. A total of 8.5% of patients had more than 1 Geenius test in 2017, and 11.2% of the time, results of the first and second tests differed. A total of 74.2% of test sequences matched the CDC-recommended algorithm. CONCLUSIONS Our study findings suggest that the CDC HIV diagnostic algorithm is complex and may pose suboptimal testing efficiency. Opportunities to improve diagnostic efficiency by reducing indeterminate results and repeat tests are warranted.
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Affiliation(s)
| | | | | | | | | | - James K Karichu
- Roche Molecular Systems, Inc, 4300 Hacienda Dr, Pleasanton, CA 94588.
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Shenolikar R, Liu S, Tse J, Cao Y, Near A. Real-world treatment patterns of metastatic non-small cell lung cancer (mNSCLC) patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
289 Background: Among mNSCLC patients positive for EGFR mutation (EGFRm), first-line (1L) treatment with an EGFR TKI is recommended for best outcomes. This study describes real-world treatment patterns of mNSCLC patients using EGFR TKIs in the 1L setting, including osimertinib, the most recently approved EGFR TKI for 1L use. Methods: Patients with ≥1 claim for an EGFR TKI (1st generation [1G]: gefitinib, erlotinib; 2nd generation [2G]: afatinib, dacomitinib; 3rd generation: osimertinib) from January 1, 2015 – April 30, 2020 were identified in IQVIA’s prescription (LRx) and medical claims (Dx) databases; first date of EGFR TKI was the index date. Patients had 12-month baseline period before index, variable follow-up after index, ≥1 lung cancer diagnosis on index or in baseline, and earliest metastatic cancer diagnosis on or 90 days before index. Kaplan-Meier analysis was used to estimate 1L treatment duration, where treatment discontinuation was defined as >60-day gap in medication supply of the index EGFR TKI. Patient characteristics and treatment patterns were stratified by 1L EGFR TKI. Results: Overall, 2,505 mNSCLC patients received 1L EGFR TKI (982 osimertinib, 1,060 1G, 463 2G). Median ages were 66-69 years, 64.6-67.1% were female, and 32.4-38.9% had central nervous system metastases on or before index. Most patients were commercially insured (50.8-62.9%), 35.3-45.9% had Medicare, and 0.6-3.3% had other payer types. Nearly all patients had 1L EGFR TKI monotherapy (97.6-99.7%). 1L treatment duration was longer for osimertinib compared to 1G or 2G EGFR TKI (median months, 17.8, 8.7, 10.5 respectively). 2L treatment was observed in 32.5% of 1G and 36.3% of 2G EGFR TKI cohorts. Osimertinib monotherapy, chemotherapy, and immunotherapy (monotherapy or combined with chemotherapy) accounted for 58.3%, 7.0%, and 4.3% of 2L treatments after 1L 1G EGFR TKI, respectively, and 60.7%, 4.2%, and 4.8% of 2L treatments after 1L 2G EGFR TKI. Conclusions: In real-world practice, 1L treatment duration is longer with osimertinib compared with other EGFR TKIs. Future studies with longer follow-up are recommended to understand treatment patterns after progression on EGFR TKIs, mainly osimertinib, given its recent approval.
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Affiliation(s)
| | - Sizhu Liu
- AstraZeneca Pharmaceuticals LP, Gaithersburg, MD
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Near A, Tse J, Young-Xu Y, Hong DK, Reyes CM. 86. Health Resource Burden of Influenza Among the Elderly with Underlying Conditions in the United States. Open Forum Infect Dis 2020. [PMCID: PMC7777202 DOI: 10.1093/ofid/ofaa439.396] [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] [Indexed: 11/14/2022] Open
Abstract
Background Seasonal influenza poses a substantial clinical and economic burden, despite influenza vaccination efforts. This study evaluates healthcare resource utilization attributable to influenza in elderly populations at increased risk of influenza-related complications. Methods Elderly (≥ 65 years of age) patients (pts) with ≥ 1 influenza diagnosis (Dx) during influenza seasons from October 1, 2014 – March 1, 2019 were identified in the IQVIA PharMetrics® Plus claims database. The earliest influenza Dx was the index date and pts had evidence of pulmonary, cardiovascular, or renal disease before index. Pts had ≥ 12 months continuous enrollment (baseline before index) and ≥ 30 days follow-up after index. Medically-attended influenza cases were identified by primary influenza Dx codes or any influenza Dx with a record of an influenza test within ±14 days. Influenza pts were 1:1 propensity score matched to pts without influenza using baseline demographic and clinical characteristics and baseline healthcare costs. All-cause hospital and emergency department (ED) visits and total healthcare costs during follow-up (30-day and in the index influenza season) were compared in the matched cohorts. Results Baseline characteristics were balanced after matching. Elderly influenza pts had 3 to 7 times higher 30-day hospitalization rates compared to pts without influenza, including pts with congestive heart failure (41% vs. 8%), chronic obstructive pulmonary disease (35% vs. 6%), coronary artery disease (23% vs. 4%), and stage 5/end stage renal disease (ESRD)/dialysis (44% vs. 13%; all p< .05; Figure). Hospital and ED visit rates in the influenza season were 2 to 3 times higher in pts with vs. without influenza; ED visit rates were 49% vs. 23%, 44% vs. 18%, 37% vs. 14%, and 60% vs. 28% for the above cohorts, respectively (all p< .05). Mean total healthcare costs per patient per season were $3,299 to $12,398 higher in pts with vs. without influenza (all p< .05, except myocardial infarction and stage 5/ESRD/dialysis pts). Figure. All-cause 30-day hospitalization rates in matched cohorts of elderly patients with baseline comorbidities with and without influenza ![]()
Conclusion Hospitalizations, ED visits, and total healthcare costs are elevated in the elderly after evidence of medically-attended influenza, but to varying degrees depending on baseline comorbidities. Continued efforts to reduce influenza burden in high-risk populations are needed. Disclosures Aimee Near, MPH, Employee of IQVIA; IQVIA paid by VIR Bio to complete research project (Consultant) Jenny Tse, MS, Vir Biotechnology, Inc. (Other Financial or Material Support, I am employed by IQVIA which was paid by Vir Biotechnology, Inc. to complete this study.) David K. Hong, MD, Vir Biotechnology (Employee) Carolina M. Reyes, PhD, Vir Biotechnology (Employee, Shareholder)
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Tse J, Wada K, Wang Y, Coppolo D, Kushnarev V, Suggett J. Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika ® and Acapella ® Devices. Int J Chron Obstruct Pulmon Dis 2020; 15:2527-2538. [PMID: 33116469 PMCID: PMC7585550 DOI: 10.2147/copd.s256866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Managing and preventing disease exacerbations are key goals of COPD care. Oscillating positive expiratory pressure (OPEP) devices have been shown to improve clinical outcomes when added to COPD standard of care. This retrospective database study compared real-world resource use and disease exacerbation among patients with COPD or chronic bronchitis prescribed either of two commonly used OPEP devices. Patients and methods Patients using the Aerobika® (Trudell Medical International, London, ON, Canada) or Acapella® (Smiths Medical, Wampsville, New York, USA) OPEP device for COPD or chronic bronchitis were identified from hospital claims linked to medical and prescription claims between September 2013 and April 2018; the index date was the first hospital visit with an OPEP device. Severe disease exacerbation, defined as an inpatient visit with a COPD or chronic bronchitis diagnosis, and all-cause healthcare resource utilization over 30 days and 12 months post-discharge were compared in propensity score (PS)-matched Aerobika device and Acapella device users. Results In total, 619 Aerobika device and 1857 Acapella device users remained after PS matching. After discharge from the index visit, Aerobika device users were less likely to have ≥1 severe exacerbation within 30 days (12.0% vs 17.4%, p=0.01) and/or 12 months (39.6% vs 45.3%, p=0.01) and had fewer 12-month severe exacerbations (mean, 0.7 vs 0.9 per patient per year, p=0.01), with significantly longer time to first severe exacerbation than Acapella users (log-rank p=0.01). Aerobika device users were also less likely to have ≥1 all-cause inpatient visit within 30 days (13.9% vs 20.3%, p<0.001) and 12 months (44.9% vs 51.8%, p=0.003) than Acapella users. Conclusion Patients receiving the Aerobika OPEP device, compared to the Acapella device, had lower rates of subsequent severe disease exacerbation and all-cause inpatient admission. This suggests that Aerobika OPEP device may be a beneficial add-on to usual care and that OPEP devices may vary in clinical effectiveness.
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Affiliation(s)
- Jenny Tse
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Keiko Wada
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Yi Wang
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Dominic Coppolo
- Monaghan Medical Corporation, Clinical Strategy and Development, Plattsburgh, NY, USA
| | - Vladimir Kushnarev
- Trudell Medical International, Science and Technology, London, ON, Canada
| | - Jason Suggett
- Trudell Medical International, Science and Technology, London, ON, Canada
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Elvin J, Danziger N, Corines J, Vergilio JA, Killian J, Lin D, Williams E, Tse J, Ramkissoon S, Severson E, Hemmerich A, Edgerly C, Duncan D, Huang R, Schrock A, Alexander B, Venstrom J, Reddy P, McGregor K, Ross J. 2001P Adenoid cystic carcinomas (ACC) of the trachea, salivary gland, breast: A comparative comprehensive genomic profiling (CGP) study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tan A, Han X, Near A, Tse J, Preger L. Real-world clinical and economic burden associated with hospitalization in metastatic triple-negative (ER-/PR-/HER2-) breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19236 Background: Metastatic triple-negative breast cancer (mTNBC) is associated with poorer disease prognosis and higher healthcare utilization and costs compared with other breast cancer subtypes, with hospitalizations being a major cost driver. This study aimed to understand reasons for hospitalization and describe the clinical and economic burden associated with hospitalizations in mTNBC patients following 1L treatment initiation. Methods: mTNBC patients were identified in the IQVIA Real-World Data Adjudicated Claims-US database (Jan. 2012 – Jan. 2019) and indexed on the day of 1L treatment initiation. Women ≥18 years of age with mTNBC who had continuous enrollment for ≥12 months before (baseline) and ≥30 days after (follow-up) index and no evidence of other primary cancers during baseline were included. Patient baseline characteristics and all-cause hospitalizations during follow-up were described. Results: 4,617 mTNBC patients were identified (mean age 54 years; 99.7% with chemotherapy as IL); 1,595 (35%) had ≥ 1 hospitalization during follow-up (mean duration 17 months). More hospitalized patients had ≥2 metastasis sites (25% vs. 15%, p < 0.01) as well as visceral (15% vs. 7%, p < 0.01) or bone metastases (15% vs. 8%, p < 0.01) than non-hospitalized patients. The average time from index to first hospitalization was 7.4 months and hospitalized patients had a mean of 2.4 hospitalizations per patient per year (PPPY), with mean length of stay of 6 days. 25% of hospitalized patients were admitted from the ED. Reasons for hospitalization included chemotherapy-related adverse events (AEs; 76%), followed by disease progression (72%), breast-related surgeries (6%), and others (4%). Common chemotherapy-related AEs included infection or pyrexia (46%), anemia (35%), and neutropenia (17%). Total cost associated with hospitalization was $57,115 PPPY, with the annual out-of-pocket cost averaging $3,659 per patient; mean out-of-pocket cost per hospitalization was $1,840. The proportion of patients with hospitalization was similar between metropolitan and rural patients (35% vs. 37%, p = 0.51), yet metropolitan patients had slightly longer hospital stays (mean 6 vs. 5 days, p = 0.03). Conclusions: Approximately one-third of mTNBC patients were hospitalized following 1L treatment initiation and in turn, bear a high economic burden. New therapies are needed to mitigate the clinical and economic burden associated with hospitalizations in this population.
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Affiliation(s)
- Amie Tan
- Genentech, Inc., South San Francisco, CA
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Mehra R, Huang H, Seal B, Tse J, Shenolikar RA, Burudpakdee C. Real-world treatment patterns for patients with metastatic head and neck squamous cell carcinoma treated with immuno-oncology therapy. Head Neck 2020; 42:2030-2038. [PMID: 32149458 DOI: 10.1002/hed.26126] [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: 10/01/2019] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Real-world use of immuno-oncology (IO) therapies (nivolumab and pembrolizumab) in metastatic head and neck squamous cell carcinoma (mHNSCC) has not been well studied. METHODS mHNSCC patients treated with an IO therapy were identified from a large US claims database from 2016 to 2017. Treatment patterns before and after initiation of IO therapy (index date) were described. RESULTS Among 416 mHNSCC patients, 85% had ≥1 regimen prior to IO therapy. Ninety-seven percent of patients initiated IO as monotherapy and 3% initiated IO combined with another systemic treatment. One hundred seventeen (28%) patients had a subsequent regimen, usually chemotherapy (n = 58, 50%) or IO monotherapy (n = 27, 23%), of which 22 patients restarted the same IO therapy and 5 switched to another IO monotherapy. CONCLUSION The majority of mHNSCC patients initiated IO as a monotherapy. Approximately half of patients with a subsequent regimen received chemotherapy and one-fourth received IO monotherapy.
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Affiliation(s)
- Ranee Mehra
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | | | - Brian Seal
- AstraZeneca, Gaithersburg, Maryland, USA
| | - Jenny Tse
- IQVIA, Cambridge, Massachusetts, USA
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Abstract
This article reviews the essential considerations in planning and designing nuclear medicine departments. There are four proposed categories to consider as 'shielding commissioning factors' (SCF). The first SCF: 'Patient flow optimisation and workload' emphasises the importance of carefully considering patient flow in the departmental design, which would impact the cost of the shielding and the management of radioactive patients. The second SCF: 'Equipment and space allocation' discusses the principles of space allocations in the department for cost-effective designs. The third SCF: 'Shielding calculation methods' reviews the methodologies of shielding calculations in nuclear medicine to offer a standardised approach. The fourth SCF: 'Shielding integrity' reviews the plan to inspect, eyewitness and verify shielding integrity. All discussions were supplemented by practical examples. Overall, this article aims to be a practical manual which health or medical physicists can use when providing counsels to the design committee.
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Affiliation(s)
- F Salehzahi
- Medical Physics and Radiation Engineering, Canberra Health Services, Canberra, Australia
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Karichu J, Cheng M, Rodriguez P, Robinson N, Burudpakdee C, Near A, Tse J, Faccone J. 1782. Real-World HIV Diagnostic Testing Patterns in the United States. Open Forum Infect Dis 2019. [PMCID: PMC6808732 DOI: 10.1093/ofid/ofz360.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Current HIV diagnostic laboratory testing guidelines from the US Centers for Disease Control and Prevention (CDC) recommend a sequence of tests for detection, differentiation, and confirmation of HIV-1 and HIV-2 diagnosis. There is a gap in knowledge about real-world implementation of the testing algorithm. The aim of this study was to characterize the population that underwent HIV antibody differentiation and confirmatory testing and to describe subsequent testing patterns from a large US clinical laboratory database. Methods Patients who received one or more HIV-1/2 antibody differentiation test (BioRad Geenius™ HIV 1/2 Supplemental Assay [Geenius]) in the Quest Diagnostics laboratory database between January 1, 2017 and December 31, 2017 were selected into the study; earliest test date was index date. Geenius tests, HIV-1 qualitative RNA (Aptima HIV-1 RNA Qualitative Assay [Aptima]), and HIV-2 DNA/RNA confirmatory tests subsequent to index date were captured. Study measures included pt demographic characteristics, testing frequency and sequencing, and test results. For patients with >1 Geenius test in 2017, concordance between index and subsequent test results was assessed. Results There were 26,319 unique patients identified who received ≥1 HIV antibody differentiation result from the Geenius assay. Mean age was 40.7 ± 14.3 years, 66.4% were male, and 42.5% were from southern states. Among the study population, there were 28,954 Geenius, 7,234 Aptima, and 298 HIV-2 DNA/RNA confirmatory tests. 26.4% of Geenius test results were discordant with the initial positive fourth-generation HIV screening results and required subsequent confirmatory testing. In terms of sequencing, the CDC-recommended HIV diagnostic algorithm was followed 74% of the time after screening. 8.5% of patients had >1 Geenius test in 2017; 11.2% of the retests returned different results compared with the first test. Conclusion The CDC recommended algorithm for HIV diagnosis is complex for laboratories to implement and currently available assays do not support testing efficiency. To mitigate observed inefficiencies and reduce the laboratory burden of HIV testing, a more accurate and reliable approach for HIV differentiation and confirmatory testing is needed. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- James Karichu
- Roche Molecular Diagnostics, Inc., Pleasanton, California
| | - Mindy Cheng
- Roche Molecular Diagnostics, Inc., Pleasanton, California
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Burudpakdee C, Near A, Tse J, Young-Xu Y, Connolly L, Reyes CM. 2758. Identifying Populations at High-Risk for Influenza-Related Hospitalization: A Real-World Analysis of Commercially Insured Population in the United States. Open Forum Infect Dis 2019. [PMCID: PMC6809593 DOI: 10.1093/ofid/ofz360.2435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The disease burden of seasonal influenza (flu) is high and contributes to morbidity, mortality and healthcare utilization. While only 1–2% of flu cases are hospitalized, these events are costly. The objective of this study was to describe and quantify risk factors for flu hospitalization. Methods Patients with 1 flu diagnosis (Dx) over 4 seasons (October 1, 2014–May 31, 2018) in IQVIA’s Real-World Data Adjudicated Claims – US database were selected into the study; the earliest flu Dx was the index date. Patients were required to have ≥12 months continuous enrollment in their health plan before index (baseline), ≥30 days after index, and either a record of a flu test ± 14 days of index or a flu Dx in the primary position. Comorbidities during a fixed 12-month baseline period were categorized by AHRQ and CDC definitions. The study outcome of interest, flu-related hospitalization during the 30-day follow-up period, was defined as hospitalization with Dx of flu or a pre-defined flu-related complication in any position. A logistic regression model assessed the odds of flu-related hospitalization, adjusting for age, sex, region, payer, season of index Dx, evidence of flu vaccination, and comorbidities. Results More than 1.6 million medically-attended flu cases were identified, of which 18,509 (1%) had a hospitalization. 40% of patients were < 18 years of age, 47% were male, and 28%, 15%, 24%, and 33% were identified in the 2014–2017 flu seasons, respectively. More hospitalized patients were ages 50+ compared with non-hospitalized patients (57% vs. 20%) and 44% of hospitalized patients had 4 or more AHRQ/CDC comorbidities vs. 8% of non-hospitalized patients. In adjusted analyses, older age (65+ vs. 5–17; OR = 9.4, 95% CI 8.8–10.1) and leukemia/lymphoma/metastatic cancer (OR = 3.2, 95% CI = 2.9–3.5) were key drivers of hospitalization (Figure 1). Conclusion The risk of flu-related hospitalization is high for elderly populations and those with certain underlying co-morbidities among all age groups. While these findings reflect the burden of medically-attended flu in a younger, commercially insured population, additional research is needed to address the flu burden in high-risk populations. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Yinong Young-Xu
- Veteran’s Affairs Medical Center, White River Junction, Vermont
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Liu J, Near A, Chiarappa JA, Wada K, Tse J, Burudpakdee C, Behl A, Ranganath R, Antonarakis ES. Clinical outcomes associated with pathogenic genomic instability mutations in prostate cancer: a retrospective analysis of US pharmacy and medical claims data. J Med Econ 2019; 22:1080-1087. [PMID: 31352849 DOI: 10.1080/13696998.2019.1649267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 01/12/2023]
Abstract
Background: Prostate cancer (PC) is a clinically heterogenous disease, and genetic mutations may be useful for patient risk stratification. This retrospective cohort study compared clinical outcomes, pharmacy use, and outpatient resource use in PC patients with and without pathogenic genomic instability mutations, including DNA repair deficiency (DRD) mutations and those in TP53, PTEN, and RB1. Methods: Patients ≥18 years newly-diagnosed with PC between June 2011-March 2016 were identified in medical and prescription claims databases linked to a genomic dataset. All-cause and PC-specific pharmacy use and outpatient resource use (office visits, laboratory tests, radiology examinations, and radiation therapies) over 1, 2, and 3 years and time to evidence of disease progression after PC diagnosis, based on secondary cancer diagnosis codes and treatments received, were evaluated in mutation carriers with ≥1 of 24 gene mutations and in a sub-set of DRD gene mutation carriers, with each compared to non-mutation carriers. Results: Mutation carriers (n = 274) and non-mutation carriers (n = 74) had similar demographic and clinical features. Non-mutation carriers had lower risks of developing metastasis and castration-resistant PC than mutation carriers (hazard ratio [HR] = 0.7, 95% CI = 0.5-0.9; HR = 0.5, 95% CI = 0.3-0.9, respectively) and DRD mutation carriers (HR = 0.5, 95% CI = 0.3-0.7; HR = 0.4, 95% CI = 0.2-0.7, respectively). Compared to non-mutation carriers, mutation carriers had more all-cause pharmacy claims over 2 years of follow-up (74.4 vs 59.1, p = 0.04) and more PC-specific pharmacy claims over 2 years (11.1 vs 6.5, p = 0.01) and 3 years (17.9 vs 9.8, p = 0.01) of follow-up. No differences were observed in outpatient resource use during the follow-up period by mutation status. Conclusion: PC patients carrying ≥1 pathogenic DNA instability mutation, and DRD mutation carriers specifically, had higher clinical burden than non-mutation carriers. Targeted therapies for these patients are needed to reduce clinical burden and associated healthcare resource utilization.
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Affiliation(s)
- Jinan Liu
- Janssen Scientific Affairs, LLC , Horsham , PA , USA
| | | | | | | | | | | | - Ajay Behl
- Janssen Scientific Affairs, LLC , Horsham , PA , USA
| | | | - Emmanuel S Antonarakis
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Abstract
INTRODUCTION The patient cost burden of oral anticancer medicines has been associated with prescription abandonment, delayed treatment initiation, and poorer health outcomes in the US. Since 2011, several small molecule tyrosine kinase inhibitors have been approved for the treatment of non-small cell lung cancer (NSCLC) patients with rearrangement of the anaplastic lymphoma kinase (ALK) gene. The objective of this study was to measure the impact of copay assistance on patient cost sharing and treatment patterns in patients prescribed oral ALK inhibitors (ALKi's). METHODS Patterns of claims approval/rejection and payment/reversal, out-of-pocket (OOP) costs, and treatment persistence were reported for patients identified in the IQVIA Formulary Impact Analyzer database from January 2013 to August 2017 linked to a medical claims database. The primary study cohorts were patients with copay assistance, including manufacturer's copay cards, other discount cards, or free-trial vouchers, on the index ALKi claim, and patients without copay assistance at any time during the follow-up period. RESULTS In total, 3,143 patients were included in analyses related to claim patterns, and 1,685 patients were included in analyses related to treatment persistence. Copay assistance decreased the OOP cost for the first approved ALKi by $1,930, on average. Patients with copay assistance picked up ALKi prescriptions from the pharmacy sooner than patients without copay assistance (2.6 days vs 25.7 days). In adjusted analyses, patients with copay assistance had 88.2% lower risk of abandoning their first approved prescription and 24.3% lower risk of discontinuing treatment with the first observed ALKi (all p < 0.001). CONCLUSION Copay assistance reduced the patient cost burden for ALKi's and was associated with patients picking up their ALKi prescriptions, beginning ALKi treatment sooner, and remaining on treatment.
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Affiliation(s)
| | - William Wong
- b Genentech Inc , South San Francisco , CA , USA
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Liu J, Near A, Chiarappa JA, Wada K, Tse J, Burudpakdee C, Behl AS, Antonarakis ES. Comparison of healthcare resource use and treatment among prostate cancer patients with and without DNA damage repair gene mutations. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jinan Liu
- Janssen Scientific Affairs, LLC, Horsham, PA
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Dunn EC, Wang Y, Tse J, McLaughlin KA, Fitzmaurice G, Gilman SE, Susser ES. Sensitive periods for the effect of childhood interpersonal violence on psychiatric disorder onset among adolescents. Br J Psychiatry 2017; 211:365-372. [PMID: 29097401 PMCID: PMC5709674 DOI: 10.1192/bjp.bp.117.208397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 02/14/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022]
Abstract
BackgroundAlthough childhood adversity is a strong determinant of psychopathology, it remains unclear whether there are 'sensitive periods' when a first episode of adversity is most harmful.AimsTo examine whether variation in the developmental timing of a first episode of interpersonal violence (up to age 18) associates with risk for psychopathology.MethodUsing cross-sectional data, we examined the association between age at first exposure to four types of interpersonal violence (physical abuse by parents, physical abuse by others, rape, and sexual assault/molestation) and onset of four classes of DSM-IV disorders (distress, fear, behaviour, substance use) (n = 9984). Age at exposure was defined as: early childhood (ages 0-5), middle childhood (ages 6-10) and adolescence (ages 11-18).ResultsExposure to interpersonal violence at any age period about doubled the risk of a psychiatric disorder (odds ratios (ORs) = 1.51-2.52). However, few differences in risk were observed based on the timing of first exposure. After conducting 20 tests of association, only three significant differences in risk were observed based on the timing of exposure; these results suggested an elevated risk of behaviour disorder among youth first exposed to any type of interpersonal violence during adolescence (OR = 2.37, 95% CI 1.69-3.34), especially being beaten by another person (OR = 2.44; 95% CI 1.57-3.79), and an elevated risk of substance use disorder among youth beaten by someone during adolescence (OR = 2.77, 95% CI 1.94-3.96).ConclusionsChildren exposed to interpersonal violence had an elevated risk of psychiatric disorder. However, age at first episode of exposure was largely unassociated with psychopathology risk.
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Affiliation(s)
- Erin C. Dunn
- Correspondence: Erin C. Dunn, ScD, MPH, Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building Sixth Floor, Boston, MA 02114, USA.
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Heggie JCP, Barnes P, Cartwright L, Diffey J, Tse J, Herley J, McLean ID, Thomson FJ, Grewal RK, Collins LT. Position paper: recommendations for a digital mammography quality assurance program V4.0. Australas Phys Eng Sci Med 2017; 40:491-543. [PMID: 28914430 DOI: 10.1007/s13246-017-0583-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 12/21/2022]
Abstract
In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).
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Affiliation(s)
| | - P Barnes
- I-Med Radiology Network, Head office Melbourne, Melbourne, Australia
| | - L Cartwright
- Medical Physics Department, Westmead Hospital, Westmead, Australia
| | - J Diffey
- Hunter New England Imaging, John Hunter Hospital, New Lambton Heights, Australia
| | - J Tse
- Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, Australia
| | - J Herley
- Radiation Protection Services Pty Ltd, Brisbane, Australia
| | - I D McLean
- Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, Australia
| | - F J Thomson
- Radiological Physics Consultants Ltd, Warrington, New Zealand
| | - R K Grewal
- Medical Physics Department, Westmead Hospital, Westmead, Australia
| | - L T Collins
- Medical Physics Department, Westmead Hospital, Westmead, Australia
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Gomez SH, Tse J, Wang Y, Turner B, Millner AJ, Nock MK, Dunn EC. Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents. Depress Anxiety 2017; 34:734-741. [PMID: 28544045 PMCID: PMC6171345 DOI: 10.1002/da.22650] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although child maltreatment is a well documented risk factor for suicidal behavior, little is known about whether the timing of child maltreatment differentially associates with risk of suicidal ideation, suicide plans, or suicide attempts. The goal of this study was to examine whether a first exposure to physical or sexual abuse during specific developmental periods significantly elevated risk for suicidal behavior in adolescents. METHODS Data came from the National Comorbidity Survey Adolescent Supplement, a population-based sample of US adolescents aged 13-18 years old (n = 9,272). Using discrete time survival analysis, we assessed the association between timing of first abuse (early childhood: ages 0-5; middle childhood: ages 6-10; adolescence: ages 11-18) and suicidal ideation, plans, and attempts. RESULTS Exposure to either physical or sexual abuse increased the odds of reporting suicidal ideation (odds ratio [OR] = 5.06 and OR = 3.56, respectively), plans (OR = 3.63 and OR = 3.58, respectively), and attempts (OR = 5.80 and OR = 4.21, respectively), even after controlling for sociodemographic covariates and psychiatric disorders. However, the timing of physical and sexual abuse exposure was unassociated with suicidal behavior (all p values >.05). CONCLUSIONS Exposure to child maltreatment is strongly associated with risk for adolescent suicidal behaviors, though this association did not vary based on the developmental timing of first exposure. These findings suggest that prevention efforts should be implemented throughout early development and target all children, regardless of when they were first exposed.
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Affiliation(s)
- Stephanie H. Gomez
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts
General Hospital, Boston, MA, USA
| | - Jenny Tse
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts
General Hospital, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Yan Wang
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts
General Hospital, Boston, MA, USA
| | - Brianna Turner
- Department of Psychology, University of Victoria, Victoria, British
Columbia, Canada
| | | | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA,
USA
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts
General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Cambridge, MA,
USA,Stanley Center for Psychiatric Research, The Broad Institute of
Harvard and MIT, Cambridge, MA, USA
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Tse J, Oldroyd S, Totten V, Vandegrift M, Sebat F. 67 Predictive Value of Abnormal Signs of Vitality on Transfer to the Intensive Care Unit Within 24 Hours of Admission. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tse J, Wang Y, Zengeya T, Rozners E, Tan-Wilson A. Peptide nucleic acid probe for protein affinity purification based on biotin-streptavidin interaction and peptide nucleic acid strand hybridization. Anal Biochem 2014; 470:34-40. [PMID: 25447466 DOI: 10.1016/j.ab.2014.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 01/25/2023]
Abstract
We describe a new method for protein affinity purification that capitalizes on the high affinity of streptavidin for biotin but does not require dissociation of the biotin-streptavidin complex for protein retrieval. Conventional reagents place both the selectively reacting group (the "warhead") and the biotin on the same molecule. We place the warhead and the biotin on separate molecules, each linked to a short strand of peptide nucleic acid (PNA), synthetic polymers that use the same bases as DNA but attached to a backbone that is resistant to attack by proteases and nucleases. As in DNA, PNA strands with complementary base sequences hybridize. In conditions that favor PNA duplex formation, the warhead strand (carrying the tagged protein) and the biotin strand form a complex that is held onto immobilized streptavidin. As in DNA, the PNA duplex dissociates at moderately elevated temperature; therefore, retrieval of the tagged protein is accomplished by a brief exposure to heat. Using iodoacetate as the warhead, 8-base PNA strands, biotin, and streptavidin-coated magnetic beads, we demonstrate retrieval of the cysteine protease papain. We were also able to use our iodoacetyl-PNA:PNA-biotin probe for retrieval and identification of a thiol reductase and a glutathione transferase from soybean seedling cotyledons.
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Affiliation(s)
- Jenny Tse
- Department of Chemistry, State University of New York at Binghamton, Binghamton, NY 13902, USA
| | - Yuanyuan Wang
- Department of Biological Sciences, State University of New York at Binghamton, Binghamton, NY 13902, USA
| | - Thomas Zengeya
- Department of Chemistry, State University of New York at Binghamton, Binghamton, NY 13902, USA
| | - Eriks Rozners
- Department of Chemistry, State University of New York at Binghamton, Binghamton, NY 13902, USA
| | - Anna Tan-Wilson
- Department of Biological Sciences, State University of New York at Binghamton, Binghamton, NY 13902, USA.
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Yuen D, Leu R, Tse J, Wang S, Chen LL, Chen L. Novel characterization of bEnd.3 cells that express lymphatic vessel endothelial hyaluronan receptor-1. Lymphology 2014; 47:73-81. [PMID: 25282873 PMCID: PMC4636729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Murine bEnd.3 endothelioma cell line has been widely used in vascular research and here we report the novel finding that bEnd.3 cells express lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) and vascular endothelial growth factor receptor-3 (VEGFR-3). Moreover, these cells express progenitor cell markers of Sca-1 and CD133. Upon stimulation with tumor necrosis factor-alpha (TNF-alpha), the bEnd.3 cells demonstrate enhanced formation of capillary-type tubes, which express LYVE-1. As the bEnd.3 cell line is derived from murine endothelioma, we further examined human tissues of endothelioma and identified lymphatic vessels in the tumor samples which express both LYVE-1 and podoplanin. Moreover, a significantly higher number of lymphatic vessels were detected in the endothelioma samples compared with normal control. Taken together, this study not only redefines bEnd.3 cells for vascular research, but also indicates a broader category of human diseases that are associated with lymphatics, such as endothelioma.
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Ma HL, Kien F, Zhang Y, Tse J, Poon LLM, Nal B. Identification of human annexin A6 as a novel cellular interactant of influenza A M2 protein: implications for influenza life cycle. BMC Proc 2011. [DOI: 10.1186/1753-6561-5-s1-p67] [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: 11/10/2022] Open
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Chan K, Tse J, Jennings F, Orme M. Plasma Concentrations of I.V. Pethidine in Healthy Volunteers Under Conditions of Various Urinary PH Values. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1981.tb11746.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Chan
- School of Pharmacy, Liverpool Polytechnic, Liverpool L3 3AF
| | - J Tse
- School of Pharmacy, Liverpool Polytechnic, Liverpool L3 3AF
| | - F Jennings
- Department of Anaesthetics and Clinical Pharmacology, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP
| | - M Orme
- Department of Anaesthetics and Clinical Pharmacology, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP
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Chan K, Latham SM, Tse J. A Rapid and Simple Method for the Determination of Mexiletine in Human Plasma and Urine by Gas-Liquid Chromatography (GLC). J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1980.tb10901.x] [Citation(s) in RCA: 3] [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] [Indexed: 11/29/2022]
Affiliation(s)
- K Chan
- School of Pharmacy, Liverpool Polytechnic, Liverpool, L3 3AF, U.K
| | - Susan M Latham
- School of Pharmacy, Liverpool Polytechnic, Liverpool, L3 3AF, U.K
| | - J Tse
- School of Pharmacy, Liverpool Polytechnic, Liverpool, L3 3AF, U.K
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Ma HL, Kien F, Zhang Y, Tse J, Poon LLM, Nal B. Identification of human annexin A6 as a novel cellular interactant of influenza A M2 protein: implications for influenza life cycle. BMC Proc 2011. [PMCID: PMC3019495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- HL Ma
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR,Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - F Kien
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - Y Zhang
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR,Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - J Tse
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR
| | - LLM Poon
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - B Nal
- HKU-Pasteur Research Centre, Hong Kong, Hong Kong SAR,Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
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36
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Tse J, You W. How accurate is the electronic health record? - a pilot study evaluating information accuracy in a primary care setting. Stud Health Technol Inform 2011; 168:158-164. [PMID: 21893924] [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: 05/31/2023]
Abstract
BACKGROUND Electronic health records (EHR) are increasingly used for both administrative and clinical tasks with major implications for patient safety and quality of care. This study aims to determine a baseline EHR level of accuracy present on measurable information fields within an Australian general practice. METHODS Quantitative and descriptive pilot study of patients attending a private general practice. Patients who consented to participate in the study had their patient records reviewed to determine how many items were correct, incorrect or not recorded in each EHR information field. Statistical analysis was performed on the data collected. RESULTS A total of 33 patients gave consent to participate in this study. High levels of accuracy were found in the area of demographic details (94%). Moderately high levels of accuracy were reported for allergies (61%) but also a considerable percentage of non-recorded information was present (36%). Inaccuracies in medication lists were reported in 51% of records reviewed with 32.1% of all medications being inaccurately recorded. While over 91% of participants had a history summary with eight or less items present, omissions were reported for one in every five participants. There were no significant associations present between inaccurate data and frequency of practice visits or those with more than five past medical conditions listed in the EHR. CONCLUSION The study has confirmed that errors and inaccuracies exist in EHR in our Australian pilot study. The pilot study has also allowed us to complete a trial ensuring that a study of this type can be done safely and with correct methodology. As health informatics plays an increasingly important role in health care, studies of this type will better inform practitioners/ researchers in designing systems to ensure quality electronic patient information.
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Affiliation(s)
- J Tse
- Royal Melbourne Hospital Clinical School, The University of Melbourne, Parkville, Victoria.
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37
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Tse J, Baker T, Adler S, Gerhardstein P. The role of awareness in saccadic conditioning. J Vis 2010. [DOI: 10.1167/7.9.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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38
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Baker TJ, Tse J, Gerhardstein PC, Adler SA. Six-month-old infants' ability to detect contours. J Vis 2010. [DOI: 10.1167/6.6.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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39
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Tse J, Gerhardstein P. Simulating the development of contour integration. J Vis 2010. [DOI: 10.1167/3.9.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Tse J, Gerhardstein P. Contour detection in young human infants. J Vis 2010. [DOI: 10.1167/6.6.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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41
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42
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Tse J, Gerhardstein P. A higher-order mechanism beyond good continuation in contour integration. J Vis 2010. [DOI: 10.1167/5.8.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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43
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Till H, Yeung CK, Bower W, Shi Y, Tian Q, Chu W, Yip HY, Tse J. Fetoscopy under gas amniodistension: pressure-dependent influence of helium vs nitrous oxide on fetal goats. J Pediatr Surg 2007; 42:1255-8. [PMID: 17618890 DOI: 10.1016/j.jpedsurg.2007.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Recently, gas amniodistension has been advocated for fetoscopic surgery to employ ergonomics similar to laparoscopy. However, neither the optimal type of gas nor its physiological influence on the fetus have been clearly outlined yet. This study investigates the impact of helium (HE) vs nitrous oxide (N2O) on fetal goats during fetoscopy. METHODS We insufflated either HE or N2O in 12 pregnant goats (15 fetuses; HE = 7, N2O = 8), then increased the pressures from 0, 4, 7, to 10 mm Hg in 30-minute intervals and recorded the fetal and maternal vital parameters. Finally, whole-body computed tomography to asses for intracorporeal gas was performed. RESULTS All fetuses survived. Mean fetal vital signs showed no significant differences between HE or N2O at specific pressure levels. In detail, HE/N2O at 0 vs 10 mm Hg caused a fetal temperature decrease (32.9 degrees C/33.2 degrees C vs 32 degrees C/32.5 degrees C), heart rate increase in the N2O group (100/102 vs 102/121 beats per minute), and no significant change in arterial pressure (45.8/48.3 vs 53.7/46.7 mm Hg). The PO2 was adequate (3.7/3.3 vs 3.7/2.9 kPa), whereas the pH remained unchanged (7.4/7.3 vs 7.3/7.3). However, fetal pCO2 was elevated in the N2O group before insufflation (5.5/7.2 vs 6.8/8.0 kPa) owing to maternal hypoventilation (maternal PCO2: 4.9/5.8 vs 5.0/5.4 kPa), correction of which was slower in the fetus than in the maternal animal. Computed tomography ruled out intracorporeal gas accumulation. CONCLUSION Neither HE nor N2O impose significant physiological harm for the fetus. Heating of the gas and maternal anesthesia seem essential. Considering the potential teratogenicity of N2O, however, HE could be the favorable environment for fetoscopic procedures under gas amniodistension.
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Affiliation(s)
- Holger Till
- Department of Pediatric Surgery, University of Leipzig, Childrens' Hospital, 04317 Leipzig, Germany.
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44
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Harris JR, Krepelka J, Chau J, Tse J, Seikaly H. P099 Laryngotracheal Injury After Percutaneous Dilation vs Open Tracheostomy in Fresh Cadaver Specimens. ACTA ACUST UNITED AC 2006. [DOI: 10.1001/archotol.132.8.885-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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45
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Tse J, Chang W, Yeung C. Doctors practising alternative medicine--the legal considerations. Hong Kong Med J 2006; 12:164-6. [PMID: 16603788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Affiliation(s)
- J Tse
- Johnson Stokes & Master, 16-19/F Prince's Building, 10 Chater Road, Hong Kong
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Abstract
En route to a circular bis-PNA molecule, we have synthesized and characterized the DNA binding of several "clamp"-type bis-PNAs. In order to incorporate charge into a circular PNA, a new linker based on the achiral 2-aminoethylglycine has been used.
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Affiliation(s)
- R H E Hudson
- Department of Chemistry, The University of Western Ontario, London, Ontario, Canada.
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47
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Abstract
The Pd0/Cu1 catalyzed cross-coupling of terminal alkynes onto peptide nucleic acid monomers or submonomers bearing iodinated nucleobases has been utilized as a route to base-modified oligomers. Both 5-iodouracil and 5-iodocytosine derivatives undergo the cross-coupling to give the expected products in moderate to good yields. However, depending on the particular substrates and reaction conditions, the cross-coupling may be followed by a ring closing reaction to give the fluorescent furano- and pyrrolo-fused uracil and cytosine derivatives, respectively.
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Affiliation(s)
- R H E Hudson
- Department of Chemistry, The University of Western Ontario, London, Ontario, Canada.
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48
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Tse J. Expression of vascular endothelial growth factor in third-trimester placentas is not increased in growth-restricted fetuses. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s1071-5576(01)00096-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dinter H, Tse J, Halks-Miller M, Asarnow D, Onuffer J, Faulds D, Mitrovic B, Kirsch G, Laurent H, Esperling P, Seidelmann D, Ottow E, Schneider H, Tuohy VK, Wachtel H, Perez HD. The type IV phosphodiesterase specific inhibitor mesopram inhibits experimental autoimmune encephalomyelitis in rodents. J Neuroimmunol 2000; 108:136-46. [PMID: 10900347 DOI: 10.1016/s0165-5728(00)00265-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is an autoimmune disease with pathological features reminiscent of those seen in multiple sclerosis and thus serves as an animal model for this disease. Inhibition of type IV phosphodiesterase (PDE IV) in animals with this disease has been shown to result in amelioration of disease symptoms. Here we describe the immunomodulatory activity of the novel potent and selective PDE IV inhibitor mesopram. In vitro, mesopram selectively inhibits the activity of type 1 helper T (Th1) cells without affecting cytokine production or proliferation of type 2 helper T (Th2) cells. Administration of mesopram to rodents inhibits EAE in various models. Clinically, EAE is completely suppressed by mesopram in Lewis rats. This is accompanied by a reduction of inflammatory lesions in spinal cord and brain. RT-PCR analysis revealed a marked reduction in the expression of interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) in the brains of these animals. Furthermore, the ex vivo production of Th1 cytokines by activated spleen cells derived from mesopram-treated animals is significantly reduced compared to vehicle-treated controls. Amelioration of the clinical symptoms is also observed during chronic EAE in mesopram-treated SJL mice as well as in relapsing-remitting EAE in SWXJ mice using a therapeutic treatment regimen. These data demonstrate the anti-inflammatory activity of mesopram and provide a rationale for its clinical development.
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MESH Headings
- 3',5'-Cyclic-AMP Phosphodiesterases/antagonists & inhibitors
- 3',5'-Cyclic-AMP Phosphodiesterases/metabolism
- Acute Disease
- Animals
- Anti-Inflammatory Agents/pharmacology
- Anti-Inflammatory Agents/therapeutic use
- Cell Division/drug effects
- Cells, Cultured
- Central Nervous System/drug effects
- Central Nervous System/immunology
- Central Nervous System/metabolism
- Central Nervous System/pathology
- Chronic Disease
- Cyclic Nucleotide Phosphodiesterases, Type 4
- Dose-Response Relationship, Drug
- Down-Regulation/drug effects
- Encephalomyelitis, Autoimmune, Experimental/drug therapy
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Female
- Humans
- Inflammation/drug therapy
- Inflammation/metabolism
- Inflammation/pathology
- Interferon-gamma/biosynthesis
- Interferon-gamma/metabolism
- Interleukin-5/biosynthesis
- Interleukin-5/metabolism
- Lymphocyte Activation/drug effects
- Mice
- Mice, Inbred Strains
- Multiple Sclerosis/drug therapy
- Oxazoles/pharmacology
- Oxazoles/therapeutic use
- Rats
- Rats, Inbred Lew
- Recurrence
- Spleen/drug effects
- Spleen/immunology
- Substrate Specificity
- Th1 Cells/cytology
- Th1 Cells/drug effects
- Th1 Cells/immunology
- Th1 Cells/metabolism
- Th2 Cells/cytology
- Th2 Cells/drug effects
- Th2 Cells/immunology
- Th2 Cells/metabolism
- Tumor Necrosis Factor-alpha/metabolism
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Affiliation(s)
- H Dinter
- Department of Immunology, Berlex Biosciences, 15049 San Pablo Ave., Richmond, CA 94804, USA.
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50
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Abstract
1. We tested the hypothesis that the transition to pacing-induced failure in hypertrophic hearts would result in reduced functional and metabolic responses to beta-adrenoceptor stimulation. 2. Isoproterenol (ISO; 0.1 microg/kg per min) was infused into a coronary artery in five anaesthetized open-chest control, five aortic stenosis-induced left ventricular hypertrophy (LVH) and five LVH pacing-induced failure dogs. 3. In both control and LVH dogs, but not in failure dogs, ISO significantly increased local regional work (1,923+/-665 vs 2,656+/-715, 1,185+/-286 vs 1,906+/-562 and 835+/-106 vs 849+/-216g.mm/min, respectively), force (11.1+/-1.4 vs 16.9+/-2.6, 8.6+/-1.5 vs 13.7+/-2.3 and 12.2+/-1.1 vs 11.0+/-1.8g, respectively) and myocardial O2 consumption (7.3+/-2.0 vs 10.0+/-1.5, 8.2+/-1.6 vs 11.6+/-2.6 and 4.4+/-1.5 vs 5.5+/-1.8 mL O2/min per 100 g, respectively). 4. Isoproterenol also significantly increased cAMP in control and LVH dogs (474+/-67 vs 600+/-91 and 473+/-34 vs 619+/-53 pmol/g, respectively). In heart failure, cAMP was significantly lower and there was no significant increase in cAMP in response to ISO (245+/-43 vs 314+/-40pmol/g, respectively). 5. We conclude that there were no significant myocardial functional, O2 consumption or cAMP responses to ISO after the transition from hypertrophy to cardiac failure.
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Affiliation(s)
- M W Huang
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA
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